The need: evidence base and more
Underscoring the case for healthcare worker period parity
Total read time: est. 12 - 15 minutes
Who is affected?
Why are SOS boxes important?
There is no publicly obtainable information to ascertain the percentage of healthcare workers categorised as female and aged under 25 to 55 years of age, alongside others with menstrual needs, including trans men and gender fluid staff across all four nations constituting the UK including Wales.
However, what is known from published data is that:
77% of the NHS England workforce is female (1)
45% of doctors and dentists in NHS England are female
80% of Agenda for Change NHS staff in England are female
81% of the NHS England workforce and 87% of medical and dental staff are aged between under 25 and 55 years of age
Females in this age bracket are more than likely to have menstruation-related needs (2)
Recent freedom of information act requests have revealed that there are approximately :
50, 902 ‘female’ health and social care employees between 18 and 55 within NHS Northern Ireland; (data for percentage calculation unavailable)
In Wales, this was 73,782. Full data set regarding total work was not supplied and only earlier, full time equivalent data not public
In England (social care not included) this was 1,038536. Full data set was given showing this is approx. 61% of the workforce in England
And in Scotland women plus trans men was 116, 245 (data for percentage calculation unavailable)
In total, across the UK, there are 1, 163, 581 ‘female’ (and in Scotland ‘trans men’) working in healthcare under the age of 55
The need for period parity within legislature and policy
Menstruation is a ‘vital sign’ for health yet remains a source of inequity for women, trans men and gender fluid with menstruating/periods worldwide(1). In 2014, the United Nations Human Rights Council highlighted menstruation/periods as a public health and equality matter of importance.
In the broader population, menstruation-based inequity arises through a variety of factors including stigma, miseducation and limited period product access (for financial reasons or otherwise) and appropriate facilities (1–7). Inability to meet menstrual needs can be variously defined as ‘period poverty’ ‘period inequity’ or lacking period ‘parity’ (9–10).
In 1971, the United Nations (UN) Convention on the elimination of all forms of discrimination against women (CADAW) set out the need to address gender/women-based discrimination and violation of human rights. Since then, the UN Population Fund has related menstrual needs with human rights such as right to dignity and ability to meet personal hygiene needs: “the right to human dignity”, “the right to an adequate standard of health and well-being”, “the right to work” and “the right to non-discrimination and gender equality”.
The UN Population Fund sets out what they feel women and adolescents require during menstruation:
They must have access to clean material to absorb or collect menstrual blood.
They must be able to change these materials in safety and privacy, and have a place to dispose of used menstrual supplies or to wash reusable supplies.
Menstruating women and girls must also be able to safely and privately wash with soap and water.” (6)
Alongside this, in 2014, the UN Human Rights Council highlighted menstruation/periods as a public health and equality matter of importance. Inability to meet menstrual needs can be variously defined as ‘period poverty’ ‘period inequity’ or lacking period ‘parity’ (13-15).
Since 2010, the UK Equality Act has been used to highlight and address unlawful discrimination based on protected characteristics including sex, gender reassignment and disability (11). Additionally, in 2021, Scottish Period Products (Free Provision) legislation was passed, whereby public facilities in Scotland must provide free menstrual/period products (12). Welsh Government also mandates hospitals provide sanitary/period products for inpatients. In 2022, it launched an intersectional Period Proud Action Plan, aiming to address period poverty by 2027 (10). NHS England has contractually required provision of period products for patients since 2019 (53). Apart from Scotland, all other countries within the UK do not require employers to provide freely accessible period products within workplaces.
However, UK-based period poverty exists; 24% struggle to financially afford period products for themselves or family in 2022 (13). Workplace menstruation leads to absenteeism, presenteeism and stigma, with greater unpredictable bleeding and flow in shift workers and negative period-based impacts of Personal Protective Equipment use (14–17). Despite this, worldwide data relating to period poverty for healthcare workers is limited despite known challenging working conditions, resource limitations and rising living costs (18–25). Furthermore, community setting-based experiences such as within primary care and those of trans men or gender fluid individuals who menstruate are unknown. Yet there are, as of September 2024, over 1, 279, 464 women and trans men up to the age of 55 working within the UK’s NHS who could be menstruating.
Periods within the workplace
Turning to the workplace, studies show that a happy workforce leads to a better team culture and reduced absenteeism and presenteeism (17), which lack of access to free period/sanitary products for emergency or unexpected need at work might impede. A large, cross-sectional study has linked menstruation to an increased level of presenteeism, (where an individual’s function or performance is reduced at work due to illness, disability or other factors). Furthermore, that this presenteeism is more profound where greater, prominent symptoms such as pain are reported (18).
