It takes about 10 seconds for a practised hand to transform a wad of tissue or toilet paper into a homemade tampon.

“That is a bit thick,” said Jessica, as she turns the tissue into a roll about the size of a lipstick container. “Normally it is a little bit thinner than that, you just twist and insert.”

The homemade design was something she used during points in her life when she was homeless.

“It just sits there just the exact same, actually it’s kind of better, if they made Kleenex ones I would be the first one to use them, because it actually holds more absorbency than a normal tampon,” said Jessica, who recently moved into an apartment.

As many as 235,000 Canadians experience homelessness in a year, with women accounting for 27 per cent, according to research paper The State of Homelessness in Canada, 2016. There is also, experts say, a vast number of women who count as hidden homeless, or who are living in unsafe, temporary, overcrowded or precarious conditions.

For women without housing, or with limited income, managing their periods is unavoidable, complicated and often expensive. It means that once a month the stressors of life on the margins —where to sleep, what to eat and how to stay safe and maintain dignity — are compounded by the challenges of staying healthy and clean during their menstrual cycle.

Jessica’s demonstration took place at Sistering, a 24/7 women’s drop-in centre in Toronto’s west end, where she is a peer harm-reduction worker.

Four women in that program, who have all experienced homelessness, told the Star how they would use everything from toilet tissue and socks to newspaper and cotton balls, when they didn’t have money or any other way to access pads or tampons.

Homemade products can be messy and one woman said pads she made from newspaper resulted in rashes and nicked skin. Women seek out supplies at shelters and stockpile when they can, they explained. Some women, they said, end up stealing what they need or relying on friends who do.

Spending money on menstrual supplies means not taking public transit or going without food. Anything they could get their hands on, including tampons, they might use longer than they should.

Improvised or overextended tampon use certainly comes with health risks, said Dr. Ritika Goel, with Inner City Health Associates. On the severe end of the spectrum, she said, there is toxic shock syndrome. (A rare and life- threatening bacterial infection associated with superabsorbent tampon use, according to the Mayo Clinic.)

“That is obviously, medically, the worst case,” said Goel, who sees the women at Sistering once a week.

More common problems would be chemical irritation, from using homemade products, or yeast infections because it becomes harder to stay clean.

“There is already so much about living on the streets that is undignified and takes away from women’s sense of self and sense of pride and sense of dignity,” said Goel. “The last thing they need is to feel like they are not even able to manage these basic functions and basic needs.”

The four women from Sistering — all peer harm-reduction workers — were willing to share the indignities that came with managing their periods while homeless, or strapped for cash, but like many women in similar vulnerable situations didn’t want their full names used.

Toronto’s shelters and drop-ins do provide hygiene supplies for women who can’t afford them. The women who spoke with the Star said there are rarely enough tampons or pads to stock up on, and while they appreciate shelters do what they can, it is frustrating that they constantly have to ask for, or track down, something all women need access to and is, for them, prohibitively expensive.

Striking a balance between dignity and demand is something the program co-ordinators and front-line workers who spoke with the Star said they work hard to address.

At Sistering, one program director keeps a bowl of tampons on her desk for women who end up in her office, and they also hand them out in the main program area to those who ask. At Covenant House drop-in and crisis centre, serving youth ages 16 to 24, the bathrooms used by women and girls are stocked up, so they don’t have to ask.

Shelters and drop-ins and food banks do take donations of tampons or pads, but people should check with the individual agencies. A spokesperson for P & G Canada said they give away hygiene products to shelters and food banks and community groups looking for in-kind donations are welcome to contact them. Grassroots groups have also sprung up to manage need.

The Period Project, a street outreach group, uses private donations — cash or supplies — to provide women with free kits, walking through the city to distribute them about once a month.

Co-founders Breton Kennedy, 28, and James Kesteven, 41, have been handing out clear plastic bags, stuffed with tampons, pads, wet wipes, deodorant, chap-stick, gloves, socks and candy, since July. They also tuck in handwritten notes, offering a greeting or support.

Volunteers assemble the kits. The first time four people showed up, now they have to ask people to wait their turn. “It’s definitely growing, which is great,” said Kennedy.

