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Periods in Prison: Exploring the Accessibility and Challenges to Menstrual Health Care for Incarcerated Women

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Somedays, school sucks. You’re rushing between classes and meetings, always running in a couple minutes late, you can’t seem to say the right things in class, you’re stressed about the homework you’ll have to do get done after your extracurricular activities, you don’t have time to talk to your friends… and you’re not unique. Bad days happen to the best of us. But only half of us know what it’s like to be experiencing all of that, along with the stress of knowing a piece of cotton is the only thing between your pants and a bloody mess, or having to clench your teeth and give a presentation through cramps, the worst of which doctors have recently compared to a heart attack.(1) You can’t take 6.25 to 10 years (according to various calculations) of your life off school or work.(2, 3) Although 32% of women are at times forced to take off some amount of time, missing valuable class time, losing income, or risking their jobs. I don’t explain all this, the difficult details of a normal part of most women’s lives, to complain. Because it is normal. It’s something we learn to deal with from the time we hit puberty, as early as 7 or 8 years old.(4) But there lies the fundamental reason why dealing with their period is still such a huge challenge for millions of women, even when the solutions exist. 28.7 percent of state legislatures are female.(5) It’s hard enough to have everyday conversations about menstrual health, especially with boys and men. How can we convince the other 71 percent that the discussion of a  should be tolerated in a professional environment, let alone that deliberation and change around the issue of menstrual health is a necessity they should invest their time in?

The US incarcerates women at the highest rate of any country in the world.(6) 10,567 women were put behind federal bars in 2016 alone.(7) In 2018, the first federal law mandating the provision of menstrual products in federal prison, part of the First Step Act for federal prison reform, was passed. While the Federal Bureau of Prisons had already enacted a policy in 2017 requiring the availability of menstrual products in federal facilities, in response the introduction of the Dignity for Incarcerated Women Act to Congress, subsequent surveying of those facilities showed many were not fully abiding by the mandate.(8) More official action was the next move. Section 611 of the First Step Act briefly explained the menstrual product provisions that would be newly required of all federal prisons (9):

While the requirements described here are bare bones and disturbingly lacking in specificity, it is, as the act implies, a first step. But it was already 2018. Periods have been around since, well, before we have, and forms of prisons since the beginning of organization civilization. By now we should be at the 7th step, the 40th step, looking at what we’d already built and saying that it’s not enough. Because Hugh Hurwitz doesn’t know what enough looks like. The current Director of the Federal Bureau of Prisons faces an intrinsic challenge in deciding how many pads and tampons are enough per woman per period.(10) And for many women, even having adequate pads and tampons isn’t enough. Advil and other pain relievers are essential for dealing with extreme cramping, and hot pads and towels, can provide further relief. Birth control, while theoretically not a necessity for incarcerated women, can have a huge impact on the regularity and symptoms of many women’s menstrual cycles. None of these measures are even mentioned in the three sentences devoted to an issue that in faces almost 7% (in 2016) of the federal prison population.(11)

This doesn’t even take into account further complications that can occur around menstruation. Between 10 and 20% of women develop endometriosis, a condition where the endometrium, which lines the uterus, grows into other parts of the reproductive system, causing intense menstrual and intestinal pain, digestive problems, bleeding, and sometimes infertility.(12, 13) Other common complications include migraines, unusual bleeding, and irregular periods, which have been shown to show up to be much more common in incarcerated women.(14) In one study 33% of incarcerated women surveyed reported irregular periods, and higher stress environments and events prior to or during incarceration were associated with higher rates of irregularity.(15) Kelsey Fisher, a licensed midwife for five years and a member of the Oregon Board of Direct Entry Midwifery, talked about the variety of forms Premenstrual Syndrome can have. Some women even have a condition Premenstrual Dysphoric Disorder, an extreme version of PMS, whose symptoms include depression and anxiety, and which Fisher says can lead to psychotic breaks or acting out which prisons likely don’t have the health resources to deal with appropriately.(16) Testing for these conditions, even common ones like endometriosis, is unlikely to occur in most prisons, as is the proper treatment of period related pain.

