Access to sanitary products Aberdeen pilot: evaluation report

3. Findings: Community partners

3.1 About participants

The majority of participants at community partners were white (92%, 428). The average age of participants was 30.

Table 2: Community partner participants by age group (initial survey)

	%	N
Under 18	19%	86
18-24	14%	64
25-34	28%	127
35-44	28%	124
45 and over	10%	47
Total		449

Of those respondents who provided information (434), almost half (191) were single parents; while just over a quarter (115) were couple households with children.

3.1.1 Employment and income

Almost half of respondents did not answer this question. Of those who did, around two thirds received their income wholly from state benefits/pension.

Table 3: Income status of community partner participants (initial survey)

	%	N
Wholly from state benefits or pension	68%	187
Partly from state benefits or pension	19%	53
Wholly from earnings or private income	13%	37
Total		277
Don't know / Rather not say		116
Not answered		105

The majority of participants were not in employment (see Table 4 below). Four percent were in full-time paid work and 13% in part-time paid work. Almost a fifth were in full or part-time education, but accessing the pilot via community partners.

Table 4: Employment status of community partner participants (initial survey)

	%	N
Unemployed	38%	155
Long term sick/disabled	11%	44
Looking after family/home	8%	34
Full/part time education	18%	72
Full time paid work	4%	16
Part time paid work	13%	53
Temporary sick	4%	15
Maternity leave	1%	3
Government/other training scheme	1%	6
Volunteer	0%	2
Other	2%	8
Total		408

Participants were asked about why they or their family are facing financial difficulties – 308 provided information. Over half (178) mentioned that they are living on a low income: many due to living on benefits, others because they are a full-time student or have refugee status.

"No money left after I buy essentials such as food and electric"

"Struggle to meet day to day expenses living on benefits only"

A problem/delay with benefits (27), disability/illness (24), paying off debts (20), coping as a single parent (19), and a change in family circumstances (11) were also mentioned by some.

"I failed medical assessment and had to reapply for different benefits"

"Low income due to being signed off sick"

"Repaying debts and loans has left me with reduced money"

"Being a single parent to 3 children means I can only work part time and the income does not always allow for buying products for both myself and my daughter so I would just do without and get for her."

Other reasons included managing the needs of a large family and homelessness.

3.2 Previous difficulties accessing products

3.2.1 Participants' experiences

Accessing sanitary products had presented difficulties in the past for two thirds of community partner participants; while 58% said they had been 'unable to purchase sanitary products'.

Table 5: Community participants' experience accessing products (initial survey)

	'H as accessing sanitary products presented difficulties in the past?'	'Have you ever been unable to purchase sanitary products?'
Yes	67% (282)	58% (237)
No	33% (136)	42% (172)
Total	418	409
Don't know	2	-
Not answered	78	89

Of those who said they had experienced difficulty in the survey, 200 provided a comment on why they had experienced difficulty – the main reasons were: financial, menstrual issues, embarrassment or local access.

Similar issues were raised in the qualitative interviews as those in the survey. However, in the interviews participants more often spoke about knowing other people – friends or neighbours – who had not been able to buy products because they had been in financial difficulty rather than themselves. They discussed helping out friends by buying products. This may be because of feeling uncomfortable discussing the issue with a stranger.

" Have you ever had any difficulty accessing products yourself? No, but I know people that have been in the situation with financial difficulty as well. I have had neighbours have to tap me because they've been short of money or whatever as well. That is an issue, because it can be expensive, especially having heavy periods as well, I think." Participant interview, regeneration area

Finance

The majority of survey respondents (88%, 176) gave a reason related to their ability to afford products (69 had been unable to afford products, 93 struggled to afford products, while others mentioned having to buy cheaper products or having to buy products for several household members).

"Sometimes no money at the time"; "Can't afford them sometimes"

"Prioritising between food essentials and personal essentials is often a difficult choice"

"Finding the money to pay as have 4 people in household that need them"

Living on a low income, choosing between buying other essentials and sanitary products, and having no money left at the end of the month were highlighted in interviews. There was some divergence in opinions in interviews over whether sanitary products are expensive. One group noted that products are cheap in discount shops. Others underlined that they can be expensive e.g. in the local shop, especially if you find accessing a supermarket difficult, if you have heavy periods and need a lot, or you're buying for several daughters as well as yourself.

" [Asked why she signed up to the pilot] …I said yes because it's not always easy to afford the sanitary products, when you're living on a budget or in need, your periods can be unpredictable. And when it comes to a pint of milk or sanitary products, then the pint of milk wins… so I signed up for it because I can't always afford the sanitary products." Participant interview, third sector

"They're only 55p in Lidl!" Participant focus group, Regeneration area

"I just lost my job as well so spending like, I often go through 2 boxes during 1 period, just 'cos it lasts ages. So it can be £4 to £8 depending on if they're on an offer or not. So it's difficult, it's like £8 a month or a £100 a year that you're spending that could be going on gas or electric, for someone who needs it, you know." Participant interview, regeneration area

Menstrual issues

Reasons relating to menstrual cycles including included irregular periods, heavy periods and postpartum bleeding.

"Quite often, I'm irregular so never know when I need them and when I do I'm usually skint"

"Very short cycles and heavy bleeding. Using a lot of products"

Access or embarrassment

Other reasons mentioned included embarrassment buying products and lack of access to products locally.

"I have very bad anxiety and feel ashamed buying them"

"No mobility, relies on others to take her shopping"

Managing without products

When asked how they managed without the products they needed, 156 survey respondents provided a comment. Fifty seven said they asked someone – generally a friend or family member – for products or money to buy products. While 66 reported using an alternative – most commonly toilet roll, but also rags or nappies. Other responses included not being able to leave home or having to steal products.

