In the fight for gender equality, add this to the fray: Abolishing sales taxes on feminine care products. Several states are considering legislation that would abolish the so-called tampon tax. Knowledge at Wharton recently spoke to two experts to discuss the issue and its implications for women’s health: Jennifer Weiss-Wolf, vice president for development at New York University’s Brennan Center for Justice, and Chris Bobel, associate professor of women’s and gender studies at the University of Massachusetts, Boston.

Knowledge at Wharton: How did this tax get started in the first place?

Jennifer Weiss-Wolf: To be clear, it’s not a special tax. People use the term luxury tax, and that is a riff on the European Union’s definition of value-added taxes on nonessential luxury items. Here in the United States, it’s the same sales tax that’s applied to all kinds of other items. The argument here is that tampons and menstrual products should be exempt from sales tax as a medical necessity and a matter of equity and fairness.

Knowledge at Wharton: It’s something that women use consistently and need as a part of their lives.

Weiss-Wolf: It’s absolutely needed just to function normally and regularly and be productive in society. But it’s true, too, that it’s a medical necessity. Not using these products causes infections. It’s not necessarily healthy for women.

Knowledge at Wharton: Is this a version of gender bias because these taxes have been in place for such a long time and have not been addressed?

Chris Bobel: I think it’s a reflection of the socially mandated invisibility of menstruation. We socialize each other to keep it quiet and hidden, so it doesn’t surprise me that this tax has not been challenged until recently because it’s typical of how we regard the bodily process in all sorts of ways. We just don’t take menstruation very seriously, although more than half the population globally faces it on a monthly basis for about 40 years of their lives. It’s kind of a paradox that menstruation is sort of everywhere and nowhere, so it’s exciting that finally people are tuning into this and saying, “Hey, wait a minute.” It’s probably not just that women are singled out in a way, paying a tax on a product that is a necessity.

“I think it’s a reflection of the socially mandated invisibility of menstruation.”–Chris Bobel

Knowledge at Wharton: This is a subject that needs to be brought forward and discussed, and it really hasn’t been.

Bobel: Right. When we don’t talk about our bodies, then we make it possible to not pay attention to when things aren’t working out. If we don’t educate each other and talk openly about menstruation, then anomalies of the menstrual cycle, including ovulatory anomalies, we are not noticing them and not providing information and resources and support to people. Menstrual silence and invisibility can really undermine health, in addition to making people feel badly about themselves and perpetuating shame. There really can be serious health consequences when we don’t pay attention to this natural and regular bodily occurrence.

Knowledge at Wharton: President Barack Obama was asked about this tax  in a press briefing and said part of the reason these taxes were put into place was that pretty much all of the representation was by men, so there wasn’t much of a correlation back when these taxes started to pop up.

Weiss-Wolf: Exactly, and it was a right on and brilliant answer. He was asked the question by a 26-year-old YouTuber who boldly posed the question to him. The response, that “this is what happens when women aren’t at the decision-making table, when women aren’t fairly represented in our democracy,” is right on the money, literally. Chris’ comment about the invisibility of menstruation, even though it’s sort of there and part of the lives of half the population, it’s that same invisibility in our democracy.

Knowledge at Wharton: There are several states looking at repealing a tax on tampons. How far along are those discussions in terms of bringing that legislation forward?

Weiss-Wolf: It varies by state. I and other activists put forward a national petition challenging all 40 of the states that impose the sales tax to cease from doing so, and Cosmopolitan magazine co-sponsored that petition. We put it up in October 2015, and at the start of the 2016 legislative session we saw real progress and action starting to happen.

California was the first state to put forward such legislation in this session, and seven states have followed, including Michigan, Wisconsin, Virginia, Utah. New York and Connecticut then reintroduced legislation that had arisen in the 2015 legislative session. South Carolina, Tennessee and Illinois are debating the issue now in committee and within their legislatures, though legislation has not yet been introduced.

It looks like New York might be the farthest along. It passed unanimously in the General Assembly and is headed for the Senate, where it has Republican sponsor. I should add that almost all these bills have bipartisan support, and the Republican sponsor and the Republican majority leader of the New York State Senate have indicated that there is support for this bill in the Senate. We’re hopeful that it will pass. The governor has indicated he will sign it.

I should also add that New York City introduced a five-piece package of legislation also focused on menstruation and menstrual equity. It’s a holistic and broad-reaching package of legislation that would mandate the provision of free tampons and pads in all of the cities public schools, corrections facilities and shelters. The other two pieces of legislation that were part of that package or resolution directed towards the state is to eliminate the tampon tax and include these products in their provision of food stamps and WIC benefits. What New York City did is very far-reaching, very exciting and, hopefully, will spur the sales tax legislation to advance successfully in New York.

“The sales tax discussion has elevated the entire public discussion around menstruation and the fairness of our policies.”–Jennifer Weiss-Wolf

Knowledge at Wharton: The other aspect to this story is the financial side and the potential savings that could be there for women, especially for low-income families. When you’re talking about sales tax in a lot of states, that could be 6% to 7% on a particular item, that does add up over the course of a year.

Weiss-Wolf: Every penny counts, especially for families that are struggling or have more than one person who menstruates in their household. For sure, the sales tax repeal would have real consequences and real impact on people’s lives. But I think equally important, the sales tax discussion has elevated the entire public discussion around menstruation and around the fairness of our policies and what we want to see on the part of our government and our society in terms of supporting women so they can be fully productive in school, in class and everywhere they are present. If an investment like tampons and pads on the part of, for example, our Department of Education here in New York City will improve the educational outcome of half of its students, it’s a worthwhile proposal.

