By Susan McLoughlin
Disclaimer: Although most of the research conducted around menstruation involves women and girls (which is why I often reference women and girls specifically), please remember that people of all genders menstruate, including gender-nonconforming people and transgender men.
Around the world, it is estimated that 1.9 billion people menstruate—nearly a quarter of the world’s population.[1] Yet, for many of these people, getting their period every month is a huge burden because of a phenomenon known as period poverty. According to the American Medical Women’s Association, period poverty is defined as “inadequate access to menstrual hygiene tools and education, including but not limited to sanitary products, washing facilities, and waste management.”[2] Of the people who menstruate, at least 500 million experience period poverty every month.[3]
Causes of Period Poverty
Although period poverty is a global problem, people living in low-income countries are disproportionately affected by this issue. Overwhelmingly, economic hardship is a major reason for high rates of period poverty. On average, people who menstruate use over 9,000 sanitary products in their life, and for someone already experiencing poverty, that adds up very quickly.[4]
In countries like Lebanon, where sanitary products are largely imported and there is an immense economic crisis, these products can be shockingly expensive.[5] Since the recent fall of the Lebanese currency, the pound, the price of sanitary products has risen by a staggering 500%.[6] In a report from Plan International, of the adolescent girls they surveyed in Lebanon, 66% reported they were financially unable to purchase sanitary pads.[7] As a result of the economic crisis, the Lebanese government decided to subsidize 300 “essential” imported products; although razors were deemed important enough to make the list, sanitary products were not.[8]
In a study conducted in rural western Kenya, where 63% of the population lives on less than one dollar a day, 10% of girls aged 15 or younger reported that they had transactional sex in order to receive pads.[9] This statistic shows a striking reality that the financial burden of sanitary products has put women and girls at risk of sexual exploitation and abuse. Severe period poverty is also due to a lack of physical access to these products. Andrew Trevett, UNICEF’s Kenya chief of Water, Sanitation and Hygiene, says “[T]here is also the issue of supply. Transactional sex for sanitary items happens because the items are not available in girl’s villages. In the countryside, girls are faced with no transport and can’t afford a bus fare. In some remote villages, there are no roads and there isn’t a bus service.”[10] On top of this, nearly 76% of women and girls in Kenya do not have access to adequate water and sanitation facilities when menstruating, meaning they are unable to practice menstrual hygiene management, also known as MHM.[11] MHM means being able to do things like changing your menstrual products in privacy as much as needed, using soap and water to wash parts of your body, and having access to safe facilities where you can dispose of these products.[12]
Social stigma around menstruation has also played a large role in the increase of period poverty. For example, in India, it is common for women to be considered “impure” and “unclean” during menstruation.[13] As a result, menstruating women are often prohibited from entering kitchens, participating in prayer, and touching holy books.[14] The spread of falsehoods and stigma around menstruation has led to generations of shame and secrecy around the topic. In a study done by the Tamil Nadu Urban Sanitation Support Programme (TNUSSP) in two Tamil Nadu villages, 84% of girls reported that they experienced “fear, panic, and confusion” during their first menstruation because they were never taught what menstruation is or how to prepare for it.[15] Additionally, many girls are taught to hide the purchase and disposal of sanitary products away from boys and men.[16] Since only 33.6% of women and girls in rural India use sanitary pads, many reuse and wash rags or cotton cloths as an alternative.[17] Yet, with over 163 million people in India lacking access to clean water, unhygienic conditions mean oftentimes these rags are not being washed properly, which can lead to infections such as bacterial vaginosis (BV) and urinary tract infection (UTI).[18],[19] Additionally, the pressure to keep menstruation a secret leads to many women drying these rags in dark corners of their homes, away from sunlight and fresh air.[20] These circumstances mean rags are also not being dried properly, further increasing the likelihood of infection.[21]
Period Poverty in the United States
Just like nearly every other country in the world, period poverty is also present in the United States. A survey conducted by Always, a menstrual product company, showed that 1 in 5 girls in the United States reported having missed school because they did not have access to menstrual products.[22] Despite the reality that children are missing school as a result of period poverty, only four states in the United States have laws that mandate public schools to provide menstrual products.[23] Reports also show that people of color and lower-income populations are experiencing period poverty at disproportionate rates. In a study published by BMC Women’s Health, 10% of the female college students surveyed had experienced continuous period poverty, and 14% had experienced period poverty at some point in that past year.[24] Yet, for Black and Latina women who were surveyed, these same statistics shot up to 19% and 24.5%, respectively.[25] Additionally, a study conducted in St. Louis showed that nearly two-thirds of the low-income women who were surveyed said they were unable to afford menstrual products, and many resorted to going to emergency rooms in order to obtain pads or postpartum underwear.[26]
