Occupational justice in action: A school-based menstruation education program

Menstruation affects approximately 800 million people worldwide starting, on average, at 12.5 years of age (Lacroix et al., 2023; Wilbur et al., 2019). That equates to about 2,100 menstruation days per person during their lifetime (Menstrual Health and Occupational Therapy, n.d.). Although a global push exists to address challenges related to menstruation, one notable gap surrounds menstruation among school-aged adolescents in low-income areas in the United States (U.S.) (American Civil Liberties Union and Period Equity, 2019). Research shows that students in the U.S., especially in urban areas, experience occupational disruption related to menstrual challenges and period poverty, meaning lack of access to products. Such menstruation-related barriers to occupational engagement include school absenteeism, decreased participation in school extracurricular activities, increased anxiety about menstruating, and decreased self-esteem (Kuhlmann et al., 2021; Schmitt et al., 2021). Research has shown that Black, Indigenous, and People of Color (BIPOC) students often have less education and preparedness regarding menstruation than their White peers, leading to negatives experiences (Schmitt et al., 2021). One study found that nearly 25% of students experience a lack of access to period products (Broster, 2021). These examples of occupational injustice demonstrate the restrictions on students’ ability to engage in meaningful occupations and the need for school-based occupational therapy practitioners (OTPs) to address the problem.

Considering that menstrual hygiene is an ADL, and the research showing the impact of menstruation on participation and performance at school, OTPs are qualified and equipped to put occupational justice in action to address this issue. School-based OTPs support engagement and participation in daily occupations at school such as ADLs, IADLs, education, work, play, leisure, rest and sleep, and social participation (American Occupational Therapy Association [AOTA], 2017, 2020). School OTPs can facilitate practical education and application through skilled and targeted interventions focused on everyday living and meaningful activity (AOTA, 2020; Russel et al., 2022). The Every Student Succeeds Act (ESSA) of 2015 designates OTPs as specialized instructional support personnel (SISP) and describes them as “health care professionals who help children and youth participate in a range of occupations throughout the day to promote function, health (mental & physical), and quality of life” (Bazyk et al., 2022, p. 1). This includes intervention and supports using a multitiered approach: universal school-wide/classroom-wide (Tier I), at-risk small group (Tier II), and individual (Tier III) students with a special education plan (Bazyk et al., 2022; ESSA, 2015).