Understanding Period Poverty: Are We Doing Enough?

Illustration by Jeannie Phan

In an 8th grade Biology textbook, Menstruation is defined as, “The periodic blood that flows as a discharge from the uterus.” Over the last decade, a vast volume of sociological terminology relating to menstruation has become a part of living room conversations and media discourse. These terms reflect upon the varied phenomena associated with menstruation — from “menstrual stigma” that is now regarded as a form of misogyny to “menstrual liberation” and “menstrual education”, social scientists have coined multiple terms to define society’s relationship with women’s bodies. Throughout this period, we have drawn intersections between menstruation and public policy, healthcare, religion, and gender. However, the economic and financial aspect of menstruation remains largely neglected.

In the last decade, another issue was repeatedly highlighted- the issue of global poverty. In an 8th grade Civics textbook, Poverty is defined as, “Poverty is a state or condition in which a person or community lacks the financial resources and essentials for a minimum standard of living.” In simpler language, poverty is the practice of living one day at a time. In 2012, the Indian government reported that about 22% of the Indian population was below the official poverty limit. It further reported that only 27% of adult Indian women had a job. As per a 2018 Oxfam Report on Inequality, there had been a marginal upsurge in the percentage of working women, but women still received 34% less wages than their male counterparts for the same work. In another pan India survey of organisations launched by Confederation of Indian Industry’s (CII) Indian Women Network (IWN), gender parity was found to be absent even at senior positions, where 16 per cent of organisations had no women on their board, 47 per cent reported that there were no more than 5 per cent women in senior management roles, 42 per cent female respondents said that they faced managerial bias, and 33 per cent of the female respondents believed that there were different performance standards and expectations for male and female employees working at the same level. As a consequence of such discriminatory organisational structures, occupational segregation, gender labeling, income inequality, unpaid labor and the overall sexist workplace culture, women across the globe experience disproportionately greater degrees of poverty and even greater consequences of poverty as opposed to men. In the case of Indian women, these consequences are only aggravated by the patriarchal and casteist social structure of the country.

Menstruation And The Pursuit For Substantive Equality

According to the Indian Ministry of Health, only 12% of menstruators in India have access to sanitary products.

It is important to understand that we are dealing with two significant developmental concerns here: gender discrimination and poverty. It is therefore necessary that we acknowledge the intersection between these two realities. The fact that a majority of the Indian poor are women is unsurprising and it leads us to the concept of compound discrimination, which is something that I happened to have spoken about in the past. Compound discrimination is a subset of structural discrimination that takes place on the basis of several personal grounds or characteristics/identities which operate and interact with each other at the same time and in such a way as to be inseparable. When we speak about poverty and gender, compound discrimination is at play. And, when we speak about overcoming the same, we must look at systemic solutions that address the multidimensional aspects of such discrimination. For instance, we must understand that there are significant cultural, political, and economic differences between women from different communities — between upper caste women and dalit women, between cisgender-heterosexual women and women from the LGBT community, and between Hindu women and minority women. Therefore, when we speak about securing equality for “all women”, we must understand it as “substantive equality” instead of formal equality.

Substantive equality is a socio-legal concept which recognizes that the policies and methods established for the majority of the population may appear to be non-discriminatory and inclusive, but they may not address the specific needs of certain groups of people thereby leading to a form of discrimination that is often invisible. We have been speaking about intersectionality and inclusion for years, yet when most people hear the word “equality”, they define it as formal equality which openly disregards past discrimination, cultural transgression, implicit bias, and other factors which advance discriminatory attitudes. It also disregards the reality that rights, facilities, entitlements, and privileges are unevenly distributed across society and certain communities might have special needs which other communities might not. This is why formal equality is an insufficient solution to tackle disparity — giving everybody the same resources means while someone is over-equipped, someone is still deprived. Substantive equality, on the other hand, takes us closer to equity by helping us see how layered discrimination can be and also explains why different people need different resources. When it comes to menstruation, by defining equality substantively, we open the conversation to formerly unaddressed concerns that are specific to marginalized women. One such concern is “period poverty”. As per Bodyform, one of the UK’s leading menstrual hygiene brands, “Period poverty means being unable to access sanitary products and having a poor knowledge of menstruation often due to financial constraints.”

