Title: “I stretch them out as long as possible:” U.S. women’s experiences of menstrual product
insecurity during the COVID-19 pandemic
Version: 2 Date: 25 Jan 2023
Reviewer's report:
The topic of this research is timely and important.  The author reference findings gender
inequalities related to the recent pandemic including women’s economic insecurity and
decreases in overall well-being.  In order to understand those findings more fully, the researchers
designed their study to investigate the potential impact of menstrual health experiences as
potential contributing factors that could impact the pandemic gender-related inequalities for
cisgender women. The authors are careful to note that their work is focused on “cisgendered
women who experience the process of menstruation, while acknowledging that not all
women menstruate, and that menstruation is experienced by a broader expanse of gender
identities” (p.3).  That said, not only is their work is an important starting place to consider the
role of menstrual experiences in gender-related inequalities in the context of the recent pandemic
crisis, it may hold insight for ameliorating these inequalities in future economic and health crises.
Background/Introduction:
The authors should be commended for providing ample references to underline key points in
both the Background and the Discussion.  References in the Introduction provide additional
information about women’s economic hardship during the pandemic,  menstrual health and
management, product insecurity, prepandemic “period poverty” in the U.S especially among
low-income women., and menstrual stigma. All of this detail serves to underscore the importance
of considering menstrual health and management as an important factor in understanding
pandemic-related gender inequalities.  Additionally, research presented in the discussion
revealing women’s experiences of period insecurity during the Covid-19 pandemic and reinforce
the authors’ later recommendation that menstrual products be considered as “essential items”
during an economic crisis (let alone a health crisis).
Methodology/Results:
In the Methodology section., the authors clearly describe these data as derived from a sub
sample from a larger study.  Sampling and requirement are clearly described, including the
care to include participants who reported low income, reduced income and difficulty affording
menstrual products, or having to use makeshift materials during the pandemic. Data collection
was clearly described.
A significant stumbling block for me is that although the data analysis section references a
specific text condensation method, it is not enough to name the method used and provide a
reader with references.  Much more is needed in this section to describe how initial codes were
derived from these data.  More description of a focus on apriori codes derived from the literature
(which should be detailed), and/or in vivo codes from the research data, should be detailed.
How codes were combined into overarching themes should also be detailed. Finally, there is no
information provided about how disagreements, if any, between coders (or in theme derivation)
were resolved.
This lack of detail is further problematic to me in how the results are reported.  While three
themes are described, it is not clear how many responses indicate aspects of each theme.  For
example, the words “many” or “almost all” are used, but no real “numbers” relating to responses
within themes are provided. Is one theme more prominent than another?  Is one category of
response within a theme carrying more of the theme?  Does that matter?   Because of the richness
of detail in the Results section (and its importance), I hope the authors can provide further detail
about how the themes were derived and what the prevalence of items was within the themes.
That said, descriptions of the themes’ content and inclusion of examples from participants was
exemplary.
Discussion/Conclusion
These sections (as with all others) are well written and provide a convincing basis  for taking
women’s menstrual health and management issues into account, especially during economic
or health crises.  As mentioned above, addition research is cited in the Discussion to augment
the importance of the findings of this study.  Especially effective is that authors make three
recommendations supported by their findings:  1)  expanded research on the impact of menstrual
product insecurity, in the lives of those who menstruate, broadly considered; 2) reframing
menstrual products as “essential items” (and not only during economic and health crises but also
in everyday life; and 3) increased national attention to menstrual stigma as detrimental to the
well being of those who menstruate.
In sum,  This manuscript is well written, well referenced and addresses an important topic.  Its
only flaw is the lack of detail in describing how the data analysis was done.  With that major (to
me) revision, this manuscript will be ready for publication.