This is part of a series of how design and technology perpetuate structural inequality and oppression. I’m calling this exclusionary design, the opposite of inclusive design.
This may sound obvious to some people (and shocking to others) but menstruation is a completely natural process that affects about half the human population. There is nothing gross or vulgar about it. But as a baseline, if the title and the image below are already making you squeamish, then I suggest that you find some other reading material because this is 100% period talk moving forward.
As someone who bleeds on a monthly basis, I want to focus on lack of equity in the design and distribution of menstrual products. This affects bleeders everywhere, but especially homeless, incarcerated, and disabled folks.
In an effort to be inclusive as possible with language, I am avoiding gendered terms like women, girls, and ladies. Why? Because not all women bleed (due to age or health conditions, or being a trans woman) and not everyone who bleeds is a woman (like trans, nonbinary, and gender non-conforming people with uteruses). Therefore this article uses gender-neutral language, like bleeders, menstruators, and people with periods, as the norm.
Let’s get into it:
- Menstruation 101
- History of stigma against periods
- Low-income and homeless people
- Disabled people
- Incarcerated people
- Fight the stigma and increase access
Menstruation 101
It may seem silly to start with a science lesson, but most people don’t know anything about periods, including bleeders themselves. I couldn’t rely on my health class or parents to give me any accurate information. When I first got my period I was 12, I had no idea what it meant or why I got it, so I resigned myself sadly to thinking I would just bleed out of my asshole for the rest of my life. :(
Planned Parenthood has a pretty good summary about the menstrual cycle: basically people with active ovaries produce eggs, and when an egg is mature and ready to be fertilized by a sperm cell, hormones make the uterus lining thick and spongy. If a sperm cell doesn’t fertilize the egg, then the lining breaks down and the blood, nutrients, and tissue flow out through the vagina. The typical flow varies; mine usually lasts 5–6 days. But if a sperm cell does fertilize the egg, the body keeps the lining in the uterus for the pregnancy.
A full period cycle is usually 28 days, though it can vary from person to person. This cycle drives the design of birth control pill containers (people take birth control pills once a day, usually to prevent pregnancy but also to regulate other aspects of their body and hormones). 99% Invisible has an amazing episode about how an engineer redesigned the pill case to be more user-friendly after observing his wife struggle with organizing and keeping track of the loose pills that came in a bottle.
I want to be clear about something: having your period sucks. You bleed all over your clothes and bedding. The hormone fluctuation affects your mood in weird ways. Cramping can fall anywhere on a scale of inconvenient to completely debilitating. I’m cramping right now as I’m writing this!
History of stigma against periods
My friend Katie Smiley dedicated her thesis at RISD to redesigning the period experience and wrote about period product access. She broke down stigma in 4 phases that “roughly correspond to historical time periods, but all continue to exist in some form today.” To quote her:
- Removal from society: stigma is so severe that menstruators are isolated, at home or in another shelter
- Hygienic disability: menstruation is treated as a temporary disability best hidden
- Passing as non-bleeder: menstruation isn’t a problem as long as it remains invisible and unspoken
- Radically normal: a hopeful future where menstruating is as unproblematic as urinating
So what does historical stigma look like? To start off, several historic texts like the Bible, Quran, and the first Latin encyclopedia all recommend staying as far away as possible from someone menstruating, or else crops will turn barren and fruit will fall off trees — I’m completely serious (Clue). In Ancient Greek, Hippocrates believed that if someone’s period didn’t start by age 14 then he should cut them so they start bleeding somewhere else — and yes that is absolutely fucked up (Huffpost). Doctors during the 1800’s and early 1900’s were extremely shitty in their treatment of women and queer people in general. According to the Daily Jstor, they had horrifically bad medical advice for menstruators, including that people should not sing during menstruation (this was in 1926!).
