Imagine being a young girl who yearns to learn and dream of future pursuits, only to find yourself staying at home multiple days a month because you're unable to manage your period. This is the harsh reality for millions of girls across the globe.

The menstrual cycle is a natural phenomenon, yet it remains shrouded in social stigma. Thus, period equity has become a prevalent issue in the 21st century. It is characterized by a lack of access to menstrual products, hygiene facilities, and education [1]. It is a pressing, yet overlooked issue, especially in South Asia, where this challenge is compounded by cultural stigmas, economic barriers, and the aftermath of conflict, all impacting the health, education, and dignity of many.

A silent crisis.

The economic barriers of some countries prevent the purchasing of sanitary products, leading to common alternatives such as cloth rags. Additionally, cultural stigmas perpetuate the shameful and impure perspective towards menstrual blood [2]–which limits access to menstrual hygiene education.
Let’s hear from our interviewee [3], a formerly institutionalized individual from Sri Lanka, and her first experiences with her menstrual period. She is now part of an international non-profit organization that helps promote family care and aids the unfortunate circumstances of orphaned children in Sri Lanka.
She describes, “...I got my first period when I was 14 years. Staff had given us a cloth to keep with pants. We didn’t supply with the pads. We all wear cloth.”

She shares her experiences with dealing with her period as uncomfortable, stating, “...Sometimes I felt like vomiting. I never touched those cloths by my hands to wash, just wash using my foot. I am getting too much of pain and I never used to go to school on the first day of the period.”

Lack of hygiene, scarcity of mental support, social support, and medical attention to menstrual pain are all major contributors to period equity.

She continued to add, “Until I was 16 years old, I wore those cloths. There were few reason[s] that why we didn’t get pads. One, girls always kept used pads here and there. No proper way to dispose. Two, every water pump [was] also blocked due to girls throwing these pads inside the toilets. And three, there are more than 20 girls who need pads and the donation was not enough.”

For many women in South Asia, the high cost of sanitary products is a major barrier. Tax rates on menstrual products are very high. Sri Lanka is notable for having one of the highest tax rates at 51.07% [4], but why?
The Sri Lankan civil war, (1983-2009), had significant repercussions for citizen’s lives and government organizations. The disruption of its infrastructure has led to a lack of menstrual sanitation [5]. Using unsanitary menstruation management is associated with serious health hygiene issues which has a significant impact for those living below the poverty line. Cloth rags, for instance, are often reused without proper cleaning, increasing the risk of infections and other life-threatening diseases like cervical cancer, which is coincidentally the most common type of cancer among Sri Lankan women [6]. As our interviewee mentioned, the lack of access to clean water and private sanitation facilities increases these risks, and they are common concerns in most South Asia especially with many countries located in Stages 2 or 3 per the Demographic Transition Model.

Menstruation is considered controversial in many culturals, including in Sri Lanka, and stigmas discourage open discussions about menstrual health leaving many girls unprepared for menarche. Schools, in particular, often lack proper sanitation facilities and menstrual education, leading to high rates of absences among menstruating girls. The United Nations Population Fund reports that around 30% of schoolgirls in South Asia miss school during menstruation due to a lack of access to menstrual hygiene products [7]. It was even reported that more than 60% of Sri Lankan parents don’t allow their girls to go to school during their period [8].

Gender equity frameworks advocate for equal access to menstrual hygiene products, education, and resources for all individuals. This could include taking initiatives to distribute free or subsidized menstrual products or provide proper menstrual hygiene education [9].

However, how will comprehensive menstrual education help achieve menstrual equity? Menstrual education goes beyond addressing the biological aspects of menstrual cycle, and as it includes discussions on gender norms, stereotypes, and the social, cultural, and religious aspects surrounding it.

Our interviewee explained, “After 16 years old, I received pads and at least changed it three times a day.” –at a point in time when menstrual health and advocacy had started to take off.
In many cases, menstrual education dispels the misconceptions surrounding the topic, empowering girls with the knowledge they need to navigate their emotions and bodily processes with confidence. Incorporating the menstrual health curriculum in schools would ensure that they provide safe and welcoming environments for students and their teachers as well [10].

However, the methods for addressing menstrual health in low-resource areas have often been characterized by the Western savior outlook, where external organizations impose solutions without adequately considering local contexts and preferences [11]. This is paternalistic and fails to address the needs and realities of individuals in all communities.