Kelsey Fisher, Oregon Board of Direct Entry Midwifery

https://www.oregon.gov/OHA/PH/HLO/Pages/Board-Direct-Entry-Midwifery.aspx?Paged=TRUE&PagedPrev=TRUE&p_Date=20180904%2007%3A00%3A00&p_Title=Upcoming%20HLO%20closures%20due%20to%20state%20holidays&p_ID=35&PageFirstRow=3&&View={587A001C-9B84-4300-8D75-F7C985BE938C}

Of course, mistreatment of women’s pain in prisons is reflective of a trend across society. Fisher explains, “Historically, the medical system has not done a good job at believing women are in pain. Women having heart attacks usually have to present to the ER twice before they’re diagnosed with a heart attack because they’re pain is written off.” She says this is especially true for women who are overweight and women of color, who are often told they need to lose weight in order to relieve their pain, while signs of injury or other sources of their pain go ignored. Fisher is hopeful that recently published research showing the presence of this trend will have an impact both in medicine and in other areas of society. “I think that [research] can have a huge impact, if we just start believing women, there’s so many aspects of life where if we just believed women, things would be better for everyone.”

But all of that starts with a conversation. Fisher says some of the most significant changes she has seen recently are on a small scale – the openness with which teenage girls today talk about their periods, increased availability of pads and tampons in middle and high schools, more and more young women learning about their options for menstrual products, and choosing to use menstrual cups. These changes come along with an open dialogue; Fisher recounts her own experience discovering menstrual cups and introducing them to her friends, who, at first uncomfortable about the idea, have come to rely on them. Fisher says having the courage to talk about your periods with friends and peers, and of parents to make it a comfortable topic of conversation with their children, will go a long way towards removing the stigma existing around the topic now. What stood out to Fisher about some of the school movements towards providing more menstrual products are the role male students played in advocating for change along with their female peers. Despite improvements in the ways girls feel they can talk about periods, it continues to be an awkward subject between male and female peers. I remember in middle school, when one girl’s unused tampons fell out of her bag at lunch, the disgust among her male friends across the table. They jumped away as it dropped onto the lunch table, shrieking, all over a small piece of cotton in plastic packaging. Sure, it was funny, but it was uncomfortable too, even frustrating, and all too relatable for the many friends to whom I’ve recounted that story.

Maybe it seems harmless. But 30 years ago, the members of the current all male Arizona House Representatives were those same boys sitting at the lunch table, disgusted by what some taxes label a “luxury good” but should be a basic human right, allowing so many women the dignity, once a month, to continue life uninterrupted by something they can’t control. While the First Step Act may have put into legal terms basic menstrual health provisions in federal prisons, only 6,000 of the 219,000 incarcerated women in 2018 are being held in federal facilities. 86% of the female adults serving long time sentences are instead held in state prisons.(17) In response to the new federal policy, many states have followed suit, drafting and often passing legislature making free menstrual products a legal requirement in state prisons. In 2018, four states, New York, California, Maryland, and Illinois, had already passed laws, with several other states joining them since, or currently in legislation.(18) One such state, which has since passed legislation on this issue, is Arizona. HB 2222, which would provide women with unlimited access to free products, instead of the 12 free pads they were getting, was proposed in Arizona last January to an all male House of Representatives.(19,20) The bill was initially blocked from being heard in Arizona State Congress by the Rules Committee Chairman T.J Shope. Shope felt the law was redundant, despite testimony from former inmates describing the immense difficulty of obtaining sufficient pads at Arizona’s only women’s prison.(21) The bill did finally get through, after women across the state posted on social media and sent menstrual products to Shope’s office. While it was being hear in the house, one Representative, Jay Lawrence, actually said, “I’m almost sorry I heard the bill…I didn’t expect to hear about pads and tampons and the problems of periods”.(22) When our elected officials can’t even bear to mention the word “tampon” without cringing, how are we supposed to open a dialogue about the needs of those who menstruate?

Yet we need a dialogue. Because even when we do have one, the challenges we need to overcome to face this problem are immense. With a prison population growing at an average of 12 percent per year over the past 30 years, even a rapidly growing Department of Corrections Budget has no chance of keeping up. Services including health and inmate support have taken heavy blows while financial focus is put on making room for more and more inmates.(23) When every feminine hygiene product is an expense that doesn’t exist for male prisoners, it’s tempting to provide less than the bare minimum for women, if menstrual products are provided at all. In Oregon’s only women’s prison, The Coffee Creek Correctional Facility, women are allotted 10 products total, in any mixture of tampons and pads. Now let’s do some math here:

Women are advised to change a tampon every 4-6 hours, and pads almost as frequently. A typical period lasts 5-7 days. An example schedule from the North Carolina Department of Public Safety gives inmates up to 7 hours between lights out and wake up.(24) While it’s fairly common practice to sleep with a tampon in, if they are kept in any longer than 8 hours, users run the risk of developing Toxic Shock Syndrome (TSS, see National Organization for Rare Disorders for more information.(25)) Let’s say you change your tampon right before and after sleep, sometime around the eight hour mark. With the 16 hours left in the day, changing every approximately 5-6 hours, you’ll use another 3 tampons. So 4 tampons a day for an average of 5 days gives an average of 20 tampons per cycle. These could be substituted by pads used at a similar rate. This doesn’t even take into consideration that many women’s periods last longer than 5 days, or are particularly heavy, requiring more frequent changes. Furthermore, for those who do use tampons, the use of a pad or panty-liner (smaller, thinner pad) is common as a backup in case of leakage, especially on the heavy first days of a cycle.
So, clearly, 10 tampons per month isn’t a lot. Not for a woman on her period. But it is a lot of material, a lot of the most heavily pesticided crop, cotton, a lot of waste, and a lot of money. Reusable menstrual products have been around for centuries. In the late 19th and early 20th centuries, patents for menstrual napkins and, in 1935, the first mainstream menstrual cup, were distributed.(26) And yet, it’s only in the last decade that reusable menstrual products, especially menstrual cups, have become increasingly popular.

This figure shows the use of different types of menstrual products among voluntary participants of an online survey.

https://www.bbc.com/news/business-45667020

Another figure shows that, online searches, whether simply looking for information as part of the growing conversation about menstrual cups, or seeking to buy a menstrual menstrual cup, are up.

https://www.bbc.com/news/business-45667020

So why would menstrual cups be the ideal fit for prisons? First, there’s the cost. While menstrual cups might appear to be a formidable investment (popular cups retail from 12 to 40 dollars), they end up being a much cheaper product. An assembly woman in California estimated that period products (only tampons and pads) cost the average Californian about $7 per month, or $84 a year.(27) Considering how few products prisons are providing female inmates – in the case of Coffee Creek, less than half the average – that number is likely quite a bit lower. A recent Walmart search showed the cost of a tampon to be between approximately 10 and 30 cents each while pads can be as high as almost 40 cents each. Even if prisons are only spending 20 cents on each of the 10 products they provide per period, per inmate, they will spend 24 dollars on each female inmate per year, outweighing the expenses of the most expensive menstrual cups within two years. And menstrual cups usually last for about 8-10 years, meaning the prisons would be saving hundreds of dollars by the time the need for a new cup came around.

This figure highlights the immense savings in both money, resources, and landfill space represented by a menstrual cup over a ten year period, as opposed to pads and tampons:

https://www.organicup.com/blog/powerful-environmental-reasons-to-switch-to-a-menstrual-cup/

Another huge benefit posed by menstrual cups is their environmental sustainability. In fact, Fisher points to this as a primary reason everyone should be concerned about this issue, apart from looking at it as a human rights issue. Cotton requires more pesticides than almost any other crop in the world, and while organic products are available, they’re much more expensive than non-organic ones, strengthening the economic disparities present around an issue as universal as menstrual health.(28) Furthermore, Fisher points out the immense amount of single use plastic associated with each product whether it is the applicator for a tampon, the backing of a pad, ot packaging for either. Just like the straws and plastic bags we’re doing so much to reduce, menstrual-related plastics end up in nature and especially in our oceans. The British Marine Conservation Society reported that tampon applicators and used pads made up a significant part of the 8.5% of all washed up trash made up of items flushed down our toilets.(29) Finally, the constant production of new menstrual products translates into factories producing CO2.

This graphic shows the sheer volume of menstrual-related waste produced by a single woman in her lifetime.

And this chart shows the amount of CO2 produced as a result of the fabrication of menstrual products over one year for one woman with various types of menstrual products. The Diva Cup, one of the first popular brands of menstrual cups, only needs to be replaced every 10 years, so produces minimal CO2 per year as compared to other products such as tampons and the Softcup, a non-reusable (although a reusable version now exists) menstrual-cup-like product.

https://genderedinnovations.stanford.edu/case-studies/menstrualcups.html

And yet, despite increasing popularity and clear cost/sustainability benefits, compared to its cousins, the pad and tampon, menstrual cups are relatively unknown. So what exactly are they and how do they work? The video below does a great job of answering these questions, and with the use of a model, you can learn a bit about to properly insert and remove a menstrual cup, if you’re interested.