"Had to ask friends"; "Had to borrow money or products"

"Using ripped up sheets"; "Used toilet paper folded up"

"Staying in but it makes you feel horrible"

Buying cheaper own brand products, asking friends/family, and using toilet roll were mentioned as ways of coping in interviews. Written feedback was provided by staff for a group of young women (age12-15) who are referred to the organisation through social workers and did not want to formally sign up to the pilot. They talked about experiences such as:

"We have had to use ripped up sheets and t-shirts in the past "

"Have used all my pocket money on products before"

"My Mum doesn't use these things, she never asks if I need or how much I use"

How participants felt about being unable to access products

Anxiety, embarrassment, or feeling dirty or degraded was mentioned by some survey respondents (15). Similarly, some of those who did talk about their own experience in interviews, mentioned embarrassment at not being able to buy products, and having to ask friends. Being anxious about leaking when having to use toilet roll was also mentioned.

"Toilet paper which was sore, uncomfortable and degrading. No protection"

3.2.2 Partners' views

Most partner staff interviewed had some awareness of the issue of inadequate access to sanitary products prior to the pilot.

"I suppose it's something that we look at kind of as part of the basic needs. And so we provide food parcels, and clothing and bedding, and we cater to basic needs of service users as well as the other range of support that people need. But we're very aware that for women sanitary products are a basic need. We have been fortunate that it is something we do get donated quite regularly, and in large quantities as well. So it's definitely something that we've seen a need for before the pilot and have been providing to people anyway – just kind of as required." Initial interview with staff member, third sector

Many of the third sector organisations, who work with vulnerable women, had already identified this as an issue and were providing products in an ad hoc manner – generally, when they had them donated or had small pots of money available to buy products.

"Normally, just through small pots of funding that that we've got, we keep stocks of sanitary products here. Not a lot, just bits and pieces. Or even the women who work here bring in sanitary products and we've got a little box. But yeah it does come up quite a lot. …and people always say 'oh it's just come on, I didn't know'. But it's not – you do know, it's just they that they don't have the money to go and get them." Initial interview with staff member, third sector

Even some of those who did work with vulnerable groups had learned more about what some of their clients went through when they did not have access to products.

"When you see the different answers that they've given to the questions about have they struggled before, as staff members we were quite surprised at what we were reading as well. People going into just public toilets and taking loo rolls, and people using even using nappies and things. You just don't think about it if it's a not a problem for yourself." Initial interview with staff member, third sector

Some partners also reflected on the specific local context for the pilot in Aberdeen – the downturn in the oil and gas industry over the last few years and "seeing more and more people who have been made redundant, who are on low incomes, who are unable to keep up with mortgages and debt etc. so actually basic needs would be an issue for them." (End-point interview with staff member, third sector)

3.3 Accessing products during the pilot

3.3.1 Promoting the pilot

CFINE promoted the overall pilot, with partners supporting and promoting provision in their local services and community. Throughout the pilot there was a lot of media attention due to this being the first scheme of its kind, and multiple local, national and international articles were published. Promotion included: social media, posters, leaflets, information stands ( e.g. ACC Health & Equalities Fair), promoting the pilot to groups within the organisation or through coffee mornings; and mentioning it to clients when they drop in or use a service. Many partner staff noted that word of mouth had been important. However, most thought that the majority of their participants were people who were already accessing their services or centre, and that they had not managed to reach out very widely.

"We find that with all our projects, people that come along, that's great, but have we really reached the hard to reach people? Or have we just reached the kind of hard to reach ones? It's not about just giving the people products, it's about the administration of it all." End point interview with staff member, regeneration area

One organisation, with a strong social media presence and very active volunteer had, had success reaching a relatively large number of people in that community.

3.3.2 How participants heard about the pilot

Participants were asked how they heard about the pilot. The majority had heard about it direct from the partner organisation they signed up with, although word of mouth and social media had also played a role (see Table 6 below).

In the interviews, most participants talked about finding out about the pilot either through contact with a staff member or volunteer at one of the partner organisations or through Facebook.

Table 6: How community participants heard about the pilot (initial survey)

How heard of pilot	%	N
From partner organisation	67%	331
Social media	7%	34
Through group activity	5%	24
Word of mouth	14%	70
News	1%	5
Poster	1%	4
Other	5%	23
Total		491

Participants' suggestions about how to better promote provision included: posters in cubicles in the toilets, social media for younger people, leaflets to parents from schools, posters in the doctor, chemist or health visitor.

"I think inside the cubicles, when you're sitting on the toilet, you've got nowhere to look except the walls, do you, so you're gonna see it..." Participant interview, regeneration area

3.3.3 Accessing products

As outlined previously, the way products were made available in all partners was shaped by the need to monitor the number of people signing up and the products provided, as well as to gather data about participants.

Distribution of products varied depending on how partners work with service users and what they judged appropriate and included: via 1-to-1 support or engagement with individuals; group engagement settings; or making products available at customer service points such as reception areas. Other delivery methods included:

• volunteers taking products with them on visits to the families they work with
• support workers signing up clients and collecting products for them
• products being included in a food parcel that is being collected
• automatically handing out the same as each participant received initially.

3.3.4 Participants' views on accessing products

The majority of participants who completed the end-point survey (94%) said they felt comfortable collecting products.

Table 7: How comfortable participants felt collecting products (end-point survey)

	%	N
Very comfortable	55%	57
Quite comfortable	39%	40
Quite uncomfortable	6%	6
Very uncomfortable	-	0
Total		103
Prefer not to say / Missing		6

Discretion and whether products could be collected from a place that was convenient for participants to access were highlighted in interviews with participants as important factors in how products were provided. Overall, participants did not talk a great deal about how they accessed products – they generally seemed to accept the process that was used.

