‘Project period’: a workplace health promotion innovation in a higher education setting

Menstrual Health is on the Global Agenda

In recent years, The World Health Organization has placed menstrual health on the global agenda. ¹ Around 1.8 billion people, 26% of the global population, menstruate every month. The physical and mental health impacts of menstruation associated with hormone fluctuations and blood loss are well documented.^2,3 This ‘mental burden’ of menstruation has detrimental effects on participation in work and leisure activities. ² In the workplace, management of menstruation accrues ‘additional labour’ in managing pain and symptoms, dealing with social stigma and accessing necessary facilities. ³ Resource limitations, particularly a lack of access to menstrual materials and facilities, have been recognised as a problem, even in high-income countries (104 studies; 16 countries). ² In addition, ‘period poverty’ (i.e. a lack of access to sanitary products due to financial constraints) is becoming a growing issue for those from low-income households, ⁴ and this is likely to increase given the rising cost of living in the UK.

A Gap in Policy and Practice for Workplaces and Universities

In 2019, Scotland made public health history, by legally protecting the right to access free period products, under the Period Products Act. ⁵ In England, free period products are available to hospital patients (via NHS England offer) and those in custody (following changes in legislation by the Home Office). The government ‘period product scheme’ provides free period products to girls, women and non-binary or transgender learners who menstruate, in state-maintained schools and colleges, who need them in their place of study. ⁶ This scheme does not currently include universities or workplaces.

While menstruation and gynaecological health are becoming part of discussions around gender inequity at work (e.g. via the debate relating to menstrual leave policies), ⁷ workplace occupational health promotion interventions rarely include gynaecological health awareness or free sanitary products. ⁸ Yet, menstruation is associated with sickness absence (time away from work) and presenteeism (productivity loss while at work), ⁹ so there are economic implications for employers. Furthermore, menstruation impacts negatively on students’ academic performance. ¹⁰ There is a need for universities to include menstruation and gynaecological health in staff and student health promotion programmes and engage with initiatives that support menstruation management in the workplace. This will contribute to increasing inclusion and reducing stigma and gendered inequalities and help to address period poverty.

‘Project Period’: A Step-Change in Workplace Health Promotion

In February 2020, Project Period was initiated, an innovation involving the provision of free period products to students and employees on a university campus. The aim was to address four issues: (1) being ‘caught short’ (in urgent need of sanitary products), (2) period poverty, (3) cultural differences in a university setting with diverse demographics, (4) education, including promoting open and inclusive conversations around menstruation and menopause.

Following a six month pilot test in a single area, the innovation was rolled out across an academic institute in September 2020. Disposable sanitary pads and tampons were made available in female-labelled, gender neutral and accessible bathrooms (Figure 1). Stocks were replenished monthly, and a concurrent menstrual awareness campaign was launched. This included educational leaflets, information in newsletters and workshops and events that educate and raise awareness about the challenges faced by those who menstruate and go through menopause.

Figure 1

Evolution of Project Period: free sanitary products at the University of Nottingham (UoN). The initiative was run for over 3 years by volunteers, who self-funded the project from March 2020 until seed funding was won in January 2022. The survey described in this article was pivotal in securing funding and providing the credibility and critical mass required to scale the project during 2022. By April 2023, 100,000 pads and tampons had been distributed across all seven of UoN’s UK campuses, leading to the university committing to procure and centrally distribute 1.2 million pads and tampons annually, with emphasis on sustainable, plastic-free products

After 12 months, we undertook an online survey with 154 staff and students based onsite to explore their views towards the innovation. The survey was hosted on Jisc online surveys, and data were analysed using IBM SPSS Version 27.0.1 (IBM, Armonk, NY, USA). There were 94 employees (61%: 50% full-time, 11% part-time; aged 24–61 years) and 60 students (39%: aged 22–55 years). Respondents identified as female (79.9%, n = 123), male (17.9%, n = 26), non-binary (2.6%, n = 4) or preferred not to say (0.6%, n = 1). Of the 154 respondents, 63.6% (n = 98/154) reported that they were currently menstruating, of which 86.7% (n = 85/98) were worried about their periods while at work, primarily associated with managing symptoms in the workplace and/or being ‘caught short’. Reported menstrual symptoms were diverse, impacting physical (e.g. fatigue, pain), psychological (e.g. mood) and social (e.g. participation) wellbeing.

Of 126 respondents to items on absenteeism/presenteeism (28 non-responders/154), 19% (n = 24/126) reported having been absent from work during the past 12 months due to menstrual complaints, including menstrual, perimenopausal or menopausal symptoms (‘absenteeism’). 81% of respondents (n = 102/126) reported having attended work despite being hindered by menstrual complaints during the past 12 months (‘presenteeism’). Of these, 65.6% (n = 67/102) reported presenteeism on more than five occasions during the year.

Awareness of Project Period was high (92.2%, n = 142/154), and more than half of those who responded to an item relating to accessibility had accessed the free sanitary products (52.4%, n = 66/126); reasons for access were being ‘caught short’ or financial reasons. On a Likert-type scale (0 = not important to 10 = very important), the ongoing availability and sustainability of the products were viewed to be very important (n = 154: mean 8.53, SD 2.1; and mean 7.95, SD 2.3, respectively). Perceptions of stigma in the workplace were prevalent. Of 34 individuals (34.6% of 98 menstruators) who indicated they would leave work if they needed to due to menstrual symptoms or the need to access products, only nine of these felt able to discuss menstruation openly with their line manager.

Conclusion

To our knowledge, this was the first implementation and evaluation of free sanitary products in a university setting, which has now been upscaled across a multisite university. By April 2023, 100,000 products had been distributed across seven campus sites. Research is needed to explore the cost implications of this provision, the views of employees and students (including the experiences of non-binary, transgender and culturally diverse menstruating students), any impacts on perceived stigma and inequalities and any challenges to implementation of Project Period across different sites and settings. This represents an important step towards normalising conversations about menstruation and gynaecological health and influencing policy and practice on the provision of free sanitary products in universities and other workplace settings.