Free Menstrual Product Dispensers in a Community Health System: A Quality Improvement Pilot for Menstrual Health Equity

Introduction

Menstrual health is increasingly recognized as an essential component of health equity and patient-centered care.⁵ Period poverty, defined as the inability to afford menstrual products, burdens nearly two-thirds of low-income menstruators in the United States.¹ Further, this disproportionately affects lower-income patients and people of color.²

This discrepancy is significant, leading to missed days from school or work, reduced participation in daily activities, and increased stress, shame, and embarrassment.³ Additionally, period poverty poses significant health risks, including increased rates of reproductive tract infections due to the use of unsafe alternatives, serious sequelae such as decreased fertility, and worsened self-esteem.⁴

Hospitals serve as critical community access points, and are uniquely positioned to address basic hygiene needs. While products such as toilet paper, soap, and paper towels are routinely provided, menstrual products are often unavailable despite being similarly essential for many patients and visitors.⁶

Providing free menstrual products may represent a simple intervention capable of improving patient dignity, comfort, and overall healthcare experience. Recognizing this opportunity, we implemented a quality improvement pilot within a community health system to evaluate the feasibility, utilization, and sustainability of providing free menstrual products through in-stall dispensers in hospital and community clinic bathrooms.

Methods

Setting

This quality improvement initiative was conducted within the Nuvance Health system at:

• Danbury Hospital
• Danbury Community Health Center
• Norwalk Hospital
• Norwalk Community Health Center

Bathrooms were selected based on patient and visitor traffic volume, accessibility, and operational feasibility. These facilities primarily serve diverse, lower-income urban populations, making them particularly relevant sites for a menstrual equity intervention.

Intervention

Free menstrual product dispensers supplied by the partner vendor, Egal Pads, were installed in select public-facing bathrooms. Dispensers provided menstrual pads in a “tear-off” fashion, similar to toilet paper, to decrease stigma associated with menstrual products that is not typically associated with other bathroom hygiene products. These pads were supplied within stalls, at no cost to users. Facilities personnel incorporated dispenser maintenance and product restocking into existing workflows. Initial installation and setup were coordinated in partnership with the vendor.

Study Design

This project was designed as a quality improvement initiative using Plan-Do-Study-Act (PDSA) methodology.

• Plan: Identify implementation sites, obtain stakeholder approval, establish restocking procedures, and define evaluation metrics.
• Do: Install dispensers and begin product distribution.
• Study: Monitor utilization patterns, refill frequency, operational burden, and stakeholder feedback.
• Act: Develop recommendations for sustainability and future expansion.

Measures

Primary Measures

• Number of products distributed: The number of pads per refill, and the total number of refills, acted as a measurement of product inventory and therefore total product usage. These measures demonstrated notable usage in the first three months of this pilot, with refills being required even prior to the conclusion of the initial pilot period.
• Refill frequency: The frequency with which pad dispensers required restocking, including in which locations, served as a measure of rate of product usage. Refills were ultimately needed in all dispensers by the end of the three-month pilot period, but were more quickly needed in busier and smaller hospitals (namely, Norwalk Hospital was first to require dispenser refills). This may guide future re-ordering patterns when considering which sites have the greatest bathroom foot traffic and thereby most significant need.
• Operational feasibility: The timeliness of workflow integration of re-ordering products by facilities staff, and regularity of updating the refill log, acted as measurements of operational feasibility at the implementation level. The initial integration demonstrated challenges, namely of incorporating a new product into the pre-existing ordering system, and ensuring that the financial cost could be adequately and consistently covered by supporting parties. Once the system was integrated, however, it allowed for a seamless pathway to maintaining stocked dispensers consistently.
• Maintenance burden: The self-reported time and perceived effort per facilities staff in re-ordering and refilling dispensers acted as a measure of the burden this project may place on maintenance staff. As discussed above, initial challenges included incorporating a new product with a unique makeup, cost, and source vendor into the pre-existing ordering system, however once this system was fully integrated, re-stocking was straightforward and accessible for maintenance staff.

Secondary Measures

• Patient and visitor feedback
• Staff feedback
• Cost per product distributed
• Projected annual operating costs

Data Collection

Utilization data were collected through facility supply records and refill communications. Due to variability in real-time inventory tracking during the pilot, utilization figures represent retrospective estimates derived from supply orders, restocking communications, and facilities logs.

Variables included:

• Number of refill events
• Quantity of products distributed
• Time between refills
• Site-specific utilization rates

Anonymous user feedback was collected through optional QR codes in the bathroom stalls containing dispensers, which linked to surveys that assessed respondent’s perception of the intervention.

Analysis

Descriptive statistics were used to summarize utilization patterns, refill frequency, and feedback responses.

Results

Implementation Outcomes

A total of 40 dispensers were installed across four facilities. This pilot operated from March of 2026 through June 2026. While this report focuses on observations and data from this pilot period, the initiative remains active at these sites, with plans for continued sustainability and future expansion.

Utilization

During the study period:

• Total menstrual products distributed: 8,600
• Average products distributed per month: 2,866

Feedback

Feedback was collected from users via optional anonymous QR code surveys. Key themes included improved accessibility, appreciation for free availability, and positive perceived impact on patient experience. Overall responses were unanimously positive; constructive feedback centered on suggestions for expansion of the initiative.

Discussion

This quality improvement initiative demonstrated that providing free menstrual products in healthcare settings is operationally feasible and highly aligned with the principles of patient-centered care. Similar to other hygiene products routinely supplied in healthcare facilities, menstrual products meet a basic physiological need and contribute to patient comfort and dignity.

Our findings are consistent with existing literature demonstrating that healthcare institutions are well-positioned to address social determinants of health as a frequent point of care for many patients.⁸ Menstrual product insecurity frequently intersects with economic hardship and other health inequities, making healthcare-based interventions particularly relevant for the populations these facilities serve.²

Our results suggest that utilization was sufficient to justify continued availability, while operational burden remained manageable upon successful integration into existing facilities workflows. Importantly, implementation of this project required relatively modest financial investment compared with other patient-experience initiatives.

Several lessons emerged during implementation. First, informal observation suggested that restroom location influenced utilization, with high-traffic public areas appearing to demonstrate greater product use. Second, partnership with both facilities staff and the product vendor (Egal Pads) was essential to sustainability, and early coordination enabled smoother integration into existing restocking workflows. Finally, stakeholder engagement early in the planning process facilitated ongoing institutional support.

Limitations

Several limitations should be considered. This pilot was conducted within a limited number of facilities and may not be generalizable to all healthcare settings. Utilization data were reconstructed retrospectively from supply communications and restocking records rather than through prospective systematic logging, which introduces the possibility of estimation error. Additionally, participation in feedback collection was voluntary, introducing the possibility of response bias. The three-month pilot duration may also not capture seasonal variation in utilization patterns. Finally, bathroom site selection was based on operational feasibility and may not represent the highest-need locations.

Future Directions

Future efforts should evaluate long-term sustainability, expansion across additional healthcare facilities, and integration into broader health equity initiatives. Additional work may explore patient-reported outcomes, rigorous cost-effectiveness analyses, and implementation in rural or resource-limited healthcare settings. Prospective data collection methods should be implemented in future pilots to improve data quality and comparability.

Conclusion

The provision of free menstrual products through in-stall restroom dispensers represents a feasible, cost-effective intervention that improves access to essential hygiene products in the healthcare setting. This initiative offers a practical model for advancing menstrual equity and patient dignity, while supporting institutional commitments to health equity and patient-centered care.