So far we’ve explored the logistical benefits of menstrual cups, but there’s more to why so many women have decided to make the switch. Fisher explains that menstrual cups are often more comfortable for women, as they sit at a different place inside the vagina than tampons, and for many women cause less cramping and pain. Because they aren’t absorbent like tampons are, they don’t absorb the natural moisture of the vaginal canal, and therefore don’t cause the microtears upon removal that tampons can. For women prone to infections such as yeast infections, this can have a big impact in reducing the risk of occurrence. While menstrual cups are associated with a low risk of TSS and with potential as a biohazard, these risks exist to the same degree as they do with pads and tampons, potentially even less because all of the period blood in menstrual cups is immediately dumped and flushed down the toilet. Finally, says Fisher, in her experience women who start using a menstrual cups almost always feel more aware of and connected to their bodies and menstrual cycles, and reproductive systems. For incarcerated individuals, who have much higher rates of a history of abuse, this can be important. While past sexual abuse can make women feel disconnected from certain parts of their bodies, which they may associate with trauma, Fisher says that learning to use a menstrual cup can play a key role in moving past that trauma, often reconnecting with their bodies in a powerful way and having very positive experiences.

Of course, having guidance from an experienced menstrual cup user would be essential to get past that initial adjustment period, whether for emotional reasons as described above, or for the practical difficulties of learning how to properly insert, remove, clean, and take care of their menstrual cups. In order to make the investment worthwhile, proper instruction and resources would be essential. Another challenge that might be especially present in prisons would be assuring that women had sufficient privacy and time available to them to comfortably figure out how to use their menstrual cups, which can be a difficult and uncomfortable process. The upfront cost and work invested are easy excuses for a heavily budgeted prison to dismiss menstrual cups as a potential solution. But the benefits for our planet, the prison’s finances, and female inmates who, despite their sentences, still deserve the dignity and humanity of something as essential to everyday life as menstrual products, are innumerable and will, overtime, vastly outweigh the challenges up front.

49% of the population has never had a menstrual cycle, has never experienced the shock of their first period, the anxiety of realizing they are out of tampons or pads, the fear of a particularly heavy flow leaking through their pants during an important presentation. And too much of prison leadership is male. Bills discussing women’s menstrual rights like HB 2222, and HB 2515 in my home state of Oregon, end up in front of all or mostly male Houses of Representatives. Most women spend 6.25 years of their lives on their periods, dealing with the same day to day challenges men do, but with the constant awareness of the heavy uncontrolled blood flow that they’ll have to deal with between classes or meetings, which could leak at any moment, and which for many women causes cramps comparable to a heart attack. That doesn’t begin to take into account the lack of access to painkillers, rigid scheduling, limited access to specific types of food, and, of course, to menstrual products, all of which pose additional challenges around periods for incarcerated women. Trying to reduce the stress, pain, and consumption of time that periods put on women in prison in ways that aren’t difficult, and are reflective of options available to most non-incarcerated women, is an important step. But when bills that aim to address these issues are blocked from legislative proceedings, or ignored because the content (a reality faced by half the population) is too offensive to someone who hasn’t personally experienced the challenge, it indicates a deeper problem in our society. That issues faced only by women are blocked on principal from centers of legal change and societal importance invalidates their presence in public life. Periods don’t disappear when women leave their bathrooms at home, they continue to exist in the background of so many social situations, covered up, pushed aside, and so often unseen. Making a move within prisons towards a more sustainable, safe, cost effective, and equitable tool for women to handle their periods is an important goal, but only when men are willing to take these conversations seriously, to have a voice in them, and to be aware of their lack of knowledge and step back when appropriate, will it become the expectation that women have access to the health tools they need, even when they are only needed by women.

What’s next and how can we help?:

Since 2017, changes have come about in states across the country. While the legal requirements that have recently been put in place are far from enough, by continuing to advocate for the bills that do exist in places where those laws still do not, we can all play a role in making sure change continues to happen.

