A5675

An Act concerning menstrual disorders, amending P.L.2023, c.147 and P.L.2023, c.240, and making an appropriation.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 2 of P.L.2023, c.147 (C.18A:33-30) is amended to read as follows:

2. a. As used in this section, "menstrual products" mean tampons and sanitary napkins for use in connection with the menstrual cycle.

b. A school district shall ensure that students in each school educating students in grades six through 12, or any combination thereof, have direct access to menstrual products in at least 50 percent of female and gender-neutral school bathrooms, if applicable, free of charge.

c. Any costs incurred by a school district in providing an adequate supply of menstrual products to meet the needs of its students shall be borne by the State.

d. The Department of Education, in conjunction with the Department of Health, shall periodically review and assess whether the provision of free menstrual products pursuant to [this act] P.L.2023, c.147 (C.18A:33-29 et seq.) meets the needs of menstruating students, and, if necessary, shall make recommendations regarding the expansion of access to menstrual products to students in grades below grade six.

e. A school district shall prominently display, in the school bathrooms where students in grades six through 12 have direct access to menstrual products pursuant to subsection b. of this section, and disseminate, in writing, to the appropriate students, a notice with the information contained in the educational resources made available to school districts pursuant to subsection d. of section 3 of P.L. c. (pending before the Legislature as this bill). Each notice posted or distributed pursuant to this subsection shall be in English, Spanish, and at the school district's discretion, any other language spoken by the majority of the students in the district.

(cf: P.L.2023, c.147, s.2)

2. Section 1 of P.L.2023, c.240 (C.26:1A-131.1) is amended to read as follows:

1. The Legislature finds and declares that:

a. Menstrual disorders such as endometriosis [and] , polycystic ovarian syndrome, uterine fibroids, and premenstrual dysphoric disorder affect many women and can have a negative effect on fertility and overall maternal health;

b. According to the United States Department of Health and Human Services' Office on Women's Health, endometriosis may affect more than 11 percent of American women between the ages of 15 and 44, which is approximately 6.5 million women in the United States alone; endometriosis may also occur in pre-menarcheal and post-menopausal individuals;

c. According to the Mayo Clinic, endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of a woman's uterus, called the endometrium, grows outside the uterus;

d. In patients who have endometriosis, the endometrial-like tissue thickens, breaks down, and bleeds. However, since this tissue has no way to exit the body, it becomes trapped;

e. When endometriosis impacts the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions that can cause pelvic tissues and organs to stick to each other;

f. The primary symptom of endometriosis is pelvic pain. Although many women experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that is much worse than normal cramping, which pain may increase over time;

g. Symptoms of endometriosis include: painful periods known as dysmenorrhea, pain with intercourse, pain with bowel movements or urination, excessive bleeding, infertility, fatigue, diarrhea, constipation, bloating, and nausea;

h. Ovarian cancer is more common in those who have endometriosis as compared with the general population;

i. Although rare, another type of cancer called endometriosis-associated adenocarcinoma can develop later in life in those who have had endometriosis;

j. According to the federal Centers for Disease Control and Prevention, polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting as many as five million, or six to 12 percent, of women of reproductive age in the United States;

k. Polycystic ovary syndrome is a lifelong health condition that can affect the lives of people who have it far beyond their child-bearing years and involves other serious health complications;

l. Women with PCOS are often insulin resistant, which means that their bodies can make insulin but are unable to use it effectively, increasing their risk for Type 2 diabetes;

m. Women with PCOS also have higher levels of androgens, which are hormones that can stop eggs from being released and cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body;

n. More than half of women with PCOS develop type 2 diabetes by age 40. Women with PCOS can also develop gestational diabetes when pregnant, which puts the pregnancy and baby at risk and can lead to type 2 diabetes later in life for both mother and child;

o. Women with PCOS are at higher risk of heart disease, which risk increases with age;

p. Women with PCOS can also experience: (1) high blood pressure, which can damage the heart, brain, and kidneys; (2) high LDL or "bad" cholesterol and low HDL or "good" cholesterol, which increases the risk for heart disease; (3) sleep apnea, which is a disorder that causes breathing to stop during sleep and raises the risk for heart disease and type 2 diabetes; and (4) stroke;

q. PCOS is also linked to depression and anxiety;

r. Menstrual toxic shock syndrome is a menstruation-related condition that can lead to serious adverse health symptoms, including death if left untreated. The symptoms of menstrual toxic shock syndrome generally begin with low fever, muscle aches, chills, fatigue, and headaches, but as the condition progresses, symptoms can include high fever, vomiting, rashes, redness of the eyes, lips, and tongue, low blood pressure, and mental confusion;

s. Menstrual toxic shock syndrome is generally treatable with antibiotics, but treatment relies on identifying the signs of the condition and seeking professional help. Anyone can contract menstrual toxic shock syndrome, but women using tampons and similar devices are at a higher risk; [and]

t. [Given all of the increased health risks associated with menstrual disorders, such as endometriosis and PCOS, as well as the risks of menstrual toxic shock syndrome, and the number of women impacted by these conditions, it is imperative that the Department of Health establish a public awareness campaign about the effects of menstrual disorders and menstruation-related conditions on fertility and overall maternal health.] Deleted by amendment, P.L. , c. ) (pending before the Legislature as this bill).

