From Mandate to Maintenance: Quantifying the association between menstrual product availability and school attendance.

OBJECTIVE: Period poverty affects one-third of menstruating girls in high-income countries and is associated with toxic shock syndrome, psychosocial distress, and educational absenteeism. We conducted the first evaluation of implementation fidelity for a school-based menstrual equity policy and its association with student-reported health and attendance outcomes in a rural Ontario school board. METHODS: A cross-sectional analysis of a subsample of the Time 1 2025 Health and Peer Relations Study was conducted. Girls in Grades 5-12 who had reached menarche (N = 863) reported on dispenser stocking frequency and policy benefits (attendance, extracurricular participation, well-being, and financial relief). We used binary logistic regression to estimate adjusted odds ratios (aOR) and calculated the unadjusted absolute risk difference (ARD). RESULTS: Menstruation-related school disruption was common, with 57.1% reporting at least one form of absenteeism. Only 33.1% of students reported that dispensers were reliably stocked; middle school students reported that dispensers were never stocked significantly more often than secondary school students (29.7% vs. 10.5%). Reliable stocking was associated with nearly triple the odds of improved school attendance (aOR = 2.69, 95% CI 1.91-3.78) and overall well-being (aOR = 3.13, 95% CI 2.20-4.45). Reliable access corresponded to a 22.6 percentage-point ARD for school attendance. BIPOC students were significantly more likely to report financial relief than white students (31.3% vs. 19.5%). CONCLUSION: Legislative mandates for free products do not ensure health equity if implementation, specifically stocking reliability, is inconsistent. Reliable access to menstrual products in schools represents a primary healthcare intervention that significantly reduces the burden of menstruation-related disruption, including school absenteeism.