It will take a lot more than free menstrual pads to end period poverty
All of those who menstruate, wherever they live, experience challenges when managing their period. These might include a lack of products, toilets or disposal facilities, enduring pain, being bullied or being restricted from activities and locations. In high income countries these challenges are often referred to as "period poverty" and in low-middle income countries as "poor menstrual hygiene management." But the result is the same: a large proportion of the global population are disadvantaged by having a period.
The solution that is normally advocated is for menstrual products be made affordable, for example by removing the "tampon tax," or providing these free in schools and through food banks. Most programmes that distribute free menstrual products in high-income countries provide disposable pads or tampons, while in low-middle income countries disposable or reusable pads are preferred over tampons. Free and cheaper products are clearly necessary in some situations, and can manage short-term issues, but they will not solve what is a complex socio-economic issue.
Most period poverty headlines focus on girls not attending school because they can't afford menstrual products. But there is little evidence that pads alone will keep girls in school. The following are stories that we heard from Ugandan girls who received reusable pads, which show that providing products alone is not necessarily enough to improve school attendance.
Having pads but missing school
Jane, for example, was given reusable pads but chose not to use them. She didn't attend school as a result. (Names in this article have been changed to protect participants' anonymity.) Jane didn't have the information she needed to make an informed decision to use the pads. She had heard rumours that washable, reusable pads may increase risk of infection or even cancer. Her mother uses traditional cloths so wasn't able to advise her. And when Jane got the pads out of the box, it wasn't clear to her how they should be used. She was too embarrassed to ask at school so she put them back in the box under the bed and continued to skip class when she had her period.
Susan, on the other hand, decided to use the reusable pads, but it was difficult for her to use them in a school environment while following the instructions she'd been given. So she still ended up skipping class. She had been told that the reusable pads she received needed to be washed with soap and dried in the sun. But the bathrooms at school didn't have water or working locks. She tried putting the used pad in her bag to take home to wash but she was scared that one of the other pupils would see it in her bag.
So she decided to only change her pads at home. But they started to get uncomfortable and itchy during class and she was so worried that they would leak that she couldn't concentrate on what the teacher was saying. In the end, she felt it was easier to stay at home. Even there, it was embarrassing to be seen carrying extra water to wash the pads, so she dried them under her bed where her dad and brothers couldn't see them.
Meanwhile, her friend Esther was having similar challenges with her new disposable pads. There was nowhere to dispose of them at school, and she had heard rumours that menstrual blood can be used in witchcraft. She was also forced to wear them for long periods of time, terrified of leaks. She decided it was easier just to stay at home.
Mariam, more positively, managed to use her pads comfortably and safely but still didn't make it to class. She had figured out a way to use her pads at school, but some of her male friends realised that she had her period and teased her mercilessly. They refused to sit next to her because of fears that they would be contaminated by her. The teachers ignored what was happening. They were really embarrassed by the whole situation and didn't know how to respond. Mariam's mother was not sympathetic as she had always told her to stay away from men and boys during her period. Unfortunately for Mariam, having a period was incompatible with realising her full potential. She skipped class every month and her grades suffered.
Menstrual stigma everywhere
Although the stories above come from Ugandan girls, other work has shown stark similarities to the UK. For example, in interviews with girls from both locations, recent University of Leeds graduate Lizzie Goolden was told by one UK girl: "My sister gets very anxious whenever on her period because she is worried about leaking and what people will think. This makes her not want to leave the house." No doubt the memory or reality of such fears will ring true with anyone who has ever menstruated, and is echoed in a Plan International UK report.
What all this shows is that there are myriad reasons why someone may not attend school, despite having access to menstrual products.
Building on Coventry University's community work aiming to end female genital mutilation in Europe, we have been partnering with communities to identify why it is that menstruators are unable to manage their periods hygienically and with dignity. A pilot of this method in Uganda was reacted to positively by the community. Local champions worked together with researchers and practitioners to dismantle menstrual taboos in the wider community and create sustainable solutions. This was achieved by educating men, women, boys and girls about menstruation and setting up access to a range of locally made and affordable menstrual products.
In the coming years, we plan to expand the work to evaluate the effectiveness of this approach in other parts of East Africa, Melanesia, remote Australian communities and the UK.
Donors across the globe are increasingly distributing funds to end period poverty, which is fantastic news. The UK government recently announced its campaign to end "period poverty" globally by 2030. But it is key that these programmes are directed towards evidence-based solutions—which are likely to involve more than supplying girls with pads. Understanding and addressing the root causes of period poverty is the only thing that will allow us to move towards a period positive environment for everyone who menstruates.