While it’s somewhat hilarious how inaccurate these historical superstitions and medical theories were, they had serious consequences on the treatment and social mobility of menstruators. Even today, according to a 2016 study many women and girls in India are banned from religious spaces, schools, and the kitchen when they are menstruating (Hindustan Times). You can only imagine how restricted and ostracized people must have been hundreds of years ago.
These are all examples of removal from society and menstruation as a temporary disability. While I think they are all seriously fucked up, we have to remember that seeing that much blood is legitimately scary, and for thousands of years people didn’t fully understand the meaning behind it. Also, many period products that are commonplace today were only invented in roughly the past century. Before that, many people with periods would cloth or plant-based devices that would leak, or they would just free bleed. This could get both smelly and unhygienic.
(Respect to people who free bleed today, I’m not suggesting you’re smelly or unhygienic. I free bleed all the time! Just keep in mind that we can make that choice instead of it being forced on us, and we now have ready access to showers, soap, and laundry — which was historically unavailable and changes the context of free bleeding.)
So basically, bleeders freaked out non-bleeders for years until finally the invention of period products and clothing allowed them to move freely in public, since it absorbed the blood and helped them become more discrete and therefore acceptable to the public eye. Allure made a really cool video about the history of period products, starting with simple cloth fixtures and sanitary belts and moving on to the first tampons and pads. This leads us to the passing as a non-bleeder attitude that Smiley refers to — as long as no one notices or mentions bleeding, then menstruation is socially acceptable. This is the attitude that I’ve experienced, born and raised in America.
I talk about periods. But apparently, the way I talk about periods is taboo because most of the world uses a euphemism instead (according to this giant survey by Clue). I remember growing up and seeing people hide pads and tampons up their sleeves when they go to the bathroom and whispering, “it’s that time of month” to each other. This is a clear indication of the shame surrounding this experience. So just in case I haven’t already, we are going to destroy that barrier right now:
THERE’S BLOOD COMING OUT OF MY VAGINA. THAT’S MY PERIOD. I MENSTRUATE. IT’S KIND OF CHUNKY. DID I MENTION BLOOD? I BLEED FOR DAYS. BLOOD EVERYWHERE.
Examples of period taboo in graphics include avoiding the word “tampon” or “pad” and opting instead to use “feminine products.” Calling these products “feminine” stem from a desire to mask everything that women do as beautiful and feminine. People love pretending that menstruators and women don’t perform regular bodily functions. Ever heard the “girls don’t poop” jokes? I also want to point out: this is transmisogyny, as there are trans women and transfeminine people who don’t use period products.
Until very recently, period companies were also too scared to use blood or anything that resembled blood in their ads, opting instead of use some inoffensive mysterious blue liquid. Bodyform used actual blood in their ad in 2017, that’s only two years ago! This is very similar to how women’s razor ads almost never show women with body hair (so you usually get someone shaving their already cleanly shaved leg instead, which is just…weird).
When will we think of periods as radically normal as urinating? You might think that in America we already do, and that the taboo I mentioned is unfortunate but is not directly oppressive, but I’m here to tell you that’s not true. Toilet paper is free in America. Go into any bathroom, and you can pee and wipe yourself clean without a problem. Period products are not free. And not only are they not free, but they have a tax — most states charge a 6.85% sales tax on menstrual products because they are not considered “medically necessary” (NY Times).
Periods are not radically normal, because period products are inaccessible to some of the most vulnerable people in society — low-income and homeless people because of cost, disabled people because of design, and incarcerated people because of a fucked up system of artificial scarcity.
Low-income and homeless people
Where are homeless people supposed to find a tampon in public? If they have the money to pay for it, do they have to decide between a meal and their personal hygiene? In this article by Teen Vogue, it describes the experience of Stephanie who was homeless while also being young and in school. It was very difficult for her to find menstrual products, making her too anxious to go to school for fear of bleeding through her pants.
Low-income earners also struggle to pay for period products, resorting to use cloth, rags, paper towels, or even children’s diapers (EurekAlert). According to a survey of 183 bleeders between the ages of 18 and 69 in the St. Louis area, nearly two-thirds of the people were unable to afford menstrual products sometime in the past year and about 20% of them lacked supplies on a monthly basis.