u. Uterine fibroids are noncancerous tumors composed of muscle and connective tissue that develop in or on the uterus, causing heavy, prolonged, or irregularly menstrual bleeding, severe menstrual cramps or pelvic pain, and often lead to menstrual disorders. Uterine fibroids are extremely common, affecting 70 to 80 percent of women by age 50, with higher prevalence in women with early menarche, obesity, or hypertension;

v. Premenstrual dysphoric disorder (PMDD) is a severe and chronic condition that affects women of childbearing age during the week before menstruation, caused by hormone changes and serotonin deficiency. Symptoms of PMDD, including, but not limited to, back pain, fatigue, sleep problems, confusion, mood swings, anxiety, depression, feelings of hopelessness, and thoughts of suicide, can be severe and often interfere with daily life;

w. PMDD affects up to ten percent of women of child bearing age, and many women with PMDD may also have anxiety or depression. The disorder is generally treatable with over the counter pain relivers, vitamin supplements, and changes in diet. Women with more severe cases are prescribed birth control pills or anti-depressants; and

x. Given all of the increased health risks associated with menstrual disorders, such as endometriosis [and] , PCOS, uterine fibroids, and PMDD, as well as the risks of menstrual toxic shock syndrome, and the number of women impacted by these conditions, it is imperative that the Department of Health establish a public awareness campaign about the effects of menstrual disorders and menstruation-related conditions on fertility and overall maternal health.

(cf: P.L.2023, c.240, s.1)

3. Section 2 of P.L.2023, c.240 (C.26:1A-131.2) is amended to read as follows:

2. a. The Department of Health shall establish a public awareness campaign to promote awareness among State residents about how menstrual disorders, menstruation-related disorders, and menstruation-related conditions affect fertility and overall maternal health. The campaign may provide for the development of print and electronic media in languages including, but not limited to, English and Spanish

b. The public awareness campaign shall include, but not be limited to, the following:

(1) a comprehensive description of common menstrual [and] disorders, menstruation-related disorders, and menstruation-related conditions, such as endometriosis [and] , PCOS, uterine fibroids, and PMDD, including discussion of causes, symptoms, and treatment options;

(2) information on the causes and symptoms of menstrual toxic shock syndrome and the ways in which women may reduce the risk of developing the syndrome;

(3) information about educational resources available to women concerning menstrual disorders, menstruation-related disorders, and menstruation-related conditions; and

(4) materials encouraging women to schedule routine gynecological examinations, consult with their physicians about, and seek treatment, if appropriate, for, menstrual [and] disorders, menstruation-related disorders, and menstruation-related conditions, and seek treatment if they are experiencing symptoms associated with menstrual toxic shock syndrome.

c. (1) The department shall make available to the public, including, but not limited to, public libraries, institutions of higher education, local health departments, community health centers, public health clinics, shelters and organizations serving individuals experiencing homelessness, and other public or nonprofit entities that provide menstrual products to members of the public, in print, and electronically on its website, information about common menstrual [and] disorders, menstruation-related disorders, and menstruation-related conditions, such as endometriosis [and] , PCOS, uterine fibroids, and PMDD, and their effects on maternal health, as well as informational literature concerning the signs, causes, and dangers of menstrual toxic shock syndrome.

(2) The information made available pursuant to paragraph (1) of this subsection shall be in: (a) English and Spanish; (b) various other languages based on the 10 most prevalent language access needs in the State; and (c) a manner and format in which the information can be accessed by individuals with disabilities.

d. The department shall make available to every school district that ensures students in grades six to 12 have direct access to menstrual products pursuant to the provisions of P.L.2023, c.147 (C.18A:33-29 et seq.) and P.L. ,c. (pending before the Legislature as this bill) educational resources containing information about common menstrual disorders, menstruation-related disorders, and menstruation-related condition, such as endometriosis, PCOS, uterine fibroids, and PMDD, the causes and symptoms of, and when to seek treatment for, such disorders and conditions, and the signs, causes, and dangers of, and when to seek treatment for, menstrual toxic shock syndrome.

(cf: P.L.2023, c.240, s.2)

4. There is appropriated from the General Fund $500,000 to the Department of Health for preparation and dissemination of the information and educational resources made available by the public awareness campaign pursuant to subsections c. and d. of section 3 of P.L. , c. (pending before the Legislature as this bill).

5. This act shall take effect immediately.

STATEMENT

This bill amends P.L.2023, c.240 (C.26:1A-131.1 et seq.) to require the public awareness campaign established pursuant to the law to include information on uterine fibroids and premenstrual dysphoric disorder. Currently, the public awareness campaign provides information to the public on endometriosis, PCOS, and menstrual toxic shock syndrome but is not required to provide information on any other disorders and conditions.

The bill also amends the law to require the Department of Health (DOH) to make available to: (1) public libraries, institutions of higher education, local health departments, community health centers, public health clinics, shelters and organizations serving individuals experiencing homelessness, and other public or nonprofit entities that provide menstrual products to the public, information about common menstrual disorders and menstruation-related disorders and conditions; and (2) school districts that ensure students have access to menstrual products pursuant to P.L.2023, c.147 (C.18A:33-29 et seq.) educational resources about common menstrual disorders and menstruation-related disorders and conditions.

Current law requires the DOH to make the information provided to the public available electronically, but does not: (1) mandate that the DOH make the information available in print; (2) specify the entities or organizations that are to receive the printed information; or (3) require the DOH to provide certain information about menstrual and menstruation-related disorders and conditions to school districts that ensure students access to menstrual products.

The bill amends P.L.2023, c.147 (C.18A:33-29 et seq.) to require school districts prominently display, in the school bathrooms where students have access to menstrual products, and disseminate, in writing, to the appropriate students, a notice in English, Spanish, and any other language spoken by the majority of the students in the district, with the information contained in the educational resources made available by the public awareness campaign.

The bill appropriates $500,000 to the DOH for preparation and dissemination of the information and educational resources made available by the public awareness campaign.