Poor access to menstrual products in N.M. creates health hazards

Lawmakers to consider eliminating the so-called ‘tampon tax;’ advocates say it’s a good step but won’t solve the problem completely

By: - September 7, 2021 6:30 am

(Photo by Marisa Demarco / Source NM)

Advocates are illuminating for state legislators the expense of tampons, cups and pads in a low-income state, promising to again seek a tax break on menstrual products in the coming session. Their argument: Cutting the cost is one quick way to create more equity and dignity for people who need these products. Lawmakers balked at the cost of such a tax cut two years ago.

Scarcity and rationing

Stacy Burleson was incarcerated for half a decade in the former women’s prison in Grants, N.M.  The prison was then privately owned and run — from 1989 to 2016 — by the  Corrections Corporation of America, or CCA. There were never enough menstrual products, she said. 

Today, Burleson is the executive director of Albuquerque-based Women In Leadership, a nonprofit aimed at supporting women impacted by the criminal legal system. Though it was years ago that she was behind the walls, she remembers relying on other inmates and innovation to get through each month’s menstrual cycle, which for her started with a heavy flow.

“We would have to try to find the women who no longer had their period or may have been pregnant when they were passing out pads,” she said, “and then we would just kind of pass them out to each other.”

It was standard practice for the women’s prison in Grants to issue only three to four pads per inmate at a time, Burleson said, and if women needed more, they would have to ask. That rationing of menstrual pads led to awkward interactions with the guards, she added, who were mostly men. “They have been known to make jokes about people having their period and having to come ask for pads,” she said. “It was embarrassing to have to go ask for additional pads.”

Burleson said the scarcity of menstrual products was sometimes also leveraged in a punitive way during her time in prison. “When we would have a shakedown where they would come in here and take all our stuff, if you had pads, they would take them,” she said. 

Though prisons and jails consider tampons luxury items, 70% of menstruating people used tampons in 2015 in the U.S. — CNN

On average, a person uses about 20 tampons or 20 pads per monthly cycle. — Huffington Post 

Tampons, Burleson said, had to be purchased separately from the prison commissary with personal funds, because prison officials only distributed pads. That’s still the case today, according to the Prison Flow Project, which used the 2021 handbooks for both women’s prisons in N.M. as a reference.

For people in prison, the price of a box of tampons can put them well out of reach. 

Rep. Antonio Maestas, a Democrat from Albuquerque, said these policies are unacceptable. “With a $363 million annual prison budget,” he said, “there is no reason any inmate has to pay even a nominal fee for any hygiene products.”

Toxic shock syndrome

Most inmates who wanted to wear tampons would tear pads into strips and try to use them as makeshift tampons, Burleson said. Those kinds of health care improvisations can lead to disastrous consequences.

Toxic shock syndrome is a rare but life-threatening infection that can result from women using a single tampon for too long. When people can’t access or afford enough menstruation supplies, sometimes they try to make them last beyond their suggested use or invent alternatives that leave remnants in the body. 

Amanda Lokke is a fourth-year medical student at the University of New Mexico. She explained this during a legislative committee hearing on Aug. 17. “Toxic shock syndrome can begin with a number of symptoms, including fever, headaches, sore throat, muscle aches, nausea, vomiting and profuse diarrhea.”

In extreme circumstances, toxic shock syndrome can lead to sepsis and become fatal.

“If there is no early intervention, blood pressure can fall dangerously low and result in inadequate blood supply to body tissues, which will then lead to organ failure, including kidney, liver, heart and lung failure,” she said. At this stage, “there’s a hospitalization rate of 98%, and a large portion of these cases will end in death.”

Other nonfatal health problems associated with inadequate menstrual hygiene are yeast infections, bacterial vaginosis, rashes, urinary tract infections and others that can be harmful, embarrassing and stigmatizing, Lokke said. They can also lead to chronic obstetric and gynecological health complications.

When people don’t have access to enough menstrual products, TSS is a threat, according to health experts.

In 2020, Biden signed the Coronavirus Aid, Relief and Economic Security (CARES) Act into law as part of the pandemic relief package. This law enacted a change to the Internal Revenue Service tax code and included menstrual products as items “eligible for reimbursement by flexible spending accounts and health savings accounts,” according to Pharmacy Times. 

New Mexico lawmakers will consider whether to cut the tax on period products in January’s budget-focused legislative session. It’s not a new idea for the state’s legislators. In 2019, Rep. Christine Trujillo, a Democrat from Albuquerque, introduced the Feminine Hygiene Products Gross Receipts bill, which would have exempted feminine hygiene products from the gross receipts tax. She’s bringing it back to the Roundhouse in a few months.

New Mexican women spend an estimated $23 million on feminine hygiene products every year, according to the 2019 fiscal impact report. 

The state lags behind others in policy and funding for what advocates say is a public health equity issue. Sixteen states have exempted the sales tax on tampons: California, Connecticut, Florida, Illinois, Maryland, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Utah and Washington.

Five do not levy a tax on any sales: Alaska, Delaware, Oregon, Montana and New Hampshire.

