Period equity: What it is and why it matters

Photo of tampons, pads, and menstrual hygiene products on floor

It’s happened to so many people who menstruate: you’re going about your life until you realize that you just got your period. The ungainly scramble to find a restroom and the fervent prayer that you packed a menstrual product leaves you feeling anxious, vulnerable, and exposed. This is compounded by the fact that our society stigmatizes menstruation — or really, anything to do with a uterus — and a taboo hangs over these discussions.

This scenario is far worse if you are one of the nearly 22 million women living in poverty in the US who cannot afford menstrual hygiene products, a problem known as period poverty. One study in Obstetrics & Gynecology demonstrated that 64% of women reported ever having difficulty affording menstrual products, such as pads, tampons, or reusable products like menstrual cups. And 21% reported that they were unable to afford these products every month. People who are homeless or incarcerated are at particularly high risk of not having access to adequate menstrual hygiene products.

Why are period products a luxury?

Menstruating is a basic fact of human existence. Menstrual hygiene products are necessities, not luxuries, and should be treated as such. Unfortunately, food stamps and subsidies under the WIC (women, infants, and children) program that help with groceries do not cover menstrual products.

I have had patients tell me that they use toilet paper or paper towels instead of pads or tampons because they cannot afford menstrual products. People with heavy periods requiring frequent changes of these products particularly face financial challenges, as they must buy even more pads or tampons than the average menstruating person. If they try to extend the life of products by using them for multiple hours at a time, they can wind up with vulvar irritation and vaginal discomfort. They may also be at greater risk for toxic shock syndrome, a life-threatening infection.

Why is it important to talk about stigma around periods?

We need to address stigma around menstruation in order to understand and fix the challenges people face around access to menstrual hygiene products. Period poverty is real. Period equity should be real, too. Embarrassment or taboos may prevent people from advocating for themselves, but if that stigma is removed — or even eased by talking through these issues — we as a society can move forward to address the needs of half of our population. There is no equity when half the population bears the financial and physical distress as a consequence of the reproductive cycle needed to ensure human survival.

How can we address period poverty?

There are simple solutions to period poverty. The first is to eliminate the tax on menstrual products. Think about it: just as food, a necessity for all of us, is not taxed, menstrual products should not be taxed. Products that are reusable, such as menstrual cups or underwear, should be subsidized, and their use encouraged, to eliminate excess waste from individually wrapped pads and tampons. If these products are publicized, promoted, and affordable, more women may opt for them. Pads and tampons should be available free of charge in schools and federal buildings (note: automatic download).

Finally, you can take action: write to or call your legislators! There is a fantastic bill, Menstrual Equity For All Act of 2019, sponsored by Representative Grace Meng, that was introduced on March 26, 2019, but never received a vote. There is no good reason why this bill, which would allow homeless people, incarcerated people, students, and federal employees free access to menstrual hygiene products, was never even brought forward for a vote. We live in one of the world’s wealthiest countries, and lack of menstrual hygiene products should never impact someone’s ability to work or go to school. It’s time to stop treating people with a uterus as second-class citizens.

About the Author

photo of Huma Farid, MD

Huma Farid, MD, Contributor

Dr. Huma Farid is an obstetrician/gynecologist at Beth Israel Deaconess Medical Center, and an instructor in obstetrics and gynecology at Harvard Medical School. She directs the resident colposcopy clinic and is the associate program director for the obstetrics and … See Full Bio View all posts by Huma Farid, MD


Year three of the pandemic is underway: Now what?

A pattern of smaller and larger coronovirus cells in light red against an orangey-pink background

Let’s not kid ourselves: the pandemic is still with us, despite how it may sometimes seem.

Increasingly, people are going back to work in person. Schools reopened this spring. And mask mandates are history in most parts of the US. In many places, case rates are falling and deaths due to COVID-19 have become uncommon. For many, life now closely resembles pre-pandemic normalcy. So, what do you need to know about where we are now?

Not so fast: COVID remains a big problem

The virus is still very much with us, not behind us. According to the CDC, in the US there are nearly 100,000 new cases (likely an underestimate) and around 300 deaths each day due to COVID as of this writing. Despite this, more and more people are paying less and less attention.

That could be a big mistake. With summer travel season here and some dire warnings about fall and winter, it’s worth stepping back, taking a deep breath, and reassessing the situation.

