Except that tampons are almost never mentioned.

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Americans have an abiding discomfort, bordering on revulsion, toward any discussion of menstruation. In discourse both public and private, this most human of bodily functions is treated as secret and shameful, a demi-illness that must be concealed if the sufferer is to have any hope of being taken seriously in functional society. God forbid a man catch you with a tampon in your hand.

Even as our generosity is called upon to help meet the daily needs of hurricane survivors, though, the specific needs of menstruating people are largely forgotten. Some organizations, such as food and diaper banks, include requests for period supplies in their appeals; a handful of menstruation-specific nonprofits exist; and there have been occasional media mentions, but these are by far the exception rather than the rule. For the most part, the parts of being a victim that are deemed unpleasant are studiously ignored.

Of course, for many Americans, it doesn’t take a natural disaster for the everyday to become tenuous. The poor, the homeless, the unemployed, and underemployed must regularly choose between school supplies or winter coats, diapers or tampons.

Depending on type, brand, and coverage, tampons and pads cost roughly $6 to $9 for a package of about 40, which any menstruator can tell you may not even last a month. Four weeks later that expense comes by again, to the tune of $70 to $110 a year before sales tax. For people who make $15,000 working full time at a minimum-wage job, that’s the kind of expense that can easily mean the difference between paying a bill or defaulting.

In recent years a movement has emerged to lessen this burden by eliminating sales taxes on period supplies; recently enacted laws to that effect are both hugely welcome and not remotely sufficient. What’s really needed, nationwide, is something akin to the law passed last year in New York City providing tampons and pads free of charge at schools, shelters, and correctional facilities—a move echoed by the federal government in late August, when it issued a recommendation that all federal penitentiaries do likewise.

Because lest we forget, period supplies are not optional. At the end of the day, pads and tampons serve one purpose: to contain menstrual fluid. With nothing to stop it, the combination of vaginal secretions, uterine lining, and (yep) blood can become a powerful mess. It’s a feature of the human reproductive system, not a bug—half of human bodies were designed to function this way. Forgetting that humans need period supplies is like forgetting that they need toilets (and then shaming them for urinating).

Girls and women (and some trans boys and trans men) who can’t readily meet this need are forced to make do however they can, often resorting to inappropriate or fundamentally unsanitary solutions that threaten their health, fertility, and basic ability to get things done—it’s hard to focus in math class or on the job if you know you’re bleeding all over your chair. That’s why Human Rights Watch recently released a report recognizing that menstrual hygiene is in fact not just a question of finances, but a human right.

We are right to open our hearts and our wallets to those who have had to watch as all they hold dear is literally washed away. No matter the weather, families always need food, babies always need diapers, and people who menstruate always need pads or tampons.

But what is true for the survivors of hurricanes is also true for the survivors of poverty. The deeply held misogyny that prevents us from treating female bodies as normal intersects with our dehumanization of poor people, and it prevents us from seeing that need (much less meeting it).

As we struggle to build a world that’s fairer for everybody who lives in it, it’s not enough to consider only the bodies we feel comfortable talking about. Whether rising to the challenge posed by natural disasters or acting to mitigate the unnatural disaster of poverty, we must begin to acknowledge the full humanity of all affected, reproductive organs included.

It took the entirety of both the state’s regular legislative session and a month-long special session, but the bipartisan bill finally crossed the finish line. The new law will extend the state’s Maternal Mortality and Morbidity Task Force’s expiration date to 2023 and require it to report on disparities in pregnancy-related deaths (including socio-economic status) and best practices in lowering mortality rates in other states, as well as actually evaluate options to reduce maternal deaths.

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The task force, which was created in 2013, has already identified a lack of early pregnancy care as a significant contributor to death. In some ways, that’s unsurprising: Nearly 25 percent of Texas women are uninsured, and the state leads the country in the total uninsured rate. Because of cost, over the past year 52 percent of Texas women reported skipping a doctor’s appointment or test, not getting specialist care, or being unable to fill a prescription. This is a far higher percentage than what was found in states with similar uninsured rates, such as Florida, as well as in states with similar populations, such as California.

Despite this bleak picture for women in need of care, the legislature failed to send any proposals to the governor that would have actually provided for greater coverage for the treatment and care of women struggling financially.

One reason for the high uninsured rate is the state’s extremely restrictive Medicaid eligibility standards: In addition to failing to expand Medicaid under the Affordable Care Act, parents of two children in Texas must earn less than $386 a month to qualify for Medicaid coverage. (That’s only one-fifth of the federal poverty level, which is $2,050 for a family of four). Texas allows more women to gain care through Medicaid during the duration of their pregnancy, but drops them 60 days after delivery. The task force also found that the majority of deaths occur more than 42 days after birth—likely after many women at risk for death lost access to the program.