Legislators estimate the GRT proposal on the table might cost the state around $1 million in lost revenue from gross receipts taxes.

Rep. Jason Harper, a Republican from Rio Rancho, said New Mexico relies heavily on revenues from gross receipts taxes, and even though many are good, “we have over 300 different exemptions, deductions and credits to our tax code.”

He went on to explain that this results in a higher tax rate across the board. “And the problem is, we have this tax code that looks like a block of Swiss cheese, where we’ve narrowed our base, narrowed our base and narrowed our base,” he said.

When you look at the entire base, we could in effect have roughly half the sales tax rate of the gross receipts tax rate we have now. I mean, that's huge.

– Rep. Jason Harper, R-Rio Rancho

Harper is not the only  member of the Tax and Revenue Committee that opposes any more tax exemptions as a matter of principle. Rep. Maestas—who’s in favor of tampon distribution in prisons—said he voted against the proposal for the same reason: “too many special interest loopholes.” 

“Any hesitation in Santa Fe from a GRT exemption for tampons and other necessary female hygiene products stems from that principled position,” he said. 

Lokke, the medical student, asked for two things during her presentation: One, lifting the tax on period products, and two, $1 million to provide free menstrual products to at least 10,000 people who need them. Though there is legislative opposition to a tax exemption, a $1 million appropriation request may be better received, because the state is predicted to have a nearly $1.4 billion budget surplus this next year. 

“It does seem to me that this year, we’ve got plenty of money,” said Sen. Jerry Ortiz y Pino (D-Albuquerque) during the August hearing. “That should not be an excuse.” 

A hard choice

Anita Cordova is the chief advancement officer at Albuquerque Health Care for the Homeless. She said the clients she serves regularly have difficulty accessing menstrual products.

“We do outreach on the street, and people come into our resource center seeking sanitary napkins and other hygiene supplies,” Cordova said.

Cordova said tampons and pads shouldn’t come with a price tag for people experiencing homelessness.

“If you have a very limited amount of money, and you’re forced to buy tampons or sanitary pads, that can keep you from a safe place to sleep, or food to eat or medication you might need to buy,” Cordova said. “It creates some really, really unsurmountable, competing priorities and decisions a person would have to make.”

Cordova said eliminating the sales tax on menstrual products wouldn’t go far enough for someone who is homeless.

Access to sanitary products for a person who is menstruating is a matter of dignity, and being able to get them wherever you need them — and get them in a self-autonomous way — is very important for somebody's self-esteem, self-awareness and ability to feel like they're in control in their life.

– Anita Cordova, Health Care for the Homeless

A monthly distribution of funds to people who qualify for state and federal assistance might help address these concerns, Cordova said. For those without access to benefits or who are experiencing a gap in the benefit, she suggested free access in community and public spaces. And privacy — that helps too, she said.  “Lack of bathrooms and access to things one would need while menstruating are big barriers.”

Food stamps do not cover period products despite more than 25 million U.S. women living in poverty, reported Forbes earlier this year. 

Going the distance

Malia Luarke is the executive director of Indigenous Women Rising, a reproductive health organization focused on equity. She said access to affordable, comfortable menstrual products is about more than just cost for rural communities like hers. 

Luarke lives in Laguna Pueblo, about 60 miles west of Albuquerque, and she said the grocery store there has a limited selection. “Down here where I live, they only sell the cardboard tampons.”

Options are even worse in other more remote communities, she added. “There’s other reservations that don’t have a grocery store — they have a gas station — and they only offer the travel-size ones for regular or light (flow),” she said. “And that doesn’t help with the first couple of days of your period. Or, if they do sell pads, they don’t sell any other type of products like menstrual cups.”

As the pandemic increases economic and health pressures, people with low incomes who need menstrual products have been depending on private donations.“At the height of the pandemic last year, Indigenous Women Rising organized many donations of various menstrual products,” IWR Co-founder Nicole Martin said, “and distributed them along with our COVID-19 care packages across this country and Canada.”

 “The pandemic has highlighted the uncertainty of accessing health care and meeting our basic necessities,” she said. “Our state and country should help alleviate the barriers people face.”

Looking ahead

Lokke said the next steps for the policy proposal are to work with the legislative sponsors on the language of the bill, ensuring that there is an appropriation in addition to a tax exemption, and to build more support from the community — especially the health care community. 

Legislation can be prefiled starting Jan. 4, 2020. The New Mexico 2022 legislative session runs Jan. 17 through Feb 18, 2022. 

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Lissa Knudsen
Lissa Knudsen

Lissa Knudsen was the news editor at the New Mexico Daily Lobo, following a stint as the publication’s public health beat reporter. She also worked as a data analyst for local NPR affiliate KUNM News. Her areas of coverage include politics and policy with an emphasis on racial and gender equity. Knudsen holds a bachelor's degree in health science and a master's degree in program planning and health education. She’s a critical cultural communication doctoral candidate, emphasizing reproductive justice, maternity and health. She is a board member of the New Mexico Public Health Association. Before she realized she was supposed to be a journalist, Knudsen was involved in local politics up until mid-2014, getting into hot water with her bosses as she pushed for transparency and public accountability.