Homeless women face practical challenges in managing menstruation alongside feelings of embarrassment and shame

Homelessness is an experience that compromises health in many ways: physical, mental, social, emotional and sexual. For women, this includes menstrual health. Little is known about the extent of this problem.

A new study published online at Women and Health reviews the literature on this topic, from practical challenges through emotional distress to demonstrations of resourcefulness in managing periods while homeless.

Record

Homeless women are often faceless and voiceless in research and health care, even though mental illness is often the cause and/or result of homelessness. Recent research has shown that a quarter of homeless women have unmet health needs, including pregnancy complications and disability. Many homeless women no longer waited for or sought health care.

Women face unique challenges associated with their periods and pregnancy. Period poverty is a phenomenon where a woman is too poor to have access to sanitary products for her period. This makes menstrual health management (MHM) a challenge and promotes the use of potentially or actually unsafe hygiene products such as cloths or toilet paper.

At the same time, schools in many low-income countries or regions are failing to meet the needs of girls who are menstruating, an issue UNICEF has highlighted. The same unmet needs for privacy and MHM facilities exist for homeless women, but without any apparent effort by organizations to strategize to address them.

Most existing research on period poverty focuses on either very poor or middle-class white women in the developed world. Underprivileged women in industrialized countries, including those experiencing homelessness, have so far not been addressed. This is ironic given the widespread knowledge that homeless shelters already often struggle to provide bedding, privacy or ventilation sufficient for users’ needs.

The present study is a qualitative review aimed at gathering evidence about the needs of menstruating women in the homeless population.

About the study

The researchers searched several online databases using relevant keywords. The nine included studies were from four countries, namely the USA, Canada, Nepal and the UK, with nearly 600 participants. Five addressed only MHM among homeless women.

Recurring patterns in this study were the challenges in accessing facilities, materials, and privacy for MHM while homeless, the positive and negative emotions elicited as a result of this need for MHM, and how women dealt with these challenges.

Logistics challenges

The main difficulties they faced had to do with the lack of privacy, hygienic environment or access to menstrual products while homeless. Period poverty was high in this group, leading to neglect of basic needs to manage this requirement.

Shelters often ask residents to leave during the day, forcing them to rely on public facilities. Public restrooms and toilets are not readily available, forcing homeless women to manage their menstrual needs in public places like the corner of a subway, for example. This puts both their health and safety at risk. Restrooms in restaurants and shops are only open to customers and therefore inaccessible to these women.

The lack of facilities to change menstrual products leads to an increased chance of leakage and a larger load of clothes to wash. Unfortunately, this is due to the limited availability of hostels for homeless people. This means that stained items are discarded rather than washed, and the woman must then purchase a replacement or leave without that garment.

Sanitary disposal of period products is also a problem in many homeless shelters, negatively affecting public cleanliness and often leading to toilet blockages.

Cultural sensitivities should be respected when designing solutions, for example by providing washable menstrual pads in places where it is the preferred option. Period products are also costly, and even those provided for free are not always enough, falling short of a timely offer or number.

With all these factors at play, the resulting difficulty in maintaining a neat and clean appearance triggered a vicious cycle where such women could not access private bathrooms for washing and changing menstrual products.

Emotional cost of MHM

Difficulties in keeping clean and looking immaculate during menstruation lead to feelings of shame, where women feel looked down on and stigmatized because of their periods. Others were more likely to assume the worst about these women because of their perceived unhealthy habits.

Again, many menstrual products are provided free of charge through male workers, which causes feelings of shame for women who have to reveal that they are on their period and further humiliates them. In many cases, hostel staff were seen as more like prison officials, making women even slower to disclose their menstrual-related needs.

Unfortunately, this means that “women feel discriminated against, harassed, sexually harassed because they are menstruating.” Access to menstrual products is limited for people experiencing homelessness, who also lack the freedom to choose the type of product they prefer.

How to manage

Homeless women have tried to cope with these challenges and still maintain their self-respect by using old rags, sponges or even pieces of paper to hold back the menstrual flow. Others reused menstrual products even though they were already soiled. This allowed them to get away with buying or asking for menstrual products from a perceived hostile staff.

Some used sanitary napkins as towels when available. However, vaginal infections were more common due to the difficulty of good MHM in these extreme conditions, exacerbated by the inability to administer effective ointments.

Desperate women sometimes pretend to be sick so they can go to the hospital and gain privacy as well as access to menstrual products.

Some women routinely chose not to eat or walk instead of taking the bus, or gave up a valuable leisure activity so they could buy menstrual products. Others shoplifted (‘life theft”). Others used public assistance or handouts from friends and family to buy what they needed for MHM. However, others gave up bus tickets or money for recreational activities to buy menstrual products.

The future course of action

This is a pioneering study into the experience of menstruation in homeless women, exploring and helping to fill a research gap. Further extensive studies are needed to understand how race, disability, and neurodisparities may have additional effects on period management among individuals experiencing homelessness.

The researchers noted that some services were very helpful, especially when they were done privately. These included the distribution of menstrual products and birth control products.

Homeless women appreciated having open public centers as places where they could go to ease their suffering after leaving their night shelters. Peers relied on sharing their knowledge of places where they could shower, share menstrual products, and receive other MHM support.

The study sheds light on the desperate need of people experiencing homelessness for “free, readily available, good quality, culturally appropriate period health products.” Instead of donating products indiscriminately, it also highlights the need to stop hoarding and provide clean, private and safe washing and bathing facilities for all marginalized groups.

“These findings highlight the need for a call to action for Commissioners and policy makers to address the suboptimal provision of MHM resources in homelessness services as a fundamental right alongside other health provisions.”