Here are responses to five questions I’ve been hearing lately.

1. I haven’t gotten COVID by now. So, do I still need a vaccine?

Yes, indeed! Vaccination and boosters are the best way to avoid a severe case of COVID-19 infection.

Maybe you’ve been spared infection so far because you’ve been vigilant about physical distancing, masking, and other preventive measures. Or perhaps you’ve inherited genes that make your immune system particularly good at evading the COVID-19 virus. Or maybe you’ve just been lucky.

Regardless of the reason, it’s best not to let your guard down. The SARS-CoV-2 virus that causes COVID is highly contagious, especially the most recent variants. And while some people are at higher risk than others, anyone can be infected and anyone can become seriously ill from this virus. Even if you get a mild or moderate case of COVID-19, remember that some people experience symptoms of long COVID, such as fatigue and brain fog.

2. More and more vaccinated people are getting sick with COVID. And I’ve heard that more COVID-related deaths have occurred since vaccines rolled out than before they were available. So, how much of a difference do vaccines and booster shots really make?

They make a huge difference.

It’s estimated that COVID-19 vaccinations have saved more than two million lives in the US. If vaccination rates had been higher, estimates suggest more than 300,000 additional lives could have been saved.

We know that rates of infection, hospital admission, and death dropped dramatically among vaccinated people soon after vaccines became available. We also know that most severe cases of COVID-19 among the vaccinated occur among people who haven’t had a booster shot. Overall, severe cases and deaths remain much lower among people who are vaccinated and boosted than among people who are not vaccinated.

Is it true that the share of severe COVID cases and deaths occurring among the vaccinated has risen? Yes, but possible explanations for this trend actually show that vaccines continue to protect people from serious illness:

  • When rates of infection fall, overall rates of hospital admission and death fall for everyone, vaccinated or not. So, the gap between rates of infection and death between vaccinated and unvaccinated people gets smaller.
  • Available vaccines aren’t as effective against new variants of the virus. True, but these vaccines still effectively reduce the risk of severe disease.
  • Immunity wanes over time. That’s true for even the best vaccines, which is why boosters are needed. Yet only about a third of the US population has received a COVID booster. That makes it easier for the virus to continue to spread and mutate.
  • We’ve now logged more time with vaccines than without them since the pandemic began. Because no vaccine is 100% effective, the numbers of cases and deaths will continue adding up, eventually outnumbering pre-vaccine cases and deaths.

3. First, vaccines were going to solve this. Then we needed one booster shot. Now we need two. What’s happening, and why should I even consider this?

Good questions. The protection provided by most vaccines tends to wane over time. That’s why tetanus shots are recommended every 10 years. We’ve learned that protection against COVID-19 may wane a few months after the initial vaccine doses. A first booster is recommended for everyone who is vaccinated, five months after completing the two-dose Moderna or Pfizer vaccine series or four months after the single-dose J&J vaccine.

Because immunity from the first booster may wane sooner in older adults and people with certain health conditions, another Pfizer or Moderna vaccine dose is now available to those over age 50 and others at particularly high risk.

4. Now that mask mandates are in the rearview mirror and everyone is tired of COVID restrictions, what else helps?

It’s not yet clear that mask mandates should have been lifted as soon as they were, especially when rates of infection were starting to rise again. We’ll only know in retrospect if that was a good idea.

As for other measures, physical distancing, masking up, and other steps still make sense in certain situations. For example, if you’re using public transportation or traveling by air, a well-fitted mask can provide a measure of protection. If you’re regularly exposed to a lot of people and know you will soon be in close contact with someone who is at high risk, mask up and get tested in advance.

5. What’s the bottom line here?

Get vaccinated! If you’re eligible for a booster, get one. It makes no sense to get the initial vaccine and forego boosters. If you’re one of very few people who had a significant reaction to one type of vaccine, ask about getting a different type of vaccine as a booster.

When the pandemic began, few were expecting that more than two years later it would still be causing so much suffering and death. But we shouldn’t pretend it’s over; don’t throw out your masks just yet and do follow public health recommendations. If you’ve decided not to get vaccinated or boosted, think again (and again)!

Yes, we’ve all had it with the pandemic. But I think of it this way: when it looks like rain, throwing out your umbrella and pretending it’s sunny are decisions you’ll probably regret.