The Impact of COVID-19
The COVID-19 pandemic has exacerbated many of the factors that cause period poverty. Firstly, the pandemic has created a global economic crisis that has disproportionately affected women. Although women make up 39% of the global workforce, they have accounted for 54% of overall unemployment.[27] As more and more women are experiencing economic hardship, rates of period poverty continue to rise. In a survey by U-Report, when asked what changes there have been in accessing menstrual products, 58% of people said that during this past year, they have had less money to buy these products.[28] On top of this, there has been a huge decrease in the physical supply of menstrual products available to people across the globe. The organization I Support Girls, which distributes menstrual products, bras, and underwear to individuals in need, reported that since the start of the pandemic, there has been a 35% increase in requests for products.[29] This has been a result of many factors, one of those being the closure of facilities that commonly offer sexual and reproductive health resources and information, like schools, health clinics, and community spaces.[30] Additionally, a report from Plan International showed that of the health professionals they surveyed across 30 different countries, 78% reported that there was “restricted access to [menstrual hygiene] products, through shortages or disrupted supply chains” as a result of the pandemic.[31]
What Does This Mean?
As a result of period poverty, there are serious consequences that menstruating people are faced with. As stated earlier, people who do not have access to or cannot afford menstrual hygiene products are often forced to use unhygienic materials such as dirty rags, which can lead to serious infection and even infertility.[32] There are also cases of people who undergo sexually exploitative measures in order to have access to these products.[33] Additionally, for menstruating children, not having access to these products often leads to them missing weeks of school or dropping out of school altogether. Without the proper products to efficiently stop their bleeding, people cannot leave their homes for the whole day in fear that they will bleed through clothes – and this fear/embarrassment is worsened with intense social stigma and the spread of misinformation about menstruation. As a result of both stigma and lack of access to hygiene products, in India, nearly 40% of students miss school during menstruation, and 1 in 5 drops out of school after their first menstruation cycle begins.[34] In addition, there have been studies that show higher rates of anxiety and depression in those who experience period poverty. In the BMC Women’s Health study cited earlier, 68% of the women who experienced period poverty every month showed symptoms of moderate to severe depression, compared to 43% in the population who had not experienced period poverty.[35] The main message here is that people who menstruate should not have to face the burden of financial, physical, mental, and social consequences just because they menstruate. Access to adequate and affordable menstrual hygiene products and management as well as education regarding menstruation is a basic human right. Yet, millions of people across the globe are being denied this right, and there is still little being done to address this issue for what it is: a global crisis.
Combatting Period Poverty
All three of the countries mentioned earlier – Lebanon, Kenya, and India – have abolished taxes on menstrual products.[36] In addition, Kenya became the first country to create a national “Menstrual Hygiene Management Policy,” which was established in 2019.[37] Although these policies should not be the only tactic used to combat period poverty, they are critical first steps. Unfortunately, these are steps the United States has not yet taken. In the United States, 30 states still consider menstrual hygiene products a “luxury,” meaning they are taxed products, and government programs such as the Supplemental Nutrition Assistance Program (food stamps) and Medicaid do not cover the cost of tampons or pads.[38],[39] In 2019, the “Menstrual Equity For All Act” was introduced in the U.S. Congress, and although it has yet to be passed, this bill was created to “increase the availability and affordability of menstrual hygiene products for individuals with limited access.” [40]
In 2018, Scotland famously became the first country in the world to make menstrual hygiene products free for all students.[41] England followed suit shortly after, in 2020, when the British Department of Education funded a scheme that also made menstrual hygiene products free for all students.[42] Later in 2020, Scotland actually expanded their legislation to make these products free to everyone who needs them.[43] These key pieces of legislation are excellent examples that period poverty can be addressed on a national level and will hopefully inspire other countries to do the same. Four states in the United States – New York, New Hampshire, California, and Illinois – have implemented similar legislation.[44] New Hampshire, California, and Illinois all require public schools to provide free menstrual hygiene products to students. New York’s legislation is the most expansive and requires not only public schools but also prisons/detention facilities and city shelters to provide menstrual hygiene products at no cost.[45]
How to Help
There are many ways that you can work to fight period poverty in your own community, state, or country:
- If you live in a state that does not have any legislation that addresses period poverty, call your state representative and demand that they institute laws that provide schools, prisons, shelters, etc. with free menstrual hygiene products.
