Workplace menstrual product policies and worker well-being: Insights from Queensland, Australia

Abstract

In 2022, the World Health Organization acknowledged menstrual health as a global human right and encouraged a shift in responsibility from individuals to the community. Globally, menstrual products are rarely included in workplace policies, hindering equitable well-being by placing disproportionate burden on menstruating workers. This exploratory study in Queensland, Australia supplied a public sector workplace with menstrual products for two months in 2023. A questionnaire with qualitative and quantitative aspects assessed the experiences of 21 menstruating workers. Before the supply, 94.7 % had experienced menstruation at work without access to products, leading to mental distress. Additionally, 71.4 % worried about lacking products when needed and 38.1 % believed this worry decreased their mental well-being or concentration. After the supply, 94.1 % reported improved emotions, 70.6 % perceived improved concentration and 64.7 % felt improved mental well-being. However, only 57.1 % believed that menstrual product supply should be mandated by workplace policy. Factors contributing to exclusion of menstrual products from global workplace policies are discussed, such as limited awareness, poor workplace infrastructure and persistent stigma. This study was limited by a small sample size and self-reporting bias. Regardless, the findings highlight the respective positive and negative impacts of including or omitting menstrual products in workplace policy, even in a socioeconomically privileged country like Australia. This emphasises the underestimation of menstrual health as a basic human right in workplace health and safety, urging more research on workplace menstrual product provision and related feminine sanitary infrastructure especially in low-resourced nations.

Highlights

• •Lacking menstrual products at work is associated with anxiety and distress.
• •Workplace supply of menstrual products improves menstruating worker well-being.
• •The findings open debate on workplace responsibility for menstrual product supply.

1. Introduction

Menstrual health is a state of physical, mental, and social well-being in relation to the menstrual cycle [1]. In 2022 the World Health Organization (WHO) acknowledged menstrual health as a global human right issue with social, psychological and physical dimensions [2]. The WHO urges menstrual health responsibility to shift from the individual to the community [2]. This includes the need for workplaces to support dignified menstrual management [2]. Poor menstrual health can inhibit full participation in work activities [1,2]. Menstruating workers are disadvantaged compared to non-menstruating workers by “blood work”: the physical, financial and mental burden of menstruating workers to manage and ‘hide’ their menstrual bleeding and symptoms [3,4]. Improving access to menstrual products at work is a potential focus for community intervention for both developing and developed nations.

Menstrual products are frequently absent from workplace policy and so menstruating workers must supply their own. Failure to do so can lead to being ‘caught short’ at work [5], causing distress and anxiety [[3], [4], [5]]. Menstruating workers may resort to using toilet paper as a substitute [3] or wearing products longer than recommended [4]. This violates the right to effective, clean materials needed for good menstrual health [1], risks leakage through clothes [3] and increases risk of genitourinary infections [6]. This is particularly detrimental in low- to middle-income nations, where workplaces may additionally lack adequate sanitation to wash or change menstrual products [7] and workers frequently struggle to afford necessities [8]. Even menstruating workers in developed nations like the United Kingdom (UK) and Spain cannot always afford menstrual products [4,5]. Workplace interventions to support menstrual health can have profound psychosocial and economical improvements on workplaces [5,9,10], but such impacts are insufficiently researched [7,11]. This study aimed to address the knowledge gap by exploring the psychosocial impacts of a workplace menstrual product intervention in the state of Queensland (QLD), Australia.

The developed nation of Australia provides an example of community commitment to improving menstrual product access. Menstrual products were historically taxed as “luxury items” [12] but in Australia the goods and services tax was removed from menstrual products in 2019 [13] and the tariff removed in 2024 [14]. Nearly all State and Territory Governments in Australia endorse menstrual products in public schools [[15], [16], [17], [18], [19], [20]] resulting in the improved attendance and well-being of students [21,22]. In some State or Local Council jurisdictions in Australia this extends to healthcare centres, hospitals [[23], [24], [25]] and other public places such as libraries or community centres [20,[25], [26], [27]]. In the Australian Capital Territory (ACT) the Period Products and Facilities (Access) Act 2023 enforces the provision of menstrual products in all public places including workplaces in the ACT [25] but not to other States or Territories of Australia. To date, Scotland and Canada are the only other nations with legislation mandating supply of menstrual products in workplaces [28,29]. Apart from these few jurisdictions and nations, the absence of menstrual products in nearly all other workplace legislation highlights a global underestimation by workplace policy makers of their necessity.

1.1. Menstrual bleeding and work health and safety policy in QLD

This study used a public sector workplace in the State of QLD, Australia to demonstrate how inclusion of menstrual products in workplace policy can improve well-being of menstruating workers. In QLD, workplaces abide by the Queensland Work Health and Safety Act 2011 (WHS Act) [30] and are regulated by WorkSafe QLD (WHSQ) and their Codes of Practice [31]. The relevant Codes of Practice to this study include the WHSQ Managing the work environment and facilities 2021 [32] and the WHSQ First aid in the workplace 2021 [33]. For the purpose of this research they will be collectively referred to as WHSQ Policy. WHSQ Policy recommends a constant supply of toilet paper and soap in sanitary facilities [32] to maintain cleanliness [32] and for infection control [33]. Adequacy of sanitary facilities considers the ratios and numbers of biological men and women [32]. Two-thirds of the QLD public sector workforce are women between 19 and 65 years old [34]; demographics aligning with a menstruating population [35]. Despite this, reducing risk of menstrual blood exposure is only addressed by provision of menstrual product disposal bins [32] but not menstrual products. Similarly, workplace first aid kits are required to contain pads for interruption of wound-related bleeding but not menstrual bleeding [33]. Adequate sanitary facilities are necessary in workplaces for basic health, welfare, privacy, dignity and personal hygiene [36].