In addition, evidence shows that ‘healthy workplaces’ as defined by the World Health Organisation (19) and ‘workplace health promotion’ as defined by the 2018 Luxembourg declaration of the European Network of For Workplace Health Promotion (20) may improve productivity and reduce absenteeism, amongst other measures of improvement for employees and employers (21).
In healthcare, a recent General Medical Council-commissioned report from Professor West and Dame Coia, “Caring for doctors, caring for patients”, highlighted the need for the NHS to care for doctors as humans with basic needs, and that this is critical to restore wellbeing (5).
Furthermore, introduction of measures that truly enhance equality, diversity and inclusivity are shown to lead to enhanced team-working, innovation and progressive culture change (30–35).
Moreover, there are legal, ethical and moral imperatives to ensure basic human rights including the menstrual needs are consistently met in a dignified and enabling manner within and outwit workplaces (36–40).
The healthcare context
At present, scanty to a lack of easily accessible stores of free period/sanitary products 24 hours a day, 7 days a week for NHS workers who have periods/menstruate to access for unexpected or urgent need whilst working have been reported.
Many NHS workers such as resident doctors (formally junior doctors or trainees), nurses, healthcare assistants, radiographers, porters some more senior doctors are shift workers. Shift work, particularly night shifts, and stress are linked to menstrual irregularities and unpredictable period/menstrual dates (3, 4).
Recent legislation in Scotland passed in 2021 (22) requires all public organisations to provide period/sanitary product provision. Yet, when provision for healthcare workers within the NHS was last ascertained, availability, whilst improving, is still substantially deplete (32)
Period/sanitary products in hospital-based shops and vending machines tend to be sold at inflated prices (more costly than supermarket and high street products). Additionally they often have a limited selection and are only able to be purchased from shops within fixed opening hours. In General Practice and other community-based centres, these healthcare workplaces often have no shops or vending machines accessible. This limits a NHS worker’s ability to meet their individual period/menstrual product needs through lack of access throughout a shift, helping to perpetuate period poverty.
NHS staff, such as resident doctors, report frequently having limited to no access to personal storage space such as lockers at their workplaces (23). This limits the ability for them to keep a personal stock for emergency need, or a lapse in placing supplies in their work bag. This is potentiated from almost always needing to work away from their belongings due to infection control, patient safety and practicalities. This undermines their privacy rights and dignity needs whilst at work.
The seemingly ever rising intensity of work and limited access to breaks reported by many NHS shift workers (24-26) may restrict the time staff who have periods/menstruate have available to search for period/sanitary products in various work locations and enquire with colleagues when unexpectedly needed. Staff may also feel they have to disclose their menstruation status to be able to do this, which undermines their right to privacy and confidentiality.
Alongside this, people who have periods/menstruate have reported substantial additional difficulties when needing to work in Personal Protective Equipment (PPE) whilst menstruating (28).
Additionally, the steadily rising costs of living have impacted notably on the healthcare workforce. They may therefore potentiate period poverty within the healthcare workforce with all too regular accounts of healthcare workers needing to access food banks (29). NHS workers - be it nurses, resident doctors, radiographers, community-based physiotherapists, porters or one of many other groups - were historically reported to earn good, assured salaries. However, the reality is, with the rising costs of living, some job shortages and many having to self-finance their career progression, many healthcare workers have substantial student loans and debts to pay and basic salaries that may not allow them to purchase their own period/sanitary products (30, 31).
SOS box initiative surveys (see below) so far have revealed the extent of worry many who have periods/menstruate have within a healthcare workplace without access to a SOS-box like resource. Yet, studies have shown the deleterious impact of stress and distraction on a wide range of cognition aspects, not least narrowing bandwidth, impairing performance, communication, innovative practice and learning. Therefore, lack of period parity could be needlessly affecting the NHS in a notable way.
In summary
Therefore, set against this background, it appears ever more important to continue to establish and highlight the existence of period/menstrual poverty within NHS staff and the imperative to meet menstrual needs of healthcare workers. Investing in creation of equitable, inclusive workplaces welcoming healthcare worker diversity is known to lead to wide reaching benefits for organisations if sustained. Moreover, to present the evidence-based, feasible and relatively low-cost SOS box solution appears more important than ever if we are to achieve the benefits of greater inclusivity and equity within healthcare workspaces (33-38).
Research basis for lack of period/menstrual product accessibility within healthcare
Research evidence directly relating to period parity, poverty and experience of periods/menstruation within healthcare workplaces is sparse. In 2025, the SOS box initiative will be conducting a UK-wide study with the aim to help address this.
What currently exists is a single site quality improvement-based publication, two unpublished but presented SOS box initiative surveys and some released headlines from a recent freedom of information and member survey by BMA Scotland relating to the Scotland-specific period equity legislation NHS response.
