Measuring Menstrual Deprivation Across U.S. States: A Multidimensional Index

• In Event: Lightning Session: Health Policy

Abstract

Background. Period poverty is commonly measured through affordability alone, yet no comparable state-level measure captures menstrual deprivation beyond product cost. This is a consequential policy gap: U.S. states differ substantially in how they recognize menstrual health, structure access, and formalize policy responses.

Research Question. This study asks whether a multidimensional state-level index can provide a more policy-relevant measure of menstrual deprivation across U.S. jurisdictions than affordability-only approaches. Rather than estimating causal effects, it develops a diagnostic measurement tool for cross-state comparison.

Methods. Drawing on Amartya Sen’s distinction between resources, conversion conditions, and realized capabilities, the Index of Menstrual Deprivation (IMP) conceptualizes menstrual deprivation across three analytically distinct dimensions: economic affordability pressure, cultural visibility and recognition constraints, and institutional policy response gaps. The current application is cross-sectional and covers all 50 states and Washington, D.C. (N = 51), using the most recent comparable data available across dimensions, including 2024 ACS income estimates, state curriculum and public health documents, and statewide policy records. F1 captures the ratio of standardized menstrual product costs to monthly disposable resources among low-income households. F2 captures cultural visibility and recognition constraints through two coded indicators derived from state K–12 curriculum standards and official public health materials; the coding scheme was independently cross-checked, with 95% agreement on final classifications across the reviewed subset. F3 captures institutional policy response gaps through a minimal auditable policy set: menstrual product sales tax status and statewide school free-product legislation. The three dimensions are equally weighted as a transparent baseline specification, and two alternative weighting schemes are used to assess robustness.

Results. IMP scores range from 0.02 to 0.70, indicating substantial cross-state variation. Under equal weighting, the highest scores appear in Mississippi, West Virginia, Kentucky, Arkansas, and Oklahoma, while the lowest scores appear in Washington, Maryland, California, Massachusetts, and Oregon. Results are broadly robust across alternative weighting schemes, with 50 of 51 jurisdictions remaining stable in rank classification. IMP scores are positively correlated with state poverty rates (Spearman ρ = 0.507, p = 0.0001), providing preliminary convergent validity evidence. This relationship is driven primarily by the affordability dimension, while the cultural visibility and institutional response dimensions show weaker associations, suggesting that IMP captures deprivation patterns not reducible to poverty alone.

Implications. IMP offers a low-cost diagnostic tool for state policy analysts to identify whether menstrual deprivation in a given jurisdiction is more closely associated with affordability pressure, public invisibility, or policy response gaps, and thus where policy attention may be prioritized. Notably, the widespread absence of explicit menstrual health recognition in state public health materials suggests a concrete and potentially addressable policy gap within existing public health systems. Despite relying on proxy indicators and a deliberately minimal policy set, IMP provides a transparent and scalable basis for future refinement, including broader institutional coverage and potential district- and school-level applications.

Author

• ZIFEI CHEN, University of Washington
  Presenting Author