This study explores the perception of menstrual product inclusion in WHSQ Policy on well-being in a QLD public sector workplace by answering the following questions:

• 1.What is the current opinion amongst menstruating workers towards the idea of WHSQ Policy mandating workplace menstrual product supply?
• 2.What challenges are faced by menstruating workers due to a lack of mandated supply of menstrual products in WHSQ Policy?
• 3.Is menstruating worker well-being improved through subsequent supply of menstrual products in workplace sanitary facilities?

2. Methods

2.1. Study design

This was an exploratory study to obtain data through a hybrid quantitative and qualitative questionnaire on the experiences, opinions and challenges surrounding menstrual product access in a workplace in QLD, Australia. The workplace was provided menstrual products from August 1st 2023 to October 31st 2023 and a questionnaire after these two months retrospectively assessed the perceived impact of the provision by menstruating workers.

2.2. Study setting

This study was conducted in a public sector workplace in the State of QLD, Australia. The chosen workplace was indoors and provided a cross-section of night, day and weekend shift workers. The workplace did not already supply menstrual products for workers, and personal belongings including menstrual products were not stored in toilet facilities. The workplace was also chosen for convenience, as there were only three toilet facilities to supply menstrual products. A limitation of this study setting in the study period (August –November 2023) was the small total workforce of only 38 workers (9 male and 29 female) excluding staff movements and absences. This meant the maximum potential sample size was too low for correlative analysis to reach statistical significance, but it was believed the potential qualitative findings still possessed sufficient relevance to accomplish the exploratory aims of this study and validate the necessity for further research in the topic of menstrual product provision in workplace policy.

2.3. Data collection

Participants within the chosen workplace were obtained through convenience sampling. Workplace staff were informed of the impending research through email communication. From August 1st 2023 to October 31st 2023 menstrual products were made available in all three workplace toilet facilities. Disposable menstrual products including a variety of sizes of winged pads, non-winged pads, tampons and liners were continuously supplied by the investigators during the study period. Workers were informed that they could use the menstrual products supplied as part of this study regardless of participation in the questionnaire. After supplying menstrual products in the workplace for two months, the study questionnaire was made available to participants online for one month and advertised via email and posters in the workplace. All staff were invited by email to optionally participate in the questionnaire, regardless of whether they menstruate. The questionnaire was hosted online via Citizen Space [37].

2.4. Questionnaire design

The questionnaire was designed based on menstrual product challenges identified in the literature in other workplace settings. A pilot test was done on a sample of three menstruating persons outside of the study population, including one person from the lesbian, gay, bisexual, transgender, intersex and queer community. Additional questions were developed based on their feedback to enhance the collection of meaningful responses, such as adding whether opinions on menstrual product inclusion into workplace policy reflected those of workplaces supplying toilet paper.

The questionnaire was split into three parts (see Supplementary File A). Part one (13 questions) pertained to demographics and opinion on menstrual product inclusion into WHSQ Policy and was available to all menstruating and non-menstruating participants. Part two (17 questions) contained questions about menstrual product challenges in the workplace, including psychosocial and physical impacts of menstrual product inaccessibility in the workplace. Part three (8 questions) pertained to whether the preceding two-month menstrual product supply impacted well-being. Parts two and three could only be accessed if participants answered “yes” to if they have ever menstruated during their working life.

The questionnaire used mostly quantitative questions with multiple choice answers, but many questions also allowed a free-typed response, for example, when asked about the emotions experienced when lacking menstrual products at work when required. This hybrid approach was for several reasons: firstly, it allowed results to be analysed quantitatively or qualitatively contingent on the number of participants. Secondly, the hybrid approach made responses easier to categorize and analyse than traditional open-ended questions and interviews. Thirdly, it allowed the questionnaire to be answered by participants online at their own pace and time without the pressure of an interviewer being present. Fourthly, the multiple-choice options prompted memories participants may not have recalled if only asked open-ended questions. Fifthly, the free-type answer options could reveal unique experiences not encompassed by the other multiple choice answer options. Finally, the use of quantitative questions lays the groundwork for further research, where use of the same questionnaire would standardize responses for additional participant pools and allow for uni- or multivariate analysis where sample size permits.

2.5. Data analysis and ethics approval

Proportional analysis was performed in SPSS Statistical Software Suite. Relationship correlations between variables such as age, discomfort discussing menstruation in the workplace, and whether one believed menstrual product provision should be incorporated into workplace policy were not analysed due to low sample size.

Ethical approval and site-specific approval were granted by the Central QLD Hospital and Health Service Human Research Ethics Committee (reference numbers HREC/2023/QCQ/96966 and SSA/2023/QCQ/96966), QLD Health, Australia.