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD


Ring vaccination might help curtail monkeypox outbreaks

A red figure standing in a white circle connected to a white circle with a black figure, who is connected to circles with two other black figures; the concept of how infection spreads

By now, you’ve probably heard that there is a monkeypox outbreak traveling around the globe. Cases have spread far and wide, including in the US, Canada, Europe, and Australia. It’s the largest outbreak ever recorded outside of western and central Africa, where monkeypox is common.

But controlling this outbreak demands preventive measures, such as avoiding close contact with people who have the illness and vaccination. One method of vaccination, called ring vaccination, has worked well in the past to contain smallpox and Ebola outbreaks. It may be effective for monkeypox as well.

How can monkeypox be contained?

According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization, monkeypox is unlikely to become a pandemic. At this time, the threat to the general public is not high. The focus is on identifying possible cases and containing the outbreak as soon as possible.

Three important steps can help stop this outbreak:

  1. Recognize early symptoms
  • Usually, early symptoms are flulike, including fever, fatigue, headache, and enlarged lymph nodes.
  • A rash appears a few days later, changing over a week or two from small flat spots to tiny blisters similar to chickenpox, then to larger, pus-filled blisters.
  • The rash often starts on the face and then appears on the palms, arms, legs, and other parts of the body. If monkeypox is spread by sexual contact, the rash may show up first on or near the genitals.
  1. Take steps to stop the spread
  • Monkeypox spreads through respiratory droplets or by contact with fluid from skin sores.
  •  Anyone who has been diagnosed with monkeypox, or who suspects they might have it, should avoid close contact with others. Once the sores scab over, the infected person is no longer contagious.
  • Health care workers and other caregivers should wear standard infection control gear, including gloves and a mask.
  • In the current outbreak, many cases began with sores in the genital and rectal areas among men who have sex with men, so doctors suspect sexual contact spread the infection. As a result, experts are encouraging abstinence when monkeypox is suspected or confirmed.
  1. Use vaccination to help break the chain
  • Monkeypox is closely related to smallpox. People who received a smallpox vaccine in the past may have some protection from monkeypox. (The US smallpox vaccination program was discontinued in 1972, and smallpox was declared eradicated worldwide in 1980.)
  • Stockpiled smallpox vaccinations and newer vaccines that can be used for monkeypox or smallpox are also available.

Ring vaccination

Monkeypox differs from the virus that causes COVID-19. People with monkeypox usually have symptoms when they’re contagious, and the number of infected persons is usually limited.

This means it’s possible to vaccinate a “ring” of people around them rather than vaccinating an entire population. This selective approach is called ring vaccination.

Ring vaccination has been used successfully to contain smallpox and Ebola outbreaks. It may come in handy for monkeypox as well. Here’s how it works:

  • As soon as a case of monkeypox is suspected or confirmed, the patient and their close contacts are interviewed to identify possible exposures.
  • Vaccination is offered to all close contacts.
  • Vaccination is also offered to those who had close contact with the infected person’s contacts.

Ideally, people should be vaccinated within four days of exposure.

This approach requires widespread awareness of monkeypox, rapid isolation of suspected cases, and an efficient contact tracing system. And of course, vaccines must be available whenever and wherever new cases arise.

Are the vaccines used for monkeypox effective?

According to the CDC, the smallpox vaccine is 85% effective against monkeypox.

While a newer vaccine (JYNNEOS) directed against monkeypox and smallpox has only been tested for effectiveness in animals, it is also expected to be highly effective in humans.

Of course, vaccinations can only work if people are willing to receive them. We’ll learn more about this as more people are offered the option for vaccination.

Are the vaccines used for monkeypox safe?

As with most vaccines, the most common side effects include

  • sore or itchy arm at the site of the injection
  • mild allergic reactions
  • mild fever or fatigue.

Fortunately, more severe side effects, such as significant allergic reactions, are rare.

The bottom line

In light of the current monkeypox outbreak, you may soon be hearing more about ring vaccination. Then again, if appropriate measures are taken to prevent its spread, this outbreak may soon be over. Either way, this won’t be the last time an unusual virus shows up seemingly out of the blue in unexpected places. Climate change, shrinking animal habitats, rising global animal trade, and increasing international travel mean that it’s only a matter of time before this happens again.

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD