Introduction

The World Bank estimated that, in 2022, 500 million women worldwide lacked access to menstrual products and adequate facilities to allow them to manage their menstruation.^[1] In Canada, results from a 2019 Plan International survey show that approximately 35% of women and girls who menstruate have had to regularly or occasionally sacrifice something else within their budget to afford menstrual hygiene products.^[2] These individuals experience what is called menstrual poverty or period poverty.

Menstrual poverty can force women and individuals who menstruate to miss school, work, or social activities. It can also affect their health, particularly if they must use menstrual products for a longer period than what is considered safe. They might also experience shame and stigma if they cannot access adequate washrooms to manage their menstruation. Therefore, menstrual poverty has a negative impact on multiple rights of women, girls and individuals who menstruate, including their right to health, education, work, non-discrimination, gender equality, and to participate in public life.^[3]

To respond to these issues and to help achieve menstrual equity in Canada, the House of Commons Standing Committee on the Status of Women (the Committee) undertook a study on menstrual equity and poverty in Canada, in particular an examination of barriers that make it difficult for some Canadians to access menstrual products and participate in daily activities.^[4]

In this report, the Committee uses the term “women and individuals who menstruate” to refer to individuals who have a menstrual cycle. The Committee notes that individuals who menstruate predominantly self-identify as women and girls; however, individuals of all genders can menstruate.

This report has been informed by expert witnesses, advocates, and entrepreneurs. In June 2023, the Committee heard from 16 witnesses representing 13 organizations. The Committee also received two written briefs. The Committee thanks all witnesses who took the time to participate in this study.

This report focusses and makes recommendations to the Government of Canada on the following main issues:

• increasing access to affordable menstrual products;
• improving education about menstrual health;
• raising awareness about menstruation and related health issues; and
• informing Women and Gender Equality Canada’s new Menstrual Equity Fund.

Overview of Menstrual Poverty in Canada

Menstrual poverty or period poverty can be described as the inability or the struggle a person faces to access menstrual products, menstrual health education and adequate sanitary facilities.^[5] Some definitions of menstrual poverty include the financial, social, cultural and policy barriers that women and individuals who menstruate can face, such as stigma and discrimination.^[6] According to the United Nations Population Fund, women and individuals who menstruate must have access to the following items to ensure their menstrual health and manage their hygiene during menstruation:

• clean material to absorb or collect menstrual blood;
• places to change, clean and dispose of their menstrual products in safety and privacy;
• places to safely and privately wash; and
• education about the menstrual cycle and appropriate care if they experience menstruation‑related disorders.^[7]

Lack of access to these items may make women and individuals who menstruate vulnerable to menstrual poverty. Menstrual poverty can result in negative consequences for individuals who are affected, such as having to miss school or work.^[8] Referring to the results of a research project conducted in 2021 in British Columbia, Sussanne Skidmore, Co-Chair of the Period Promise Campaign, United Way British Columbia, told the Committee:

Accessing menstrual products is … a gateway for accessing community. More than 18% of respondents had missed school, 22% had missed work, 29% had missed out on community events, and 27% had missed out on social activities. All of those numbers increased for people with lower family incomes, [I]ndigenous folks, people living with disabilities and immigrants or refugees.^[9]

Some of the factors influencing menstrual poverty are described in the sections that follow.

The Price of Menstrual Products

The price of menstrual products is one of the main barriers to menstrual equity. It is estimated that women and other individuals who menstruate will spend up to $6,000 on menstrual products in their lifetime.^[10] Individuals who are struggling financially might have to forego buying menstrual products in order to cover the cost of necessities like food and rent.^[11] Danielle Kaftarian, Operations Manager at The Period Purse, told the Committee:

We know that families are struggling to afford day-to-day tasks due to inflation increases—there are all sorts of different things there—and they're choosing between putting food on the table or spending $15 on a box of tampons. These are all decisions that are causing people to struggle to afford period products. It's not just about people who are unhoused; it's also about people who are living on the cusp. We're seeing that in food banks. I work very closely with many of them. People are requesting these products, now that it's becoming more open in the food banks and they're needing these products.^[12]

