“Why is nobody else eating?” I ask, referring to my older sisters and mom. If they don’t eat now, then their fast, or abstaining from food and water during the daylight, will be unbearable.
It’s 3 am in July. Quietly, I eat cereal while seated at the kitchen table. My dad takes a bite of his toast and glances at the newspaper.
“They can’t fast,” he says, without explanation. I finish my cereal and go back upstairs to sleep.
Before I got my first period at age 13, there was no discussion surrounding the topic in my family. In Islam, women are told to not fast, not pray, and not read the Quran (religious text) while on their periods because they are “impure.” In Hinduism, for the same reason, it is expected that women not enter the temple while menstruating (1). These beliefs and gender inequality contribute to period stigma.
I am fortunate to have received period education in school. I will never forget the relief I felt, in 5th grade, when I learned that a period is “not like a waterfall [of blood].” Although, in the US, only 21% of elementary schools and less than 50% of middle schools teach lessons about puberty. New York does not require its public schools to teach sexual health until 6th grade (2). Yet, the US average age of menarche, or a first period, is 12. But many, especially Black American and Latina girls, are starting their periods by age 8 (3).
The lack of period education in not unique to the US. Globally, girls receive less general education than boys. China has, traditionally, prioritized the education of girls less because the expectation is they will attain success upon marrying into another family. Periods are not perceived as a suitable topic for school (4). In Quetta, Pakistan, a remote area near the Afghanistan border, 80% of female adolescents have “no prior classes or discussions about menstruation and hygiene at school.” Many turn to their mothers for answers (5). Misinformation and stigma is then passed on.
The health of women is threatened when they are unable to access period education. Menstrual hygiene management (MHM) is not innate. Period products should be changed or cleaned often. In India, MHM is a challenge in rural areas. Due to certain taboos, women are told to not bathe, cook, or work while menstruating. Disposable period products are expensive so most women choose cloth pads. But washing facilities are ill-equipped to sanitize a reusable period product. In rural and urban areas of India, public bathrooms cannot manage menstrual waste. Schools may have “incinerators” for girls to place disposable period products but “shyness or fear of being seen by others” causes many to flush them down the toilet instead which clogs sewer systems. River banks, in rural areas of India, are littered with disposable period products. Blood, that may be infected with hepatitis or HIV, can seep into the soil and affect the larger population (6).
Poor menstrual hygiene management is not restricted to the unsanitary practices that stem from period stigma. In Quetta, about 40% of female adolescents have missed school due to their periods (5). A similar finding arose by assessing six schools in Delhi, India. One school had no girls-only bathroom and, unsurprisingly, had the highest rate of absenteeism (7). In China, a menstrual health education program was established at one school. It improved “menstrual health, promoted a positive attitude and confidence, and increased pain relief practice” (4). If girls are empowered to speak about their periods, then they can receive help from teachers or nurses instead of skipping school, which is detrimental to academic achievement and emotional health.
Period poverty, or the inability to access period products, is a direct result of period stigma. In the US, low-income women have resorted to rags, paper bags, and toilet paper when period products were unaffordable. The sales tax imposed on period products, called the tampon tax, is considered to be a form of gender discrimination (9). India repealed theirs in 2018. The US has not completely abolished the tax. But, the 2020 CARES Act made period products a reimbursable expense when purchased with health savings accounts (HSAs) and flexible spending accounts (FSAs) (10).
In 2018, Michigan State University’s (MSU) initiative, Mission Menstruation, was launched to provide free emergency period products, in dorms and academic buildings, for students of any gender-identity (11). The program was both welcomed and well-received. Recently, the team, which I am a part of, established a nonprofit, with the same name, so other universities can create similar initiatives. In addition, one goal is to design a destigmatizing and accurate period education curriculum for schools and local organizations that support low-income adolescents. By reducing period stigma, across the globe, the well being of those who menstruate improves, building a more equitable and healthier environment for all genders.
1. Sachdev, C. (2015). Indian Women Flout Menstrual Taboos By Saying They’re #HappyToBleed. NPR. Retrieved from https://www.npr.org/sections/goatsandsoda/2015/12/13/458321907/indian-women-flout-menstrual-taboos-by-saying-theyre-happytobleed
2. Greenfield, B. (2018). What’s the state of menstruation education in U.S. schools? ‘Significantly lacking,’ say experts. Yahoo! Life. Retrieved from https://www.yahoo.com/lifestyle/whats-state-menstruation-education-u-s-schools-significantly-lacking-say-experts-130030452.html
3. Martinez, G. (2020). Trends and Patterns in Menarche in the United States: 1995 through 2013–2017. National Health Statistics Reports. Retrieved from https://www.cdc.gov/nchs/data/nhsr/nhsr146-508.pdf
4. Su, J., & Lindell, D. (2016). Promoting the menstrual health of adolescent girls in China. Nursing & Health Sciences, 18(4). Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/nhs.12295
5. Michael, J., Iqbal, Q., Haider, S., Khalid, A., Haque, N., Ishaq, R., . . . Bashaar, M. (2020). Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Women’s Health, 20. Retrieved from https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0874-3
6. Kaur, R., Kaur, K., & Kaur, R. (2018). Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal of Environmental and Public Health. Retrieved from https://www.hindawi.com/journals/jeph/2018/1730964/
7. Vashisht, A., Pathak, R., Agarwalla, R., Patavegar, B., & Panda, M. (2018). School absenteeism during menstruation amongst adolescent girls in Delhi, India. Journal of Family & Community Medicine, 25(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6130156/
8. UNICEF. (2019). Guide to menstrual hygiene materials. Retrieved from https://www.unicef.org/wash/files/UNICEF-Guide-menstrual-hygiene-materials-2019.pdf
9. 30 states have until Tax Day 2021 to eliminate their tampon tax. (2020). Retrieved from https://www.taxfreeperiod.com/
10. Rodriguez, L. (2020). US Government Acknowledges Period Products Are Necessities in COVID-19 Stimulus Bill. Retrieved from https://www.globalcitizen.org/en/content/cares-act-covid-19-menstrual-products-fsa-hsa/
11. Emergency Menstrual Hygiene Products. (2020). Retrieved from https://wacss.msu.edu/emergencymhp/index.html