You are 13 years old. Your family is poor. Each month you have to take a week off school. In a few months you are so behind in your school work that you drop out for ever. You live in an African country, in India, in the Australian outback...in Leeds.
You are 14 years old, and you live in a village in Nepal. Each month you are shut up in a hut for a week and left to yourself. It is cold. You light a fire and die of smoke asphyxiation.
You are a British teenager thrilled to be at Glastonbury. Your period comes on early. Your only pair of trousers is stained with the blood which is running down your legs. You wade through the mud to queue in the rain outside a toilet block. The vending machine is jammed with a counterfeit coin.
The evil eye
Throughout history menstruation has been regarded with suspicion. Bread made by menstruating women won’t rise, crops will shrivel, men will be defiled by the evil eye. Prejudice is institutionalised. Menstruating women are feared and are sequestered from social and religious activities and from the marital bed till they are ‘clean’ again.
Since sanitary pads were introduced after the first World War, ‘sanpro’ has grown into an industry worth billions of dollars: a disposable product with a massive potential market. It could make life easier for half the world’s population for 3000 weeks of their existence. But poor women cannot afford it; only 10% of Indian women use sanitary protection. Worldwide, millions of women rely on rags or leaves or ashes or newspaper. These are ineffective, uncomfortable, they fall out, and they promote infections.
Decent sanitary protection provides dignity. It liberates women to complete their education, to work and socialise in confidence. But only if their society, their menfolk, permit them access to information. A BBC reporter, being patted down on entry to Egypt, was found to have a strange object in her jeans pocket. What was it? Egyptian Arabic doesn’t have the vocabulary to explain what a tampon is. Eventually, after all the tampons in the box in her luggage had been scanned, she was permitted to enter Egypt, and the security woman asked in a whisper whether these items were available in Cairo. Yes, in a few places, the reporter replied, and gave her the instruction leaflet. A small victory for liberation.
Programmes for donating sanitary products to schools, prisons, food banks (where they are more in demand than baked beans) and to the poor and homeless the world over are admirable, but they don’t address all the problems and they aren’t a sustainable solution. Also required are adequate water supplies, soap, privacy, disposal facilities and understanding. If you are transgender, unisex toilets may be helpful, but they make managing periods more difficult for another, much larger, section of society. And commercial products are made with plastic, and with cotton which requires huge quantities of water to grow. They take centuries to break down in landfill. They contain potentially irritant chemicals. They have to be distributed over long distances.
What is the answer? Reusable pads and silicone cups are catching on because women are spreading the word, but they can still be costly and they require cleaning and drying. In a close-knit society, who is going to hang out their pads to dry in the public gaze?
There are inspiring examples of locally made answers. Saathi, a woman-led company in Gujarat, makes disposable pads from banana fibres, a fully environmental and sustainable process. In Malawi, Trinitas Mhango Kunashe founded a social enterprise which makes reusable pads. In Tamil Nadu, Jayaashree Industries is the result of a five-year struggle by an uneducated villager to produce affordable sanitary protection. His wife, mother and society disowned him out of shame, but he finally invented a simple machine to make pads from local materials. It takes only three hours to learn to use it. Women’s groups throughout India and beyond are buying it. It provides employment and dignity. I’m glad to say his wife returned to him and now supports the project.
Out in the open
Meanwhile, at home and abroad, women are bringing menstruation out of its discreet sanpro packaging and launching campaigns using social media. They use hashtags such as #periodpositive and period-related emojis. It isn’t easy: Ugandan activist Stella Nyanzi’s campaign led to her imprisonment. President Trump’s unpleasant misogynist tweets don’t help – or are they so outrageous that they shock people into awareness? There are programmes to promote decent toilet facilities in educational establishments – I hope they have reached my former school.
Menstrual leave from work is contentious. Japan introduced it in 1947, and the idea has spread from the Far East to Italy and Bristol. But many women are too embarrassed to take advantage of it. And critics complain that it reinforces the view that women are unreliable employees. But in India, where periods are unmentionable, the heads of two companies have authorised menstrual leave and are making sure the press reports their action, to publicise the humiliating realities endured by Indian woman.
There is a very long way to go before menstruation is no longer a handicap. However many photos you post on Instagram of blood-stained white jeans and tampon threads, however right-on your sanitary protection, however liberated the men you work with are, there is no getting away from the fact that for many women periods are painful, messy, unpredictable and not a great topic of conversation, and pretending otherwise is to burden women with yet another guilt – that of failing to embrace menstruation in the correct spirit.
It is going to take time. It was Albert Einstein who said, “What a sad era when it is easier to smash an atom than a prejudice.”
Newsflash: Scotland has just become the first national government in the world to distribute free sanitary products to poor women through a pilot project launched in Aberdeen in July 2017.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…