2018-19: the first SOS box survey
This explored the experiences of resident doctors currently training in hospital-based posts within South Wales
88% had needed to use period/sanitary products at work and hadn’t had any personally with them
38% had needed to change clothing due to soiling as a result of not having the needed period/sanitary products at work
63% felt lack of access to period/sanitary products at work had had a negative impact on their dignity
100% said it was difficult to acquire period/sanitary products at work if they did not have any personally with them
54% had needed to use a particular type or absorbency of period/sanitary product at work and not personally had any with them
73% said it was very difficult to acquire the type and absorbency of period/sanitary products they needed at work
75% had needed to ask colleagues for period/sanitary products at work
79% found it harder to obtain period/sanitary products out-of-hours (between 5pm-9am, weekends, bank holidays)
Free text responses built on quantitative data:
“A small change that’s made a huge difference”
“I used it on call when my period came unexpectantly [sic]“
“Great to have access to this in emergencies “
“Takes a lot of worry off “
“It’s made me feel like someone cares about doctor wellbeing”
“It would be great to have access to this in emergencies! Especially on long days on call when I can’t get to the toilet as often as I need to”
“Think it's a brilliant idea”
“It would be invaluable”
“Such an amazing initiative in terms of both physical and psychological wellbeing at work.”
“it’s great to know it’s there in emergencies”
“it would make me feel a lot better”
“It shows they care for their staff and are interested in their wellbeing”
“I would appreciate it.”
“Essential. Much needed. Finally, our health rights are also being taken into consideration when we do so much for our patients often at the detriment of our own health.”
“I have used the SOS box recently and it made an embarrassing situation so much more bearable. Bearing in my mind I was already having a rubbish day, having sanitary products easily available was just a small something that made a huge difference to how I coped with the rest of the day”
Some resident/junior doctors anecdotally reported having had an intrauterine system inserted to induce amenorrhea to avoid dealing with periods/menstruation at work. Resident/junior doctors also reported a lack of hygienic period/sanitary product disposal bins available in toilets, requiring them to store used products in their bags, or hide them in toilet tissue to find a (non-human waste) bin outside bathrooms.
Please see the SOS box toolkit page here for more information regarding the cost and usage analysis of the SOS box introduction.
Twitter (now X)-based feedback on SOS box project 2019
“What a fabulous idea, especially for staff working on nights.”
“This is fantastic”
“Love this.”
“That’s great!”
“Fantastic idea. Well done. I’d love to introduce this in my hospital. Might head out tomorrow and stock up!”
“These boxes are really fabulous, great initiative showing that simple things can be really effective. I bet the contents of both boxes feel lifesaving at times. I think I need to take this to my hospital department “
“Great work”
“Thanks … we were talking about something like this -‘X’ had some ideas for stocking the bathrooms at our hospital in certain areas - this is helpful. Well done!”
“Sanitary vending machines should be widely available in all hospitals. Every female doc has had to borrow sanitary products at some point. Doctors lives matter too!”
“You legend!”
“Fantastic idea.... it is often the little things that make a big difference to staff wellbeing”
“Well done”
”…on why she provides free emergency period products for fellow doctors. Shocking #essentialnotluxury #periodsatwork”
“Simple idea to make a big difference to doctor wellbeing. Well done”
“Great initiative! Why aren’t round the clock medical shops available in the hospital premises?”
“Wonderful idea! Article doesn't mention how irregular shifts/sleeps/eats can cause irregular menses, which they did for me.”
A group of resident doctors training in Glasgow, UK undertook surveys as part of the trial of provision of freely accessible period products at select sites within a large teaching hospital with 5819 healthcare staff. The first survey included clinical staff members in the acute medical assessment and treatment unit department with 22 respondents. The second pre-intervention and third post-intervention surveys were open to all clinical staff at the hospital. 840 staff who had periods/menstruate responded, 128 responded who did not. The third survey exploring location of period product supplies had 46 respondents.
Published data from their survey across clinical staff members in the hospital (surveys 2 and 3) revealed that:
91% of surveyed staff who had periods/menstruated felt period product provision within their hospital-based workplace was inappropriate; 50% of those who didn’t have period thought this too
84% of staff did not have access to a supply of period products when needed and 84% did not know where to access period products in their hospital
This lead to 55% asking colleagues for products, 50% used makeshift products and 8% used hospital clinical pads
91% felt their experience of having a period/menstruating at work would improve if freely accessible period products were available
91% of medical department staff would prefer hospital-ward based product provisions for staff
Period product provision/SOS box-type intervention:
95% felt these would meet their needs
82% felt period product access for staff had improved with introduction of the scheme
56% now felt able to access period products at work with 33% having used the new Project Period supplies for themselves (time from launch of products in workplace to survey not stated)
2021: #project period
The 2021 SOS box initiative survey explored the views of clinical staff across professions within a large hospital-based Paediatric and emergency assessment department in South Wales.