Foregoing buying menstrual products to pay for other necessities is not as uncommon as some might think. Witnesses told the Committee that some studies show that 25% of women and other individuals who menstruate in Canada report having had to make that choice.^[13]

For individuals who live in rural or remote communities, the price of menstrual products can be “four to five times as much as [products] purchased in large urban cities.”^[14] Veronica Brown, Lead of the Ontario Chapter of Moon Time Sisters, shared with the Committee some of the preliminary results of a crowdsourcing survey conducted with the University of Saskatchewan. In particular, the survey results showed that:

• 73% of Indigenous respondents living in remote communities and 55% of Indigenous respondents living in non-remote communities indicated sometimes or often having difficulty accessing menstrual products;
• the main reasons given by these respondents for having difficulty accessing menstrual products include products being unavailable in stores, having other priority items to buy, and the unaffordability of the products; and
• Indigenous respondents living in remote communities were more likely to miss work, school and exercise due to a lack of access to menstrual products than those living in non-remote communities.^[15]

The Committee also heard that access to the Internet is another barrier to menstrual equity in rural and remote communities, as communities might struggle to place online orders for menstrual products.^[16]

Groups facing the highest poverty rates in Canada (groups such as "unattached individuals, one-parent families, transgender and non-binary people, Indigenous people, racialized groups, refugees, and recent immigrants”)^[17] can be disproportionately affected by menstrual poverty. In a written brief, A.J. Lowik noted that since data available show high rates of poverty, housing insecurity and homelessness among transgender people in Canada, it is possible to conclude that transgender individuals who menstruate would also be affected by menstrual poverty and that they might face unique challenges in accessing menstrual products; for instance, in public bathrooms, shelters, schools, and workplaces.^[18]

Women and individuals who menstruate who are not able to afford an adequate supply of menstrual products may resort to using products longer than they should or using alternative products (e.g., rags and paper).^[19] According to a Plan International Canada survey conducted in 2022, 22% of respondents who menstruate reported that they have had to ration or use products longer than they should.^[20] This can cause infections or other medical problems.^[21]

Therefore, the Committee recommends:

Recommendation 1

That the Government of Canada consult with Indigenous peoples to address period poverty and accessibility, particularly in northern communities where limited access to menstrual health products is common.

Recommendation 2

That the Government of Canada ensure funding for First Nations and First Nations-designated education organizations to procure the quantity needed as well as the desired type of free menstrual health products, including reusable and sustainable products, for students both on and off reserve.

Lack of Access to Clean Water

Lack of access to clean water is also a barrier to menstrual equity. For instance, drinking water advisories intersect with menstrual equity in that “reusable pads, period underwear, and cups need to be boiled and cleaned correctly in order to keep them sterile and working properly.”^[22] Therefore, a lack of access to clean water might prevent women and individuals who menstruate from choosing reusable products that need cleaning, even if it is their preferred product option.^[23] The Committee heard that reusable products that do not require boiling water to be cleaned are starting to be available on the market, the Bfree Cup for example.^[24] Clean water is also necessary for women and individuals who menstruate to clean themselves and wash their hands, for example.^[25] In Canada, long-term drinking water advisories affect Indigenous communities disproportionately.

Therefore, the Committee recommends:

Recommendation 3

That the Government of Canada ensure all First Nations communities have reliable access to clean water and safely lift, as soon as possible, all long-term drinking water advisories on public systems on reserves in Canada.

