What is period poverty and what are its consequences?

Many women do not have access to basic sanitary products like pads and tampons, much less medications for period pains or apps to track their menstrual cycle. — AFP

One of the biological roles of females is to perpetuate the human species during their reproductive years, i.e. the time from menarche, when menses (periods) start, to menopause, when menses cease.

The menses are the shedding of blood from the uterine lining.

Menstruation is controlled by hormones in the brain and ovaries.

These hormones cause the release of an egg (ovum) from the ovary at the start of each menstrual cycle, and the uterine lining to thicken to prepare for the implantation of the fertilised egg.

If there is no fertilisation, pregnancy does not occur.

The uterine lining then breaks down and is shed as menses.

The menstrual cycle is the term for the sequence of events that occurs as females prepare for the possibility of pregnancy each month.

Each individual’s menstrual cycle is slightly different from others and can change from their teenage years to their 40s and 50s. However, the process is the same.

The United Nations Population Fund estimates that about 800 million females menstruate daily.

Although menstruation is a biological process, it is also an inconvenience.

What is period poverty?

The access to menstrual products; safe, hygienic facilities in which to use them; and the right to manage menstruation without shame or stigma, is vital for everyone who menstruates.

The World Bank defines poverty as hunger, lack of shelter, being sick and not being able to see a doctor, not having access to school, not having a job, fear for the future, and living one day at a time.

Poverty isolates by restricting access to recreational activities.

With the revised national poverty line in July 2020, the World Bank estimated that 5.6% of Malaysian households are in absolute poverty.

Meanwhile, period poverty is defined as a lack of access to menstrual products, hygiene facilities, waste management and education.

There are different types of period poverty, which are related to access, affordability and/or culture; embarrassment or the fear of it; environmental conditions, i.e. lack of supplies and/or sanitary facilities; and loneliness, which is due to a combination of the above.

Period poverty is prevalent in both developing and developed countries.

According to the World Bank, an estimated 500 million females globally lack access to facilities to manage their menstruation.

The United Nations Entity for Gender Equality and the Empowerment of Women estimated in 2019 that 1.25 billion females (the equivalent of India’s population) have no access to a safe, private toilet, and 526 million (the equivalent to the combined population of the United States, Mexico and the United Kingdom) have no toilet at all.

There is no published data on the prevalence of period poverty in Malaysia.

Some women and girls have to resort to using rags to absorb their menses as they cannot afford to buy pads or tampons. — Filepic

Health consequences

Period poverty can lead to physical and mental health problems.

Females who do not have access to menstrual products use a variety of products that include rags, newspapers and leaves, and even mud in some countries.

The smell and leakages are problematic and can cause infections.

When there is no access to clean water – which is still the case in parts of Malaysia – hygienic management of periods is difficult.

Mental health problems can occur with women who suffer from period poverty experiencing moderate to severe depression.

Teenage girls may feel lonely, and even ostracised, especially when they have no one to share their experience with.

They may also experience discomfort and distractions, leading them to self-medicate or avoid food, which can result in anaemia and absenteeism.

Educational and job consequences

Reports that not all Malaysian children complete secondary school are of concern.

School dropouts would have difficulty securing jobs, and even if they do, their pay would be low, exposing them to socioeconomic poverty.

Some societal segments continue to have unscientific myths and stigma about menses, like menstruating females being unclean, moody or irrational.

Girls without access to menstrual products may be unable to attend school, as they cannot risk bleeding through their clothes.

School avoidance may also be due to the lack of facilities for changing to fresh menstrual products, or because of painful menstrual cramps.

There may be fears of being teased, shame or negative stigmatisation.

Participation in sports and extracurricular activities may be embarrassing for menstruating girls because of concerns about blood leakage or not wanting to change in front of others.

Girls who miss out on exercise because of period poverty may be at risk of poor health as regular exercise is essential for good health.

Furthermore, missing out on the social aspects of team sports can lead to isolation and adverse mental health consequences.

Stigma and shame may cause girls who are menstruating to skip sports in school, which is not good for physical or mental health.

A health and human rights issue

The World Health Organization (WHO) called for menstrual health to be recognised, framed and addressed as a health and human rights issue, and not as a hygiene issue, at the 50th session of the United Nations Human Rights Council (UNHRC) held from June 13 to July 9, 2022.

The international health body called for three actions: “Firstly, to recognise and frame menstruation as a health issue, not a hygiene issue – a health issue with physical, psychological and social dimensions, and one that needs to be addressed in the perspective of a life course – from before menarche to after menopause.

“Secondly, to recognise that menstrual health means that women and girls and other people who menstruate, have access to information and education about it; to the menstrual products they need; water, sanitation, and disposal facilities; to competent and empathic care when needed; to live, study and work in an environment in which menstruation is seen as positive and healthy, and not something to be ashamed of; and to fully participate in work and social activities.

“Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured.”

Providing menstrual products

Instead of providing menstrual products for its staff, the Health Ministry can and should, as a start, do more to reduce period poverty, like ensuring the provision of environmentally-friendly menstrual products either free or at reduced cost to the poor in society, particularly in schools.

Malaysia is currently a member of the UNHRC and vice-president of the World Health Assembly, the governing body of the WHO.

It behooves us to set a good example for the rest of the world.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.