Surekha Kunwar is 14 years old and, while she is on her period, she must stay in a shed built outside, unable to enter her house, cook, touch some food or trees, or eat with her own family. This is because in some rural areas of Nepal there is a practice called chhaupadi partha whereby women are isolated during the time they are menstruating. According to Hinduism, the fact that a girl has her first period means a loss of purity. The story of this teenager was collected by the photographer María Contreras Coll in her work journey to impurityand reflects one of the problems faced by a large part of the female population of the planet: the lack of access to menstrual health and hygiene.
Approximately every 28 days, for a week and on average about 40 years. That is the relationship of women with the period, which is often accompanied by pain and discomfort that can become incapacitating. These are not exact data because each menstrual cycle is unique, but what is certain is that it affects half of the world’s population at some point in their lives. According to a recent joint report by the World Health Organization (WHO) and Unicef on the situation of access to water, sanitation and hygiene in homes –including menstrual hygiene management– we are talking about 1.9 billion women between 15 and 49 years.
Despite the large volume of women affected, menstruation has been a taboo subject in many areas until very recently, but menstrual health is increasingly being talked about in debate spaces, and data on these aspects is being recorded and monitored.
The Global Menstrual Collective establishes that menstrual health and hygiene is a state of physical, mental and social well-being, beyond the absence of diseases or ailments related to the menstrual cycle. In other words, a broad definition that would imply both the access of girls and adolescents to information about their cycle and the changes that their body will experience throughout their lives, as well as affordable access to resources and hygiene services, diagnosis and medical care in case of problems and participation in the different spheres of their lives without exclusion or discrimination by the rule, among other aspects. SDG 6.2, which refers to guaranteeing the availability of water and its sustainable management and sanitation for all, also includes menstrual health as one of its global objectives foreseen in the 2030 Agenda, when it establishes that special attention will be paid to the needs of women and girls, and people in situations of vulnerability.
There is no talk of the rule
Even though menstruation is a completely normal biological process (and its absence in reproductive age denotes a health problem or a pregnancy), there is still no global database that serves to make a comparison between countries and gain an in-depth understanding of their different realities . “The issue of menstrual health has many implications, and the first thing that is needed is information. The key is that data is needed to eliminate myths, for the rule to stop being a taboo and for it to be considered something natural, not a source of shame”, explains Blanca Carazo, head of Unicef Programs in Spain.
For the first time, albeit in a very limited way, information on menstrual hygiene has been collected on a national scale, as reflected by different indicators in the report by the World Health Organization (WHO) and Unicef. It has been taken into account if the girls had received information before their first period, the use of menstrual products (pads, tampons, cup…), if they have access to a clean and private space to wash and change, and if they participate in social activities such as going to school. The details of the report show a great disparity at the global level: apart from being very recent, there are only data from 42 countries, none of them with high economic income, and almost half are in sub-Saharan Africa.
Data is needed to eliminate myths, so that the period ceases to be a taboo and is considered something natural, not a reason for shame
Blanca Carazo, head of Unicef Programs in Spain
School absenteeism during menstruation days is one of the main problems arising from the lack of proper menstrual hygiene, as stated in the report. 20% of girls and adolescents in the Ivory Coast and 23% of those in Nigeria missed school during the days they were menstruating. Taking into account the average duration of the cycles, this supposes approximately an absence from class of one week per month. Isolation and lack of participation in social life is also another of the most serious consequences: one in three girls and women in Chad and the Central African Republic, more than half in Bangladesh and more than two thirds in Nepal did not participate in daily activities during those days.
Double trouble: having the period and being poor
Menstrual hygiene implies significant gender discrimination, but it is a reality influenced by biological, social and economic factors. Those who are poor, live in rural areas, belong to an ethnic minority, are refugees or those with a disability are the most disadvantaged in access to this fundamental resource. The consequences of a lack of menstrual hygiene range from school dropout to child marriage, child pregnancies or even the exchange of sex for hygiene products, as reported by different organizations.