In discussing Texas’ maternal mortality rate, many advocates have noted that births paid for by Medicaid (which are unfortunately higher-risk than those paid for by private insurance) significantly increased after the state cut family planning programs by tens of millions in 2011. The cuts must also be factored into understanding why Texas’ mortality rate has stayed consistently high for years after the initial spike.

But, though the state has undoubtedly been slashing family planning funds and shuttering clinics at a reckless rate for several years now, the fact is that the dramatic increases in deaths began before these reckless policies were passed and implemented.

There are other early findings that do not have clear answers yet. Despite being among most likely to be uninsured, Latina women were found to have an even lower mortality rate than white women. In contrast, African American women are disproportionately likely to experience maternal death: While only accounting for approximately 11 percent of births, these women make up about 29 percent of deaths.

The task force’s new responsibility to evaluate approaches in other states will prove illuminating for some of these unanswered questions: North Carolina, for example, implemented a variety of programs to incentivize doctors examining women for conditions that could lead to high-risk pregnancies and provide wraparound supports for those expectant mothers facing health dangers. By doing so, the state made a huge stride forward that should—and must—catch the attention of Texas’ policymakers: It closed the racial gap in the rate of maternal deaths in white and black mothers.

After an onslaught of statistics, it’s important to remember that behind every death statistic is a woman who suffered. Expectant parents everywhere wake up worried about coping with the newborn months. Too many mothers-to-be in Texas, however, must also wake up worried about whether they will even live to see their child crawl or walk.

Given that mothers are the primary or co-breadwinners in more than 60 percent of Texas households, these deaths are not only personal tragedies but ones that can devastate the economic standing of a family. Already, 1 in 4 Texas children live in poverty. And since the average age of new mother is 26, health problems related to birth may hit as a young woman is still working to launch her career with little savings built up.

It would be unacceptable to allow this to continue. The legislature passed a law that will spur research that will illuminate a greater understanding of how to effectively improve maternal health and lower the rates of maternal death. It will be essential, however, for those who truly care to turn that analysis into meaningful change.

This move came at the recommendation of the Department of Health and Human Services (HHS), headed by Tom Price. In many ways, it’s on brand with Price’s career as an enthusiastic advocate for restricting women’s choices: He has signed personhood acts that ban emergency contraception and abortion, opposed the Obamacare birth control mandate, tried to defund Planned Parenthood, and defended cuts to Medicaid that would deny millions of low-income women health care.

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On an intellectual level, Price’s cuts are frustrating because they represent another piece of a regressive puzzle the Trump administration is assembling in order to control women’s choices. And personally, I’m devastated because I know what these cuts mean to the communities that they will affect.

I attended public school for my entire K-12 education in Tom Price’s former district, where abstinence-only education is the norm. The single day of sex education I received promoted the idea that all sexual acts outside of a heterosexual marriage are dangerous and shameful, and did not make any distinction about whether these acts were consensual or not. It espoused gendered roles that posited women as defenders of their precious virginity, and put the responsibility on women to prevent sex from happening to them. That’s perfectly in line with the content requirements for sex education in Georgia: They consciously exclude information about contraception, coercion, orientation, and HIV/AIDS, and they stress abstinence and marriage.

Because I was lucky, and because I am privileged, I was able to go to a college with real resources—extracurricular trainings, a health clinic, and actual academic courses—that helped me unlearn the detrimental sexual education I received in high school. I got the practical information that I needed, and I started unraveling my skewed concept of consent.

When I attended a “Take Back the Night” rally my freshman year of college, I realized that my abstinence-only education had led me to view myself as responsible for sexual acts committed without my consent. Consequently, I felt shame instead of empowerment to take the steps I needed to recover. This is a common phenomenon for young people that experience abstinence-only education; when all expressions of sexuality are described as negative and shameful, the lines between consensual and nonconsensual acts become blurred.

College gave me a second chance at sex ed, but a lot of people don’t have that opportunity. For rural communities, low-income communities, and communities of color, high school sex education and community-based programs are often the only options available to acquire stigma-free, accurate education about consent, contraception, and sexual health. These populations already face myriad barriers to sex education, including culture, finances, and distance. In my home state of Georgia, there are only four Planned Parenthood clinics—one of the only affordable health centers with enough name recognition that people know to seek it out when they need help—and three of the four are located in the Atlanta metro area in the northwest corner of the state.