3. Results

3.1. Participant demographics

Participant age, ethnicity and minimum education level are summarised respectively in Fig. 1, Fig. 2A and B and detailed in Table 1. A total of 23 participants (21 menstruating and 2 non-menstruating) completed the questionnaire (see Table 1). “Menstruating workers” were defined as workers who answered “yes” to whether they have ever menstruated during their working life. The 21 menstruating participants represented 72 % of the total female (sex) population of this workforce (data not shown) and menstruating participant ages ranged from 22 to 65 years old (mean 32.9 years old, standard deviation 12.2 years). The two non-menstruating participants represented 22 % of the total male (sex) population in this workforce (data not shown) with a mean age 54.5 years old. There were no discrepancies between disclosed sex and gender identity in any of the 23 participants. Due to the underrepresentation, non-menstruating worker data was excluded. The majority (85.7 %) of menstruating participants possessed at least a tertiary education (certificate or higher) and just under half (47.6 %) possessed at least a bachelor level degree (see Table 1). Eighty-one percent (81.0 %) of menstruating participants were not religious and 85.7 % were Australian (non-First Nation), although 23.8 % had at least one or both parents born overseas.

Fig. 1.

Age distribution of menstruating workers^a in this study.

^a Based on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

Fig. 2.

Ethnicity (A), minimum education level (B) and opinion towards menstrual product incorporation into workplace policy (C) of menstruating workers^a in this study.

^a Based on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

Table 1.

Sociodemographic characteristics of participants.

Characteristics	Mean (years)	SD (years)
Age	35.4	12.3
Male	54.5	–
Female	32.9	12.2
Characteristics	Mean (%)	n
Sex assigned at birth
Female	91.3	21
Male	8.3	2
Intersex	0	0
Current gender identity
Female	91.3	21
Male	8.3	2
Other	0	0
Have you ever menstruated while at your workplace at any time of your life?
Yes	91.3	21
No	8.3	2
Characteristics (menstruating workers onlya)	Mean (%)	n
Education
Bachelor	47.6	10
Certificate	19.0	4
Diploma	14.3	3
Preferred not to specify	9.5	2
High school year 12 or equivalent	4.8	1
Postgraduate Certificate or Diploma	4.8	1
Postgraduate Masters or PhD	0	0
Religious
No	81.0	15
Yes	14.3	3
Preferred not to specify	9.5	2
Unsure	4.8	1
Ethnicityb
Australian (Non-First Nation)	85.7	18
New Zealand Peoples	4.8	1
Central Asian	4.8	1
Preferred not to specify	4.8	1
Australian Aboriginal (First Nation)	0	0
Australian South Sea Islander (First Nation)	0	0
Australian Torres Strait Islander (First Nation)	0	0
Migrant status of participant
Born in Australia	81.0	17
Born overseas	9.5	2
Preferred not to specify	4.8	1
Unsure	0	0
Migrant status of participant's parents
Both parents/guardians born in Australia	61.9	13
One parent/guardian born overseas	14.3	3
Both parents/guardians born overseas	9.5	2
Preferred not to specify	9.5	2
Unsure	4.8	1

SD, standard deviation.

^aBased on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

^bSome response options have been omitted due to 0 % selection by respondents. For full list of possible responses please see Supplementary File A.

3.2. Research question 1: What is the current opinion amongst menstruating workers towards the idea of WHSQ Policy mandating workplace menstrual product supply?

3.2.1. Supply of menstrual products in the workplace is important, but whether this should be mandated in WHSQ Policy is uncertain

Just over half (57.1 %) of menstruating participants thought that menstrual product supply should be mandated through WHSQ Policy, while 19.0 % were unsure and a quarter (23.8 %) disagreed with the notion (see Fig. 2C). All menstruating participants agreed that toilet paper, handwashing facilities and menstrual product disposal bins should continue to be supplied as part of WHSQ Policy (see Table 2). A few participants free-typed reasons for or against menstrual product inclusion into WHSQ Policy (Supplementary File C). Three participants suggested that menstrual hygiene is a personal rather than corporate responsibility. Another participant suggested that workplace menstrual product provision become a shared responsibility by menstruating workers rather than individual or corporate responsibility. On the other hand, two respondents felt menstrual product workplace provision in WHSQ Policy is important for catering the basic biological and hygiene requirements of all employees. Four participants mentioned that workplace menstrual product supply is vital for menstruating workers as an emergency supply, one adding her own experience with irregular menstrual cycles. Another participant pointed out that shift workers cannot always leave the workplace during their shift and therefore menstrual product provision should be the responsibility of the workplace.

Table 2.

Opinion amongst menstruating workers^a on discussing menstruation in the workplace and the idea of WHSQ Policy mandating menstrual products in workplaces.