Knowledge at Wharton: A lot of people probably don’t associate the mental-health benefit that could be there for young women, especially in a case of school systems.

Bobel: Beyond the financial implications, which are not trivial, there is the sort of emotional consequences of feeling secure, feeling that you have access to resources to take care of your body, not worrying about leaking, not worrying about how I am going to pay for the next box of pads or tampons. Those are subtle kinds of distractions, but when it’s your body, it’s profound. I think, as Jennifer rightly points out, this is part and parcel of an entire movement that’s trying to raise awareness around the reality of menstruation, trying to de-stigmatize it and to have plain-talk conversations about this biological process that does impact only female bodies.

It’s an exciting moment that we’re actually talking about periods openly in lots of spheres, where there’s legislation that’s been reintroduced to mandate the National Institutes of Health to allocate resources for independent testing of menstrual care products. If that got some traction in Congress, wouldn’t that be exciting?

Knowledge at Wharton: How do you expand that conversation?

Bobel: It has to happen simultaneously in lots of different contexts, certainly the schools. Right now, we do have menstrual health education schools, but it’s owned by fem-care companies such as Proctor & Gamble and Johnson & Johnson that provide free curricula and materials to educators. That’s OK, but it would be better if we had it built into more than one place in the curriculum and it wasn’t tied to a corporate agenda.

Families certainly need to be empowered and supported to talk about these issues, and not just moms and daughters but fathers and daughters so that it’s not just a women’s issue, because we all have a stake in healthy bodies and healthy lives. It’s great to see it playing out in the media beyond just menstruation as a punch line or as a vehicle for comedy, but an honest conversation about options to care for our bodies, implications of caring for them in positive ways. The Canadians and the sitcom writers have been the only voices, and it’s great to see more people talking about it, including health educators who interestingly have neglected this issue historically. It doesn’t show up in reproductive health care agendas. It doesn’t show up on feminist healthcare agenda, which has been sort of an odd silence, but it’s starting to shift.

Weiss-Wolf: I would add that creative, bold and often female policy makers and lawmakers are a huge asset and driving force in advancing this agenda right now. In addition to the municipal agenda put forth by Julissa Ferreras-Copeland and other leaders in the New York City Council, there are legislators at the state and municipal level across the country who are implementing and trying to advance similar legislation.

U.S. Congresswoman Grace Meng, who is also from New York, has introduced a bill that would reclassify the IRS tax code status of menstrual products so they could be included in our flexible spending account allowances. Currently, the way they are classified in the tax code makes them exempt from FSA allowances. That is a simple fix that would provide cost savings and accessibility for millions. She also was able, in a very simple way through one of the committees that she sits on for homeland security, to add these products to the list that FEMA funding could be used to purchase on the part of emergency shelters.

Knowledge at Wharton: There are so many women out there who don’t have a flexible spending account with the company they work for, so they would need another option.

Bobel: Jennifer’s right. It’s one way, but it’s not the only way. There has to be a lot of different approaches in order to address a lot of different people’s realities. Bodies come in all shapes and sizes and different income brackets and different accesses to different kinds of resources, so it wouldn’t be a silver bullet, for sure.

“Real menstrual equity and menstrual equity policy goes much, much deeper than the roughly 8 cents on the dollar that we’re paying for our tampons.”–Jennifer Weiss-Wolf

Knowledge at Wharton: Do you think it’s a better approach do this at the federal level rather than working state by state? At the federal level, it may take less time to get this changed.

Bobel: There are different reforms that are going to achieve different outcomes. Taking on the sales tax question, for example, is a state question. The taxes are levied by the states, and there’s not a federal avenue to take there. But again, the kinds of reforms like Congresswoman Meng has introduced are one idea for federal reform, and there are others. Our food stamps program is probably in need of all kinds of overhaul, and including these products in federal benefits programs that are largely used by women and women-led families would be an excellent federal avenue to pursue.

I think what’s really neat and exciting about taking on menstrual advocacy is that there are solutions at the community level, at the city level, at the state level and at the federal level. It’s time-consuming to take them all on. Like Chris said, there is not going to be a silver bullet for meeting the needs of half of our population who have different income brackets, different realities, different everything, but the idea that solutions exist in so many different avenues of our society that people are willing to take on this issue and explore them is about as promising an advancement as I can imagine.

Knowledge at Wharton: The hope then is to see some of these states pass this legislation at some point during the course of this legislative year? Once you get it passed in a handful of states, then other states will jump onboard?

Weiss-Wolf: Yes, it becomes a little bit more inevitable. I will be thrilled to see this tax lifted in all 40 states, but that’s just the beginning. Real menstrual equity and menstrual equity policy goes much, much deeper than the roughly 8 cents on the dollar that we’re paying for our tampons.

Bobel: I agree completely. It’s pushing the boulder up the hill, and I think it’s smart, strategically speaking from a social movement perspective, to focus on the cost piece because that really resonates for people.

It’s a little harder to talk about menstrual discourse or menstrual conversation or shutting the shame or challenging the stigma. But when you actually put [it in terms of] 8 cents, people will listen to that. I think it’s an important sort of wedge and opens up a whole range of possibilities to reform all the kinds of ways that menstruation impacts our lives and the ways that we manage it currently quite dysfunctionally.