Scotland on Tuesday became the first country in the world to provide pads and tampons to anyone who needs them. In public bathrooms — at libraries, museums, government buildings, schools and universities — menstrual products will now be treated like toilet paper: always there and always free.

When Inga Dale heard the news, she said, she felt like crying.

“It just feels as if you’re valued as a woman,” said Dale, a 30-year-old writing coach who lives in Edinburgh, Scotland. “You are free to have your period, and it’s not something you should be ashamed of.”

The announcement, widely celebrated in Scotland and around the world, could increase pressure on other countries to reevaluate their period-related policies. The U.S. currently lags far behind Scotland, with dozens of states still implementing a “pink tax” that treats period products as luxury goods, adding an extra fee to every purchase. But experts say the issue has been gaining momentum in the United States, with some state governments doing more to combat period poverty, providing free products in schools. Scotland’s news has led many to wonder: Would the U.S. ever make pads and tampons free?

“The U.S. is on the complete other end of the spectrum from Scotland. We’re still fighting for pads and tampons not to be considered a luxury,” said Lynette Medley, founder and chief executive of No More Secrets, a sexuality awareness nonprofit that distributes free pads and tampons. “But with the new president,” she said, referring to President-elect Joe Biden, “I think people will be talking about it more and more.”

Period poverty is often discussed in the United States as a faraway issue, affecting people who menstruate in lower-income and developing countries, said Anne Sebert Kuhlmann, a professor of public health at Saint Louis University and board member of Dignity Period, a nonprofit dedicated to increasing access to menstrual products. While Dignity Period originally focused only on providing pads and tampons to women in Ethiopia, Kuhlmann said, their focus quickly expanded to include the many women who can’t afford pads and tampons in their own city.

“We realized there wasn’t much data that showed the magnitude of this problem in the U.S.,” she said. In her 2019 study of 183 low-income women in St. Louis, Kuhlmann found that 64 percent had to go without period products in the past year.

“It’s an issue of dignity,” she said. She says she met women in St. Louis who couldn’t afford pads and tampons and would quickly bleed through their one pair of underwear. “How does that make you feel when you can’t take care of yourself?”

Most efforts in the U.S. so far have focused on schools. Four states — New York, California, Georgia and, most recently, Virginia — now require middle schools and high schools to stock their bathrooms with sanitary products, allowing students to take as many as they need. These measures are making an impact, said Claire Coder, founder and chief executive of Aunt Flow, which manufactures menstrual products for schools. New York began offering free products across the state after a successful pilot program. With free pads and tampons, attendance rates for girls rose by 2.4 percent.

Scotland also started by providing products for students, requiring all schools and universities to offer free pads and tampons in 2018.

Free access in schools is one step in the right direction, said Medley — but it’s important that countries don’t stop there. Period poverty is often a barrier for unemployed or underemployed women trying to break back into the workforce, she said. If they can’t afford pads and tampons, they might have to miss interviews or days on the job. School-based measures are particularly inadequate during the pandemic, she said, when many students are learning from home.

Many period activists celebrated the Cares Act, passed by Congress in March in response to the coronavirus, for including menstrual products on a list of health expenses eligible for reimbursement for people with a health savings account (HSA) or a flexible spending account (FSA). Medley was more critical: This legislation addressed the needs of the “haves” who could afford an HSA or FSA, she said, but not the “have-nots.”

If Congress really wanted to tackle period poverty during coronavirus, she says, they would have offered free menstrual products to anyone on Medicaid or Medicare.

Medley blames deep-seated stigma for the government’s lack of action. It’s hard to hold high-level conversations about product accessibility when periods are widely “demonized” and treated as “something dirty,” she said. Regular people — both men and women — often struggle to talk about menstruation. In her work, she says, she is constantly urging women not to hide their pads on their way to the bathroom or wait to buy tampons until there’s a woman at the cash register.

Women are less likely to sound the alarm on a period-related problem, said Kuhlmann. If they can’t afford products, they’ll use toilet paper or a sock and just “figure it out.”

It’s important to have female legislators who can personally understand the issue, she said. Scotland’s top government official is First Minister Nicola Sturgeon. It’s much harder to imagine this happening with a man in charge, Kuhlmann said.

“She has that lived experience,” said Dale. Women are in a unique position to solve this problem, she said: Since parliament passed its new menstrual policy on Tuesday, she’s seen quite a few men on Twitter criticizing the legislation, asking why pads and tampons should be free.

“I’m like, excuse me, you don’t get your period, so you don’t get an opinion.”

Other countries might follow Scotland’s lead, said Kuhlmann, and enact sweeping, national reform on menstrual product accessibility. But it’s unlikely to happen in the United States anytime soon, she said. U.S. reforms will probably happen state by state, she said — starting in schools.

More data will be critical. To convince U.S. legislators that free pads and tampons are necessary, activists need to be able to pinpoint the “longer-term cost” of people missing work and school because they can’t afford products, Kuhlmann said.

“What’s the trade-off there? What’s the economic impact?”

It’s probably much larger than anyone expects, she said.

Editor’s note: A previous version of this story said Ann Kuhlmann is the board director of Dignity Period. She is a board member. We regret the error.

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