Lack of Access to Clean and Safe Washrooms

Lack of access to clean and safe spaces to manage menstruation is also a barrier to menstrual equity for some Canadians.^[26] For instance, women and individuals who are homeless might not be able to easily access a private washroom to change their menstrual product.^[27] As well, women and individuals who menstruate and work in workplaces where men are overrepresented might not have access to adequate washrooms.^[28] In addition, Danielle Kaftarian explained that “[w]ithout access to washrooms, transgender and non-binary people may have to choose between a washroom that matches their gender identity and one that has the period products and amenities they need.”^[29] Having to use a washroom that does not align with their gender identity, for example to access menstrual products, can be physically and mentally dangerous for transgender and non-binary individuals and creates additional equity barriers for them.^[30]

Achieving Menstrual Equity in Canada

The Committee was told that “[m]enstrual equity means accessible period care for everyone who needs it”^[31] and that it “sits at the intersection of social justice, human rights, gender equality, food security, poverty reduction, education, and so much more.”^[32] Clara Bolster-Foucault, Co-Director of Monthly Dignity, noted that “[t]o effectively tackle period poverty in Canada, we need a comprehensive approach that addresses both immediate and long-term needs while recognizing and adapting to local contexts.”^[33]

Over the course of this study, witnesses shared many ways in which the Government of Canada could help achieve menstrual equity in Canada. However, witnesses cautioned against taking a “one-size-fits-all” approach to reducing menstrual poverty and achieving menstrual equity, as women and other individuals who menstruate are diverse.^[34] For instance, Madeleine Shaw, Spokesperson for the Sustainable Menstrual Equity Coalition, told the Committee:

Achieving universal menstrual equity will take more than just placing an endless supply of traditional, largely plastic-based disposable products in bathrooms; achieving true menstrual equity means universal access to quality products of choice, education and a stigma-free social climate. It means we need to diversify not just product offerings but also access methods for people living in remote and rural areas and on reserves, access for those living with disabilities or without access to transportation; and access for those whose periods simply arrive at an inconvenient time or who have needs that do not fit into the model of bathroom access only. In those moments when you are finally able to access a pad or tampon, it's worth asking what happens three or four hours later, when the hunt for the next product begins again.^[35]

Suggestions and recommendations from witnesses are detailed in the sections that follow.

Facilitating Access to Free Menstrual Products

To reduce financial barriers associated with accessing menstrual products, witnesses recommended distributing these products in a variety of settings, including in workplaces. In particular, Clara Bolster-Foucault stated that the focus should be to respond to the needs of “underserved communities by reducing financial and structural barriers to accessing” menstrual products.^[36] In addition to distributing free menstrual products, this could be achieved by “increasing social assistance funding, subsidizing the cost of menstrual products … and allocating additional funding for community-based organizations to purchase the products that they need to distribute.”^[37]

The Committee was told that financial barriers are not the only reason someone might need easy access to menstrual products. Indeed, most women and other individuals who menstruate have been caught off guard and gotten their periods without expecting it. It might also be someone’s first period, or because they have irregular periods, they did not expect it.^[38] In this situation, if a person is not able to find menstrual products, they might have to leave school, work, or an activity to find a solution.^[39] Lara Emond, Founder and President of Iris + Arlo, noted that this is “an uncomfortable and embarrassing situation that occurs solely because sanitary facilities have not thought to accommodate persons who are having their period.”^[40]

The Committee heard that to achieve menstrual equity, menstrual products should be treated as essential products,^[41] on the same level as other essential items found in washrooms, such as toilet paper and soap.^[42] Witnesses described access to menstrual products of choice as a human right.^[43]

Type of Menstrual Products and Location

Diverse types of menstrual products, both disposable and reusable, should be made available to women and other individuals who menstruate.^[44] Providing access to a variety of menstrual products allows for the respect of people’s cultural and religious beliefs and possible history of sexual trauma.^[45] Ayla Banks, Drop In Manager at Resource Assistance for Youth Inc., stated that “[p]roviding access and choice provides dignity and safety” to women and individuals who menstruate, which is crucial for their “mental and physical health.”^[46]

Disposable menstrual products can be the product of choice for many women and other individuals who menstruate because of their practicality. However, reusable menstrual products can also be the best option for some individuals. This can be the case for low-income individuals and those who live in rural and remote communities because of “comfort and peace of mind,” the products being less expensive in the long term, and the fact that, since the products are reusable, they will not run out of them.^[47] As well, Lara Emond noted that “it is possible to promote the adoption of reusable menstrual products by providing grants, as many municipalities have done, and rethinking restrooms in order to facilitate their use.”^[48] Witnesses said that more sustainable and environmentally friendly products should also be made available.^[49]