Opinion	Mean (%)	n
Feel comfortable talking about menstruation in the workplace
No - never	9.5	2
Yes - sometimes	38.1	8
Yes - most of the time	14.3	3
Yes - always	38.1	8
Unsure	0	0
Prefer not to specify	0	0
Feel comfortable when other people in the workplace talk about menstruation
No - never	0	0
Yes - sometimes	14.3	3
Yes - most of the time	42.9	9
Yes - always	33.3	7
Unsure	0	0
Prefer not to specify	0	0
Think that toilet paper, handwashing facilities and menstrual product disposal bins should continue to be mandated in workplace toilets as a part of WHSQ Policy
Yes - toilet paper	100.0	21
Yes - handwashing facilities	100.0	21
Yes - menstrual product disposal bins	100.0	21
Unsure	0	0
Prefer not to specify	0	0
Think that the supply of menstrual products, like toilet paper, should be mandated in workplaces by WHSQ Policy
Yes	57.1	12
No	23.8	5
Unsure	19.0	4
Prefer not to specify	0	0
When participants would use workplace-supplied menstrual productsb
Would often use them during menstruation in the workplace instead of bringing personal supply	27.8	5
Would only use them in an emergency (i.e. unexpected bleeding, ran out/forgot/exceeded personal supply)	61.1	11
Would often use them during menstruation in the workplace and also take some to use at home	0	0
Would not use workplace-supplied menstrual products	11.1	2
Reasons workers would continue to supply their own personal menstrual products at work even if workplace supply mandatedb
If the workplace did not supply their preferred brand/size/type of disposable menstrual product	63.2	12
Prefer to use reusable menstrual products rather than disposable menstrual products	5.3	1
Feelings of guilt for regularly using workplace-supplied menstrual products instead of bringing their own	21.1	4
Feeling unhygienic regularly using workplace-supplied menstrual products instead of bringing their own	5.3	1
Other	15.8	3
Prefer not to specify	0	0

WHSQ, Work Health and Safety Queensland.

^aBased on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

^bTwo participants were excluded from the calculations because they indicated they no longer menstruate (e.g. due to menopause, uterine ablation, hysterectomy, etc.).

3.2.2. Workplace menstrual product supply should include at least tampons and pads for emergency use

When asked what products should hypothetically be supplied in workplaces at a minimum as part of WHSQ Policy, the majority (89.5 %) suggested the minimum supply of regular tampons with at least one other product (data not shown), most commonly with winged regular pads (64.7 %), winged large pads (47.1 %), and/or another tampon size (mini or super) (35.3 % each). Only one participant (5.3 %) suggested a single product (pad - regular, with wings) should be supplied as a minimum (data not shown). Based on the assumption of their proposed minimum workplace supply, more than half (61.1 %) of participants said they would only use workplace-supplied products in an emergency (e.g. unexpected bleeding) and 11.1 % would not use them at all (see Table 2). Reasons for not using them regularly or at all (see Table 2) included workplace omission of personal preferences of types or brands (63.2 %) or feelings of guilt for regularly using workplace-supplied products (21.1 %). One participant's free-typed explanation for not using workplace-supplied products was believing the restocking of the workplace supply would be too unreliable (Supplementary File C.2).

3.3. Research question 2: What challenges are faced by menstruating workers due to a lack of mandated supply of menstrual products in WHSQ Policy?

3.3.1. Menstrual cycle unpredictability is common during working life

Nearly all (90.5 %) of menstruating workers had experienced irregular menstrual cycles at least once during their working life (see Table 3). This means they could not always predict exactly which day they would require menstrual products at work. The most common reasons were losing track of their menstrual cycle (78.9 %) or unknown cause (47.4 %). Irregular menstrual cycles caused by work-related stress or shift work were reported by 31.6 % and 36.38 % of participants respectively. Many fertility, contraceptive or hormonal factors were also reported to cause irregular menstruation at some point during their working life (Table 3).

Table 3.

Menstrual cycle dysregulation, clothing conscientiousness and anxiety amongst menstruating workers^a due to lack of menstrual product supply in the workplace.

Factors causing menstrual cycle unpredictability	Mean (%)	n
Had an irregular menstrual cycle or unexpected bleeding at work
Yes	90.5	19
No	9.5	2
Prefer not to specify	0	0
Had an irregular menstrual cycle or unexpected bleeding at work due tob:
Work-related stress	31.6	6
Stress outside of work	36.8	7
Lost track of when you are due to get your period	78.9	15
Shift work (shifts outside of the hours of 8 am-5 pm)	36.8	7
Polycystic ovary syndrome (PCOS)	21.1	4
Endometriosis	15.8	3
Fertility treatment	10.5	2
Recent childbirth	15.8	3
Recent breastfeeding	5.3	1
Recent miscarriage	10.5	2
The contraceptive pill	36.8	7
The intrauterine (contraceptive) device	10.5	2
The contraceptive subcutaneous implant (“Implanon”)	10.5	2
Perimenopause	15.8	3
Unknown cause	47.4	9
Prefer not to specify	0	0
Clothing choice and incidents during menstruation in the workplace	Mean (%)	n
Purposely worn clothing that contains pockets to work so that you could store menstrual products on your person	47.6	10
Purposely worn clothing to work whose material and/or colour would hide any accidental leaking of menstrual blood	61.9	13
Had blood leak onto your underwear due to untimely access to menstrual products at work	66.7	14
Had blood leak onto the outside of your clothing due to untimely access to menstrual products at work	42.9	9
Had to change a piece of clothing at work due to untimely access to menstrual products at work	23.8	5
None of the above	14.3	3
Prefer not to specify	0	0
Felt uncomfortable transporting menstrual products to the workplace toilet in case somebody sees them
Yes	76.2	16
No	23.8	5
Prefer not to specify	0	0

^aBased on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

^bTwo participants were excluded from the calculations for answering “no” to ever having had an irregular menstrual cycle or unexpected bleeding.

