Supporting menstrual health in homeless services: provider-informed strategies for multilevel change

Abstract

Background: People experiencing homelessness (PEH) face heightened barriers to menstrual health, including limited access to products, hygiene facilities, and consistent care. Social service providers (SSPs) and healthcare providers (HCPs) are critical in supporting PEH but often work within resource-constrained systems. This study explores SSP and HCP perspectives on the menstrual health needs of PEH in a rural-serving community in the U.S., using the Social-Ecological Model (SEM) to identify multilevel barriers and opportunities for intervention.

Methods: We conducted semi-structured interviews with 12 SSPs and HCPs in Tippecanoe County, Indiana. Transcripts were analyzed using thematic analysis to identify key challenges and recommendations related to menstrual health support for PEH.

Results: Our analysis revealed complex challenges providers faced in supporting the menstrual health of PEH, including emotional burden, resource scarcity, and limited organizational guidance. They described how stigma, provider discomfort, and systemic gaps in training and infrastructure hindered effective care. Providers also shared that menstrual health was often deprioritized due to competing health needs and structural barriers such as lack of housing, transportation, and product access. Despite these challenges, providers offered actionable recommendations to improve menstrual health support through education, policy change, and more equitable organizational practices.

Conclusions: This study highlights the multi-level barriers providers face when supporting the menstrual health needs of PEH. Our findings show that meaningful change requires coordinated efforts across all levels of the SEM. Actionable strategies include provider training, improved intake processes, expanded access to menstrual products and hygiene resources, and policy reforms to address housing and insurance gaps. These insights can inform training programs, shelter protocols, and advocacy efforts to promote menstrual health equity and provider sustainability.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-12932-1.

Keywords: Health equity; Healthcare providers; Homelessness; Menstruation; Social service providers; Social-ecological model.