Kennedy explained that part of their goal is to help women feel they are cared for and supported, or at least not forgotten.

One recent Sunday, their team packed 30 kits in a board room donated by animation studio House of Cool Inc., then broke into teams to hand them out across the city. Extra kits are donated to shelters.

“In the summer, it is different. They go in about 20 minutes. In the winter, it is not as easy to find people,” said Kennedy.

This day, they met Marie Roy, 41, who has housing, but is having issues with rent and fears eviction. She accepted a bag, but said she doesn’t get a period, or her “time,” as she calls it, because she is on the injection birth control Depo-Provera.

“So that is one thing, don’t get my time, so it kind of helps in a sense. I can’t imagine the girls out here. That would really be tough, yeah.”

Roy said women can find supplies at shelters and drop-ins, and said even men’s shelter staff have told her where to go to get what she needed.

The group also gave a bag to Tracy McGowan, standing with friends outside the Salvation Army.

“These I will use. These ones, I like the applicators,” said McGowan. “To be honest this isn’t enough to last a day for me.”

She said anything she doesn’t need she’ll give away, something she does with donated items she won’t use. A minute later she hands a sandwich and snack to a man asking if she has candy. “I should probably do this kind of stuff. I am a hairdresser, and I really can’t find a job because of where I am.”

McGowan, who is in her early 40s, isn’t from Toronto and is rotating through the shelter system. She drinks and doesn’t always agree with shelter rules.

“If I had somewhere to go, I would be there,” she said.

She does get tampons from shelters, but said you might only get three at a time.

“Three? It is my first day on it, I need at least 20,” said McGowan. “You never see a bowl of tampons and maxi pads, but you always see a bowl of condoms.”

Stories from the street:

The Star’s Jesse Winter spoke with a number of women who’ve struggled to manage their periods while on the street. They share their experiences living with precarious housing and how a lack of easy access to menstrual products can complicate an already difficult existence.

D.N.

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D.N.’s daughter was 10 years old when she died.

“She had a rare blood type, and she was waiting for a kidney,” D.N. says.

A year before, her marriage broke up, and she was living with her daughter at a shelter. But her daughter’s death was too much.

“I started using crack cocaine, and then I went off into a suicidal mode and ended up on the street,” she says.

Today D.N. works doing harm reduction outreach with other women on the street. Many of the city’s shelters and community health centres will give out tampons or pads to women in need, but it’s not enough, D.N. says.

“What if I have a heavy flow?” she says. “It’s hard enough. It takes a lot of courage to go and ask for stuff like that.”

Jessica:

Jessica was homeless at 13.

In December she finally got the place of her dreams, a subsidized downtown condo she got with help from the YWCA.

When she was on the street, she had to choose between buying hygiene products or feeding herself.

She got pretty good at fashioning tampons out of rolled-up Kleenex.

“I figured it out for myself. I had no choice. I have bad periods because I’ve had five kids,” she says.

Jessica says the prices need to come down.

“All women have this. Why should women have to pay? This isn’t something that we’re choosing.”

Lourdes:

Lourdes has a place of her own right now, but says she’d been homeless off and on since 2010.

She won’t use homemade tampons. It’s too dangerous, she says.

“I’m not putting anything up there… I just don’t think it is safe.”

She worries bacteria from jerry-rigged tampons could cause infections.

“It’s not like we have the money to get antibiotics,” Lourdes says. “I would rather just be safe.”

Heather:

Bus fare.

That’s what Heather would have to give up to buy tampons. The 52-year-old isn’t on the street anymore, but she’s got plenty of experience dealing with precarious housing, and the health challenges that come with it.

When she couldn’t afford to buy tampons, she’d build a stockpile.

“They only give you four or five at a time, so if you’re having a really bad flow that’s only going to last three or four hours.”

Tracy McGowan:

Tracy McGowan isn’t from Toronto, but she’s been cycling through the city’s shelter system for a while. In her early 40s, she says she drinks and sometimes runs afoul of shelter rules.

She said the two or three tampons she can get from shelters and drop-in centres often aren’t enough.

Women need easier access to supplies, she said.

“You never see a bowl of tampons and maxi pads, but you always see a bowl of condoms.”