3.3.2. Lack of workplace menstrual product supply in the workplace causes emotional distress

The majority (90.5 %) of participants have lacked immediate access to menstrual products at work when required on at least one occasion (see Table 4). Participants were asked to free-write feelings associated with these incidents (summarised in Fig. 3A and detailed in Supplementary File C.3). No participants described positive emotions, one participant felt neutral emotions, while 94.7 % mentioned negative emotions such as anxious (31.6 %), stressed (26.3 %) and embarrassed (15.8 %). A couple of participants described a lack of menstrual product access at work as a personal failure: “unorganised for not having my own supply” and “as if I was incapable of managing my life properly” (Supplementary File C.3). The most common reasons for lacking menstrual products in the workplace included unexpected bleeding (73.7 %), lacking immediate menstrual products in the toilet cubicle (73.7 %), forgetting to bring menstrual products to work (68.4 %) or needing more products than expected (47.4 %) (see Table 4). A few participants (15.8 %) reported not always being able to afford menstrual products that week. Several methods (see Table 4) were utilised to rectify unexpected bleeding incidents when lacking menstrual product access; most commonly asking close work colleagues for menstrual products (73.7 %) or using toilet paper as a substitute (63.2 %). However, while 84.2 % of participants would feel comfortable doing the former, only 36.8 % would feel comfortable doing the latter (Supplementary File B, Supplementary Table B.3). One participant wrote that she was “scared that toilet paper substitute may not last as long as needed” (data not shown). Approximately half (47.4 %) of participants had to use a method of obtaining menstrual products that they were not comfortable with (see Table 4).

Table 4.

Menstrual product supply challenges by menstruating workers^a in a workplace where menstrual products were not supplied.

Reasons and solutions for menstrual product inaccessibility in the workplace	Mean (%)	n
Had to supply own products in a workplace where menstrual products are not supplied
Yes	100.0	21
No	0.0	0
Prefer not to specify	0	0
Ever lacked access to menstrual products in the workplace when required
Yes	90.5	19
No	9.5	2
Prefer not to specify	0	0
Reasons menstrual products unable to be accessed in the workplace when requiredb
Unexpected bleeding	73.7	14
Forgot to bring some to work that day	68.4	13
Could not afford menstrual products that week	15.8	3
Did not have any menstrual products in the toilet cubicle at the time	73.7	14
Unexpectedly need exceeded supply (e.g. menstruated heavier than expected)	47.4	9
Prefer not to specify	0	0
Emotionsc felt by menstruating workersa when unexpectedly menstrual bleeding at work without immediate access to menstrual products
Positive words	0.0	0
Neutral words	5.3	1
Negative words	94.7	18
Prefer not to specify	0	0
Methods of obtaining menstrual products when menstruating in the workplace due to lack of supply
Had to ask a work colleague (who you consider a close friend) for menstrual products	73.7	14
Had to ask a work colleague (who you do NOT consider a close friend) for menstrual products	26.3	5
Had to ask a family member to bring you menstrual products	10.5	2
Had to ask a partner to bring you menstrual products	15.8	3
Had to ask a friend outside of work to bring you menstrual products	26.3	5
Had to leave work to obtain menstrual products	26.3	5
Had to leave work and take sick leave for the rest of the day	15.8	3
Had to use toilet paper as a substitute	63.2	12
Other	0	0
Prefer not to specify	0	0
Had to source menstrual products in the workplace through method(s) they were not comfortable withd	47.4	9

^aBased on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

^bCalculations only included participants who responded “yes” to whether they ever lacked access to menstrual products in the workplace when required (n = 19).

^cResponse to this question was a free-typed answer only rather than multiple choice. See Supplementary File B Supplementary Table B.2 and Supplementary File C.3 for specific words used.

^dCalculated from the respondents who had not selected the correlating method of obtaining products in the subsequent question “if you ever lacked access to menstrual products during menstruation in a workplace where menstrual products were not provided, which solution would you feel comfortable doing?” (data not shown).

Fig. 3.

Perceptions by menstruating workers^a of their emotions^b, concentration and mental wellbeing without (A, C) and with (B, D) access to workplace-supplied menstrual products.

^a Based on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

^b See Table 4, Table 5 for categorization of specific emotions.

3.3.3. Menstruating workers experience clothing-conscientiousness during menstruation at work

Menstruating workers had negative incidences or anxiety surrounding their appearance during menstruation (see Table 3). During menstruation, most menstruating workers (76.2 %) felt uncomfortable being seen transporting menstrual products. Half (47.6 %) of participants chose to wear workplace clothing that have pockets in which to transport menstrual products. More than half (61.9 %) chose workplace clothing whose colour or material would hide any accidental menstrual blood leakage. Sixty-seven percent (66.7 %) of participants have had menstrual blood leak onto at least their underwear in the workplace due to inadequate menstrual product supply. Nearly half (42.9 %) have had an incident where the menstrual blood has become visible on the outside of their clothes while at work due to a lack of menstrual product access.

3.3.4. Menstruating workers worry about menstrual product inaccessibility at work

Many menstruating workers (71.4 %) worried about running out of menstrual products at work, and nearly half (42.9 %) expressed concern for their fellow menstruating colleagues running out (see Table 5). Over a third of participants felt that worry surrounding menstrual product inaccessibility negatively impacted concentration (38.1 %) or mental well-being (38.1 %) at work (see Fig. 3C).