Discretion and privacy

Signing up for the pilot individually or in a private office and getting products in a discreet bag were mentioned as making participants feel more comfortable. While one participant felt the sign up process could have been more discreet.

"…I would say it's quite embarrassing because the girl was just a worker at the project and I had to kinda go over, it's quite personal things that you are speaking about. So I don't know if there was somewhere you can maybe do it a bit more discreetly – it's like an open plan office and you're speaking about a personal thing." Participant interview, third sector

Embarrassment

For some, talking about sanitary products and periods was uncomfortable or just not something they expected to talk about to anyone other than very close female family members. Similarly, some participants talked about feeling embarrassed buying products, especially if a man is serving them.

" How do you feel about discussing things like this? Strange. Do you speak about it to your friends or family? No, not really – if I have a bad period I tell my mum. So you don't really feel that comfortable speaking about it? It's not that I feel uncomfortable speaking about it, it's just not really something you talk about." Participant interview, regeneration area

" So when it first came into this centre to get the products, how did you feel about it? I was a little bit nervous about picking them up, but they gave them in a brown paper bag so it was not as bad. I don't like even walking about the shops with them in my basket or anything like that. I try to cover them with things, and it's even more embarrassing going to the till, especially if it is a man serving you." Participant interview, regeneration area

3.3.5 Partners' views on providing access to products

Practical considerations

Partners considered a range of different factors in deciding how to make products available. How this new provision would fit with the way their service/project is run and the space they had available for storing products, having conversations with participants and distributing products shaped decisions. In many partners, products were available during specific times because this is when e.g. key staff were available or the food bank is open.

Dignity and stigma

Along with these practical aspects, dignity and respecting people's privacy were also considerations for many partners. Partners discussed approaching people on a one to one basis to introduce them to the pilot and making sure products could be collected from a discreet location. The majority of the staff and volunteers interacting with participants as part of the pilot were female. One interviewee did reflect on the importance of having enough female staff to run the pilot as their male staff did not feel able to raise the issue with clients.

"I suppose they wanted to make sure that things were accessible, but I didn't particularly want a stack of sanitary towels and Tampax there on the front table – I just felt that you almost want to be respectful of people's privacy. If they want it, fine, but they shouldn't have to be picking up where other people are. So we took the decision that it would be something that we could approach people on a 1-2-1 – just as part of our work that actually we can get you this, tell us what you need and we can get you it." End-point interview with staff member, regeneration area

"I think the difficulty for me was that, when it came to the products, I was like: "are you heavy? Are you not heavy? Know what I mean – personal stuff you're asking folk. So we then developed a wee leaflet thing that [….] they could just tick what they needed, and they could come in and it's in our filing cabinet (that's where we've got the stuff, because we haven't got any space). So then we were able to just go in and get the stuff." End point interview with staff member, regeneration area

Embarrassment and demand for the pilot provision

Many partner staff talked about being surprised that demand for the provision had not been higher. Most reflected on the difficulties they had raising awareness of the pilot and getting people to take part, and identified stigma or embarrassment as an issue. Having to speak to someone in order to access products was commonly discussed in interviews as a likely barrier. Several interviewees highlighted difficulty broaching the topic of sanitary products – as menstruation is still considered awkward to discuss.

"I just can't believe the stigma around it, I just thought it would be a lot easier. I didn't realise it was going to be so hard to get people to sign up." End point interview with staff member, regeneration area

"…I think it's probably, as well, having to go and ask. How do you make it that sanitary products are just there and you don't have to ask anybody at all? That's what we were thinking – in our toilets there's baskets with condoms. What we've been doing is just leaving sanitary products in there as well. And they've been going from there." End point interview with volunteer, third sector

Appropriateness of raising the topic

Raising the topic of sanitary products was not always considered appropriate – depending on the context of the discussion – especially where there was not an existing relationship. For some organisations, clients could be presenting in crisis and access to sanitary products was not always felt to be a priority to raise. Two organisations were not able to fully engage with pilot due to this, and concerns about asking participants for data, although both already provided sanitary products as part of their work supporting women.

"…the people that we're trying to maintain contact with will turn up on a Friday at 4 o'clock. They'll be presenting in crisis and need support with this, that and the next thing. It's hard enough to get them to do the essential forms that we ask them to be doing, applying for crisis grants etc., so that extra level is just not even on their radar. Getting access to sanitary products is definitely important but being part of the pilot is not at the top of their agenda." End point interview with staff member, third sector

Other reasons for not signing up

For a few partners, an issue with reaching women was that the majority of their clients are male. Other feedback on why some people may not have signed up included being on a type of contraception where they do not get periods or considering themselves financially able to pay for products.

"…there were a couple who said it's a minimal cost, it's fine. Not everyone has a low budget that we work with [...] a few people came back and said I don't need it for financial reasons. Quite a few didn't use it because of the contraception that they're using – they didn't have periods anyway." End point interview with staff member, third sector

Returning to collect products each month

The majority (63%) of participants were recorded as receiving products on one occasion only (see Table 8 below). However, participants who had signed up during January-February may not have needed to return yet. Looking at the participants who signed up in the first three months of the pilot, the proportion receiving products only once fell to 46%.

Table 8: Number of time participants collected products (Admin data)

	All		Signed up Sep - Nov
	%	N	%	N
Once	63%	334	46%	112
Twice	25%	134	31%	75
Three times	5%	29	11%	26
Four or more times	6%	31	12%	29
		528		242

Partners' views on why participants did not return

Some partners also reflected on why participants might not be returning in interviews. Ease of access and having to speak to someone were again considered important in influencing whether people returned monthly.