Where I live, in Oregon, a recent bill, House Bill 2515, being promoted by the ACLU of Oregon, would make Oregon policy require free menstrual supplies sufficient to the needs of incarcerated individuals who have a menstrual cycle (which may include non-female-identifying individuals).(30) The bill, proposed this past January, is currently going through initial hearings and revisal stages, and any voting processes, may be far off, but looking at similar bills considered throughout the country, it’s not difficult to imagine some of the challenges it might face.(31) Bills like this one exist in many other states, here are the ones I could find, with some articles, but be sure to check what the laws are in your state, city, or county:

Mainehttps://www.foxnews.com/politics/maine-bill-aimed-at-guaranteeing-menstrual-products-for-inmates-not-needed-gop-lawmaker-says

Tennessee – Senate Bill 75 and House Bill 129, https://www.cut50.org/sb75

Florida – Senate Bill 332 http://www.mysuncoast.com/2019/03/22/state-legislation-progressing-with-bill-provide-female-inmates-with-personal-hygiene-products/

Coloradohttps://www.coloradoindependent.com/2019/03/15/women-tampons-jails-civil-rights/

To make your voice heard, write to, or call your representative! Find your representative through this website, and remember you want to contact your representative in the state congress, and not your federal representatives: http://www.congress.gov/state-legislature-websites

Hi, my name is [your name] and I’m a constituent from [your city/area]. I’m calling/writing in support of [House/Senate Bill xxxx] to guarantee free access to sufficient menstrual products to incarcerated women. Menstrual products are an essential dignity for all women and a basic human right, and taking them away is not in a woman’s sentence, and should not be a part of her punishment.

Menstrual cups are a promising avenue for the future of menstrual health in the prison system. Throughout the past month and a half, I have been in communication with several menstrual cup companies with a commitment to serving women with limited access to menstrual products and care, as well as with the administration of the Coffee Creek Correctional Facility in Oregon. Both have shown a strong interest in working together to organize the introduction of optional menstrual cups in that facility. Hopefully by continuing to communicate and work with each other, that idea will become a reality in the near future, and can become an option at other facilities as well. In my conversation with Kelsey Fisher, we also discussed the possibilities that introducing menstrual cups to the juvenile facilities or to pre-teens in the foster care system would open up. There are so many avenues for making girl’s and women’s menstrual cycles more manageable and less of a challenge, but, as Fisher reminded me, the only way to get there is to start small and start with what’s manageable.

What we can all do, no matter our situation, our background, or our identity, is to start conversations. It’s 2019 and we’re dealing with the same menstrual-related challenges our ancestors thousands of years ago dealt with. The stigma and taboo that has always existed around female menstrual cycles, whether religiously, philosophically, or societally, has played a huge role in that being the case. But by starting with the people we know, and having the courage to make periods a comfortable topic in our own communities, we can, and already are, moving towards change on a much larger scale.

1) Lauren Williamson, “Period Pain Can Be As Bad As A Heart Attack, Doctor Says,” Women’s Health, March 21, 2018, , https://www.womenshealth.com.au/period-pain-can-be-as-bad-as-a-heart-attack.

2) Delphine Chui, “The Average Woman Spends 10 Years On Her Period In Her Lifetime,” Marie Claire, February 14, 2017, https://www.marieclaire.co.uk/life/average-woman-spends-10-years-of-her-lifetime-menstruating-475798.

3) Jessica Kane, “This Is The Price Of Your Period,” HuffPost, December 07, 2017, , https://www.huffpost.com/entry/period-cost-lifetime_n_7258780.

4) “What Age Do Girls Start Their Period – And Why Is It Getting Earlier? – Knixteen,” Knixteen, March 28, 2018, , https://www.knixteen.com/blogs/the-rag/what-age-do-girls-start-their-period-and-why-is-it-getting-earlier.

5) Katie Ziegler “Women in State Legislatures in 2019.”  National Conference of State Legislatures. 14 February 2019.

6) Cady Drell, “This New Bill Could Finally Give Incarcerated Women the Period Products They Need,” Marie Claire, December 19, 2018, , https://www.marieclaire.com/politics/a25630624/first-step-act-pads-tampons/.

7) United States, Department of Justice, Office of the Inspector General, Review of the Federal Bureau of Prisons’ Management of Its Female Inmate Population (2018), 1.

8) Melissa Jeltsen, “Women In Federal Prisons Are Now Guaranteed Free Tampons And Pads,” HuffPost, August 30, 2017, https://www.huffpost.com/entry/federal-prisons-pads-tampons_n_59930a82e4b09096429a16e0.

9) H.R. S 756, 115th Cong., 54 (2018) (enacted).

10) United States, Federal Bureau of Prisons, AG Sessions Announces Hugh Hurwitz as the Acting Director of the Federal Bureau of Prisons (2018).