One of the most common spaces to distribute menstrual products is in women’s washrooms. However, witnesses explained that menstrual products need to be accessible in diverse locations.^[50] For example, A.J. Lowik noted in a written brief that many transgender individuals avoid using public washrooms outside their homes because they are “sites of discrimination and violence.”^[51] The written brief noted:

Trans people report that the lack of privacy and the lack of dispensing and disposal receptables in men’s bathrooms, the overall absence of gender-neutral bathrooms, and the increased policing of gender non-conformity in public spaces generally, all exasperate menstrual inequities and further contribute to public bathroom avoidance.^[52]

It was recommended that free menstrual products be available in all washrooms (women’s, men’s, and gender-neutral), but also that efforts be made to ensure washrooms are safe spaces for transgender individuals and to increase the number of gender-neutral washrooms available.^[53]

In addition to washrooms, other general access points mentioned during this study include shelters, schools, libraries, community centres, student fairs and food banks.^[54] Nicola Hill, Chair of the Government of British Columbia’s Period Poverty Task Force, explained that:

[P]ublic and physical spaces do not always ensure that menstrual products are available to people who are vulnerable because they may not be accessing a workplace or a school. We have seen through the pandemic where those buildings were shut down, even if they had menstrual products.^[55]

As well, Ayla Banks explained that “due to the often inaccessible nature of bathrooms for some of our more street-entrenched and marginalized community members,” menstrual products should be available for outreach and frontline workers.^[56] Other examples shared with the Committee include the provision of vouchers and gift cards that can be redeemed for menstrual products:^[57] this allows women and individuals who menstruate to choose their preferred products. Witnesses noted that the Government of Canada could collaborate with provincial, territorial and municipal governments to ensure the availability of menstrual products in more spaces, including in schools and shelters, for example.^[58]

Therefore, the Committee recommends:

Recommendation 4

That the Government of Canada, respecting the jurisdiction of, and in consultation and collaboration with, municipalities, provinces, territories and Indigenous peoples, support community-based and non-profit organizations, and grassroots initiatives that work towards menstrual equity.

Recommendation 5

That the Government of Canada ensure access to menstrual products for transgender, non-binary and gender-diverse individuals by increasing the number of safe spaces and gender-neutral washrooms and ensure menstrual equity programs and services are inclusive in a manner that treats individuals with dignity and addresses barriers in accessing menstrual products.

Recommendation 6

That the Government of Canada make available menstrual products to organizations which provide outreach to vulnerable individuals, individuals who are in precarious situations or unhoused individuals.

Access to Menstrual Products in the Workplace

One avenue for increasing access to menstrual products is to provide them in the workplace. Clara Bolster-Foucault argued that access to free menstrual products should become the norm in all workplaces, which would help change the perception of and awareness about menstrual poverty among the public.^[59] As of 15 December 2023, federally regulated employers will be required to make menstrual products available to workers at no cost while they are in the workplace.^[60] Linda Biggs, Co-Chief Executive Officer of joni, told the Committee that this change to the Canada Labour Code is “a great start to set the tone for what is required when we're going into our workplaces.”^[61]

The Committee was also told that the Government of Canada needs to consider ways to make menstrual products available for employees who telework.^[62] To provide federal employees with menstrual products, as required by law, Madeleine Shaw called for the Government of Canada to innovate and consider ideas such as vouchers, electronic gift cards and diverse distribution points.^[63]

Therefore, the Committee recommends:

Recommendation 7

That the Government of Canada, respecting the jurisdiction of, and in consultation and collaboration with, municipalities, provinces, territories and Indigenous peoples, and other stakeholders, promote menstrual equity by encouraging employers to provide free or subsidized menstrual products in workplaces, particularly in low-wage industries where menstrual poverty may be prevalent, and by working to establish menstrual-friendly facilities in public spaces with well-equipped restrooms featuring sanitary disposal bins, sufficient menstrual product supplies, and hygiene essentials.