"I think probably for the re-engagement, if people don't come here that often, if it's out of their way, if I am a new or strange face to them […] because it's still a slightly taboo subject, me trying to speak to them about their periods when they didn't know who I was, probably did create a bit of a barrier. And I think that, to some extent in this area, having to fill out forms – a lot more people would have been interested if you were just giving them the products, no names, no form signing, nothing, just actually hand them the products, very little conversation." End point interview with staff member, regeneration area

" Did a lot of people come back? Quite a few, yes – the ones that come regularly. We had some that came in just once, because they weren't regular goers, but people who come in regularly came back. I think word of mouth sometimes works better. But I think it was a lot more to do with if they were regularly coming here then they would come in past to get their stuff." End point interview with staff member, regeneration area

3.4 Products provided

Almost all community partner participants received products, and more received towels than tampons (see Table 9 below).

Participants received between one and six packs of products (containing 10-20 towels or tampons depending on type and absorbency) – it should be noted that some participants also collected products for family members and this was not always clearly recorded. On average participants received two packs. Many of those receiving multiple packs received a mix of type (tampons and towels or liners), absorbencies (normal and super) or day and night time products.

Table 9: Product received by participants – overall (Admin data)

	%	N
Towels	54%	287
Tampons	15%	81
Tampons & towels	19%	98
Menstrual cup	2%	13
Reusable towels	3%	14
Pre-paid card	7%	35
Total		528

3.4.1 Participants' views on products

The majority of participants (133) who completed the end-point survey received products directly from a partner organisation; two received a pre-paid card and one received cash.

Quantity of products

The majority (96%, 131) of participants who completed the end-point survey said they received enough products. In the qualitative interviews, participants generally reported receiving enough products, although a couple mentioned either being unsure how many packs it was ok to take or feeling uncomfortable about being seen to be taking too many.

Choice of products

Slightly fewer than 70% (94) of participants who completed the end-point survey said they received a reasonable choice of products, while 30% (41) chose 'partially – I was able to choose the type of product I wanted but not my preferred brand';, and one respondent said they had not been able to choose the product they wanted. Two survey respondents commented that they were offered supermarket own brand products which was not their preference, two said a wider range of sizes ( e.g. for those with a heavier flow) would be better, one stated a preference for pads with wings and 20 participants commented that the choice was good.

In the qualitative interviews and focus groups, participants also generally reported that there was a good choice of products.

" And what did you think about the choice of products that was available?

F1: Really good.

F2: Yeah good.

F3: Alright, yeah

F1: I always bought the… I think the Asda ones are as good as the Tampax. I always bought just the Tesco's own version, Asda's own version. They're all the same, really. But they offer you the Tampax… so you get a good variety – night time ones, day time ones, ones with wings, ones without wings…! [laughter]" Participant focus group, third sector

Absorbency and type

Most participants discussed having a choice of type (tampon/pad), absorbency and other practical aspects (wing/no wings, type of applicator for tampons) as the most important elements of choice. One participant noted that only winged had been available and she did not like pads with wings, while another noted that 'I thought the choice was fine, but they could of done with more flow types' (Participant interview, regeneration area).

" So when thinking about the products how important is the choice? I was tampons, and I prefer like the plastic applicators as opposed to the paper ones, so yeah that. Did it matter what type of product as in branded or unbranded? It doesn't bother me that... I think I went for branded tampons because I knew it would have been plastic (applicators)." Participant interview, regeneration area

Product brand

A couple of interviewees did note that the products they were offered were unbranded, but went on to say that the supermarket own ones were ok or just the same. When asked if she was getting her preferred option, one interviewee said: "Probably go for the better brand, 'cos you can afford to do that when you are more secure." (Participant focus group, third sector) This perhaps suggests that, while many participants were happy to use unbranded products, offering branded products may convey participants are valued and that it is not just the cheapest products being offered.

3.4.2 Partners' views on products

When buying products CFINE aimed to purchase a wide range of quality, mid-range products, while noting that it was not possible to provide a complete selection because of the large number of brands and ranges that are available in stores. A smaller range of products were purchased initially, and greater variety was introduced as the pilot progressed and specific requests were taken into account. Partners differed as to the variety of products they reported receiving and being able to offer participants. Some noted that they had received a limited range initially and had requested more choice.

Range of products offered

In terms of product choice, providing a sufficient range of absorbencies was generally considered most important, with a few partners noting that they requested a greater range of absorbency products, especially night-time and higher absorbency products ( e.g. 'super plus'). The importance of being able to take more than one pack of products was also noted by some in providing sufficient quantity (for those who use more than one pack per period) and choice ( e.g. different absorbencies, day and night-time pads, or tampons and pads) of products. A need for incontinence pads was also raised by one partner.

Product brand

Partners generally reported that most participants had not expressed strong preferences regarding brand, conveying feedback that the non-branded products are just as good. However, an interviewee who worked with a group of vulnerable young women reported that: "they were glad that it was products that looked good quality; that it wasn't smart price, kind of own brand things. So they felt that at was respectful, I guess, towards them that they were getting quality products." (Initial interview with staff member, regeneration area) Different preferences in different groups were also noted by CFINE staff.

"Right at the very beginning, we had a request from I think it was the university wanting different brands. They were saying that the branded items were much more popular with the students and also they would prefer regular and/or light rather than other organisations who would prefer heavier stuff. […] we were able to think well this is really more appropriate for this organisation or this is more appropriate based on what they were already using. I think out in the community groups night pads with wings and quite high absorbencies were seen as being the most popular." End point interview with staff member, CFINE

3.4.3 Providing the means to buy products

In considering the findings on cash and card, it is important to bear in mind that only CFINE, Foyer and Homestart offered cash to participants, while CFINE, Foyer, Homestart, the college and university offered pre-paid cards. Many partners opted out of offering cash due to their organisation's policy on handling cash.