Shifting perceptions are valued and highly needed, especially in communities lacking affordable menstrual products [12]. However, to do so, promoting a choice that best suits societies contextually is also essential. In rural towns and villages, women aren't always given the freedom of choice, especially in terms of menstrual products and period pain management. By involving women in decision-making processes and prioritizing their preferences, community-based organizations can ensure that interventions are culturally sensitive, effective, and sustainable in the long term.

Community engagement is central to this approach, where local perspectives and experiences are integrated into initiatives. This not only includes advocating as a community, but also involving all community members. Menstrual health is often seen as a “women’s issue,” but in actuality, it impacts everyone. Implicating people of all genders and ages allows for a diverse perspective in aid.

Period equity is not just an issue in South Asia; it is a global challenge. Although menstrual equity has served as a significant barrier to female empowerment and equity, by listening to the stories of individuals, we can better understand the need for urgent solutions. Organizations and those leading NGOs, grassroots movements, government agencies, and advocacy groups have already been instrumental in challenging menstrual stigmas [13]. Their initiatives utilize resources and networks to create educational materials, organize events, and push for policy changes to enhance access to menstrual products and facilities.
It’s time to take it several steps further.

We must work together to propel this initiative to not only address menstrual equity from a Western lens but rather from the lens of each individual within their cultural contex. Factoring in social variables and cultural preferences can boost period equity initiatives to the next level. It’s imperative to reeducate ourselves about what menstruation is and how it shapes the lives of 1.8 billion human beings worldwide.

References
1. “Period Poverty – Why Millions of Girls and Women Cannot Afford Their Periods.” UN Women – Headquarters, 24 May 2024, www.unwomen.org/en/news-stories/explainer/2024/05/period-poverty-why-millions-of-girls-and-women-cannot-afford-their-periods#:~:text=Period%20poverty%20refers%20to%20the.
2. “Puberty Rituals in Sri Lanka: A Tale of Blood, Demons, and Flower-Baths - Roar Media.” Archive.roar.media, 23 Nov. 2017, archive.roar.media/english/life/culture-identities/puberty-rituals-in-sri-lanka-a-tale-of-blood-demons-and-flower-baths.
3. Anonymous interviewee. Interview. July 7 2024.
4. “Putting the Period on “Taxing” the Period.” Latest in the News Sphere | the Morning, 8 Mar. 2024, www.themorning.lk/articles/1T3epr2oxcW3U8bMTwDZ.
5. Schultheis, Timothy, et al. "The Menstrual Health of Adolescents in Sri Lanka." PLoS One, vol. 9, no. 11, 2014, doi:10.1371/journal.pone.0112223.
6. “Challenging Unjust Cultural Stigmas and Tax Issues with Authenticity,….” Atlas Network, www.atlasnetwork.org/stories/challenging-unjust-cultural-stigmas-and-tax-issues-with-authenticity-research-and-compassion. Accessed 13 July 2024.
7. “Menstrual Health in Sri Lanka: A Timeline.” UNFPA Sri Lanka, 5 June 2023, srilanka.unfpa.org/en/resources/menstrual-health-sri-lanka-timeline.
8. “Breaking the Stigma on Menstruation.” UNFPA Sri Lanka, 29 May 2018, srilanka.unfpa.org/en/news/breaking-stigma-menstruation.
9. “Menstrual Equity | Division of Equity and Social Justice | County of Santa Clara.” Desj.santaclaracounty.gov, desj.santaclaracounty.gov/resources/menstrual-equity#:~:text=Menstrual%20equity%20refers%20to%20equal.
10. Henry, Joely. “Period Stigma and the Unacknowledged System of Oppression | Digital Education.” Digitaleducation.stanford.edu, 27 May 2022, digitaleducation.stanford.edu/period-stigma-and-unacknowledged-system-oppression.
11. Zimmerman, Jesse. “Foreign Policy and the Problem of the “Western Saviour Complex.”” Rabble.ca, 26 June 2012, rabble.ca/anti-racism/foreign-policy-and-problem-western-saviour-complex/. Accessed 13 July 2024.
12. Rideout, Nicole. “OHSU Study Finds Significant Gaps in Menstrual Research and Clinical Care.” OHSU News, news.ohsu.edu/2023/02/15/ohsu-study-finds-significant-gaps-in-menstrual-research-and-clinical-care.
13. Phillips-Howard, Penelope A., et al. "Menstrual Needs and Hygiene Practices of Girls in Kenya." BMC Public Health, vol. 19, no. 1, 2019, doi:10.1186/s12889-019-7062-5.
Written by Sathvega Somausndaram & Shreya Nadagowda