Table 5.

Worry, concentration and mental well-being amongst menstruating workers^a before and after menstrual product supply in the workplace.

Anxiety surrounding lack of menstrual product access at work	Mean (%)	n
Ever worried about running out of menstrual products at work
Yes	71.4	15
No	28.6	6
Unsure	0	0
Prefer not to specify	0	0
Think that this worry would be reduced if workplaces supplied menstrual products in their toilets
Yes	93.3	14
No	6.7	1
Unsure	1.0	2
Prefer not to specify	0	0
Not applicable - I have never been worried about running out of menstrual products at work	19	4
Worry about menstrual product access at work negatively impacted concentration at work
Yes	38.1	8
No	47.6	10
Unsure	14.3	3
Prefer not to specify	0	0
Worry about menstrual product access at work negatively impacted mental well-being at work
Yes	38.1	8
No	57.1	12
Unsure	4.8	1
Prefer not to specify	0	0
Ever worried about fellow workers running out of menstrual products at work
Yes	42.9	9
No	42.9	9
Unsure	14.3	3
Prefer not to specify	0	0
After the two month supply of menstrual products in the workplace	Mean (%)	n
Noticed the supply of menstrual products during the study period
Yes	95.2	20
No	4.8	1
Unsure	0	0
Prefer not to specify	0	0
Used the menstrual products suppliedb
Yes	66.7	12
No	38.9	7
Prefer not to specify	0	0
Emotions used to describe feelings in response to the menstrual product workplace supplyb
Totals
Positive words	94.1	16
Neutral words	11.8	2
Negative words	0	0
Specific words usedb, c
Positive words
Respected	35.3	6
Relieved	70.6	12
Happy	35.3	6
Reassured	70.6	12
Cared for	5.9	1
Supported	5.9	1
Neutral words
Indifferent	5.9	1
None of the above	5.9	1
Think that concentration improved after supply of menstrual products in the workplaceb
Yes	70.6	12
No	29.4	5
Unsure	23.5	4
Prefer not to specify	0	0
Think that mental well-being improved after supply of menstrual products in the workplaceb
Yes	64.7	11
No	29.4	5
Unsure	29.4	5
Prefer not to specify	0	0

^aBased on answering yes to “Have you ever menstruated while at your workplace at any time of your life?”.

^bThree participants were excluded from the calculations for indicating they longer menstruate (e.g. due to menopause, uterine ablation, hysterectomy, etc.) and one participant was excluded from the calculations for indicating they did not notice the menstrual products supplied in the two-month study period.

^cSome response options have been omitted due to 0 % selection by respondents. Multiple choice options and free type options were available for answering this question. For full list of possible responses please see Supplementary File A.

3.3.5. Not all menstruating workers are comfortable talking about menstruation in the workplace

Discussing menstruation in the workplace was a minor issue (see Table 2). Just over half (52.3 %) of menstruating participants felt comfortable discussing menstruation in the workplace most or all of the time, and the majority (76.1 %) were comfortable most or all of the time if other workers discussed menstruation.

3.4. Research question 3: Is menstruating worker well-being improved through subsequent supply of menstrual products in workplace sanitary facilities?

3.4.1. Improved mental well-being and concentration was perceived in over half of menstruating workers after subsequent workplace menstrual product supply

Four participants were excluded from the analyses post-workplace menstrual product supply, one because they did not notice the supply of menstrual products at the workplace and three because they indicated they no longer menstruate. Of the remaining participants, two-thirds (66.7 %) indicated they used the menstrual products supplied in the two-month study period (see Table 5). Participants who answered “no” to using the menstrual products were not asked to provide a reason. Many (70.6 %) of the participants felt that their concentration at work improved due to the workplace supply of menstrual products, and 64.7 % felt that their mental well-being improved (see Fig. 3D). This reported improvement in mental well-being is also reflected in the increased positive emotional vocabulary of participants post-supply (see Fig. 3B). Most menstruating participants (94.1 %) used positive words to describe the workplace supply of menstrual products, such as reassured (70.6 %) and relieved (70.6 %) (see Table 5). Of the five participants who indicated they did not use the menstrual products during the two-month study period, four still indicated feeling reassured for having them supplied, and three felt that their concentration and mental well-being improved (data not shown). A minority of participants felt no improvement in concentration (29.4 %) or mental well-being (29.4 %) from the menstrual product supply (see Fig. 3D) but two out of six of these respondents did not use the menstrual products supplied (data not shown).

4. Discussion

This exploratory study in a QLD public sector workplace identified workplace challenges consistent with the concept of “blood work” [3] and were similar to those reported in other Australian and overseas (e.g. Spain, UK) research. This included anxiety about menstruating unprepared [3,5,38], anxiety about (or actualisation of) visible clothing leakages [3], work pressures interfering with access [3,4,[38], [39], [40]], unaffordability [4,5], having to use toilet paper as a substitute [3,4] and discomfort discussing menstruation with managers [3,5] or colleagues [3,40]. While physiological factors such as recent pregnancy, perimenopause, or contraceptive use were also identified by participants as stressors to menstrual unpredictability, the most common cause of unexpected menstruation in this study was losing track of their menstrual cycle. Additionally, this research identified menstrual product inaccessibility in the workplace as a psychosocial issue, triggering conscientiousness in work clothing choice to hide menstrual products or bleeding. Conversely, workplace menstrual product provision was perceived to improve concentration or mental well-being for 70.6 % and 64.7 % of menstruating participants respectively, highlighting both individual and collective benefits. The workplace provision also inspired positive feelings of reassurance and relief in nearly all participants. Positive emotions, perceived improved concentration, or perceived well-being were felt even in some participants who did not use the provided products, indicating that the mere presence of workplace-provided menstrual products contributed these benefits.