As shown in Table 9 previously, pre-paid cards made up a small proportion (7%) of overall monthly provision. However, looking at CFINE's product data only – where cards were offered for a longer period – pre-paid cards made up almost a fifth (30/158) of their recorded provision during the time they were offered.

Participants' views

In the initial survey, participants were asked whether they would be interested in receiving cash and a pre-paid card (see Table 10 below).

Cash

Of those survey respondents who answered these questions, 80 provided comments on their response to receiving cash and 54 on a pre-paid card. Comments on cash included:

• It would provide choice (12 respondents) – "ability to choose preferred brand and type"
• It would be convenient (13) – "may be easier than coming out for products and just get it in with weekly shopping"
• Receiving cash to buy your own products would be less embarrassing than collecting products (8) – "it's embarrassing asking for this".
• Might be spent on other things (32) – "would end up being spent on the kids"

Card

Positive comments on the card also included that it would be convenient (14) and provide choice (5), and less likely to be abused than cash (11). A few also mentioned that the card could also be spent on other things (7) or felt that it would identify them as needing help or be embarrassing (7).

"I think this would deter people abusing the system"

"everyone will then know if you are on a low income or not"

Table 10: Interest in receiving cash or pre-paid card (community, initial survey)

	Interest in cash for products	Interest in pre-paid card for products
Yes	34% (79)	47% (101)
No	51% (116)	35% (74)
Don't know	15% (34)	18% (39)
Total	229	214
Not answered	269	284

In interviews participants raised some similar concerns about the cash or card not being used to buy products. Whether the shops the card could be used in were accessible for participants was also mentioned.

"If it was a pre-paid card that would depend on how many you need – you might need more that month, but you don't want people abusing it. So I don't know, as it could be used on alcohol and cigarettes. Participant interview, third sector

"…when you mentioned the prepaid card, I ignored that straight away, because I wouldn't be able to go to NISA to pick up my sanitary products, I would have to then go somewhere else. I don't drive so that means getting a bus, it's more bus fares to get your products." Participant interview, regeneration area

Partners' views

Many partners raised the issue of giving participants cash instead of products during interviews. There was a strong feeling of discomfort around this element of the pilot, linked to the fact that many of the clients community partners work with are vulnerable and uncertainty about whether the cash would be spent on products. It should be noted, therefore, that while in theory cash was offered it is not clear how widely or actively this option was promoted to participants.

The pre-paid card was more widely accepted by partner staff. Some partners still mentioned concerns that participants would not use the card to buy products. There was also a feeling among some partners that both of these options added an extra layer of unnecessary complexity – if people need products, just give them that – and that participants were coming to them to get products rather than having then to go to the shop and buy products.

3.4.4 Reusable products

Reusable products include menstrual cups, reusable towels and period pants. Menstrual cups and reusable towels were the main products discussed and made available during the pilot. It is suggested that these products can last up to five to ten years. Menstrual cups are used internally like tampons but collect menstrual flow rather than absorbing it, and can be emptied and rinsed. Reusable towels are cloth pads that can be machine washed.

CFINE were keen to promote reusable products as part of the pilot due to the financial and environmental benefits. Staff brought together a group of volunteers who had experience using reusable products as a 'Reusable Steering Group' to inform this aspect of provision. The group produced a video introducing reusable products to help promote reusable products and spread information about them. ^[12] The group also visited some of the partner organisations to hold small information workshop sessions or coffee mornings. This usually involved showing participants the video, volunteers with experience of reusable products talking about their experience and the opportunity to ask questions and look at examples of products.

CFINE staff and volunteers observed that engagement was initially slow, with very few participants being open to the idea of trialling reusables, but that more people became interested over time. Overall, CFINE purchased and distributed 100 reusable products to partners: 51 are recorded as having been given out to participants (32 menstrual cups and 19 reusable towels), 16 have been returned to CFINE, and 33 are still with partners (it is likely some of these have been distributed without a record being kept). Some participants received only a reusable product, some received towels or tampons then tried a reusable product and others received both reusable and disposable products.

Participants views of reusable products

Around a third of participants in community partners had heard of reusable products, while 4% had tried them. However, 59% of participants who had not used them previously said they would be interested in trying reusable products.

Table 11: Knowledge of reusable products (community, initial survey)

	Heard of reusable products	Tried reusable products	Interested in trying
Yes	32% (137)	4% (17)	59% (223)
No	68% (285)	96% (395)	41% (154)
Total	422	412	377
Not answered	76	86	104

In interviews, participants had very mixed views and experiences with reusable products. Many were not familiar with them before taking part in the pilot. Some participants talked about using reusable products as distasteful or raised practical issues around, for example, having to carry a used pad around with you or having to empty and wash a cup in a public toilet.

However, taking part in the pilot and learning more had made minority of participants and staff/volunteers consider trying reusable products. Although openness to reusable products did not necessarily translate into regular use, some positive feedback was received from participants who had trialled them. One example was a mother and daughter who had allergies to some brands of disposable towels, and reported that the reusable towels were 'perfect for their needs' and that they would not have known about or been able to afford the initial outlay without the pilot.