Understanding Barriers

An Indian woman makes cloth sanitary napkins at the NGO Goonj in New Delhi; many Indian women don’t have more than scraps of old cloth when menstruating, which can pose health risks.

In India, only 42 per cent of women have access to sanitary products. Most women use cloth rags in place of sanitary pads — using these rags increases the risk of developing several diseases, even if they are regularly washed and maintained hygienically. As stated in a report launched jointly by Bank of America and Dasra, 63 million adolescent girls in India do not have access to a toilet in their homes. In the absence of a clean and private space to use sanitary pads, girls are often unable to manage their own hygiene. This can lead to urinary tract infections, vaginal infections, and rashes which could have long-term health consequences that require medical assistance. Research states that an estimated 70 percent of all reproductive diseases are caused due to poor menstrual hygiene. Join the dots. Adolescent girls in India are more prone to developing reproductive diseases later in life and facing complications during pregnancy and childbirth. Hence, providing women the resources required to practice menstrual hygiene will help in reducing maternal and neonatal mortality.

Apart from accessibility, even cultural stigma has fostered period poverty in India. Menstruation remains a hushed conversation. This has led to about 71 per cent of girls having no knowledge about menstrual health until after their first period. Due to this, menstrual hygiene is not considered a priority within Indian families and household spending on essential menstrual products is negligible owing to mothers viewing these products as unnecessary. Clearly, menstrual stigma is a larger problem than previously believed.

One of the ways through which such stigma can be tackled is incorporating menstrual education into school curricula. For instance, the government of Maharashtra has made menstrual health education mandatory in public schools. As per a UNICEF Report, in 2017, the Maharashtra government introduced pilot programs in a few districts in order to provide menstrual health information and resources to students. In addition to teaching children about menstrual health, the government also decided to work towards educating parents. Prior to this initiative, only 13% of menstruating girls and women in Maharashtra knew about periods before they experienced them. Even the Goa Government, in partnership with Procter and Gamble’s, introduced an educational module on Menstrual Hygiene Management (MHM) as part of the government school curriculum. Apart from educational institutions, the central government can also use the public healthcare system to educate families about the health-related consequences of improper menstrual practices.

A sign hung outside a temple in India.

A lack of education about MHM often leads to menstrual shame. This forces girls to stay out of school which means they miss anywhere between 10%-20% of school days. In certain families, girls are made to drop out of school after menarche, not only because of cultural beliefs, but also due to gender differences becoming more highlighted upon puberty. It has been estimated that as many as 1 in 5 girls drop out of school after they get their first period and in some regions like Maharashtra that number is nearer to 4 in 5. In Northeastern India, the outlawed practice of Chhaupadi is still very common. Under this practice, women are sent away to live in “menstrual huts” during their periods. This is not only unethical but it may also lead to several health concerns. Hence, the removal of regressive cultural beliefs that perceive menstruation as an unholy or unclean process is necessary to not only retain girls in schools, but also to ensure their safety at home. This kind of cultural change does not only need to happen within homes, it needs to be visible in election speeches, headlines, and conversations that induce menstrual shame and eventually restrict women’s education, upliftment, and financial empowerment.

Most importantly, it is necessary for girls to receive menstrual education before their first period, so that upon menarche, they do not drop out of school; so that upon menarche, they are in a position to defend their right to education, practice safe and sustainable Menstrual Hygiene Management (MHM), and educate others about menstruation. It is a cycle: menstrual health awareness during primary education is a necessary step to higher education. Getting girls into schools is not enough — we need to actively work to retain them.

