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Making Menstrual Health a Global Issue

Across the world, women are demanding access to feminine-hygiene products to lead full, productive lives.

Michelle Chen

June 19, 2018

Locally made biodegradable sanitary pads known as Makapads are disinfected at a factory in Kampala, Uganda, on July 13, 2017.(AP Photo / Stephen Wandera)

The next battlefront for gender justice is a bloody one: the culture and the politics of menstrual care. That’s because the seemingly banal matter of menstruation is giving rise to a movement for “period equity,” turning a bodily process freighted with social burdens into an economic-welfare issue intrinsic to women’s enfranchisement.

There has been a surge of demands for investments in feminine hygiene, focusing on situations where women face financial and cultural barriers to obtaining basic sanitary products: New York City recently launched one of the country’s first initiatives to provide period-product dispensers in public schools—so women can avoid the trouble of having to specially request pads during class—along with subsidized supplies for menstrual hygiene in the city’s homeless shelters and jails. Congress is considering national prison-reform legislation focused on women that includes guaranteed access to products for menstruation, along with gynecological and personal-hygiene care.

Though such policies seem absurdly basic, talking about menstruation—an issue that got massive publicity when Princess Meghan Markle promoted period justice worldwide—disrupts deeply ingrained patriarchal taboos and amplifies the demand for women’s dignity in every arena of life.

Jennifer Weiss-Wolf, a lawyer and advocate leading a national campaign for period equity, says starting with something as small as a period is an excellent segue into an array of gender-justice issues, because periods impact “all of the things that make it really hard just to live your life and be fully present and participatory in our society, whether it’s school, whether it’s just walking down the street, whether it’s the ability to go to work…the real-life impact right here and now of managing that. For people for whom a lot of the things we take for granted are challenging, menstruation is an exponential burden.”

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Globally, from draconian menstrual-banishment rituals to a lack of decent hygiene in schools, period-inequity poses significant barriers to women’s educational and social advancement across the Global South. A survey of Sri Lankan girls found that 60 percent of female students are kept out of school by their parents during menstruation. Reflecting gaps in gender-aware health education, three-quarters of girls in Nairobi’s Mathare slum reported not understanding even when to expect their periods. But the real barrier is internalized, culturally ingrained shame. The majority of mothers in India, according to one survey, “consider menstruation dirty.” Studies on girls in Afghanistan, Bolivia, and Iran indicate that because of widespread myths that link periods with contamination or disease, girls are often pressured to abstain from bathing and everyday social activities. Bangladeshi girls reported being deterred from sharing spaces with men and boys or exercising. Studies by Wateraid show that period bleeding triggers dietary deprivation in Pakistan, including “not eating spicy food, eggs, beef and fish”—taboos that, ironically, might precipitate real health risks.

Lack of clean water and basic sanitation facilities in communities is a common obstacle across the Global South, compounded by the desperate means girls resort to when they can’t afford regular menstrual products—leaves and newspapers sometimes substitute for sanitary products; others just avoid public spaces lacking disposal facilities.

Despite the overlapping social and cultural complexities of period shame, often the solutions are surprisingly straightforward, fostered by a blend of community-driven education, cultural engagement, and small-scale production innovation. Research on schools in Uganda found that a targeted program to distribute reusable sanitary pads—a local social enterprise branded as AFRIPads—along with pairs of underwear and soap, could significantly boost girls’ school attendance, compared to the status quo.

But beyond providing material aid, the most impactful interventions combine public-health initiatives for improved sanitation and safe water; menstrual-health education starting at younger ages, so girls are prepared for adolescence; and including male community members in building infrastructure and dismantling taboos. Some communities enlist boys as producers of menstrual-hygiene products—as demonstrated with a grassroots program based in Uganda to get youth involved in crafting homegrown washable pads—which is in turn fostering a worldwide trend toward more sustainable, eco-friendly menstrual care.

In the rich world, the persistence of period poverty shows that this most basic of reproductive rights issue is a First World problem, too. Just purchasing tampons and liners every month amounts to more than $2,000 altogether over a woman’s lifetime—not including the costs of dealing with complications like cramps, hormonal problems and other health issues. Some recent reforms tackle burdensome period-care costs by abolishing the so-called “tampon tax”—the sales tax has been nixed on pads, cups, and tampons in Minnesota, Pennsylvania, Massachusetts, Maryland, New Jersey, and, most recently, New York, Illinois, Connecticut, and Florida.

Period activism is trickling into society’s margins in campaigns to provide hygiene access to imprisoned women, who may struggle to even pee out of the sight of guards, much less change a tampon—part of a climate of discrimination that fuels the systematic abuse of incarcerated women. And period troubles spell agony for homeless women struggling every day just to maintain their sense of dignity and self-respect on the streets. As Alex, a young woman sleeping rough, reflected in a Bustlevideo documentary: “It’s more money than me and my boyfriend spend on a meal, together…. I would rather be clean than be full.”

With homeless women nationwide being forced to choose being dirty or malnourished, why isn’t menstruation-related health care considered just as vital a part of women’s reproductive-life cycle as pregnancy and maternal-health care?

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Feel-good slogans aside, what really matters about the global rise of period politics is the potential to galvanize dialogue on intersecting social challenges, and shedding longstanding silence. Just as the #MeToo movement has raised public consciousness about sexual abuse, a problem previously relegated to women’s private spheres is finally bursting out in the open.

“In this very polarized, toxic environment we’re in,” says Weiss-Wolf, “the idea that we can do something affirmative to address the economic, physical, and social well-being of women—in particular women we’re usually loathe to talk about—incarcerated women, homeless women—I think, is an incredible step forward.”

Periods might seem like a small issue. But the ripple effect reaches half the population and embodies a universe of challenges in women’s health and work lives, from boosting civic representation to overturning age-old body myths. No one asked for periods to become a political matter, but sometimes, that uneasy silence surrounding women’s bodies is exactly why we should make our most intimate affairs everybody’s business.

Michelle ChenTwitterMichelle Chen is a contributing writer for The Nation.


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