"I didn't know about the reusables until a couple of months ago. They showed me them and I was like, wow, I didn't even know they existed. Would you think about taking them? No, I don't know – I'm just a bit funny with the whole washing it out and putting it on, I don't know. It's psychological. I think it's just something in me that's going no, no I don't want to do that." Participant interview, third sector

Before the meeting I said to my friend, there is no way, no how, would I ever try it. However, I've got one [menstrual cup]. I haven't tried it yet. Because I got my period on Christmas day and there was no way I was faffing about trying that sort of thing. But then I got told that it… eased the pain a bit. I get really quite bad pain, and in the discussion a lot of people had said it eases the pain sometimes. Participant interview, regeneration area

Partners' views

Many partners reflected on interest in reusable products during interviews. In general they reported that participants had not been interested, and often described 'disgusted' or 'horrified' reactions. Their impressions were generally that people did not like the idea of reusing and having to clean products or saw them as 'unhygienic'. Some noted these reactions were due to a lack of knowledge about products, and that raising awareness, particularly allowing people to see products and hear from someone who has used them, was important in changing views.

" What about uptake of reusables? Nothing, apart from a couple of horrified gasps. I remember speaking to one mum, I went out to see her, we were speaking about sanitary products. And she was like yeah, yeah, I'm up for this, I'm up for that. I mentioned reusables and I thought she was going to run out of the room and be sick she was that horrified about it. So absolutely no education on the reusable products is obviously given at school or family planning or anything like that." End point interview with staff member, third sector

"They have a look at the reusables but nobody is that keen on them I'm afraid. For people it's maybe just a bit too fiddly or unhygienic. They've had a look and know that they exist. I think some people are a bit funny about using something that's reusable. Two people have ordered the Mooncups and used the Mooncups but nobody's wanted to use the pads. […] For some people it might remind them of times they have had to make do and mend. And some people, when I showed them the Mooncup, they just can't imagine where it goes and how it goes and how it fits." End point interview with staff member, regeneration area

3.5 Costs of the pilot and products

The Scottish Government provided a total of £42,000 for CFINE to run the six month pilot, broken down as follows:

• Staff and admin costs: £32,000
  • Development worker £13,000
  • Management, support £4,000
  • Driver/store person £9,000
  • Vehicle costs contribution (lease, insurance, fuel) £3,000
  • Premises and administration ( PC, telephone, fuel, etc.) £3,000
• Products costs: £10,000

Further funding of £12,000 (£3,000 per month) was provided to continue distributing products via established partners for four months after the formal end of the pilot: £10,000 for administration and £2000 for products.

Turning to CFINE's records on the actual cost of products provided during the pilot, the unit cost ( e.g. cost of one tampon or towel) varied according to:

• product type (tampon or towel)
• brand (supermarket own or branded), and
• absorbency (for example, packs of sanitary towels commonly contain 14-16 regular towels, 12 super towels or 10 night time towels).

Overall, the average unit cost was around 9p per item – around 5p for supermarket own brands and 11.5p for branded products. Menstrual cups were purchased for between around £16 and £20 per cup, and reusable towel starter pack for between around £14 and £19.

Table 12: Average cost of products purchased during the pilot

Product	Price range per unit	Average price per unit
Supermarket own towel	4-8p	6p
Branded towel e.g. Always, Bodyform	9-14p	11p
Supermarket own tampon	4-5p	4p
Branded tampon e.g. Tampax, LiLets	10-14p	12p

3.6 Coordination and distribution

For CFINE the pilot required a lot of time from already very busy staff and some volunteers. In particular, a substantial part of the resource required and a key challenge was collecting and processing information from partners. Also supporting those partners who had limited capacity with signing up participants. Dealing with the media interest in the pilot also took up a considerable amount of time. Staff reflected that the time put in by some core volunteers – e.g. signing up participants at CFINE, making up deliveries, going out into the community and delivering sessions, media involvement and inputting data – was very important in making the pilot work.

Partners were very positive about their relationship with CFINE and the way the provision was coordinated. Most already worked with CFINE as part of the FareShare network, and the distribution of sanitary products fitted into existing processes. An occasional delay getting a particular delivery or specific products was mentioned, but no broader problems with coordination or distribution identified.

"We've had a long relationship with CFINE so [name of staff member] has sent us emails when they need information from us. There's meetings. They keep us up to speed with things when we needed more stock; gives us information; asks for things to be filled in – I thought they did really well." End-point staff interview, third sector

3.6.1 Challenges for partners in providing access to products

The time taken by data collection

The work related to the data collection element of the pilot was clearly identified as the most challenging aspect of the pilot. Completing sign up forms with participants and keeping a record of products distributed added substantially to the time required to make products available.

Reliance on one person and/or volunteers

In the majority of partner organisations, the pilot activity had been driven by one committed individual on top of an already busy role. In some partners, volunteers also played an important role in running the pilot. In one organisation the pilot was led by a volunteer who was very enthusiastic about the project and put a great deal of time and energy into promoting it in their community. This meant that in many partner organisations provision was very dependent on good will and somewhat precarious. During the course of the pilot there were examples of these key staff leaving organisations, and momentum promoting the pilot being lost.

Prioritising the pilot within busy workloads

While interviews highlighted that partner staff were very supportive of the initiative, there were issues raised around prioritising the pilot within busy workloads. Some interviewees reflected that there was probably more they could have done to reach and engage potential participants, but that there just was not time alongside everything else they were doing. Other partners indicated that they were near the maximum number of participants they are likely to be able to sign up or have the capacity to manage. A few did reflect that, if uptake had been a lot higher, this would have been difficult.

Other than the time-consuming nature of data collection and the lack of free capacity within their organisations, partners were generally very positive about the pilot and did not identify any major practical issues. Many saw providing sanitary products as fitting in to the work they already did and did not feel the actual provision was too much of a burden time-wise. Some minor issues with storage/space were mentioned but were seen as manageable. Although some partners did reflect that this could become an issue if provision continued and/or increased.

