Access to sanitary products has been raised as a concern by campaigns and stakeholders. The issue has been approached from two main perspectives: concern about 'period poverty'; or an equalities or human rights informed approach that argues that free sanitary products should be considered a right. The Scottish Government funded a six month pilot in Aberdeen between September 2017 and February 2018. It aimed to explore options for providing access to free sanitary products in ways that provide choice and respect dignity, and to better understand the circumstances people are in that mean they cannot access sanitary products. The pilot explored both targeted provision for those in low income households and provision open to all in educational settings. It also considered providing products directly and providing the means for participants to buy products themselves.
The pilot was run by Community Food Initiatives North East ( CFINE) using established relationships with local partners through the FareShare network. The pilot was initially rolled out in a number of third sector organisations and regeneration areas. It was later extended to educational settings – Robert Gordon University, North East Scotland College, 3 secondary schools and 1 primary school where universal provision was offered. Just over 1,000 participants received products during the pilot: 799 via the community/third sector partners, 43 at RGU, 108 at NESCol and 133 at the four schools involved.
Pilot delivery and evaluation methods
For the purpose of the pilot, participants were asked to 'sign up' to take part. To test whether participants would prefer to buy their own products, the option of offering cash to participants was introduced in October and a pre-paid card in December. The process for signing up participants and distributing products varied depending on how the organisation works with clients. Generally, sign up took place in a private room and products were picked up from the same location. Other examples included taking products out on a visit or inclusion in a food parcel.
A range of monitoring data was collected by CFINE and partners about the distribution of products. In addition, participants were surveyed at the start and end of the pilot, and qualitative interviews were conducted with a small number of participants and administrators at a sample of the partners. Data on products received was recorded for 731 participants. The 'initial survey' was completed by 630 participants. The 'end-point' survey was completed by 136 participants.
Findings – Community Partners
The majority of participants at community partners were not in employment. Almost half of those who gave information were single parents, while just over a quarter were couple households with children. Asked about why they or their family were facing financial difficulties, over half of those who provided a response mentioned that they are living on a low income: many due to living on benefits. A problem or delay with benefits, disability or illness, paying off debts, coping as a single parent, and a change in family circumstances were also mentioned.
Previous difficulties accessing products
Accessing sanitary products had presented difficulties in the past for two thirds of participants. Asked if they had ever been unable to purchase sanitary products 58% said they had. The main reasons for difficulty accessing products related to affordability. Other reasons included irregular or heavy periods, embarrassment and local access. Ways participants managed without the products they needed included asking a friend or family member for products or money, or using an alternative – most commonly toilet roll, but also rags or nappies. Some participants noted that this made them feel anxious, embarrassed, and/or dirty.
Accessing products during the pilot
About 9 in 10 participants surveyed said they felt comfortable collecting products. Discretion and ease of access were highlighted in interviews with participants and partners as important considerations in how products were provided. Having to sign up and speak to someone to access products was identified as a barrier to taking up provision. Overall, 63% of participants were recorded as receiving products on one occasion only. Of the participants who signed up in the first 3 months of the pilot, 46% received products only once. Ease of access and having to speak to someone were also considered important in influencing whether people returned.
Almost all community partner participants received products, and more received towels than tampons. Most participants who completed the end-point survey said they received enough products. Slightly fewer than 70% said they received a reasonable choice of products, while 30% said they received the type they wanted but not their preferred brand. In interviews most participants and partners discussed having a choice of type, absorbency and other practical aspects as most important.
Providing the means to buy products
Some participants thought a pre-paid card would provide choice, be convenient, and be less embarrassing than collecting products, although others raised concerns about the card not being used to buy products. At CFINE, where cards were offered for the longest time, pre-paid cards made up almost a fifth of their recorded provision during the time they were offered. Several partners expressed discomfort about these options, especially offering cash. They considered many of their clients to be vulnerable and were uncertain about whether the cash and, to some extent, the card would be spent on products. There was also a feeling among some that both options added unnecessary complexity.
Impact of the pilot
Slightly under two thirds of participants said they thought taking part in the pilot had, had an impact on them, 22% were unsure and 15% said it had not. When asked what impact the pilot had, the most commonly selected responses were 'more money available to spend on other essential items' and 'less worried about having my period'. Around a quarter thought the pilot had introduced them to other services or meant they were more able to continue with day to day activities during their period. In interviews, impacts participants mentioned included freeing up money for other essentials, changing products more often, and worrying less.
While participants and partner staff had diverse views about the best way to provide products in the future, three key considerations emerged:
- Convenient – somewhere that fits into the day to day lives of those targeted and is easy to access for most.
- Discreet – accessing products in a way that does not require speaking to someone or being identified to others as needing free products.
- Preventing abuse of the scheme – concerns about people 'misusing' or 'taking advantage of' provision were raised.
The end point survey asked respondents' views on a set of options 'if a scheme to provide access to free sanitary products was introduced in the future'. 'Receive a card I can use in shops' and order online through a secure system for delivery by post' were the two most popular options for community respondents. Free products available in public toilets was one of the least popular options for this group.
