State Funding and Period Product Access in Missouri Schools: A Statewide Study of Lead School Nurses

Period poverty is increasingly recognized as a public health equity issue, yet limited research has examined the implementation of school-based menstrual health and hygiene programs in the United States. This study investigates Missouri school nurses' perceptions of state government funding for menstrual hygiene products, availability of products in schools, and students' needs related to period poverty. Using a cross-sectional, quantitative design, an electronic survey was emailed to lead school nurses in Missouri public and charter schools from February to March 2024. Those who serve students in fourth grade or higher were included in analyses. The survey assessed awareness of state funding, menstrual hygiene products in schools, and nurses' perceptions of students experiencing period product insecurity. Chi-square tests and logistic regression models examined associations between district-level characteristics and reported outcomes. Among 243 school nurses who responded and served fourth grade or higher, nearly all (92%) were aware of the state's grant program. 59% reported knowing students who struggle to afford menstrual products, and 12% said their school experienced product stockouts during the current academic year. Adjusting for district size and race/ethnicity, as the district's percentage of students eligible for free or reduced lunch increases, nurses were significantly more likely to report students facing difficulties accessing period products. Findings highlight critical gaps in menstrual product availability and policy implementation from nurses' perspective. Strengthening communication, standardizing distribution practices, and ensuring sustainable funding are essential to advance menstrual equity in schools. Future research should evaluate the long-term outcomes of state-funded menstrual health and hygiene programs.