This is the reality that low-income and homeless bleeders face — without access to affordable or free period products, they face severe barriers to their education and physical mobility, and therefore their socioeconomic mobility.
You might ask, what’s wrong with using cloth and towels? As long as something is covering the blood flow, shouldn’t that work? Well I’m here to tell you it sort of works, but mostly it sucks. I’ve definitely used toilet paper when I didn’t have a pad or tampon on hand, and not only is it itchy as hell but it moves around and causes the blood to leak. Homemade pads and tampons also increase the risk for infection — so this isn’t just a comfort issue, it’s a public health matter (yesmagazine).
We’ve upgraded from centuries of using cloth, papyrus, and paper to using sanitary pads, tampons, and menstrual cups that are specifically designed to fit the human body. These are serious inventions that require serious patents. These early patent drawings show some of the technological advancements in the first period products.
I recognize that the development of period products requires some intense R&D (research and development) and that kind of work requires money. But let’s be real, that’s not the reason why period products aren’t free. According to MarketWatch, the “global feminine hygiene market” will reach USD 44.3 billion by 2025. One of the biggest players in this industry is Procter & Gamble (P&G), who owns brands like Tampax and Always, as well as basically every household brand you’ve ever heard of.
In 2016 the Homeless Period Project lobbied Bodyform and P&G and secured a donation of 100,000 period products for food banks and homeless shelters (Stylist). So it’s clear that, like any other huge corporation, P&G has a huge surplus of supplies just hanging out in their warehouse. What are the barriers that keep these supplies from low-income and homeless people? Well, the company has an adjusted free cash flow of $2.7 billion, and P&G CEO David Taylor’s salary is $14 million (The Motley Fool, MarketWatch). In 2018, the category of “baby, feminine, and family care” made up 23% of their net earnings — which is roughly $2.2 billion out of a total of $9.75 billion (pginvestor, macrotrends).
Period products are expensive because corporations profit off them. And not just P&G, but also: Edge well, Unicharm, Kimberly-Clark, Lil-Lets Group, Pay Chest, and more. Most industries, especially the pharmaceutical industry, claim that these profits are necessary to promoting innovation. But this logic just doesn’t add up to me, because:
- The patents and designs for the basic pad and tampon have existed for about 100 years, there’s no new innovation there
- These corporations have the resources to produce millions of period products at a very low cost per unit
- Look at the CEO’s salary
Don’t get me wrong, there is some really cool innovative work happening in menstrual product development that requires monetary investment. For example, THINX is a brand of washable, reusable underwear that absorbs period blood. Livia is a device that relieves cramps through gel pad electrodes connected to a vibrating device. Looncup is a smart menstrual cup that connects and sends data to an app to help you analyze your cycles. They are all legitimately cool startups creating cool products. But they are not necessary — basic period products are as necessary as toilet paper and it’s a human right to have access to basic hygiene practices.
It’s noteworthy that P&G has recently acquired the organic period startup This is L for approximately $100 million (Forbes). Founded by Talia Frenkel, the startup’s mission is both to make natural period products — which they say are free of pesticides, chlorine, fragrances, and dyes — and to make period products more accessible to people in need internationally. This is an improvement, but I really doubt P&G is doing this out of the goodness of their heart. Look at their sales, organic product sales rose 4% in the second-quarter (presumably of 2018, based on this CNBC article). Like many other companies, they are jumping on the trend of a rising demand for organic products and charging more because they are targeting a market that can afford it (Investopedia).
Let’s be real, until we raid warehouses for tampons (which I’m totally down for, hit me up), we need a way to fund free tampons and pads for people. Corporations are not going to give up their profits just yet. That means we need to rely either on taxpayer-funded government programs or donation initiatives made by philanthropic and non-profit organizations. More on that in the last section.