"I suppose, for me, I don't have the time to do anything different to what I've done just now. If it had been allocated to a community worker, to say actually that could be a little bit of a project or something." End point interview with staff member, regeneration area

"I haven't found it too bad, but I know that if all 20 of my participants did keep in touch and did re-engage continually, I would've been rushed off my feet I think, but because they didn't it was ok." End-point interview with staff member, regeneration area

3.7 Impact of the pilot

3.7.1 Impact on participants

Slightly under two thirds (63%) of participants who completed the end-point survey said they thought taking part in the pilot had, had an impact on them, around a fifth were unsure (22%) and 15% thought it had not. When asked what impact the pilot had, the most commonly selected response was 'more money available to spend on other essential items', followed by 'less worried about having my period'. Other reasons given included becoming more aware or understanding of the situation other people may be in and meeting people.

Table 13: Impact participants thought the pilot had on them (end-point survey)

	Selected
More money available to spend on other essential items	68% (55)
Less worried about having my period	49% (40)
More able to continue with day to day activities during my period	27% (22)
Introduced me to other services	25% (20)
Improved my mental health and wellbeing	21% (17)
Felt embarrassed because I couldn't afford sanitary products	20% (16)
Felt embarrassed about having to discuss sanitary products	9% (7)
Total responses	81

Finance and wellbeing impacts

In the interviews with participants, impacts mentioned included: freeing up money for other essentials and worrying less.

"You've no got the financial stress, it's like you've freed up your money, you know. You've got an extra couple of quid one week your like I don't have to buy that now, I can go get something else, some shopping. You can put extra money in your gas, extra money in your electric or something, or food." Participant interview, third sector

One organisation, provided some written feedback from staff about the impact they thought the pilot had, had on the families they work with – these indicate how the pilot helped women financially in situations where they had a high requirement for products:

I provided one of my new mums with sanitary wear due to continued bleeding post birth, and at this time she no longer required to wear maternity pads. It would have been difficult for her due to the financial costs of buying pads on a more regular basis than monthly so, it was a big help to her at this time. Written feedback from staff, regeneration area

I have recently worked with a family where the woman was having issues with her menstrual cycle and this was being investigated by the hospital. She had been menstruating for approximately three months and was not in a position financially to be able to afford the high level of product she needed from day to day. Being able to provide her with these items throughout that difficult time relieved some of the stress of dealing with her condition which has now been resolved. Written feedback from staff, regeneration area

Feedback from a group of young women who are referred to the organisation through social workers, and did not want to formally sign up to the pilot, was provided by staff, with comments highlighting greater confidence:

"Feel valued"

"Feel more confident and better about myself now"

"Feel the same as everyone else now"

"Not having to take time off school / miss out on group and activities because I don't have products"

Being able to change product more often

One interviewee talking about feeling able to change products more often. Poor menstrual hygiene has been linked to Bacterial Vaginosis and Urinary Tract Infections, while changing tampons less often than recommended has been identified as a risk for Toxic Shock Syndrome.

"…and the good thing about getting the products free as well is like, when you're having to buy them, they're not always cheap, they don't always have your kind in – the strength that you need, Is that you don't have to wear the same tampon or the same pad for a whole day, because you haven't got enough to last and you can't afford to buy another packet. Whereas with getting them for free, then they are full or whatnot, you can change them, you don't have to be uncomfortable keeping the same one on." Participant interview, third sector

Feeling more comfortable talking about products

Another outcome mentioned by some participants was feeling more comfortable talking about products.

" Ok so thinking about the first time you came in and you had to get the products yourself, how did you feel about that? Probably a bit embarrassed to be honest […] it's a bit embarrassing walking through, and people seeing you, and there's a lot of men here, and some men don't want to think about it or see it. And now, how do you feel? I feel like it's made me a lot more confident in speaking about periods, especially at the coffee morning – everyone just talking about it so openly, I was just like it's ok to kinda talk about it, where I feel like before it's not something you would ever really discuss." Participant interview, regeneration area

Other comments on the pilot

There was space in the initial survey for any additional comments – 115 community respondents included a comment. Just over three quarters of these (77%, 89) were positive comments on the pilot. Nine stated their view that sanitary products should be available for free.

"This is a very good initiative and I will be interested to follow how it goes"

"This will make my life so much easier when on my period"

"This is a god send for me and 2 daughters. Between the 3 of us someone is always having a period"

"This should always be free as we do not choose to have a period".

3.7.2 Partner's views on broader impacts

Building and strengthening relationships

When considering what impact the pilot had, had on their organisation, building or strengthening relationships with service users was an additional benefit discussed by several partners during interviews. Some partners also talked about how the pilot had enabled discussion within the organisation and with service users about access to sanitary products and broader issues:

I was going to say in terms of the pilot here what are you most pleased about in how it's gone? From a selfish point of view that I felt that I made some connections with people because I was new here too and I think it's helped to break down some kind of barriers with people. End-point interview with staff member, regeneration area

" So when thinking about the pilot aspects, what were you most pleased about? I was most pleased, probably, with the conversations, dialogue that it generated, rather than actually the simple handing over of products. I think it allowed us in the office to have quite a lot of discussion about it, the staff. Issues that we all felt or didn't feel. Some of the volunteers were really interested in it – it allowed then to have quite frank conversations with families they were supporting, not just on access to sanitary products but on sexual health and contraception and all that kind of things. It gave them a reason to be discussing quite personal matters, it was a lead in." End-point interview with staff member, third sector

Making links and strengthening networks

Some partners also mentioned that taking part in the pilot has enabled them to make links with new organisations or agencies. The pilot was seen as providing an opportunity for strengthening networks between organisations with similar interests.