Still, teen pregnancy and birth rates are at an all-time low across the country. Georgia has experienced one of the most drastic declines in these rates, from the highest teen birth rate in the United States in 1995 to the 17th in 2015. The grants that Price slashed last week were a part of that story. The target audience of all of these programs are marginalized youth who have a demonstrated need for increased education. And these are the groups that are at the greatest risk for high teen birth rates: Rural counties reported an average birth rate of 30.9 (30.9 teens per 1,000 females aged 15–19), compared with the much lower rate of 18.9 for urban counties. Similarly, black and Latino teenagers experience teen pregnancy at rates twice as high as white teenagers. For these communities, removing teen pregnancy prevention programs that these grants funded will restore the negative effects of abstinence-only education that the grants were originally provided to combat. For example, one of the programs cut was run by the Augusta Partnership for Children Inc., which focuses on reducing teen pregnancy and STI rates in four rural East Georgia counties. In one of these counties, Augusta-Richmond county, the teen birthrate is 22.9 percent higher than the state average.

These cuts can’t be written off as a difference in ideology. I experienced firsthand the powerlessness that results from a shaming, abstinence-focused education, and it can be a matter of life and death for communities already on the margins. I had a second chance at a more holistic education, but it was due to luck and privilege that most folks in Georgia do not have access to. And when we’re talking about pregnancy, HIV/AIDS infection rates, and domestic and sexual violence, luck and privilege shouldn’t be the factors we have to rely on.

The study revealed that, among black women, there are 10.1 cervical cancer deaths per every 100,000 individuals—versus just 4.7 per 100,000 white women. Previously, these figures were believed to be 5.7 and 3.2, respectively.

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It’s hardly a secret that socioeconomic status and racial discrimination greatly impact patients’ health outcomes in the United States. Low-income patients with diabetes are 10 times more likely to undergo limb amputation than affluent ones, black women are 41% more likely than white women to die from breast cancer, and even though African Americans are more likely to have elevated blood pressure than white Americans, they are 10% less likely to be screened for high cholesterol. The list goes on.

But what makes the recalculated cervical cancer death rates stand out is that the disease is preventable as long as it is detected early and treated appropriately. The low fatality rates among white women by and large reflect that fact. Black women, however, die from cervical cancer at rates comparable to those in sub-Saharan Africa.

One of the factors behind the disparity is that black patients face inferior access to quality detection services and follow-up care (the root cause of which is, of course, racial discrimination). Another recent study of patients with advanced-stage cervical cancer found that a majority received substandard care, and that those patients were more likely to be black and low-income.

As Dr. Otis W. Brawley, the Chief Medical Officer for the American Cancer Society, said in response to the Johns Hopkins study, “When we look at the difference between black and white, and rich and poor, we find the same disparity. The quality of assessment and follow-up treatment can be the difference. The question becomes: How do we get adequate preventive care to all people?”

But unlike the medical community, whose goal is to expand care, Congressional Republicans’ relentless attacks on the Affordable Care Act and Planned Parenthood will dramatically reduce it—and worsen the racial disparities that have killed so many black women.

The Affordable Care Act mandated coverage of cervical cancer detection services—along with all preventive care—at no cost to the patient. But the Republican-controlled Congress and White House have already taken steps to dismantle the ACA, and the fate of preventive care is uncertain as a result. (Conversations between House and Senate Republicans reveal that there is no consensus around how best to replace the healthcare law.) If racial disparities in cervical cancer death rates boil down to unequal access to quality detection services and subsequent treatment, then patients who struggle to afford care are bound to be worse off under repeal.

The proposal to roll back the Medicaid expansion, backed by many Congressional Republicans, threatens to strip coverage—and thereby the ability to obtain detection services and treatment—from the patients who arguably need it the most. Some 11 million low-income individuals will lose access to Medicaid under this proposal, and black women are more likely to be affected. Moreover, the proposal to turn Medicaid into a block grant will cut between 14 million and 20 million patients from the health insurance program.

Furthermore, Congressional Republicans continue to target Planned Parenthood, a core provider of reproductive and sexual health services—cervical cancer detection included. If they defund Planned Parenthood, the health care provider will be stripped of more than one-third of its budget. Low-income women and women of color, who are disproportionately represented among its patients, will likely suffer worse medical outcomes as a result. And if Congressional Republicans follow through with plans to slash Title X—the nation’s only federal source of funds for reproductive health clinics—patients will find cervical cancer detection services (and other vital healthcare) even further out of reach.

Racial disparities in medical outcomes are completely avoidable—particularly when the disease in question is as preventable as cervical cancer. While the medical community rallies to address these differences in mortality rates, efforts to rectify them will only be stymied by Congressional Republicans. But the cost, in this case, is people’s lives.