The Menstrual Equity Fund

The Government of Canada announced in Budget 2022 that it will provide $25 million over two years, starting in 2022–2023, for Women and Gender Equality Canada launch a national pilot project for a Menstrual Equity Fund (the fund). On 21 September 2023, the Honourable Marci Ien, Minister for Women and Gender Equality and Youth announced that Food Banks Canada will receive $17.9 million to run the national pilot project. The pilot project aims to:

• [t]est approaches to distribute free menstrual products to community organizations serving diverse low-income populations across Canada; [and]
• [p]artner with several grassroots organizations across Canada that are already advancing menstrual equity to scale up education and awareness activities, which will inform Canadians about period poverty and reduce stigma around menstruation.[64]

Please note that the Committee conducted this study before the fund was launched.

During this study, witnesses showed support for this initiative^[65] and shared ideas of ways to ensure the project is successful. The suggestions include:

• consulting communities about their needs;^[66]
• ensuring groups of individuals who need the most help in accessing menstrual products is a primary focus when the fund rolls out;^[67]
• ensuring that sustainable and reusable menstrual products are included in the fund rollout;^[68]
• partnering with organizations already working in the field;^[69]
• including small- and medium-sized enterprises (SMEs) in the procurement process;^[70] and
• turning the fund into a permanent and sustainable initiative.^[71]

Therefore, the Committee recommends:

Recommendation 8

That the Government of Canada, when the Menstrual Equity Fund pilot project ends in March 2024, review it to:

• evaluate whether the funding provided helped reduce menstrual poverty in Canada and break down barriers to accessing menstrual products, including financial and geographical barriers;
• determine whether the funding provided made available a variety of menstrual products (reusable, disposable and sustainable products); and
• consider making it a permanent initiative, if the fund is successful in reducing menstrual poverty.

Educating Canadians on Menstrual Health

Limited education on menstruation and menstrual health is one of the barriers to menstrual equity in Canada.^[72] The Committee was told that a lack of education on menstrual health perpetuates the stigma surrounding menstruation,^[73] which in turn “stops too many people from getting their needs fulfilled in order to participate in work, school, sports and community activities.”^[74] For example, many women and other individuals who menstruate are unaware of the different menstrual products options beyond disposable pads and tampons.^[75] In addition, Nicola Hill explained that they have noted the level of education on menstrual health has decreased overtime, particularly during the COVID-19 pandemic as schools were adjusting their curriculum to the reality of online learning.^[76] In a written brief, A.J. Lowik further noted a lack of affirming menstrual health education for transgender individuals because their experiences are “largely left out of formal sex education curriculum” and healthcare providers are not always trained on the unique menstrual needs of transgender individuals and on gender-affirming care.^[77]

To break down taboos and normalize menstruation, witnesses recommended that sex education curriculum integrate comprehensive information about menstrual health. Information could include types of menstrual products available, including reusable products, and their use and health conditions related to menstruation, such as polycystic ovary syndrome and endometriosis.^[78] Suzanne Siemens also recommended providing funding to organizations that develop and distribute menstrual health-related education material in Canadian schools.^[79]

Witnesses noted that awareness campaigns can be used to increase Canadians’ knowledge on menstruation and menstrual health, building on existing campaigns such as those led by United Way and the Period Purse.^[80] To be successful, these campaigns should be adapted to the needs of diverse populations and their culture, beliefs, and lifestyles.^[81] Meghan White, Co-Founder of Period Packs, noted that the organization has been successful at raising awareness about menstrual health through training young leaders to have peer-to-peer conversations. As a supplement to receiving education on how to lead such conversations, young leaders learn about menstrual health.^[82]

Therefore, the Committee recommends:

Recommendation 9

That the Government of Canada develop and implement a public awareness campaign with the goal to increase menstrual health literacy, including about reusable and sustainable menstrual products, and eliminate stigma and negative stereotypes surrounding menstruation.

