Reproductive Rights at Work: A Missing Piece in Scotland’s Gender Agenda

In 2023, Spain made history by introducing paid menstrual leave, a first for Europe. Just two years later, Portugal followed, offering paid leave specifically to individuals living with endometriosis and adenomyosis. These reforms are more than symbolic. They mark a long-overdue institutional recognition of chronic reproductive pain and its impact on working life, pain that millions endure in silence, often without diagnosis, and with little legal protection.

Meanwhile, Scotland, globally admired for progressive gender policies, risks falling behind. This is the first ever country that made period products free by law, led on LGBTQ+ inclusive education, and most recently, passed legislation for buffer zones around abortion clinics. In doing so, Scotland has often been first to act where others hesitate. But on menstrual leave, it’s not just behind, it’s absent.

Why is it that countries with arguably more conservative public attitudes around reproductive health are legislating faster? And what does this reveal about the limits of Scotland’s participatory model when it comes to systemic, medical, and labour rights?

Scotland, Spain, Portugal: A Policy Comparison

In Spain, the 2023 law enables workers experiencing incapacitating menstrual pain to take medical leave, covered by the state from day one. While access depends on a medical certificate, the policy frames menstrual pain as a legitimate health concern worthy of structural support.

In Portugal, paid leave is granted to people with a confirmed diagnosis of endometriosis or adenomyosis for up to three consecutive days per month, paid and not deducted from sick leave. The policy has drawn praise for targeting chronic reproductive conditions specifically, though critics have warned about access gaps for those not yet diagnosed.

Scotland, by contrast, has no national framework for menstrual leave. Instead, guidance remains voluntary. There are individual employers, mostly in the public or third sector, who have introduced progressive menstrual policies. But these are patchy, unenforceable, and too often reliant on internal Human Resources cultures or individual managers’ discretion.

Progressive… but passive?

This dynamic which progressive in principle, passive in execution has become a 

pattern in Scotland’s approach to reproductive health. Culturally, the country leads: its commitment to dignity in menstruation and period poverty is globally recognised. Civil society has been instrumental in this, with strong leadership from youth activists, feminist campaigners, and local communities.

But when it comes to systemic health equity, particularly around chronic conditions like endometriosis, legislative action has been far slower. Diagnosis remains delayed, awareness inconsistent, and workplace accommodations optional rather than guaranteed. Despite growing support, there is still no binding policy to protect those affected by reproductive illness in the workplace.

This contrasts sharply with Scotland’s record elsewhere. The Period Products Act (2020) was born of grassroots activism, but it became law due to decisive parliamentary will. More recently, Scotland passed legislation establishing buffer zones around abortion clinics, representing a significant win for reproductive privacy and safety. Notably, Portugal has not introduced such zones, and while Spain has some regional protections, national implementation is uneven. These are examples of where policy led culture, not the other way around.

Bottom-Up vs. Top-Down: Who Bears the Risk?

Scotland is rightly praised for its bottom-up policymaking being participatory, consultative, often community-driven. It allows for deeper consensus and more inclusive discourse. But in cases of medically complex, stigmatised, or under-researched conditions like endometriosis, this approach can stall action. When change depends on widespread public understanding, those living with invisible illness are left to carry the burden of education and advocacy themselves.

By contrast, top-down policies like those in Spain and Portugal shift responsibility to the state. Even if uptake is slow or stigma persists, legal recognition creates legitimacy and accountability. Crucially, it doesn’t require individual workers to "perform" their pain to skeptical employers. It puts the system, not the sufferer, on trial.

Without such protections, Scotland risks a two-tier reality: where support depends more on your workplace’s culture than your medical condition. This kind of discretionary model is inherently unjust and often inaccessible to the most vulnerable.

The Case for Menstrual Leave in Scotland

Menstrual leave is not about extra days off. It is about validating the often-invisible toll of reproductive illness, and building a framework that aligns healthcare, labour rights, and gender equity.

Endometriosis alone affects one in ten people assigned female at birth. Its symptoms like chronic pelvic pain, fatigue, infertility, and depression can be debilitating. It still takes an average of eight years to be diagnosed in the UK. For many, that means nearly a decade of navigating pain without explanation and let alone accommodation.

A meaningful menstrual leave policy in Scotland could include:

• State-funded leave for those with confirmed chronic reproductive conditions

• Clear national guidance for employers, to reduce stigma and prevent discrimination

• Expanded diagnostic access, especially in rural or underserved communities

• Workforce and school education on menstrual and reproductive health

• Protections against retaliation for those seeking leave

These aren’t radical demands. They are consistent with Scotland’s existing values of dignity, equality and public health. What’s missing is action.

Reproductive Justice: The Broader Frame

To frame this solely as a health issue would miss the deeper politics at play. What’s needed is a reproductive justice lens that understands rights not only in terms of access to care, but in terms of autonomy, safety, and economic security. Who gets to be believed at work? Who is afforded comfort, flexibility, or time to recover? Who risks being seen as “unreliable” or “unproductive” for having a body that bleeds, cramps, or collapses? Until reproductive policies include the lived experiences of people with chronic menstrual conditions, justice remains incomplete.

Portugal and Spain have shown that even in countries where stigma runs deep, policy can chart a new path. Their measures are imperfect, but they exist. They’ve started.

Scotland’s Choice

Scotland has the data. It has the values. It even has the precedent. What it needs now is the political courage to act again, not just with symbolic laws, but with substantive protections for those living with reproductive pain.

Invisibility should never mean inaction. If Scotland wants to continue to lead on gender equity, it must legislate for the bodies and the realities that have been left out for too long.

The next frontier of reproductive justice is here.

Will Scotland meet it?