Disabled people
Though I imply earlier that the design of basic period products has been done for a century, I’m going to eat my own words already. That accounts for people who are physically and/or mentally able-bodied. There is still so much opportunity within the design of period products themselves to make them more accessible for disabled people.
The way that I like to frame accessibility, especially to people who think that it’s too much work for little in return, is that we should look at it as a rigorous creative exercise. Creative thinking is a problem-solving exercise, and constraints create problems for us to solve. So let’s look at some of these constraints.
Wheelchair users
Melissa Blake wrote a great article on Helloflo about her experience as a wheelchair user who menstruates. These are some aspects of her user journey:
- Logistics: Melissa needs help with daily tasks like bathing, dressing, and cooking — and therefore needs to plan activities around her period as well
- Sitting: Because Melissa spends most of her day sitting and only walks short distances in her walker, sitting makes cramping very difficult
- Ergonomics: Melissa only wears pads and not tampons due to her disability, and she finds them very bulky and uncomfortable
The surprisingly positive aspect that Melissa notes is that, in a society that tells her that her body is not normal, her period makes her feel normal. So in a way, getting her period is actually an enjoyable experience that makes her feel included.
How might we improve Melissa’s period experience? If I were to approach this as a design challenge, I think we should look at every aspect. How might we create a pad that feels comfortable for someone sitting down all the time, and is easy for another person to put on and take off? How might we relieve cramps for someone with limited mobility — is this something can be stored on the wheelchair or sit on a nearby table for easy access? How might we help wheelchair users plan their activities with their assistant, especially with something that can be as unpredictable and volatile as a menstrual cycle?
People with limited mobility
This one is exciting, because a disabled person has invented a product that addresses the problems she faces! Jane Hartman Adamé has Ehlers-Danlos Syndrome (EDS), which is a connective tissue disorder that causes joint instability and immobility. This makes it difficult for her to use traditional menstrual cups, because she could dislocate a joint in her hands, shoulders, hips, or sometimes even her back. So she stopped using cups, but she didn’t want to send more tampons and pads to the landfill. That’s when Jane started working with her friend Andy, who is a seasoned medical device designer, and they created the Keela cup. The Keela cup has a patented pull string that makes it easy to remove, like a tampon. It also has a rounded lip to maximize comfort, but it can also be used like a regular suctioning menstrual cup if the user prefers (Bustle).
I am here for this! As someone who has used menstrual cups in the past, I can attest to the fact that they are very difficult to remove and I don’t have any mobility issues in my hands. I’ve accidentally pulled them out too fast multiple times and spilled blood all over the floor. I am curious to hear user feedback on this device and how well it works, though right off the bat I’m thrilled that they took action and created something.
People with intellectual disabilities
For people with intellectual disabilities, managing their period comes with a whole set of challenges. This article by Hello Clue talks about what these are:
- Some people have trouble understanding what’s going on with their bodies, and need clear and simple support and education
- Some people have trouble keeping track of time and maintaining habits, so products like tampons and menstrual cups that need to be inserted and then removed aren’t ideal
- For those who find the process altogether too much to manage, menstrual manipulation is an option for suppressing periods or reducing the menstrual flow
I want to pay attention specifically to the second point, where the article suggests that period-proof underwear and pads are often more effective to intellectually disabled people. Period-proof underwear would also work great for me — though I’m not intellectually disabled I’m incredibly forgetful, busy, and my anxiety manifests in symptoms very similar to ADD or ADHD. This is another example of how focusing on disability makes products more accessible for everyone.