Findings – schools, college and university
Previous difficulties accessing products
Accessing sanitary products had presented difficulties in the past for around a third of college and university participants, while just under a quarter had been unable to purchase products. A fifth of pupils who answered the question had both experienced difficulty accessing been unable to purchase sanitary products ( N.B. just over half of pupil participants did not answer this question). Affordability was a key issue, but being 'caught out' away from home was also a concern.
Accessing products during the pilot
Raising awareness of provision in the college and university, amongst the volume of communications students receive, had been a challenge. From those surveyed, the main reason given for not taking part in the pilot was not knowing about it – either that the pilot was happening, how to sign up or who was eligible. Others said they had access to products or did not want to ask for products.
Having to speak to someone to access products was considered to be a key barrier for students. Embarrassment was highlighted as a particular issue for younger people. Other barriers identified were limited times for students to collect products and that students may have seen provision as just for those 'in need'. The schools involved were reluctant to make products freely available in toilets as they were concerned about misuse. The school that trialled this discontinued provision for this reason, although noted they had an on-going issue with keeping the school toilets tidy and they thought this was an appropriate approach in general.
Around three quarters of school pupils received towels whereas college and university students were more likely to receive tampons (41%) than towels (37%). Fifty nine percent of students said they received a reasonable choice of products, while 41% said partially. Awareness of reusable products was higher amongst college and university students than participants at community partners and the majority of those who had not tried reusable products were interested in trying them. However, this did not translate into greater numbers of products given out.
Impact of the pilot
Slightly under two thirds of college and university students thought the pilot had an impact on them, while 22% were unsure and 15% thought it had not. When asked what impact the pilot had, the most commonly selected response was 'less worried about having my period'.
When asked about options for future provision, free products available in school, college or university toilets was one of the two most popular options – in contrast to community respondents. Receive a card was one of the top two most popular options for school and college survey respondents, while order online was one of the top two options for university students. The least popular option was to get free products from a member of staff. Reasons given for the preferred method were similar across most of the options, and commonly highlighted that the option was easy to access or convenient, and discreet or less embarrassing.
Key learning points
To date, discussion on lack of access to sanitary products has relied predominantly on anecdotal evidence. The findings reported here provide empirical evidence confirming access to sanitary products is an issue for some people, and that different groups are affected in different ways. Two thirds of community participants had experienced difficulties, compared with one third of college and university participants, and a fifth of school participants. As provision via community partners targeted low income households, and low income was the main reason given for lack of access, this disproportionate impact is what would be expected. The findings do not, however, allow us to draw conclusions about how widespread lack of access to sanitary products is in the general population.
The findings also highlight that for some of those that who are not able to access the products they need this may impact on their wellbeing and, for a minority, their ability to continue with day to day activities during their period. While a small number of students reported that lack of access to products had an impact on their attendance at school, college or university during menstruation, the evaluation is not able to draw conclusions about the extent to which students may be missing education because they do not have the products they need.
Key learning points – provision for low income women
- The majority of participants were already engaging with the organisations involved with the pilot. This underlines that there are likely to have been individuals who are not engaged with services that the pilot did not reach. Further consideration is needed on how best to reach those who may be in need, but are not engaged with third sector organisations or community projects.
- Partner staff identified raising awareness of the pilot and getting people to take part as a challenge, while a sizeable proportion of participants did not take up the offer of regular provision. The processes imposed by requiring participants to sign up and therefore approach a member of staff or volunteer to access products was identified as a barrier. The way that participants accessed provision was shaped by the need for the pilot to gather data; different approaches could be taken in future provision.
- The reliance of the pilot activity, in part, on good will, and volunteer time raises the issue of sustainability of delivery via third sector organisations and community projects. Replicability of the pilot activity in areas that do not have an active third sector network or where there is limited access ( e.g. rural areas) is also a consideration.
- The key considerations for provision identified across the different data sources were around ease of access or convenience, provision that is discreet and does not identify recipients as needing help, and preventing misuse or abuse of any provision. Receiving a card and ordering online were popular options – seen as providing choice and being discreet. Although concerns were raised around whether a pre-paid card would be used to buy products, and lack of internet access was highlighted as a potential barrier. Picking up products up from a range of convenient and accessible locations such as pharmacies, doctor's surgeries or health clinics, or community centres was suggested by partners and participants.
- Further exploration of methods for accessing products that do not require talking to someone and other settings such as, for example, community pharmacies would help develop understanding of what a sustainable delivery system that would deliver for all those who need it would look like.
Key learning points – provision in educational institutions
- Embarrassment about periods generally and having to ask a staff member for products were considered to be particular issues in education settings, especially for younger pupils. Schools were reluctant to trial making products available in school toilets because of concerns about misuse and, where this was tested, problems were encountered.
- School staff noted a need for education around menstruation and sanitary products to reduce stigma and normalise discussion of menstruation.
- As for low income households, provision that is easy to access and discreet was highlighted as important. The least popular option for school, college and university students was to get free products from a member staff – underlining the preference for not having to ask someone to access products. As for community participants, receiving a card and ordering online were popular options.
- What was considered convenient varied in the different contexts. Unlike for community participants, having free products available in toilets was a popular option for school, college and university respondents. Reasons included that it was seen as a good option if you are 'caught short'. This highlights that making products freely available in school, college and university toilets requires further exploration, particularly in schools, to understand how the problems identified can be overcome.