Supporting Women-led Small and Medium Sized Enterprises

Witnesses also talked about the importance of supporting women-led SMEs and other groups that seek to provide increased access to menstrual products. Meghan White explained that SMEs play “an integral part in addressing period poverty in Canada,” including “by conducting their own high-quality, independent research, funding and design of educational programs. They are on the ground with grassroots organizations, working meticulously to truly understand community needs and design best practices to address them.”^[83]

The Committee heard that one way to support SMEs and other organizations working to achieve menstrual equity in Canada is to provide them with funding,^[84] as some of them rely exclusively on donations to operate or do not have a large budget to advertise their products.^[85] Another way to achieve menstrual equity is to ensure that businesses that offer disposable and sustainable menstrual products are included in Government of Canada procurement processes.^[86] Suzanne Siemens stated:

Without specific mention of women-led SMEs in the procurement process, our concern is that large multinational corporations will be the de facto or easy choice, and ultimately stand to benefit from the program. This leaves out women-led companies, such as ours. Women have spent their entire careers dedicated to providing solutions that prioritize the health of Canadians and our planet.^[87]

As well, Linda Biggs recommended that “sustainable options from women-led Canadian SMEs [be included] as part of the procurement process for the government menstrual equity program.”^[88]

Therefore, the Committee recommends:

Recommendation 10

That the Government of Canada take all efforts, including through federal menstrual equity programs such as the Menstrual Equity Fund, and the provision of free menstrual products to federal government employees starting on 15 December 2023, to prioritize the procurement of menstrual products from suppliers that use environmentally friendly and sustainable materials in their production including supporting products made from organic, biodegradable, or reusable materials to minimize environmental impact

Investing in Menstrual Health Research

Despite some information about menstrual poverty being available in Canada, the Committee heard that there is a lack of menstrual health data. Clara Bolster-Foucault noted: “However, the lack of menstrual health data really really leaves us in the dark as to the impact of menstrual insecurity. The truth is that we don't know who is facing this issue or its consequences for the persons concerned.”^[89] Furthermore, Lara Emond told the Committee:

Several studies have shown that many pesticides, endocrine disruptors, dioxins and other substances can still be found in menstrual products today. That influences the health of persons who have periods and use those kinds of products. We can't yet quantify the impact that has on health or, in turn, on our overall health system and environment in Canada.^[90]

For these reasons, witnesses recommended investing in menstrual health and menstrual poverty research,^[91] including in research on new types of materials that could be used for menstrual products and on the effects of materials found in menstrual products on the health of women and individuals who menstruate.^[92]

Therefore, the Committee recommends:

Recommendation 11

That the Government of Canada fund research projects on menstrual poverty, menstrual equity and menstrual health literacy.

Conclusion

During this study, the Committee learned that many women and other individuals who menstruate in Canada experience menstrual poverty. Experiencing menstrual poverty is the inability or the struggle a person faces to access menstrual products, menstrual health education and adequate sanitary facilities. It can also include financial, social, cultural and policy barriers that women and individuals who menstruate can face, such as stigma and discrimination. The Committee was told that the price of menstrual products as well as the lack of access to clean water and washrooms are barriers to achieving menstrual equity in Canada.

Experiencing menstrual poverty can force women and individuals who menstruate to miss school, work, or social activities. It can also affect their health, particularly if they must use menstrual products for a longer period than what is considered safe. Women and individuals who menstruate may also experience shame and stigma if they cannot access adequate washrooms to manage their menstruation.

To achieve menstrual equity in Canada, witnesses recommended facilitating access to free menstrual products, including by distributing both disposable and reusable products in a variety of settings, including in workplaces; educating Canadians on menstrual health to improve literacy and eliminate stigma around menstruation; supporting women-led SMEs; and investing in menstrual health research. Witnesses stressed the fact that there is not a “one-size-fits-all” solution to achieving menstrual equity, as women and other individuals who menstruate are diverse and have different needs.

The Committee put forward 11 recommendations directed to the Government of Canada to help achieve menstrual equity. The Committee calls on the Government of Canada to implement them rapidly.