In addition to social stigma, another obstacle that many girls and women encounter is the high price of health products. In 2004, Kenya removed the tax on pads and tampons, a move Uganda adopted in 2005, although there was no real push until 2010.
In 2013, the East African Legislative Assembly passed a resolution to exempt sanitary napkins from taxes and thus increase their availability, a move that other African countries have taken in recent years.
However, the reality for the majority of women in these countries continues to be the use of home remedies such as rags, towels or toilet paper when they have their period because they cannot afford the cost of industrial sanitary products, their limited availability or the lack of cultural acceptance and knowledge about them. The data confirms this: 83% of women in South Sudan use cloth, goat skins or nothing at all when they have their period; in Uganda, 90% cannot afford to buy a tampon.
In Uganda, 90% of women cannot afford to buy a tampon
The NGO The South Face has been giving scholarships to young girls from Kenya and Somalia for a decade so they can pursue university studies. They say that the students had been demanding some project related to their period and school for some time, because missing class while they were menstruating was something daily that negatively affected their grades and favored dropping out of school.
To make a comprehensive approach to menstrual health, education is essential. Inform and educate girls and adolescents before menarche (the first period), so that they are not scared or feel ashamed, and know what it is and how to act. Despite the measures adopted by Kenya, 65% of women in this country do not have access to menstrual hygiene products, such as pads or tampons. The South Face denounces that when their period comes, many students skip class for fear of staining their clothes or dirtying something with their blood and feeling ashamed. Therefore, having access to menstrual hygiene products is a very powerful empowerment tool.
From The South Face, they have just launched The Cup Project, a pilot project together with the Kenyan businesswoman Ebby Weyme, founder of the Grace Cup brand. For six months they are going to carry out different trainings and distribute 300 menstrual cups to young people from two schools of Mombasa, then assessing whether this product can be a useful tool so that these girls do not have to miss class and their grades (and their subsequent access to university) are not affected by having their period.
“The elimination of the tax is something new, but we are talking about a country where there is a lot of inequality. It’s a question of ‘do I charge my mobile to be able to talk or do I buy a pad?’ explains Borja Juez, founder of the entity. “You have to take into account social and economic factors. As much as the tax is lowered, many girls cannot access them. In addition, they are products that come from abroad for the most part. We believe that with the menstrual cup we are giving them something they can use for years to come,” he says.
Sustainability is another aspect in favor of the menstrual cup, which with proper maintenance can be used for 10 or 12 years, an important period in the educational life of a young woman.
Education and visibility to break prejudices
Advances in the visibility of menstrual health and hygiene are constant. As of 2014, May 28 is considered Menstrual Hygiene Day (28 due to the average length of cycles and May because it is the fifth month of the calendar, alluding to the five days that the average period lasts). Also, in 2021, for the first time, the prestigious medical journal The Lancet considered the rule as a “public health problem” and its attention a “human right”.
“Steps are being taken, a few years ago (the rule) was not even mentioned and now little by little more is being talked about. It is an issue of discrimination by gender, it is something that we have to change from the personal and the collective”, insists Blanca Carazo. “Menstruation is a very generalized taboo. The rule is not talked about and must be hidden, and that is the change that many organizations promote. It is something beautiful, which has to do with health and life”.
The objectives proposed by Unicef are aimed above all at improving access to information on the functioning of the woman’s body, as well as access to menstrual hygiene products, seeking that these training courses are aimed at boys and girls, without gender distinction. “It is important to work on this knowledge with boys and men as well. For example, in many countries we work in schools with hygiene clubs, and boys and girls go there, it’s very interesting, “explains Carazo. “The boys themselves are very aware, it is something that serves to establish more respectful gender relations.”
Although the isolation of women during menstruation is still deeply rooted in the tradition in certain rural areas of Nepal, since 2017 it has been considered a crime, with penalties of up to 3,000 rupees (about 36 euros) and three months in prison for those who force a woman to follow chhaupadi partha. Also in this country, World Menstrual Hygiene Day was celebrated in 2018 for the first time. Another sign that, gradually, society is changing. The new generations want to talk about the period.
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