"For me ASP [access to sanitary products] has been great – one for meeting new agencies, like we didn't really have a connection with RGU or NESCOL, and meeting folk again, getting out there…" End-point interview with staff member, CFINE

3.8 Access to products in the future

3.8.1 Participants' views

Most popular options – survey responses

In the end-point survey, respondents were asked, if a scheme to provide access to free sanitary products in the future, which of the six options in

Table 14 below they would prefer (firstly ticking as many as they like). The option selected by the largest number of participants was to receive a card, followed by ordering online and collecting products from a designated location. Respondents were then asked to select the one option they would most prefer. The most popular option was ordering online, followed by receiving a card.

Table 14: Participants' views on ways of accessing products (end-point survey)

Option	Select all	Preferred
Receive a card I can use in shops to get free products	51% (90)	22% (38)
Order online through a secure system for delivery by post	47% (83)	25% (44)
Collect free products from a designated location	47% (82)	12% (21)
Receive a voucher I can exchange in shops to get free products	44% (77)	16% (28)
Free products available in public toilets	40% (71)	11% (19)
Free products available from a designated person	35% (62)	14% (25)
Total responses	176	175

Advantages and disadvantages of different options – interview discussions

In the interviews and focus groups with participants, there were a range of views about what would be the best way of accessing products in the future. When asked an open question, suggestions included picking products up from: pharmacies, doctors' surgeries or health clinics, local buildings such as community centres, and ordering online.

Interviewees were also shown the six suggestions in Table 13 above as prompts for further discussion. Again views were mixed on the advantages and disadvantages of these:

• Ordering online. Advantages: saves hassle and discreet. Disadvantages: not everyone has access to the internet or an address to deliver to.
• Card/voucher. Advantages: convenient if you can collect products at the same time as your weekly shop; not having to ask for products; can choose what you want. Disadvantages: might not be spent on sanitary products, whether it can be used in a local shop; possible hassle of having to exchange a voucher or use the card separately to the rest of your shop; feeling uncomfortable if the card or voucher lets others know you need products.
• Available from local places e.g. chemist, community centre. Advantages: convenient; easy for most people to access. Disadvantages: could be abused if freely available.
• Available in toilets. Advantages: useful for if you're caught out without products. Disadvantages: could be abused if freely available.

As when the possibility of accessing a pre-paid card during the pilot was discussed, interviewees expressed doubt about how a card option would be spent. Another concern raised was whether the card would mark users out as low income:

"Like the card as well, 'cos I was saying to them is that like a specific tampon only card, like a sanitary towels only card? Cos I thought that would be a bit uncomfortable going up to a till with that. ...I don't know how comfortable I would feel, 'cos I've had to use a food token before from the council and that felt really uncomfortable handing it over and being like 'I'm skint', so I don't know how comfortable I would feel, unless obviously hundreds of people were doing it, you know." Participant interview, regeneration area

Most important aspects of how products are made available

Similarly to accessing products during the pilot, the main considerations that emerged among participants for how products should be made available were:

• Convenience – somewhere that fitted into their day to day life and was easy to access for most people. Some respondents discussed the lack of a large supermarket in their local area and the cost of bus fares to access it.
• Discreet – preference not to have people knowing you need or are collecting products.
• Preventing abuse of the scheme – several participants noted that people might take more than they need/'take advantage'.

3.8.2 Partners' views

Discreet and easy to access

As with considering how to make products available during the pilot, accessing products discreetly was considered important for any future provision. Ease of access was also highlighted as important – making products available in places that people access as part of their day to day lives. Places such as food banks, community centres, schools, pharmacists, doctors' surgeries, and via midwives and health visitors were suggested. The team at CFINE had discussed the minor ailments scheme as a potential solution. Some partners did reflect on whether organisations like them would be the best location for provision.

"…leaving sanitary products in a basket in the toilet for those that need it [would be the best way of continuing the pilot provision]. I don't mind having some products here genuinely for people coming in. If it's an on-going thing, I'm not sure – I think you would need to look at somewhere that can actually have all the products that folk want to get. So we've got NHS next door – if they could have handed out to folk… End-point staff interview, regeneration area

"I just think people want it to be easy – almost like a central point … it needs to be somewhere maybe that's busy like a GP surgery or a pharmacy." End-point staff interview, regeneration area

"Do you put it into community centres? Not everybody goes to a community centre. Do you put it to a social work? Not everybody goes to social work etc. For me, speaking about areas of deprivation, a lot of people that are struggling financially will go to their local chemist that's got the Small Ailments Scheme. I think would be one terrific way of getting a product to a person. There's a chemist in every area in Aberdeen." End-point staff interview, third sector

Places where women go on their own

An interviewee who worked with vulnerable women noted the importance of thinking about places women go on their own:

"…in terms of domestic abuse, the control of not only what women do – in terms of what they wear, where they go, who they speak to – but even sanitary protection is something that's controlled, so I think it needs to be available in places where women will go to and probably on their own. So places like doctors' surgeries, health centres, community centres, those sorts of places where they go and they have a chance for their own space…" End-point interview with staff member, Grampian Women's Aid

Reservations about a pre-paid card

General concerns around giving participants a pre-paid card were reiterated.

"Our experience is that there's an awful lot of people that come to us because their lifestyles are pretty chaotic. They don't think straight. So you and I are given a card knowing that we can go into Boots or whatever and get this. But that could be a huge challenge for some people – (a) the interaction; (b) they've probably never had a credit card or any bank card or anything. I just think giving the product for their use is helping that person. And I think making the access available to places that they're more likely to be going – which would be food banks, doctors, community centres." End-point interview with staff member, third sector