Female-Focused: Assessing Action of Health Policy Using Multiple Theories
The gender identity of legislators influences a government’s priorities and the passing of public policies. A study presented in The Journal of Politics demonstrates how governments that adopt quotas that lead to significant increases in women’s representation results in a larger proportion of their national budgets being directed toward public health. This implies that quota-elected women act as important agents of political reform and positively impact health policies that affect women.
In the United States, females make up 31% of all elected state legislatures and 26% of the Utah state legislature. While the number of females being elected to government positions has increased over the years, the ratio of men to women in legislative bodies does not reflect the 101 men to 100 women in Utah. While the election of more females into government office can continue over time, current action must take place to reflect female priorities in government policy. Discussing policy gaps in female health and hygiene must occur among legislative bodies primarily consisting of male representatives and legislators.
Utah currently ranks last in the United States for women’s equality. Although, that does not mean that Utah does not currently have policies in place supporting women. In 2018, Utah passed HB196 which legally allowed people to breastfeed in public places. The catch was that a women’s breasts must remain covered while breastfeeding to not promote immodesty in public places. Utah’s conservative political climate enforces how policies are presented in the state regarding female health. It does not go unnoticed that Utah was one of the last states to legalize breastfeeding in public, but the women of Utah must focus on how to pass female-focused policy no matter how far behind Utah is. In Utah’s 2022 general session, the legislature passed HB77 which expanded the types of contraceptives that may be provided for inmates. During this session, HB32 was also passed. This amendment updates the health care worker protection policies where assailants of health care workers can be charged with a class A misdemeanor or even a third-degree felony if they cause substantial bodily injury. This protects health care workers, especially women in health care settings, should they be threatened while performing their work duties. Such bills passing in the most recent general session demonstrate how female-focused policy continues to positively affect Utah’s female population and their fight for equity.
Understanding how to pass policies in support of women to a legislative body consisting of mostly men is no easy feat. During the 2022 Utah general session, the Policy Project conducted The Period Project, which ultimately led to the passing of HB162 to allow period products in Utah’s K-12 schools. Implementation of this bill began during the 2022–2023 school year as schools acquired menstrual products for the start of the academic year. This essay outlines the efforts put forth to pass HB162 and how more policies supporting female health can be presented in the future to demographics comparable to Utah’s legislative body. Public policy theories such as the Social Construction of Target Populations Framework, the Advocacy Coalition Framework, and the Narrative Policy Framework will be referenced in the explanation of how to promote female-supporting policies such as HB162 and the importance of incorporating female leaders in policy development.
Step 1: Social Construction of Target Populations Framework
Women as a social construct
The Social Construction of Target Populations Framework proposes that the beliefs and perceptions of social groups reinforce ideas that lead to policy ideas. These beliefs and perceptions can then either benefit or punish those social groups. Policymakers rely on these social constructs of social groups to make quick decisions and create stories and narratives for the public. Groups are perceived in many ways, from positive and negative perceptions and even to how much power they have or do not have. Regarding health policy, women can be seen as a social group whose social construct consists of having fewer opportunities than men in the form of power, money, and social opportunities. The policy design of Utah’s female population disregards the purpose of making Utah an equitable state in terms of gender.
Prior to The Period Product, Utah ended the sales tax on menstruation products. In December 2019, the end of the tampon tax signified a shift towards equity among women and removing tax costs that could benefit low-income individuals. Although, during Utah’s 2020 general session, the bill that ended the tax on menstruation products was repealed. To this day, Utah continues to tax menstruation products. When looking at the issue of taxing menstruation products, policymakers can see that the social group they are looking at is not just about women, but menstruating women. Historically, the social construct of menstruating women from a men’s perspective is negative and this demographic prefers the discussion of menstruation to be discreet. This is an issue when wanting to create policies surrounding menstruation. If the social construct is negative or taboo, then what can be done?
