(Reuters Health) - A survey of low-income women in a large U.S. city finds that nearly two-thirds couldn’t afford menstrual hygiene products such as tampons or pads during the previous year.

More than one in five women said they had this problem every month, researchers report in Obstetrics & Gynecology.

Instead, the women said they made do with cloth, rags, tissues, toilet paper and sometimes even diapers or paper towels taken from public bathrooms.

Nearly half the women said there were times in the past year when they could not afford to buy both food and period products.

“This is not a luxury,” said Anne Sebert Kuhlmann, an associate professor in the College for Public Health and Social Justice at St. Louis University. “It’s a need. It affects a woman’s sense of self, her sense of dignity and her ability to participate in life.”

As it turns out, period products are not covered by government grocery-assistance programs such as WIC and SNAP, Sebert Kuhlmann said. “And in (some states) they are taxed at the highest rate,” she added.

Making matters worse for many women is the cost of transportation to stores that sell these products in bulk at lower prices, Sebert Kuhlmann said.

For the study, Sebert Kuhlmann and her colleagues recruited 183 women with the help of 10 not-for-profit community organizations serving low-income residents of St. Louis, Missouri. “These are service organizations that provide food, shelter, job training and child care to low-income women,” she said. “We were surveying women who were already receiving some type of services. So this might be an underestimate of the actual need of women in the St. Louis area.”

Between July 2017 and March 2018, interviewers administered surveys and led focus groups with interested women. The researchers found that 64 percent of the women had been unable to afford period products during the previous year and 21 percent experienced this problem on a monthly basis. Almost half had times during the past year when they had to choose between food and period products.

While some of the community organizations provide period products, “these organizations rely on donations so it’s not a consistent system,” Sebert Kuhlmann said.

The findings surprised Dr. Leena Nathan, an assistant clinical professor of obstetrics and gynecology at the University of California, Los Angeles, who wasn’t involved in the study. “You hear about this in third world countries, but to actually realize it happens in our country is astounding,” Nathan said. “This is a very important study that can help us understand the needs of these women.”

The findings highlight “another example of the discrimination and inequities we see not just in developing countries, but even in affluent societies,” said Dr. Mary Rosser, director of Integrated Women’s Health at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City. “I was really struck by these findings. I have been practicing for more than 20 years, mostly in urban hospitals and I do hear this from patients, particularly those who work and live from paycheck to paycheck.”

It’s particularly tough on moms, said Rosser, who also was not involved in the new research. “They will put everything about themselves on the back burner to take care of their children.”

This is really a basic human need for women, Rosser added. “But sometimes it’s the last thing that gets paid for.”

The study team points out that there are health and policy initiatives to treat menstrual hygiene products more like other basic public health and hygiene necessities, such as toilet tissue. The Federal Bureau of Prisons recently began providing the products free of charge to female inmates, as do some state prisons. California and New York City already provide the products free in schools, and some states that impose a sales tax have exempted these products from the tax, the authors note.

Newer reusable products might “be more cost effective for women who don’t have access to disposable products,” Nathan said. “It’s just a matter of getting them in the hands of the women who need them. This can have a huge impact on a woman’s job and family life.”

SOURCE: bit.ly/2TEo2Rl Obstetrics & Gynecology, online January 10, 2019.