However, 42.8 % of participants opposed incorporating menstrual products into WHSQ Policy, most commonly due to the belief that the responsibility lies with the individual. This perspective persisted despite concern expressed for fellow menstruating workers, and despite observed benefits in themselves (data not shown). One participant noted, “having the supply in the bathroom has been very handy. I don't think it is [WSHQ Policy] responsibility to supply these products but I wouldn't say no”. Another believed the workplace provision “would be too unreliable”, implying distrust in workplace ability to fulfill policy obligation to supply menstrual products. It was suggested that menstruating workers could unofficially share the responsibility, rendering formal WHSQ Policy unnecessary: “if you are using the products regularly and also helping to restock.” Uncertainty towards menstrual provision in policy was also reported in Spain [4], where some menstruating people were wary that people would take advantage of free menstrual products by re-selling them [4]. Another believed menstrual products should not be provided freely because other essential products are not [4]. In the present study, some participants who supported incorporating menstrual products into WHSQ Policy still reported feelings of guilt if they regularly used workplace menstrual products instead of supplying their own (data not shown), suggesting internalised shame around menstruation. In contrast, all participants supported the mandate of toilet paper, handwashing facilities and menstrual product disposal bins in WHSQ Policy. This suggests a difference in social perception of materials used for menstrual hygiene comparted to those used for urinary or defecatory hygiene.

Supporting menstruating workers through policy is achievable, as demonstrated in this study by workplace menstrual product provision in a QLD public sector workplace. The QLD Government already has precedence for supporting menstruating workers. The QLD Women and Girls' Health Strategy 2032, for instance, aims to advance gender equality by promoting flexible work arrangements, improving workforce culture, leadership opportunities, and offering more generous paid parental leave [41]. Late 2024 saw the rollout of additional 10 days of reproductive health leave days per year for public sector workers [42]. The QLD Government also supports the charity Share The Dignity, which provides menstrual products in state schools, environmental education centres and student residential facilities [17]. In 2024 the Australian Government also pledged $12.5 million over 4 years to provide menstrual products to menstruating people living in remote First Nations communities [43], of which QLD shares a large proportion [44]. While these efforts are vital, they highlight that even a jurisdiction so progressive to gender equality can fail to acknowledge the necessity of menstrual product access in workplaces, echoing a global absence of menstrual products from workplace policy. To date, only Canada [28], Scotland [29] and the Australian Capital Territory [25], have legislated menstrual product provision in workplaces. There are a number of social and logistical barriers that could contribute to ongoing resistance to include menstrual product provision in workplace policy:

4.1. Lack of awareness and research

Recognition of menstrual health as a human right is still in its infancy so workplace policies are still catching up. The WHO acknowledged menstruation as a health issue only three years ago [2] and is not explicitly mentioned in the 2015–2030 UN Sustainable Development Goal targets [45]. Consequently, little research has been conducted to guide policymakers on how to support menstruation and associated gynaecological health conditions in the workplace [7,11,39]. In contrast, extensive research exists on how toilet hygiene is necessary for improved public health [46].

4.2. Economic and legislative barriers

Menstrual products continue to be taxed as luxury items in many jurisdictions, such as a large proportion of the Americas [12]. Menstrual products are essential to health [1] but their taxation as luxury suggest that policymakers perceive them as non-essential. Some low- to middle-income populations, and by extension their workplaces, may lack the ability to purchase menstrual products, either due to geographical location or economic reasons [9,47]. Furthermore, jurisdictions especially in low- and middle-income populations may lack the ability to create and enforce legislation for workplace menstrual product provision and related hygiene [7]. Individual workplaces may need to take initiative to create local policies for supporting menstrual health [7].

4.3. Infrastructural and logistical issues

Private, safe, and clean spaces are essential for the hygienic use and disposal of menstrual products. Workplace sanitary facilities especially in low- to middle-income countries do not always have places to dispose of menstrual products or running water to wash hands and genitals [7,8,47,48]. Progress in sanitation is slowest in the poorest populations [49]. Poor sanitation access is also exacerbated in certain occupations, such as those involving fieldwork [7,40]. Workplace menstrual product provision alone is ineffective in policy without the proper facilities in which to use them. Menstrual products are also available in a variety of types and brands, and preference can vary [4,50]. Some menstruating people may not know how to use certain menstrual products [8,9]. Workplace policy advisors may have difficulty deciding which menstrual products to supply due to varied preferences and available infrastructure.

