Homelessness, Menstruation, and Depression: A Tangled Web

For most Western women, dealing with their monthly menstrual flow is no more than a mild inconvenience. Sure, it’s aggravating having to put up with cramping, irritability and feeling out of sorts. Thank goodness for over the counter pain relievers and the ready availability of sanitary pads or tampons!

For many women, standing in a relaxing warm shower followed by a cup of hot tea or just lying down for awhile on your bed with a heating pad on your belly can often mean the difference between frank discomfort and welcome relief. And while it’s true that many women have more debilitating symptoms, including severe mood swings, nausea, vomiting and diarrhea, even these can usually be handled in consultation with your physician.


But how would you handle your menses if you were homeless? For a homeless woman of menstruating age, menses brings a week of struggling, not only to find a way to handle the physical and emotional symptoms, but to also contain the flow of blood, as tampons and pads are expensive and for most homeless women, completely out of reach. Many times, this means relying on fashioning makeshift “pads” of sorts, made from toilet paper or paper towels scrounged from public restrooms and even resorting at times to socks, rags or brown paper bags.

A box of tampons costs about seven dollars and for the woman who is homeless, the choice is all too often between buying them and having something to eat. To make matters worse, in forty states, menstrual supplies such as pads and tampons are classified as non-essential “luxury” items, further adding to their cost, while Viagra, a medication that treats erectile dysfunction, is taxed in only one state! Plus, even if a woman has access to food stamps (SNAP), feminine hygiene products cannot be purchased with this money.


When you are homeless, there is no comfort to be had from a warm shower, no retreat into your private bedroom where you can relax with a heating pad and certainly no visit to your personal physician to get a prescription for pain relieving medication. Then there’s the issue of simple cleanliness to think about, as there is also no relief from the constant threat of disease associated with the repeated use of unsanitary materials, such as yeast infections, urinary tract infections and vulvar dermatitis, not to mention an unpleasant odor, which can occur when the genital area is not cleaned daily.

Forget for a moment the comfort a warm bath would bring and just focus on how you would feel if you had your menses and couldn’t bathe, except maybe to hurriedly wipe yourself with a wad of cold wet paper towels in the stall of a public restroom. For a homeless woman and for the approximately 169,000 homeless women like her who are living on the streets on any given night in the United States, this miserable scenario is relentlessly repeated each and every month, twelve times throughout the year.

Before you think that homeless shelters and food banks are the answer to this problem, think again. Pads and tampons are not the first thing people think about when donating to a food bank, even though these supplies are among the most requested items. Homeless shelters that receive funds from the Emergency Food and Shelter Grant program are forbidden to use any of these funds for the purpose of feminine hygiene products.

So how does this situation affect homeless women? What emotional impact does having to cope with monthly menses and its accompanying problems of trying to maintain cleanliness and finding some place to dispose of absorbent materials have on women who are homeless? Even though any woman (or man) who is made aware of this issue would immediately understand the devastating emotional toll the lack of basic menstrual hygiene products would have on a homeless woman, these are very difficult questions to scientifically quantify, as public discussion of women’s menstrual needs, particular those of homeless women, is virtually non-existent.

Dr. Allegra Parillio notes in the December 2017 issue of the Rhode Island Medical Journal that a search on Google Scholar (a database containing information of most of the world’s scientific journals) for the term “menstrual hygiene management in United States homeless women” yielded virtually no meaningful results. She and her co-author, Dr. Edward Feller, call the problem of homeless women having little to no access to menstrual hygiene products a “public health disgrace.”

Rachel F. Levit notes, that while researching the literature for her May 2017 honors thesis, Waiting and Menstruation: A look at Homeless and At-Risk Women’s Experiences, she could not find any articles pertaining to both homeless women and menses. Instead, she found the public health literature focused primarily on sexual health, sexually transmitted diseases and childbirth and never on the menstrual cycle that underlies all of these issues.

Quinn Andersen, the author of Bleeding in Public: Menstrual Needs of the Homeless, writes eloquently about the plight of homeless women and menstruation stating that:

 “… the immense amount of societal taboo and stigma surrounding menstruation means that it is a topic of secrecy and avoidance not only to the public, but also for a woman herself. These attitudes toward periods are just one aspect of the many struggles that come with ‘that time of the month.’ Menstruation also comes with other emotional, financial and health related problems which are especially intensified among the homeless.”

In 2015, Brianna Roberts was one of four graduate students at the University of Georgia who developed a pilot program to supply feminine hygiene products to homeless women in Athens, Georgia (home to the University) with future plans to take the program statewide. Ms. Roberts was frank about the mental health challenges homeless women who have to cope with menstruation face, “Homeless women are already at risk for mental setbacks. Not being able to maintain their feminine hygiene leaves them feeling helpless, ashamed and vulnerable, and that cycles them back into that depression.”

A May 2016 study by Shailini Vora whose subjects were homeless women residing in Leicester and in Bristol in the United Kingdom, emphasizes the emotional findings of her research. She states “Although many participants struggled with the financial aspect of menstrual management, in many cases this was trivialised in comparison to the emotional and painful effects of menstruation.”

While the physical implications of inadequate access to feminine hygiene products for homeless women are quite easy to understand, the emotional and mental health costs to these women are much less obvious. Helplessness, shame, vulnerability and loss of dignity put homeless women, who are already at increased risk for mental health problems, in an even more precarious position.

We owe it to homeless women, who are some of the most vulnerable members of our society, access to no or very low cost basic feminine hygiene products such as pads and tampons, as well as access to safe areas to bathe and care for themselves while they are menstruating. The antiquated era of embarrassed silence and shame around women’s inescapable monthly biological cycles must end.

About the Author: Charlene Bell is a Certified Family Nurse Practitioner, United States Navy Veteran, and founder of Her Padded Truth, LLC, a company committed to providing women with safe, cost effective, and eco-friendly feminine hygiene products. As a healthcare provider, she has extensive knowledge in Adult, Geriatric, Pediatric and Women’s health.