Children as a Social Construct
Social constructs are imposed on target populations such as those shown in Figure 2. Target populations are groups that are chosen by policymakers to receive benefits or burdens through policy design. The social constructs shown in the figure are the Advantaged, the Dependents, the Contenders, and the Deviants, and the target populations are distributed throughout the figure. The placement of social constructs is based on if they are perceived positively or negatively and if they have high or low amounts of power in society. Children are considered Dependents as they have low amounts of power, which means that they cannot negotiate benefits with policymakers. However, children are often positively construed in society and treated well by the government.
The Policy Project supported the bill to end taxes on menstruation products, a bill that supports the social group of all women. Utah repealing the bill did not stop the problems around female menstruation and menstrual hygiene. The creation of The Period Project focused on making period products accessible to a particular social group — children. Male policymakers, though wary of language related to periods and menstruation, have more of a moral obligation to listen to stories of young children and assist them in overcoming obstacles. This moral reasoning allows all policymakers to use biased, emotional judgments to make decisions about a policy problem and provide the solution. The Period Project currently focuses on the moral reasoning that young girls skip school because they don’t have period products, thus interfering with their education. The solution proposed — make period products available in all K through 12 schools. This idea seems simple, but several steps, groups, and coalitions come together to make this happen. The Period Project, a female-dominated coalition, gained the support of some of Utah’s female legislators interested in such a female-focused policy. Building a network of female leaders is critical in developing female-focused policy as explained using the Advocacy Coalition Framework.
Step 2: The Advocacy Coalition Framework
The Advocacy Coalition Framework consists of many actors, which will be represented in the context of the actors used to pass and are involved with HB162. The Period Project represents an advocacy coalition where different groups of people share core policy beliefs and coordinate political activities to work toward a policy goal of implementing menstruation products in all Utah K-12 schools. Dominant coalitions that exercise a legal authority to make policy decisions and are members in positions of more authority are local school boards, charter school boards, and HB162 sponsors Chief Sponsor Representative Karianne Lisonbee and Senate Sponsor Ann Millner. Having female sponsors represent the bill allows them to already understand vocabulary regarding female menstrual health and the positive effect the bill will have on Utah’s female population. Even though the bill is aimed to support children, female sponsors who understand menstruation give The Period Project the ability to focus on educating male cosponsors about menstruation. Principal coalition actors who are expected to be more central and consistent in the process of implementing period products in schools are school nurses, janitors, and the school boards as they must allocate menstruation products to schools using state funds. At the beginning of this policy process, The Period Project stood as a principal coalition, but as period products were distributed, The Period Project became an auxiliary actor where they work on the side and are only involved for short periods of time.
All these coalition components are represented in HB162. Both The Policy Project’s and the Utah Period Project’s Instagram accounts also documented several events and meetings with various coalition actors that contributed to making HB162 possible. Social media was one of the ways that The Period Project reached people with similar deep core beliefs and educated people of other belief levels regarding menstrual hygiene. Deep core beliefs are the fundamental beliefs in a person that is difficult to change. The next tier of the belief system is policy core beliefs where beliefs are more specific and defined, but still hard to change. This belief system can be related to a person’s political beliefs and how involved government should be in personal affairs. The final tier in the belief system is secondary beliefs. These beliefs are most likely to change as people learn more about a policy issue. Secondary belief systems explain policy implementation and are the level at which coalitions will target policymakers and inform them on a policy issue. Informing policymakers can be done in many ways, but in terms of ensuring that the male legislature is educated on “uncomfortable” topics like menstruation and menstrual hygiene, it would need to take more than just charts and statistics to inform them. Female legislatures may need less education on the life of one living with menstruation, but education on period poverty must still occur. A topic that does not represent most of the legislative body can be difficult to grasp, which is why period poverty is best explained through storytelling.
Step 3: Narrative Policy Framework
All good stories consist of four things: a relevant setting, a gripping plot, complex characters, and the moral of the story for the audience to follow. The Narrative Policy Framework focuses on framing a narrative using these four tools to present issues to policymakers. Framing the narrative makes the story easy to understand and relatable to the audience. The Social Construction of Target Populations Framework demonstrates how children are the perfect characters in this story. The Advocacy Coalition Framework contributed to the characters and who influences their lives as they are dependent on the coalition actors on their outcome. The Period Product framed the narrative by establishing the key features unique to the problem — period poverty and Utah children in low-income families.