- If you live in a state that still taxes menstrual hygiene products, call your state representative and demand that they work to remove this tax.
- Talk openly about menstruation with your family and friends. The more we talk about menstruation, the easier it will be to break down misinformation and stigma around it.
- Donate to organizations that are fighting against period poverty. Below are a few examples of great organizations that are combating this crisis:
The opinions expressed here are solely the author’s and do not necessarily reflect the opinions and beliefs of Women In International Security or its affiliates.
References:
[1] The Kulczyk Foundation and Founders Pledge, A BLOODY PROBLEM: Period poverty, why we need to end it and how to do it, Report (Warsaw: The Kulczyk Foundation, October 2020).
[2] Alexandra Alvarez, Period Poverty, Blog (Illinois: American Medical Women’s Association (AMWA), October 31, 2019).
[3] Alison Choi, How Social Media Helps Reduce Menstrual Stigma, Blog (Washington: Borgen Project, October 30, 2020).
[4] Leah Rodriguez, 4 Questions About Period Poverty: Answered, Blog (New York: Global Citizen, January 8, 2021).
[5] Ban Barkawi, Rags to reused pads – why more Lebanese women face period poverty, Blog (Minnesota: Thomas Reuters, July 17, 2020).
[6] Ban Barkawi, Rags to reused pads – why more Lebanese women face period poverty, Blog (Minnesota: Thomas Reuters, July 17, 2020).
[7] Plan International, Periods In a Pandemic: Menstrual hygiene management in the time of COVID-19, Report (United Kingdom: Plan International, 2020).
[8] Ban Barkawi, Rags to reused pads – why more Lebanese women face period poverty, Blog (Minnesota: Thomas Reuters, July 17, 2020).
[9] Penelope A. Phillips-Howard, et al., “Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence,” The Journal of Women’s Health, Vol. 24, Iss. 10 (New York: Mary Ann Liebert, Inc., October 20, 2015).
[10] Maya Oppenheim, “Kenyan girls forced into sex in exchange for sanitary products,” The Independent (July 5, 2019).
[11] Maya Oppenheim, “Kenyan girls forced into sex in exchange for sanitary products,” The Independent (July 5, 2019).
[12] Jane Wilbur, et al. “Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people.” PloS one, Vol. 14, Iss. 2 (February 6, 2019).
[13] Diksha Ramesh, Breaking the Silence: Taboos and Social Stigma Surrounding Menstruation in Rural India, Policy Review (Washington, DC: Georgetown Public Policy Review, July 8, 2020).
[14] Suneela Garg and Tanu Anand, “Menstruation related myths in India: strategies for combating it.” Journal of family medicine and primary care, Vol. 4, Iss. 2 (2015).
[15] Diksha Ramesh, Breaking the Silence: Taboos and Social Stigma Surrounding Menstruation in Rural India, Policy Review (Washington, DC: Georgetown Public Policy Review, July 8, 2020).
[16] Diksha Ramesh, Breaking the Silence: Taboos and Social Stigma Surrounding Menstruation in Rural India, Policy Review (Washington, DC: Georgetown Public Policy Review, July 8, 2020).
[17] International Institute for Population Sciences (IIPS) and ICF, National Family Health Survey (NFHS-4), 2015-16, Report (Mumbai: Government of India – Ministry of Health and Family Welfare, 2017).
