“Menstrual care is often one of the first things that a family will forego.”

As pandemic-stricken households across Massachusetts struggle to cover food and rent, people who menstruate must also navigate an expense typically left out of the spotlight: period products.

Bleeding on a monthly basis isn’t cheap to manage. The Commonwealth is one of 20 states that exempt essential hygiene supplies from sales taxes, but the recurring costs of pads and tampons add up.

And against the backdrop of a rising poverty rate nationwide, one in three parents have grown concerned about their ability to afford menstrual products since the COVID-19 pandemic began, according to a study by Always.

Dignity Matters, a Massachusetts nonprofit that distributes period products to those who need them, has seen a sharp spike in requests for those items from its clients—homeless shelters, food pantries, medical clinics, and public schools—throughout the past six months.

Meryl Glassman, its director of development, said out of the more than 120 organizations it serves, many are stuck in a long waiting list.

Despite donations from a variety of foundations and companies in Greater Boston, Glassman said the need for period products greatly outpaces Dignity Matters’ ability to garner enough resources. The team continually seeks more donations, along with more funds to purchase these items.

Individuals who are unable to afford such products must often confront lose-lose choices over which necessities to prioritize. These stories, according to Glassman, are common among those who show up at social service organizations in hopes of finding help.

“Think about being a single mother who was maybe in some sort of service job earning minimum wage. Many of those jobs have disappeared, and maybe you have two or three children,” she said. “Most mothers are going to say, ‘You know what, I’m going to use a rag instead so I can buy my children food.’”

For most families living near or below the poverty line, the Supplemental Nutrition Assistance Program is a major lifeline. But while food stamps can help feed a family, the program does not provide help with attaining period products.

“For a lot of these families, if they can’t buy it with SNAP benefits, they can’t buy it, because they don’t have any other money,” Glassman said. “So menstrual care is often one of the first things that a family will forego.”

Without access to hygienic methods of handling period blood, people are forced to resort to unsafe alternatives: wadding up a newspaper or old T-shirt, reusing the same pad for the entirety of a week-long cycle, leaving the same tampon inside their body for days.

There is no viable substitution to sanitary pads or tampons, said Melinda Thomas, associate medical director of the Boston Health Care for the Homeless Program, because those hygiene products are specifically developed to absorb large volumes of blood.

Using unclean or unabsorbent materials poses the risk of introducing bacteria to the body or, depending on texture, causing irritation to the skin. Blood-soaked materials sitting against skin for long periods of time can also induce infection, along with significant discomfort, according to Thomas.

Aside from potential health issues, a lack of access to menstrual care—which, besides proper period products, includes shower facilities and soap—can deplete self-esteem as well.

“My work with homeless women in particular, this population suffers from a high level of trauma,” Thomas said. “Along with that is feelings of inadequate self-worth and embarrassment. And if you don’t have the right hygiene products, it just contributes to that.”

Bria Gadsden, cofounder of local period education nonprofit Love Your Menses, began delivering menstrual products to households in Boston when she noticed the increased need that arose once the pandemic started.

The endeavor is funded by a mix of grants from the City of Boston, individual contributions from people and waning donations from companies, many of which are financially suffering from diminished business.

Though period poverty has always existed, Gadsden said she sees the exacerbated burden it imposes in the wake of a global economic crisis.

“That’s why I also think that reusable products are starting to get a lot more attention,” she said. “People can just wash a period panty or wash a menstrual cup and reuse it as opposed to having to purchase disposable products.”

But nondisposable period products come with a challenge of their own: Relatively few menstruators have had enough exposure to them to be comfortable using something like a menstrual cup. Because of this, the nonprofit is holding off on sending these to families for now, despite having received donations of them.

“There just needs to be more education on reusable products in general,” Gadsden said. “That’s something we’re planning on doing, is hosting a workshop on how to use a menstrual cup.”

Meanwhile, state legislation to distribute free period products has been in the works for a little more than two years, targeting the communities that need them most: homeless shelters, correctional facilities, and public schools serving students grades six through 12.

The State House refiled the I AM bill this month for the new legislative session, according to Massachusetts Rep. Christine Barber, a lead sponsor. She said legislators are “really excited” about pushing it forward.

“It had a lot of support last session,” Barber said. “We felt good about it, and then when COVID hit, it became really challenging to pass many policies that weren’t directly related to COVID.”

It was the advocacy of high school students that inspired Barber to introduce the bill, she said. Teenagers in Somerville, Medford, and Cambridge had all campaigned in recent years to install free-to-use period product dispensers around their school campuses.

Free pads and tampons were available in the nurse’s office at Somerville High School, but students found themselves having to leave class for a lengthy trek across campus whenever they needed to obtain some.

“They would often miss part of a class to do that … and [there’s] also just the stigma of having to leave class for that long,” Barber said. “I’m really grateful that the students uplifted this as an issue because it honestly, before that point, wasn’t one that I had given much thought.”

Menstrual processes and needs have long been left out of conversations surrounding poverty, advocates say, due to the traditionally taboo nature of the topic. Sasha Goodfriend, president of the Massachusetts National Organization for Women, has seen how the stigma shapes expectations. When the Massachusetts Menstrual Equity Coalition, which partners with MassNOW, began calling homeless shelters across the state to ask whether they needed period products, nearly every person who picked up the phone expressed surprise at the question.

Goodfriend said society’s suppression of open period discourse means that not only might menstruators feel ashamed to ask for products, but shelters and other service providers tend not to include such purchases in their budget.

The I AM bill, which MassNOW has worked closely with legislators on, aims to combat that stigma through its name.

“We call it the I AM bill for two reasons,” Goodfriend said. “One, it’s an acronym to increase access for menstrual products. And two, because we want to break the taboo and the stigma around menstruation, and our menstrual activists in our coalition are proud and unapologetic about being menstruators.”

While shame poses a significant barrier to asking for period products at schools and in shelters, menstruators in prison or jail can also face confusion. Correctional facilities in Massachusetts report that they have plans for free distribution, yet period products continue to be sold in commissaries.

“It begs the question, what is the difference between the free products and the ones sold?” Goodfriend said. “And is there enough availability [of] the free products, or is that why they need to sell them as well?”

And if incarcerated menstruators or correctional staff are unaware of these policies, they become essentially nonexistent—menstruators will assume their only option is to buy. This, she said, is another example of why the state should implement official legislation to ensure enforcement.

In a step forward for advocates, the first-ever period policy from the Commonwealth passed in mid-January as part of an economic development bond bill. It allocates $500,000 to homeless shelters for the purpose of purchasing and providing menstrual products.

To Glassman and her colleagues at Dignity Matters, the bill was a “big step in the right direction” because it demonstrated that lawmakers realize period poverty is an issue worth addressing. But, she said, it won’t be enough.

Dispensers alone can cost anywhere from $2,000–$5,000, and prices of period products can vary widely depending on where they’re sourced from. So, this lump sum may not stretch far enough to cover costs for a substantial portion of the unhoused community.

“Ultimately,” Glassman said, “we’re going to need a much larger and a much broader mandate for the availability of free menstrual care to really make a dent in period poverty in Massachusetts.”