Incarcerated people
Trigger warning: abusive treatment of incarcerated people who are menstruating and/or pregnant
The prison complex system is basically modernized slavery. Are we on the same page here? The US has the highest incarceration rate in the world, with about 2.2 million people in federal and state prisons (Marketplace, 2017). In most states, incarcerated people earn less than a dollar an hour (Prison wage policies). They can buy a pack of 24 maxi pads for $2.63 at the commissary; pretty affordable for people earning a living wage, but ridiculously expensive for someone in prison. An incarcerated person in Alabama has to work 10.5 hours to buy those pads — I know, what the fuck. They might not even be able to get the pads if they need $1.50 toothpaste, aka 6 hours of work. (The Guardian)
As of August 2017, all [bleeders] in federal prisons have access to free tampons, pads, and panty liners (lunette). This is great! However, most bleeders actually go to state and local prisons, which haven’t allowed the same access. These facilities technically have the ability to provide the inmates with products, but often keep them just out of reach as a power play. Chandra Bozelko, who spent 6 years in a facility in Connecticut, wrote about her experience in the Guardian article I cited earlier:
Stains on clothes seep into self-esteem and serve as an indelible reminder of one’s powerlessness in prison. Asking for something you need crystallizes the power differential between inmates and guards; the officer can either meet your need or he can refuse you, and there’s little you can do to influence his choice.
Something interesting I noticed in Bozelko’s reflection is that people didn’t just use pads for their period, they would use them as ear plugs, makeshift band-aids, or cleaning supplies to tidy their cell. While I admire their innovative thinking I am also horrified that they are forced to take an already scarce resource and repurpose it for several other applications when affordable ear plugs, band-aids, and cleaning supplies actually exist!
Arizona has taken this level of control to a completely bonkers level. They give incarcerated bleeders a limited supply of 12 pads for month (because a period can last up to 7 days and it’s recommended to change it every 5–6 hours, they could need up to 28 per month). They must ask an officer for more, and cannot have more than 24 pads at a time (what the hell, why?). This supply does not include tampons, if they want those they must buy them. A $3.99 box of tampons costs 27 hours of work. According to a former inmate, they are also not allowed to blood-stain their pants, or else they will get a ticket for a dress code violation — resulting in losing visitation rights, phone calls, and the ability to purchase store items — including tampons and pads! The state considered a bill that would give them an unlimited supply of period products, but predictably, a majority cis male House committee killed it. (AZ Central)
I want to emphasize that this is a false scarcity that prisons have artificially created. Corporations have warehouses full of period products. Prisons have the funding, though when you look at the breakdown of their budget per person, you can see very little goes to the person’s well-being. In California, they spend around $49,000 annually per adult, $20,429 of which goes to security — that’s probably to pay the security guards and the upkeep of security tech (Mother Jones). $7,669 goes to medical services, although this is probably the incurred cost of contracts with local hospitals (Prison Fellowship). So prisons have thousands of dollars in their budget, and yet they require incarcerated people to pay for period products that costs them several hours of work? They’re going to charge inmates 50 cents per hour to call their family? Really?
Last December, 2018 Congress overwhelmingly passed the First Step Act, which is a major breakthrough in criminal justice reform. Specifically for people with uteruses, the bill mandates that federal facilities are not allowed to shackle pregnant women and restrict access of menstrual products (ACLU). This is a big win! The President signed this bill into action, though when he released the budget priorities for 2020 earlier this week, funding for this act specifically seemed intentionally vague (The Marshall Project). So we need to hold the administration accountable to this act, and we need to continue fighting for unlimited, free access to period products for incarcerated people.
Fight the stigma and increase access
What does radically normal for periods actually look like? How do our systems change when period products are not a luxury, but a human right? What do accessible period products look like for trans and disabled bodies? How do imagery and language change when we are not afraid of blood? What do bathrooms look like when they have period products that are free and publicly available? How does the design of our clothes evolve to not only accommodate but celebrate the flow?
These are all questions that I don’t necessarily have the answer to. But I want us all to think about these questions, especially if you’re a creator — especially if you’re a designer, engineer, artist, or technologist — because these are questions that we have power over and that we can change if we seek a radical future.
Here is a non-extensive list of cool initiatives, organizations, and companies that are addressing the barriers that menstruators face:
Thanks for reading. This is part of a series dedicated to exclusionary design. If you have any suggestions for what to write about, feel free to comment or tweet at me @thetuttingtutor.
