Lack of access to menstrual hygiene is the fifth leading cause of death worldwide among women. In the world, 1 in 3 girls faces the impossibility of ensuring adequate hygiene during menstruation, and many others face sometimes fatal arbitrary limitations imposed by culture.

According to a report published by WaterAid, each year about 800,000 women lose their lives due to diseases related to lack of access to water and basic hygiene, making it the fifth major cause of death globally, after cardiovascular disease, heart attack, lower respiratory tract infection and chronic lung disease.

Poor menstrual hygiene carries many health risks and has already been associated with a range of infections of the reproductive system and urinary tract. Dermatitis, altered pH of vaginal secretions, and bacterial vaginosis are some of the effects of improper hygiene during menstruation.

About 2.3 million people in the world don’t even have access to basic health services, which makes discussions about access to feminine hygiene products such as pads or tampons almost ridiculous.

In the world’s least developed countries, only 27% of the population has access to running water and soap at home. Therefore, home care during menstruation is a real challenge.

UNICEF points out that girls and women with various disabilities face additional difficulties and are disproportionately affected by the lack of access to toilets connected to water and sewer systems, or medical supplies.

Myths about menstruation, from different cultures

Some cultures celebrate the onset of menstruation. Aboriginal people in Australia celebrate the first menstruation of girls with ritual baths and special body paintings. In the Mossi tribe of West Africa, women are exempt from work and family chores during menstruation, and another West African tribe, the Dagara, attributes healing powers and special wisdom to women at this time of the cycle. In Orissa (an eastern Indian state), communities hold a four day festival dedicated to menstruation and women every year. The festival is called “Raja Praba”, and includes many indoor and outdoor games. Young girls dress in festive clothes and enjoy flower swings especially installed for them in the surrounding trees.

However, these are rare exceptions. In most cultures, menstruation is associated with negative myths and taboo practices that have affected the health of girls and women over the centuries. Menstruating women are seen as unclean, even contagious, so they are subject to a harsh set of restrictions.

In some parts of Indonesia, India, Nepal and Nigeria, girls and women are driven from their homes and forced to live in stables or “menstrual huts” every month when they get their period. The practice, which is called “Chhaupadi”, and has ancient Hindu roots, not only discriminates against women accused of “contaminating” the house, but also endangers their lives. Incidents of rape, or even death, are frequent in these small huts, which are also unprotected from insects or snakes.

In Japan, it is believed that women cannot be sushi chefs because menstruation unbalances their taste, making them unable to prepare proper sushi. Menstruating women cannot walk in temples, pray, touch holy books, and take part in religious rituals in some traditions of Hinduism, Buddhism, and Islam.

In some areas of Israel and Afghanistan, menstruating women are forbidden to wash their genitals because of the myth that washing would lead to infertility. According to UNICEF, in Bolivia, some communities believe that if menstrual and household waste are not separated, outbreaks of cancer will occur.

In rural India, women are not allowed to enter the kitchen, cook or touch certain foods during the period, as the villagers are convinced that those foods will spoil if touched.

Priyanka Tanwar, Chaonli Chakraborty and Kalpana Apte, three women who lead three organizations in India to support women’s health, say that in India, health discrimination and shame have become recurring in every subject related to health and sexual and reproductive rights. “In our culture, women are responsible to hold the pride of the entire family, community, and village and for her too. To protect this imposed burden of pride, women and young adolescents get into the trap of unhygienic menstrual management practices. This leads to poor reproductive health, increased unhealthy days, low productivity and income, poverty social connection, etc.”

“Women need to understand first the basic of menstruation as a biological natural process that is intrinsically related to a woman’s body. It has nothing to feel ashamed about it. … Second menstrual blood, which is considered so impure, also nurtures the fetus in the womb. So if a child cannot be an impure specifically male child then how is the menstrual blood impure?”

Not only a third world problem

From a distance, Romania seems far from the dramatic situation of women in poor countries. On closer inspection, however, Romania emerges profoundly deficient in at least two areas related to menstrual hygiene: infrastructure and education. A study published in 2019 by the National Institute of Statistics revealed that only a little over half of the country’s population (52.7%) has access to a sewerage system. In other words, almost half of Romania does not have running water. The situation is even more unbalanced when the statistics are broken down by environment: urban versus rural. If, in the city, 90% of households are connected to water and sewer networks, in rural areas the percentage stops at a shocking 10%. The gap is also maintained in terms of education. The Institute also showed that in the 2018-2019 school year, 3.5 million pupils and students were enrolled, but the number of graduates was only 500,000. However, 72% of pupils and students study in the city. The deficit of education and access to hygiene services contributes to the perpetuation of the shame associated with the menstrual cycle, which has been ingrained with the help of euphemisms that emphasize a negative perspective on an absolutely normal biological phenomenon. Journalist Ana Stan made a list of the most popular Romanian euphemisms about menstruation, and it was neither short nor dignified.

In countries with claims of a higher degree of civilization, shame is a defining symbol of menstruation as well. The British charity Plan International UK has published the results of a study on a sample of 1,000 girls aged 14 to 21, which shows that almost half of women are embarrassed by menstruation.

There is a real history behind this negative perspective on menstruation, and it is not only related to religion. For example, Aristotle believed that the soul of women has less energy than the soul of men, and he wrote in Metaphysics that, unlike semen, “menstrual blood has no vital force”. Thomas Aquinas would embrace the same ranking.

What can we do about it?

The first step towards normalizing menstruation and breaking the taboos surrounding this natural process is to initiate government policies to increase access to hygiene products, representatives of Global Citizen say. “Politicians don’t like this issue because it’s not sexy,” said Dr. Varina Tjon A Ten, a former parliamentarian in the Netherlands, and a professor at The Hague University.

In the richest country in the world, the United States, 70% of states levy sales tax on feminine hygiene products such as pads and tampons. They do not apply the same tax to other products classified as “necessary” such as lip balms, dandruff shampoos, condoms, or even pumpkins (in Pennsylvania), or shooting range membership cards (Wisconsin). Women’s rights activists are unhappy that so many states have not yet included menstrual care products on their list of necessary items. It is estimated that $150 million reaches the state budget annually from taxes paid on these products.

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However, many organizations have taken on this mission, without waiting for governments to synchronize on this priority.

In Malawi, a women’s protection organization offers free menstrual cups to rural students who don’t have the money to buy pads or tampons every month. Menstrual cups, invented in 1930, help girls to continue going to school during menstruation and avoid the stigma that is still associated with it. The product has certain advantages over ordinary instruments (unlike tampons, it does not absorb the beneficial vaginal secretions and does not involve the increased risk of toxic shock syndrome; unlike pads, using it for prolonged periods doesn’t produce unpleasant odors). However, menstrual cups, which have become increasingly popular, even in countries that have access to various hygiene options, are not recommended to women with recurrent vaginal infections, because blood stagnation for up to 12 hours creates a favorable environment for pathogenic bacteria to grow, causing endometriosis or toxic-septic shock.

Safety and dignity during the vulnerable period of menstruation remain, unfortunately, two elements of a luxury to which an impressive number of women in the world still do not have access.

Alina Kartman is a senior editor at Signs of the Times Romania and ST Network.