A seemingly obvious cause of period poverty is the high cost of sanitation products and facilities in India. Approximately 70.62 million people in India live in extreme poverty on less than $1.90 per day. The average Indian woman needs 300 rupees ($4.20) per month for menstrual products. Mathematically, it is infeasible for low-income households to invest in MHM and it becomes a deprioritized concern. To prevent this, in July 2018, the government of India took a step towards making menstrual products affordable by scraping the 12% tax imposed on them. At this point, it is important to note that this move only came about after months of campaigning by activists and journalists from across the country. Evidently, we need more initiative from the government on the forefront of period poverty — we should not have to protest for something so preliminary because from here, the journey is still very long. Making menstrual products tax-free is only a short-term solution to an issue as complex as period poverty. In fact, it is even an unsatisfying solution. According to a study conducted by European Sting, when Ugandan girls were provided free reusable sanitary pads, it did not necessarily improve school attendance. In one instance, girls were not aware of how the pads should be used and ended up not using them at all. In another, girls had to miss school despite using the reusable pads because their schools lacked the infrastructure needed to clean and maintain the cloth pads. In other cases, girls were hesitant about using pads at school due to teasing from male classmates. This was primarily because in Uganda, menstruation is associated with witchcraft. Hence, the government will have to go beyond just making menstrual products affordable. It will have to address menstrual stigma by enhancing the supply chain of menstrual hygiene products in different corners of the country while also ensuring that the facilities needed to use these products are available to women.

A picture of women workers making sanitary pads at Myna Mahila Foundation.

In India, there are community organisations working towards providing menstrual facilities. One such organisation is the Myna Mahila Foundation. Founded in June of 2015, Myna Mahila Foundation is based in Mumbai, Maharashtra. The organisation works towards improving menstrual hygiene affordably, generating female employment in slums, and building women’s networks. In March 2018, they launched the “Sponsor a girl” campaign to provide sanitary pads to 600 girls across five slum communities. There are multiple such woman-owned organisations working to uplift and empower marginalized women, thereby proving how necessary MHM is. Despite this, the shame and silence around menstruation is alarming. It is time “MHM” becomes a part of election speeches, of manifestos, and of media debates. It is time we hear our leaders speak about issues that concern approximately 48.3% of their voter base and 48.02% of the total Indian population.

Apart from community organisations and the government, even academia has a role to play. In academic circles, a particularly surprising element of the conversation around period poverty is that women who define themselves as “progressive” and “liberal” have failed to adequately address the issue. This is primarily because most of these circles are dominated by privileged upper-caste women who do not pass the microphone to dalit rural women, who do not actively work to make dialogue inclusive by accommodating diverse voices, who do not address issues that concern women from minority communities, who construct elitist and exclusionary intellectual spaces that sideline the non-English speaking part of the population, who co-opt dalit leaders, and who are only echo chambers for brahmanical ideas that perpetuate institutionalized patriarchy that targets poor, underprivileged women who lack the resources to secure their rights. It is important to understand that the movement for women’s rights and the movement against Brahmanism must unify because the patriarchal ideology in India is inherently brahmanical. In order to abolish brahmanical patriarchy, we will have to start by bringing up intersectional issues such as period poverty and we will have to make space for dalit women in our conversations. As allies, we must understand that dalit women who come from historically oppressed communities are the stakeholders when we speak about period poverty and must be given center stage.

After academia, even individuals can adopt a number of measures to help solve period poverty. Apart from donating period products at local shelters, signing petitions, and participating in marches that pressure the government to bring about legislative changes that favor menstruators, you can take two other steps to make lives easier,

First, if you are someone who can afford proper menstrual hygiene products, ensure that you purchase from brands that donate a portion of their revenue to alleviate period poverty or partner with a non-profit organisation that works to provide menstrual products and education to marginalized women.

Second, consider donating to a charity. You can donate to Binti, which is an organisation that has adopted a threefold solution to overcoming period poverty through access, education, and destigmatization. Learn more about them here. You can also donate to Goonj under their ‘Not Just A Piece Of Cloth’ initiative. As part of this initiative, they distribute reusable cloth pads across India and organize meetings to inform women about MHM. You can donate here.

Along with this, ensure that you and the people around you are sufficiently educated about period poverty. The World Economic forum adopts a threefold approach to understanding period poverty: a lack of awareness, a lack of acceptance, and a lack of access. A lack of awareness is why menstrual needs get deprioritized. A lack of acceptance is why women end up using unsafe sanitary products and girls miss school during their period. And, a lack of access is how women get exposed to illnesses arising out of inadequate menstrual hygiene.

In the end, if governments, community organisations, corporate brands, and us as individuals choose to mobilize resources to fight period poverty, we will be able to make life easier for 23 million women in India.

Join the fight.