[18] Shreehari Paliath, Despite Improvement, India Still Has Most People Without Close Access To Clean Water, Blog (Mumbai: IndiaSpend, March 20, 2018).
[19] Padma Das et al. “Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India.” PloS one Vol. 10, Iss. 6 (June 30, 2015).
[20] Padma Das et al. “Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India.” PloS one Vol. 10, Iss. 6 (June 30, 2015).
[21] Padma Das et al. “Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India.” PloS one Vol. 10, Iss. 6 (June 30, 2015).
[22] Leah Rodrigues, 4 Questions About Period Poverty: Answered, Blog (New York: Global Citizen, January 8, 2021).
[23] American Civil Liberties Union (ACLU) and Period Equity, THE UNEQUAL PRICE OF PERIODS: Menstrual Equity in the United States, Briefing Paper (New York: ACLU and Period Equity, December, 2019).
[24] Lauren F. Cardoso, et al., “Period poverty and mental health implications among college-aged women in the United States,” BMC Women’s Health, 21, Article 14 (January 6, 2021).
[25] Lauren F. Cardoso, et al., “Period poverty and mental health implications among college-aged women in the United States,” BMC Women’s Health, 21, Article 14 (January 6, 2021).
[26] Catherine Pearson, “Two-Thirds of Low-Income Women in 1 Major City Can’t Always Afford Tampons And Pads,” Huffington Post (New York: January 11, 2019).
[27] Anu Madgavkar, et al., “COVID-19 and gender equality: Countering the regressive effects,” McKinsey & Company (New York: July 15, 2020).
[28] U Report Global, Menstrual Hygiene Day 2020, Report (U Report Global, May 28, 2020).
[29] See I Support the Girls, Coronavirus Response (Maryland: http://www.isupportthegirls.org/).
[30] Leah Rodrigues, 4 Questions About Period Poverty: Answered, Blog (New York: Global Citizen, January 8, 2021).
[31] Plan International, Periods In a Pandemic: Menstrual hygiene management in the time of COVID-19, Report (United Kingdom: Plan International, May 28, 2020).
[32] Neelofar Sami, et al., “Risk factors for secondary infertility among women in Karachi, Pakistan.” PloS One, Vol. 7 No. 4 (April 27, 2012).
[33] Maya Oppenheim, “Kenyan girls forced into sex in exchange for sanitary products,” The Independent (July 5, 2019).
[34] IANS, “How COVID-19 impacted menstrual hygiene in India,” Telangana Today (February 16, 2021).
[35] Lauren F. Cardoso, et al., “Period poverty and mental health implications among college-aged women in the United States,” BMC Women’s Health, 21, Article 14 (January 6, 2021).
[36] My Period is Awesome, The Period Tax Around the World, Blog (Sweden: My Period is Awesome, October 12, 2020).
[37] Ministry of Health, Menstrual Hygiene Management Policy (Republic of Kenya: Ministry of Health, 2019).
[38] Deborah D’Souza, Tampon Tax, Blog (New York: Investopedia, February 16, 2021).
[39] Brittany Wong, “The COVID-19 Pandemic Is Making ‘Period Poverty’ Worse,” Huffington Post (January 22, 2021).
[40] H.R.1882 – 116th Congress (2019-2020): “Menstrual Equity For All Act of 2019.” (May 3, 2019). https://www.congress.gov/bill/116th-congress/house-bill/1882/text
[41] Nadia Khomami, “Scotland to offer free sanitary products to all students in world first,” The Guardian (August 24, 2018).
[42] Richard Adams, “Free period products to be available in schools and colleges in England,” The Guardian (January 17, 2020).
[43] Megan Specia, “Tackling ‘Period Poverty,’ Scotland is 1st Nation to Make Sanitary Products Free,” New York Times (November 24, 2020).
[44] American Civil Liberties Union (ACLU) and Period Equity, THE UNEQUAL PRICE OF PERIODS: Menstrual Equity in the United States, Briefing Paper (New York: ACLU and Period Equity, December, 2019).
[45] Emma Goldberg, “Many Lack Access to Pads and Tampons. What Are Lawmakers Doing About It?” New York Times (January 13, 2021).
