I broke the floodgates of my own personal period, or menarche as they say, while beachcombing on a windswept beach in Cornwall in an ill-fated pair of baby pink jeans. It was the ’90s. I was 12. And, while I knew all about menstruation, the arrival of a gusset full of rust still made me worry, for a second, that I’d shat myself.
But I, of course, am one of the lucky ones. The world of menstrual bleeding differs wildly depending on where you happen to have been born. Two years ago state troopers confiscated tampons but allowed guns into the Texas Capitol (that’s the equivalent of Manchester Town Hall). In 2013 Taiwan passed a law allowing all female workers three days of menstrual leave a year. Last year, NGOs and charities in Ethiopia united to make a National Menstruation Hygiene Day to draw attention to the fact that girls in education on average miss 10-20% of school days due to their periods. In the UK today sanitary towels and tampons are taxed at 5% while edible sugar flowers and razors aren’t taxed at all. In short, it’s a bloody mess.
‘The realities of a woman in Switzerland or Britain are very different to the woman in rural India,’ Dr Venkatraman Chandra Mouli of the World Health Organisation (WHO) tells me on the phone from his home in Geneva. ‘My focus is on Tanzania, Azerbaijan, India – that’s where the real need is.’ You may think that need is purely physical – the need for affordable, safe and hygienic sanitaryware to stop women having to use inadequate and unhygienic alternatives like newspaper, leaves, dirty rags and even sand. But, while that is of course a huge issue, I was surprised to hear Chandra talking first of the social and psychological impact of menstruation in low and middle income countries. ‘Menstrual problems don’t kill, but self esteem is key,’ says Dr Chandra Mouli. ‘Self esteem is one of the key pillars of health. When you feel good about yourself you can get a job, get a partner, negotiate a contract with a landlord. So imagine what happens to girls five days of every month when they think they’re spotting, think they’re smelling, think they’re unclean. The girl with the period is the one who hangs her head in shame because she’s using newspapers or dry leaves to mop up her blood. Of course it leaks and it probably smells. And so her self-esteem drops. The important thing is to give women control – and that means control of your periods.’
Although, of course, menstrual problems can kill. According to Action for Southern Africa, the use of newspapers, rags, leaves and bark as a substitute for sanitary pads ‘leads to infections and an increased risk of contracting STIs such as HIV’. This is a huge problem in a country like Zimbabwe where 21% of adult women are already shouldering the burden of being HIV positive. But why is this the case? Why do women in low and middle income countries turn to these makeshift materials? Well, partly, of course, because of cost. Arunachalam Muruganantham, described as the ‘Indian sanitary pad revolutionary’ , unlike so many of his male counterparts, realised that many women in India, his wife included, had to choose between buying food or buying sanitary towels. So he invented a small, low-tech machine that allows women to create their own low-cost sanitary towels out of cotton.
Not only does this give small rural communities a source of income – it is also a public health beacon as, according to the BBC, approximately 70% of all reproductive diseases in India are caused by poor menstrual hygiene.
The underlying reason, of course, for the poor provision, understanding and access to sanitaryware is shame. ‘Menstruation is associated with reproduction, sexuality and so for many people it’s a no-go area,’ says Dr Chandra Mouli. ‘Some countries, like Sweden or Norway, have made more progress than others, but we’re all struggling to move in that direction.’ Which is why, from Bolivia to Ethiopia, The Philippines to Pakistan, there are thousands of young women who, in the words of Marni Somner, Associate Professor of Sociomedical Sciences at the Mailman School of Public Health, Columbia University, ‘are getting their first period and feeling great fear and shame, and struggling to manage their menstruation with inadequate supplies and facilities.’ In one UNICEF report it is observed that in rural Nigeria, ‘menstruation is often perceived as dirty and shameful, which influences how the issue is handled in the home...Some women choose to not wash their pads daily or worry about how to dispose of them out of fear that they may be vulnerable to witchcraft attacks.’ I may have got my first period while wearing a hellishly regrettable pair of baby pink jeans (hey, it was the late ’90s) while beachcombing in Cornwall, but the fear of being a witch? Just imagine how that would make you feel about your body’s monthly flush-out.
While it seems all too easy to lay blame at the boot of religion, there are certainly religious customs that foster this kind of superstition. Leviticus states that ‘anyone who touches [a menstruating woman] will be unclean until evening’, orthodox Judaism requires a woman to bathe in a mikvah after her period before having sex and, while Prophet Muhammad is said to have had no problem drinking water served by a menstruating woman, Shari’ah considers menstrual blood a najis, or unclean substance. Of course enlightened, modern religious communities distance themselves from this kind of scripture, but the legacy remains in, say, the difficulty in buying tampons in Iran or Saudi Arabia or Hindu women staying away from the kitchen or water supply while she’s bleeding.
Which leads us on to what Germaine Greer called in 1970s The Female Eunuch, ‘The Wicked Womb’; the fear of menstrual blood as something dirty, unholy, even harmful. ‘The silence is caused by a discomfort about sexuality, overlaid with this idea of pollution,’ says Dr Chandra Mouli. ‘That means you’re not allowed to pray, you’re not allowed to go to the temple or mosque. My grandfather had a PhD from Wisconsin University and yet when my mother had her period she was not allowed in the kitchen. But it’s true in the West, too. How many western men would have sex with their partners when they were having their period?’
Is it also true that access to sanitary wear in the West is no less a struggle for many women – particularly those stuck in poverty or homelessness. According to research carried out by KPMG in 2013, 2.9 million women are paid below the Living Wage, just under 50% of whom are under 30, meaning that women of a menstruating age are more likely to be working under the poverty line than almost any other group.
As Maya Oppenheim, writing in Vice, put it, ‘Given that there’s no standard practice of giving out supplies at sexual health clinics… and that it isn’t possible to be prescribed sanitaryware at a doctor’s surgery, as a woman in need, there are very few services you can turn to.’ Of course, there are safe, hygienic, reusable options out there. A Mooncup will last you for years and, as long as it gets washed regularly, will save you hundreds of pounds in just a few years – but it does mean an initial outlay of £20, which may be prohibitive for women on very low incomes.
According to a 2012 UNICEF report entitled WASH in Schools, one of the greatest challenges facing young women in middle and low income countries is access to private, well-resourced washing facilities in schools. ‘Girls reported sitting in the back of the classroom to keep embarrassing bloodstains hidden from view,’ it says, echoing the fears of young women across the world and economic hierarchy. ‘In addition, girls expressed a preference for staying home during menstruation rather than having to manage their periods in an unfriendly school environment.’ By unfriendly school environment we’re not just talking about your history teacher demanding to know why you took so long in the loo, here. The WASH report identifies that in rural Bolivia there are, on average, 1.2 pit latrines and 0.5 hand-washing basins per school; 21.3% of girls in Sienna Leone report that they miss school when they have their periods for fear of leaking; as recently as 2011, 20% of schools in The Philippines do not have access to water. All of which makes it very tricky if you are trying to wash reusable pads or dispose of used menstrual materials.
Of course, we all know the Gloria Steinman essay If Men Could Menstruate. We all know the argument that the balance of patriarchal power makes heart disease, arthritis, blood pressure and diabetes a public health issue but menstrual health a private affair. ‘As a woman you’re told to deal with pain, that you have to suffer it, live with it and deal with it yourself,’ says Dr Mouli. ‘So many women don’t ask for help when they have menstrual pain… Menstrual problems don’t kill. So nobody really gives a damn, except the women who suffer.’
But the women who suffer? They’re our responsibility. They’re us. And it’s up to us to start giving a damn.
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This article originally appeared on The Debrief.