Plot: Period Poverty
Period poverty is defined as the lack of access to menstrual products, hygiene facilities, waste management for period products, and education. Period poverty causes physical, mental, and emotional challenges, especially in the development of young girls. School-age girls are at the highest risk for period poverty as their periods almost all begin at age 13 before they are legally able to work. Children rarely have control over family finances or can drive to a store to purchase period products. Period poverty leads to missed school, health risks, lower confidence, shame, embarrassment, and missing out on other opportunities provided for them at school. The Period Project frames menstruation as “similar to a spontaneous bloody nose” in that it is an involuntary process that occurs monthly.
Setting: Utah’s Low-Income Population
As of 2021, 1 in 9 women and girls in Utah between the age of 12 and 44 lives below the Federal Poverty Line. While many of these women and girls receive health coverage through Medicaid, Medical Assistance, or other government assistance plans, individuals still struggle to access the basic materials necessary to thrive. In the US, 1 in 4 teens has missed class due to a lack of access to period supplies, and one-third of low-income women report missing work, school, or other commitments due to lack of access to period supplies.
The Narrative
When presenting the idea of providing free menstrual products in schools, The Period Project identified their framing and narrative and gathered stories from the community. The meso-level of analysis in the Narrative Policy Framework studies the narratives among groups or coalitions. A student in Salt Lake’s school district expressed that her parents are unable to provide period products. She expressed that every month while on her period, she laid down on the couch with a towel under her to manage menstrual bleeding and symptoms. This caused her to miss school and other opportunities while managing her period on her couch. Another girl from the Granite School District uses cotton balls as her menstrual product of choice because they are less expensive than period products. Students are not the only group affected by period poverty. A Utah custodian mentioned how she wipes the blood off classroom seats “often.” These are only a few accounts of the inconveniences menstruation has on a developing woman.
Relaying these narratives to legislative bodies, especially those consisting mainly of men, is extremely important. Figure 4 demonstrates the cycle that results in the lack of access to period products — a narrative that had to be relayed to legislative bodies to understand the gap in health policy. The moral of the story is that providing period products raises educational outcomes across the state in every female demographic. Figure 5 represents how access to period products empowers women and increases productivity levels in both education and the workforce. This shows legislative bodies how female-focused policies can contribute to positive lives for Utah’s female population.
Currently, HB162 details that schools will inform students of the availability of menstrual products once they are in place. With the addition of free menstrual products in schools, the next step is to educate the population. Needing to educate male legislatures exposes the educational gaps between males and females in the school setting. The Utah State Board of Education does not explicitly state how menstruation is to be taught in schools or about how to use menstrual products. Discovering how to gather public support in the Utah community to educate future generations about menstrual hygiene regardless of gender can be the next step in ensuring female equity. Utah does not rank the highest in female equity, but through the election of more female officials, fewer steps may need to be taken to convince the Utah legislature of passing female-focused policies.
Conclusion
Policymakers need storytellers to educate them on important issues. Through storytelling and understanding how to use the tools and voices of the community, policymakers will be convinced of the magnitude of policy situations presented to them. The Social Construction of Target Populations Framework, The Advocacy Coalition Framework, and the Narrative Policy Framework can work in conjunction with one another to achieve desired policy goals. Although, these theories are not guaranteed to always work. Utah’s political climate might shift with newly elected female officials, or it can shift with the election of individuals representing a different political party. The frameworks described must be tailored to individual situations, but the frameworks continue to be useful in finding a group in need, coalitions to support them, and educating the legislative bodies. Nevertheless, it is important to remember that policies can be influenced by gender. Women in government offices are more likely than men to support positive female health-related policies, whereas men in office may need more information regarding female-focused policies. The political climate is not stagnant, and implemented policies and elected female officials will be the deciding factor in the future shift to progressive female health programs.
