Masooma has an embarrassing memory she can’t let go of.
It happened in school, a couple of years ago. She was on her period, and because she couldn’t afford sanitary pads at the time, she was using old scraps of cloth to sponge up her monthly discharge. Before long, her makeshift napkin failed her, and a very obvious mortifying stain formed on her uniform.
“Other girls were whispering and giggling at me which made me cry,” Masooma recalled. The memory has burned the hot flush of shame deep into her psyche, so much so that Masooma requested to withhold her surname.
“We are an underprivileged family and my mother hardly earns enough to feed us for two times a day,” Masooma said, adding that since her father had died, they have had to make do with her mom’s earnings as a maid. “How is it possible that we could buy sanitary pads?”
“Instead of wasting money on pads, I use and reuse cloth to save money, which I can use to buy my lunch at school,” she said.
Keeping hygienic menstrual practices is a basic requirement for strong reproductive health, but like Masooma, many women across Pakistan remain trapped in their unsanitary ways due to lack of water and sanitation facilities; no access to toilets; poor awareness; pervasiveness of taboos, myths, and misconceptions; poverty; the high cost of pads; and other such factors. What ultimately suffers is their health and well-being.
Menstrual hygiene remains poor overall in Pakistan, a problem driven — and made worse — by weak access to water and sanitation facilities, and by staggering levels of poverty.
Poor period practices
Shahbana works in a shoe factory in Peshawar, near the northern tip of Pakistan, where she gets paid a pittance. “Sanitary pads are luxury for me which I can’t afford,” she said.
Napkins cost approximately Rs 100 (USD ~1.35), money that Shahbana could use to buy food for her family instead. “Sanitary pads are not my priority, it’s for girls who belong to affluent families,” she said. “I tear the strips of cloth from my old dresses and use it during bleeding days.” Like Masooma, Shahbana also asked to keep her surname undisclosed out of shame.
Sadly, Masooma and Shahbana are hardly isolated cases in Pakistan, where poverty keeps proper hygiene practices out of reach for millions of women.
According to a 2015 survey by Real Medicine Foundation — a humanitarian organization that provides support to people living in disaster- and poverty-stricken areas — nearly 80 percent of Pakistani women do not manage their periods hygienically.
Moreover, UNICEF data show these troubling numbers are driven by lack of access to basic hygiene needs: more than 40 percent of women and girls live in households, attend school, and go to work in places that do not have such facilities.
Sehar Taimoor, Menstrual Hygiene Management (MHM) Focal Person at WaterAid Pakistan, confirmed this. “The non-availability of women/girl-friendly toilets at home, no place to dispose of sanitary napkins, no place for washing or cleaning cloth, lack of privacy to change clothes, feeling of shame, and not communicating needs to other members of the household regarding sanitary products leads to poor hygiene.”
Aside from sorry state of sanitation in the country, several myths, unfounded beliefs, and misconceptions remain deeply entrenched in the public’s imagination and make it more difficult to promote healthy menstrual practices among women.
For instance, gynecologist Dr Sadaqat Jabeen says that too many Pakistanis still believe that taking a bath during their period would stop the menstrual bleeding, which they believe is bad for health. Following this logic, many women also refrain from washing themselves after answering the call of nature.
“Some myths are associated with eating less amount of food and not providing the girls with right nutrition such as meat, yogurt, and fruits,” Taimoor added.
But not only are these myths unfounded on any scientific knowledge, they are also actively harmful. Insisting to keep the body unclean in deference to the menstrual flow could put aggravate the risk of infections and other such diseases. Restricting types of food, on the other hand, could leave the body inadequately nourished and weak.
Shahbana, the shoe factory worker, knows this first-hand. Sometimes during her period, she’d use a scrap of cloth for two or three days at a time, which would give her itches and rashes in her inner thighs. Eventually, she came down with urinary tract infection.
Jabeen says that such health consequences are not surprising, given the poor sanitary practices. Other ramifications of unhygienic menstruation include reproductive tract infections, rashes and sores, irritation, pain, and pelvic inflammatory diseases.
In Pakistan, girls and women are ashamed to talk about their menstrual health and needs. Such a smothering culture of silence makes it difficult for advocates, healthcare workers, and educators to promote sanitary and hygienic practices in the country.
Breaking the culture of silence
Despite its huge health burden, menstrual hygiene is beset by a repressive culture of silence in Pakistan.
“Menstruation and menstrual hygiene are neglected subjects in Pakistan,” Jabeen said. “People are reluctant to talk about them because of the shame and taboos associated.”
Women who talk about their monthly cycles openly are labeled as immodest or shameless, which in turn pushes young girls to keep quiet about theirs. “Menstruating girls face ridicule and shame, that’s why they don’t talk about it publicly and even hide their menstruating cloth from others and keep it in secret places at homes,” Jabeen said.
This shame is so pervasive that it has even hushed households, supposedly safe spaces for young girls to learn about their bodies. “Mothers often do not tell their daughters about the menstruation process and when they reach the age of puberty, they do not have any idea what is happening to them,” said Taimoor, of WaterAid Pakistan.
In a 2017 UNICEF poll, 49 percent of the surveyed young girls said that they had no knowledge of menstruation prior to their first period.
However, Jabeen said that menstruation “is a natural process and girls should not feel ashamed of talking about it. Authorities at the helm of affairs need to pay heed to the issue and take pragmatic steps for the promotion of healthy menstrual hygiene practices.”
Building appropriate awareness of the issue, she added, is the critical first step to improving menstrual hygiene in the country. And for this to happen, breaking the culture of silence will prove pivotal. The government could partner with media companies to launch awareness campaigns involving everyone — of all sexes and gender identities, and from all walks of life.
Jabeen added that “the government should include menstrual hygiene in syllabus for girls only and lower the prices of pads so that girls from privileged families can buy it easily.”
To the point of making hygiene essentials more accessible to families, Taimoor of WaterAid Pakistan agreed. She recommended that all public buildings must have separate women/girl-friendly toilets in the public buildings, and highlighted the need to lobby for the inclusion of MHM into existing policies around health and education.
“Addressing the issues of MHM is fundamental to WaterAid’s integrated approach to water, sanitation, and hygiene (WASH), and is our distinct contribution towards gender equity in communities, institutions, workplaces, and public places,” Taimoor said.
WaterAid has been involved in the improvement of MHM in Pakistan for at least eight years, working across all levels of society, engaging the individual and lobbying the government.
From 2012 to 2019, for instance, WaterAid Pakistan was able to provide Girls’ Friendly Toilets to more than 50,000 girls across over 200 schools. Their experience in the country taught them that “the key to a successful MHM project is working closely with the government, integrating MHM in the process through teacher training, formation of WASH clubs, and maintaining the toilets,” Taimoor says.
At present, WaterAid Pakistan is working on a large-scale analysis of crucial gaps in policy to promote MHM in the country, as well as undertaking campaigns to improve research and data collection for evidence-based decision making.
But there is still much to be done — way too much for one organization to tackle alone. According to Taimoor, only through robust coordination mechanisms between civil society organizations, individual advocates, and the government can Pakistani girls see true and genuine changes to their menstrual hygiene.●
Mahwish Qayyum is a freelance journalist based in Pakistan. Her work has been published in international news outfits such as Vice News, Newsweek, and Al Jazeera.
