A topic that for so long was rarely discussed above a whisper has recently been taken up by growing numbers of lawmakers.
Spurred by grass-roots activism aimed at lifting the stigma surrounding menstruation, the lawmakers are proposing measures to provide broad access to menstrual products for women. Their efforts include exempting tampons and pads from state and local taxes, compelling prisons to stop charging inmates for the supplies and making them available for free at public schools and workplaces.
"It's outrageous that something that is a basic health need should be denied women," said Sen. Cory Booker, D-N.J., who co-sponsored a bill last month with Sens. Elizabeth Warren, D-Mass., Richard Durbin, D-Ill., and Kamala Harris, D-Calif., that would require free access to menstrual products as part of a proposal to promote basic rights for incarcerated women.
"It's something that needs to be talked about. People should not be shy about putting it right up front," Booker said in an interview.
The most far-reaching legislative push has been to eliminate the sales tax on tampons and pads. Sometimes labeled the "pink tax" or "period penalty," the tax on menstrual products has been called unfair. Many say the items should be deemed essential, like food and medicine, and similarly exempted. Since 2016, two dozen of the 40 states that tax menstrual products have introduced legislation to eliminate the tax.
Four states - New York, Illinois, Connecticut and Florida - ultimately approved sales-tax exemptions, along with the cities of Chicago and Washington. But although D.C. Mayor Muriel Bowser, D, signed the bill, the budget the council approved did not include funding to cover the $3.3 million price tag, so the tax remains. In Virginia, a bill that would have eliminated the tax died in subcommittee this year. Maryland does not tax tampons.
Opponents of tax-exemption laws say they are often unwarranted and impractical.
Hygiene products are not life-sustaining in the way that food or medicine is, they say. And repealing the tax has an impact on state and local revenues, which help fund programs that serve poor families.
It's better to keep exceptions at an absolute minimum, D.C. Council Chairman Phil Mendelson, D, said. "We can find good reasons for exempting a lot of different types of goods and services," he said in a statement.
The grass-roots movement for "menstrual equity" is being fueled by thousands of women who are intimately familiar with the anxiety and embarrassment that comes from not having a tampon or pad when they need one.
"Women get it. They just get it," said Dana Marlowe, an IT consultant in Wheaton, Maryland, who founded a nonprofit called Support the Girls that distributes menstrual products and bras to homeless women.
Marlowe and other activists are also pushing to make the products easily available to other poor women and to girls in public schools.
What Marlowe refers to as the "mountain of maxipads" in her house started with a simple Facebook post, but women everywhere were quick to respond, she said. The pads, tampons and bras have come from as far away as Japan and the Netherlands and are delivered in small bags from neighbors or by the truckload from Procter & Gamble.
In July, Marlowe and volunteers delivered a minivan full of products, including more than 21,000 tampons and 1,500 pads, to Martha's Table, a nonprofit that provides food and other items and services to the needy, including free clothing and hygiene products.
In Virginia, Holly Seibold started an organization called BRAWS that supplies dozens of area shelters with menstrual products and newly purchased bras. The former teacher from Vienna and her volunteers also deliver menstrual products to about 140 school-age girls each month in shelters or schools in northern Virginia and the District because she learned some girls skip school when they have their periods.
Seibold said girls who are homeless often can't afford the products and are embarrassed to ask for them.
Terrionna Thomas, a rising senior at Roosevelt STAY, an alternative high school in the District, said she found herself questioning whether to go to school one day when her supply of sanitary pads was low and she was not sure she could make it through the day.
There is no full-time nurse, and the tampon dispensers always seem to be empty, she said. A security guard has been known to keep extra pads on hand. "But what if she's not there?" she thought. "It's not her responsibility to be supplying pads to the school."
At many schools and colleges, students are agitating for change. A "Free the Tampons" campaign has led several universities, including American University in the District, to begin stocking women's restrooms with free products.
At School Without Walls, a high school in the District, a Planned Parenthood club started supplying a bin in the girls' bathroom with a variety of free products last semester, said Janiya Proctor, 17, who just graduated.
"When I saw that, I wanted to applaud," she said.
Influenced by such activism, some lawmakers say that menstrual products are a necessity that should be stocked in bathrooms like toilet paper. The New York City Council last year passed first-of-its-kind legislation making menstrual products freely available in public schools, shelters and jails. Colorado lawmakers approved a plan to provide free tampons and pads to inmates.
In February, U.S. Rep. Grace Meng, D-N.Y., introduced the Menstrual Equity for All Act, which would, among other things, direct large companies to offer free products in workplace restrooms. It would also require state prisons that receive certain federal grants to provide free menstrual products.
"When I first started talking about this issue, you could see a lot of men - and some women - were uncomfortable. But the climate is changing. There is more openness," Meng said.
The effect of this activism has been slower to show up in jails and prisons, in part because they rarely accept donations and the public looks less sympathetically on the needs of incarcerated women, said Jennifer Weiss-Wolf, a leading activist in the movement and author of the forthcoming book "Periods Gone Public."
But she said female inmates, the majority of whom are mothers sentenced for nonviolent crimes, are caught in a system that was designed for men and does not take their physical needs into account.
A 2015 report from the Correctional Association of New York found that 54 percent of women surveyed in state prisons said they did not get enough sanitary pads each month.
Women who needed more than their allotment had to request a medical permit, the report said. One facility required women to collect a bag full of their used sanitary napkins to prove they needed more.
There is little consistency across the criminal justice system when it comes to menstrual hygiene. Some jails provide pads that women can help themselves to as needed; many do not. A policy document for the federal Bureau of Prisons simply says, "Products for female hygiene needs shall be available."
Andrea James, executive director of the National Council for Incarcerated and Formerly Incarcerated Women and Girls, served time in a federal prison in Danbury, Connecticut, where, she said, a crate full of "tiny sanitary napkins" was kept on the bathroom floor.
A tampon or something more absorbent could be purchased at the commissary, but that was not an option for many woman earning 12 cents an hour and counting out pennies to be able to call home, something that the Senate bill Booker co-sponsored also addresses.
Ashley Palmer, 24, who was recently released from the Northwestern Regional Adult Detention Center in Winchester, Virginia, said incarcerated women are often forced to fashion tampons out of sanitary pads.
"Ingenious," she recalled thinking when she made her first tampon.
But she soon learned that her resourcefulness would have to extend far beyond that. Corrections officers didn't always respond to requests in time, so she and her fellow inmates learned to improvise with anything they could find, including socks.
"Nobody cares," she said. "They don't care."
Palmer was released from the Winchester center this month and moved into Friends of Guest House, a reentry program for women in Alexandria.
A few days later, Seibold came by the house with a donation of menstrual products and underwear. She stacked boxes of tampons and an assortment of pads high on the dining room table and told the women to take whatever they wanted.
Palmer could not believe her luck.
"It's like period Christmas in here," she said.