4.4. Cultural and social barriers

Lack of menstrual product discourse in workplace policy reflects the limited discourse in society. Menstruation is often perceived as a shameful, gendered issue and is not openly discussed [3,4,8]. A study in Uganda found menstruation was perceived as women's responsibility, with failure to hide menstruation in the workplace reflective of a failure of womanhood [48]. Menstrual health issues are disregarded especially in male-dominated workforces [3,38,40] and even healthcare workers can be dismissive of menstrual health discussion [4,8,51]. Menstruating workers in especially low- to middle-income countries may be scared to advocate for menstrual health policies in the workplace for fear of losing their employment [7]. Sometimes it can be culturally inappropriate for men to discuss menstruation, such as in Uganda [48] and in Australian First Nations communities [52], making it difficult to discuss menstrual product supply in mixed-gender workplaces. The gendered and taboo nature of menstrual products has contributed to their inferior consideration compared to other sanitation requirements in the workplace.

Thus, focus on workplace menstrual health is still in its infancy with many social, economic and societal obstacles to inclusion in workplace policy. Regardless, the findings from this study suggest well-being may be improved by menstrual product provision if workplaces have the appropriate infrastructure and means to implement it. Workplace menstrual product provision therefore contributes to the right to a safe and healthy working environment [53,54] and aligns with the 2015 to 2030 United Nations' Sustainable Development Goals [45] target 5.c “Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels.” The global lack of menstrual products in workplace policy are reflective of overarching issues in menstrual health discourse, sanitary infrastructure, workplace equity and menstrual product attainability.

5. Limitations

This study was conducted in only one workplace, and this small population may not represent the beliefs and experiences of other workplaces in Australia or other nations. No statistical tests, beyond proportional statistics, were performed due to the low sample size. There were no male, gender diverse or First Nations participants in this study and socioeconomic circumstances were not considered. Improved well-being was only perceived rather than measured, and impacts of menstrual product provision on concentration and mental well-being could have been bias or placebo. The challenges of menstruation in a workplace without menstrual product supply were only retrospectively captured and may be inaccurate. Physical well-being after workplace menstrual product supply was not measured in this study. For example, whether the two-month workplace menstrual product supply led to a reduction in occurrence of negative experiences such as leaking onto clothing or absenteeism was not measured. Some other physical factors were not investigated, for example participants were not asked if a lack of workplace menstrual product supply had ever led to using menstrual products longer than recommended or if they had experienced genitourinary infection as a result. Financial burden of menstrual products on individual participants was not assessed. While costs and use of menstrual products were tracked in this study, two months is insufficient to estimate the financial burden of the hypothetical mandated menstrual product supply on the workplace.

6. Conclusion

This exploratory study in QLD provides preliminary evidence of the respective positive and negative impacts of including or omitting menstrual products in workplace policy. A lack of menstrual product access led to psychosocial and physical challenges, such as discomfort, distress, anxiety, clothing conscientiousness and difficulty concentrating at work. Losing track of one's menstrual cycle was common. After two months of workplace menstrual product provision, many workers felt relief and believed that their concentration or mental well-being improved. While most participants viewed the provision as beneficial, some opposed the notion of corporate responsibility. Limited research, stigma, sanitary infrastructure issues, cultural or economic concerns are all possible contributors to the global lack of menstrual product consideration in workplace policy. This emphasises the underestimation of menstrual health as a basic human right in workplace health and safety, urging more workplace research on menstrual products and related feminine sanitary infrastructure especially in low-resourced nations. This study was limited by bias and a small sample size. Further research with larger, diverse samples and quantitative methods is needed to clarify the broader benefits of such policies to inform legislative discussions.

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Melissa Judith Chalada: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Writing – original draft, Writing – review & editing.

Declaration of competing interest

Although the author was not a participant of this research project, the author is still a person of a similar demographic to the study population. Namely, they are of an age and sex consistent with a menstruating demographic and is employed in a public sector workplace in QLD. Future incorporation of menstrual products into WHSQ Policy could therefore also advantage the author. Contingencies to avoid bias interpretation were attempted, such as providing participants free-text responses in lieu of or additional to multiple choice options; presentation of all findings including those contrary to the hypotheses of the author, and availability of data to peer reviewers on request.

Glossary

Menstrual product

Hygiene materials used to catch menstrual flow. These can include, but are not limited to, pads that line the underwear, tampons inserted into the vaginal opening, or cups (usually made of silicone) inserted into the vaginal opening. Menstrual products may be available in reusable or disposable forms.

Menstruating workers

Employees who have ever experienced menstrual bleeding while at their workplace at any time of their life.

Appendix A. Supplementary data

Supplementary material 1: Supplementary File A: Questionnaire

Supplementary material 2: Supplementary File B: Supplementary tables

Supplementary material 3: Supplementary File C: Free-typed answers

Data availability

Although names, dates-of-birth or other formal identifiers were not obtained in this study, in extenuating circumstances the participant identities may still be guessed through demographical information such as sex, ethnicity, education status and religion due to the small sample size. As part of the conditions of ethics approval, raw data will therefore not be freely available. Data may be requested during the peer review process if necessary. Peer reviewers are required to maintain confidentiality and must not disclose the content of any material under review. This data may be provided by the principal investigator to future research if proof of ethics approval has been obtained. In this circumstance, data will only be provided about participants who answered “yes” to the question, “do you give permission for data to be used in future research in which confidentiality has been assured and research ethics approval has been obtained?” If no good reason is provided for obtaining the data, the request for the data will be denied by the principal investigator.