11) United States, Department of Justice, Office of the Inspector General, Review of the Federal Bureau of Prisons’ Management of Its Female Inmate Population (2018), 1.

12) Illinois, Department of Public Health, Cancer in Illinois/Facts about Endometriosis, , accessed April 29, 2019, http://www.idph.state.il.us/cancer/factsheets/endo.htm.

13) United States, Department of Health and Human Services, Office on Women’s Health, Endometriosis, , accessed April 28, 2019, https://www.womenshealth.gov/a-z-topics/endometriosis.

14) United States, Department of Health and Human Services, Office of Women’s Health, Menstrual Cycle/Period Problems, , accessed April 27, 2019, https://www.womenshealth.gov/menstrual-cycle/period-problems.

15) Jenifer E. Allsworth et al., “The Influence of Stress on the Menstrual Cycle among Newly Incarcerated Women,” Womens Health Issues 17, no. 4 (2007): , accessed April 26, 2019, doi:10.1016/j.whi.2007.02.002.

16) United States, Department of Health and Human Services, Office of Women’s Health, Menstrual Cycle/Premenstrual Dysphoric Disorder, , accessed April 26, 2019, https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd.

17) Aleks Kajstura, “Women’s Mass Incarceration: The Whole Pie 2018,” Women’s Mass Incarceration: The Whole Pie 2018 | Prison Policy Initiative, November 13, 2018, , accessed April 28, 2019, https://www.prisonpolicy.org/reports/pie2018women.html.

18) Tonjanique Evans, Whitney Smith, and Demetria Themistocles, Periods, Poverty, and the Need for Policy (Washington, DC: BRAWS, 2018), 20

19) AZ HB 2222, 53rd Cong. (2018) (enacted). https://legiscan.com/AZ/bill/HB2222/2018

20) Kaila White, “Arizona Legislator Kills Bill That Would Have given Female Inmates Free Feminine Products,” AZcentral, February 13, 2018, , accessed April 14, 2019, https://www.azcentral.com/story/news/politics/legislature/2018/02/12/mail-pads-tampons-arizona-rep-tj-shope-stall-bill-inmates-free-menstrual-products-rep-athena-salman/330496002/.

21) ibid

22) Erin Polka, “The Monthly Shaming of Women in State Prisons,” Public Health Post, September 4, 2018, accessed March 3, 2019, https://www.publichealthpost.org/news/sanitary-products-women-state-prisons/.

23) David Rogers, “Shackled by Old Laws, Oregon’s Budget Is Locked in Its Prisons,” Street Roots, December 18, 2012, , accessed March 3, 2019, https://news.streetroots.org/2011/06/17/shackled-old-laws-oregon-s-budget-locked-its-prisons.

24) “24 Hours In Prison,” 24 Hours in Prison, , accessed April 1, 2019, https://www.doc.state.nc.us/dop/hours24.htm.

25) “Toxic Shock Syndrome,” NORD (National Organization for Rare Disorders), , accessed March 5, 2019, https://rarediseases.org/rare-diseases/toxic-shock-syndrome/.

26) Natalie Shure, “Why Has It Taken the Menstrual Cup So Long to Go Mainstream?” Pacific Standard, June 14, 2017, , accessed April 27, 2019, https://psmag.com/news/why-has-it-taken-the-menstrual-cup-so-long-to-go-mainstream.

27) Nina Bahadur, “This Is How Much Your Period Costs,” SELF, March 2, 2016, , accessed April 30, 2019, https://www.self.com/story/this-is-how-much-your-period-costs.

28) Amanda Osenga, “The Dirty Truth About Fabric,” The Moon Cup, , accessed April 28, 2019, http://mooncup.com/the-dirty-truth-about-fabric/.

29) Erin O’Neill, “What Makes up 8.5% of All Litter Found on Our Beaches?” Marine Conservation Society, May 31, 2018, , accessed April 27, 2019, https://www.mcsuk.org/news/plastics-flushed-incorrectly.

30) Kimberly McCullough, “Periods Are a Fact of Life. Prisons and Jails Should Provide Free Tampons and Pads.,” ACLU of Oregon, January 31, 2019, , accessed March 3, 2019, https://aclu-or.org/en/news/periods-are-fact-life-prisons-and-jails-should-provide-free-tampons-and-pads.

31) “House Bill 2515,” Oregon Live, 2019, accessed March 15, 2019, https://gov.oregonlive.com/bill/2019/HB2515/.

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