Survey results (n= 35, NB was unable to select out or determine exact numbers of non-menstruating respondents)
77% had, in the past, had need of period/sanitary products but hadn’t access to them whilst at work.
49% had need for period/menstrual products at work without any access to them every six months or less, and 66% at least every year.
27% had been through the perimenopause and experienced irregular, unpredictable bleeding patterns with unexpected need for period products at work.
94% felt access to period/sanitary products in clinical work areas would have a positive impact on their dignity.
92% of respondents felt the SOS box would improve their sense of wellbeing whilst at work.
Free text survey responses again built on the quantitative results:
What would having SOS boxes (freely accessible emergency supplies of period products) mean to you?
“Reassurance/comfort that if I forget to bring or have some sanitary products on me, I know that I wouldn’t have to worry! Plus you may need them unexpectedly so it’s good to know that there is always a supply somewhere! Plus less stress and worry that I have to be carrying sanitary products on me and less worry that it may fall out of my pocket when grabbing something else out if there is an SOS box at the bathroom facilities.”
“Makes me happy that it is accessible”
“It would be very helpful in the time of need, helpful when your [sic] not expecting and would definitely help with dignity at work. Great idea, thank you”
“A great deal. Saves me panicing [sic] about this issue.”
“It means I don’t need to ever worry that I would be "caught short" in work and have to be uncomfortable throughout the shift.”
“Just the safety of having something if caught unexpectedly. Today I had an extremely heavy period and went through all of my own supplies without this box it would have been difficult/embarrassing. Thank you.”
“Makes you feel valued as a member of staff that we are human too”
“Already it makes me feel that someone appreciates how horrible you can feel at certain times of the month and to be in need of products”
“Relief knowing there are products there if caught short!! It's really stressful starting a period and realising you have no supplies. I once bled right through uniform and had to wear scrub trousers and had the whole shift with people asking why was I in scrubs and not uniform. Anything which can minimise embarrassment is a bonus!”
“This may be an absolutely amazing thing and genuinely save the day in some cases.”
“It's very useful. Often staff get caught out. Ladies do not always have a regular cycle. No shop available at the Grange which sells period products.”
“I feel this is an amazing service to provide for your colleagues as there will always be a time when you may get caught out. There is nothing worse than being caught short with an unexpected period.”
“Would save from embarrassment and make the shift feel more comfortable.”
“To the girls, they are a god send”
“I have had to use the SOS box in an emergency and it was a relief to not have to worry about not having sanitary products on me. I am very grateful that we have these boxes and I know us nurses greatly appreciate them.”
“A sense of security and being appreciated in a very small but practical way, someone else cares.”
“It would be one less thing to worry about which makes all the difference”
“I support this idea completely. There are times when you unexpectedly need something from the SOS box that saves embarrassment, promotes dignity and allows staff to access quickly and continue with busy day.”
2021: the second SOS box initiative survey
In 2021-22, the BMA has released some data relating to a series of Freedom of Information Act disclosure responses pertaining to provision of freely accessible period/menstrual products within Health Boards (unspecified whether this was for hospital or community or both sites)
Additionally, the BMA released headline results of their Scotland-based member survey exploring the impact of the period poverty legislation and any experiences of implementation.
193 responses across all health boards, and 71.5% of respondents worked in secondary care settings:
42% of respondents knew their place of work provided period products to staff.
75% of these respondents said these products were regularly stocked up
82% said they were easily accessible.
62% of respondents felt comfortable raising the issue of period products with management.
“It’s such a taboo subject still with stigma attached- “your period your problem”. I particularly wouldn’t want to bring this up to a male manager either. But I would like the availability of period products.”
“Management currently focussed on trying to safely staff the hospital unfortunately.”
However, the membership survey also revealed more challenging responses from other doctor members:
“I don’t think professionals in regular employment should be expecting free sanitary products. From a personal perspective, my salary is above average and I would be embarrassed at the thought of expecting the government to subsidise something I can clearly afford.”
“I don’t agree that this is a priority. Frankly it’s virtue signalling.”
“This is hardly a priority. Women have been getting tampons/ towels from their colleagues since the dawn of time. And we are technically adults.”
“I think that most responsible women can manage their periods and that maybe the BMA should be spending time fighting for decent pay which ensures that doctors can buy their own sanitary products. I’m not comfortable paying for my union to carry out progressively left wing and irrelevant, distracting projects when there are much larger and more pressing issues for physicians in the profession.”
“It is not a responsibility of an employer, and I would not entertain providing such. The BMA is seriously misguided in this matter.”
Taken from, and read more here
Please note: information outlined above is true to the best efforts of the author to establish facts at the time of publication. The author warmly welcomes any approaches with evidence-based correction requests.
November 2020 onward: BMA Scotland #BMAperiods
References
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