From Menstruation to Menopause and Pregnancies In-Between: Massachusetts Policy Initiatives Supporting Women’s Reproductive Health
By Andrea Kramer
In recent years, Massachusetts lawmakers have demonstrated an on-going commitment to addressing women’s health issues that span the arc of women’s reproductive lives, from filing legislation addressing menstruation and menopause to passing laws expanding maternal health options and protections for people receiving or providing abortion or gender-affirming health care. These policy initiatives help to destigmatize women’s reproductive health issues and protect women’s access to resources, options, and support in each stage of their reproductive health.
Pending Legislation: Menstrual Equity and Menopause Support
Menstruation is a fact of life for half the population for a significant portion of their lives. Yet, many women cannot afford menstrual products. For example, 64% of low-income women interviewed for a study published in Obstetrics and Gynecology in 2019 reported having difficulty affording menstrual products, such as pads, tampons, or menstrual cups, in the previous year, and 21% reported that they were unable to afford these products each month. Food stamps do not cover menstrual products, which are a necessity. This lack of ability to obtain menstrual products can lead to infection and reproductive health issues as well as stress and anxiety. The inability to access menstrual products, or “period poverty,” also reduces class attendance for students who are menstruating (usually but not exclusively female). In a 2022 survey of school nurses in Missouri, 68% of respondents knew students who had missed school because of their period due to period poverty. And for incarcerated women, access to menstrual products is sometimes used as a control tool, to stop the women from reporting inappropriate behavior or to coerce them into sexual favors, for example.
To address this aspect of “menstrual equity,” Massachusetts lawmakers have re-filed a bill, first filed in 2019, H.2483/S.1549, An Act to increase access to disposable menstrual products, that would require providing disposable menstrual products in all public schools, homeless shelters, and prisons and county jails, at no cost, and in a convenient, non-stigmatizing manner, to all individuals who menstruate. Having progressed some but not to a vote in last year’s legislative session, the House bill is currently pending in the Joint Committee on Public Health, and the Senate bill was reported out to Senate Ways and Means with amendment as S.2546. A similar bill requiring free, readily accessible menstrual products in schools for students in grades 6-12, H.684, is also presently pending. If either of these bills passes, Massachusetts will join twenty-seven other states plus the District of Columbia in enacting legislation requiring the provision of free menstrual products in schools.
At the other end of the menstruation life cycle is menopause, which can be disabling for many. Yet, menopause has rarely been addressed in law or policy. The tide is shifting. Rhode Island recently enacted a first-in-the-nation law requiring employers to provide workplace accommodations for employees experiencing menopause and related medical conditions. And in 2023 and 2024, respectively, Illinois and Louisiana passed laws that mandate insurance coverage for some or all menopause treatments. Overall, at least two dozen bills have been introduced across fifteen states this year related to insurance coverage for menopause care, awareness and education, clinician training, or addressing menopause in the workplace. In Massachusetts, a bill was filed this legislative session seeking to raise awareness about the personal, professional, and medical challenges related to menopause. If passed, this bill, H.2499, An Act pertaining to women’s health at midlife and public, medical and workplace awareness of the transitional stage of menopause and related chronic conditions, would direct the Department of Public Health to implement a patient and provider awareness campaign. Id. § 3. The bill would also require the Executive Office of Labor and Workforce Development to study the impact of menopause on the workforce. Id. § 5. And it would require the Board of Registration in Medicine to assess whether continuing medical education programs provide sufficient training on women’s midlife health. Id. § 4.
New Massachusetts Laws: Providing Birthing Options to Improve Maternal Health and Safeguarding the Confidentiality and Legality of Abortion and Gender-Affirming Care
While the bills addressing menstrual equity and menopause support are still pending, last year Massachusetts enacted a comprehensive maternal health bill that expands birthing options, An Act promoting access to midwifery care and out-of-hospital birth options. St. 2024, c. 186. Known as the Maternal Health Bill, this law, which has been referred to as one of the most comprehensive pieces of maternal health legislation nationwide, expands out-of-hospital birth options for all women and mandates state health insurance coverage for lay midwifery, birth centers, doulas, and postpartum depression screening and treatment. Id. § 6. Specifically designed to improve maternal health and pregnancy outcomes, especially in communities of color, which face worse pregnancy outcomes, this legislation creates a licensure pathway for certified professional midwives (not just nurse-midwives), as already exists in 37 other states and Washington D.C., and authorizes the Massachusetts Department of Public Health to regulate freestanding birth centers, both of which expand birthing options. Id. §§ 38, 17.
This law also requires that the Massachusetts Medicaid and Children’s Health Insurance Program cover midwifery services, doula services, and noninvasive prenatal screening for chromosomal abnormalities and that all health insurance providers cover postpartum screening and treatment, medically necessary donor human milk, and universal postpartum home visiting services. Id. §§ 39-41, 44. The law also adds pregnancy loss and failed assisted reproduction, adoption, or surrogacy to the list of acceptable uses for paid sick leave under the Massachusetts Earned Sick Time Law, G.L. c. 149, § 148C. St. 2024, c. 186, § 42.
In Massachusetts, women have options not only in birthing but also in terminating a pregnancy as well as in gender-affirming care. Because officials in other states have sought to prosecute providers and patients who access abortion services or gender-affirming care, in August 2025 Massachusetts enacted a law that expanded the scope of its 2022 “Shield Law.” Overall, the Shield Law protects health care providers and patients in Massachusetts from the consequences of civil and criminal actions in states that restrict or criminalize abortion and gender-affirming care. Under this term’s expansion, the Shield Law now prohibits the disclosure of providers’ personal information, prohibits state and local agencies from cooperating with out-of-state investigations related to legally-protected health care activities, and blocks data sharing with other states in response to investigations. St. 2025, c. 16, §§ 1, 2, 4, 6, 17. It also amends existing health information regulations to prevent government entities from obtaining identifiable health data related to abortion services or gender-affirming care unless needed for public purposes, modifies pharmacy labeling to keep prescribing practitioners’ identities confidential, and limits access to prescription monitoring data related to these services. Id. §§ 3, 7-8, 9-10. In addition, the law provides for civil actions to enforce its privacy protections and mandates nondiscrimination by insurance companies against entities engaged in these services. Id. §§ 2, 6, 11, 12, 17, 18.
Collectively, these legislative initiatives and recent policy changes reflect Massachusetts lawmakers’ recognition that women’s health policy must be shaped by access, options, and acknowledgement of the biological realities, lived experiences, and social circumstances that impact women’s health.
Andrea Kramer is an accomplished general litigator who focuses on business/commercial cases and employment disputes with Kramer Law LLC. Recognized by her peers as a top attorney, Andrea is currently working pro bono on legislation to provide employment protections to victims of abusive behavior and recently authored an amicus brief for a case pending in the Massachusetts Appeals Court regarding the Massachusetts Equal Pay Act.
