Tackling period poverty

Let’s zoom out from the doctor’s office now, to take a broader societal perspective on menstruation. And “Every month, girls in the UK face period poverty: two fifths have had to use toilet roll because they can’t afford proper sanitary products.” That’s a rather damning quote from the charity Plan International in reference to a recent report they conducted, and global campaigns manager Ema Jackson spoke to Katie Haylor and Adam Murphy...

Ema - The term period poverty refers to the inability to afford or access the products needed to manage your period. And this is an issue that's affecting millions of people all around the world and having a huge impact. It's especially acute in places of extreme poverty, as you might imagine. So places where there's little access to water and sanitation facilities. But like you say, it's also an issue here in the UK too, which people are often quite surprised about, given the fact that we're kind of in one of the richer countries in the world. We did a survey with girls in the UK and we found that many were suffering because they couldn't afford to access the products to manage their periods. So we found that 1 in 10 couldn't afford period products and then 42% - so almost half - of girls were saying that they'd been forced to use makeshift items such as socks or toilet roll because they'd been struggling to afford proper products. And our research showed us that period poverty is quite a complex issue that goes beyond simply this affordability of period products. And it's actually made up of what we're calling a kind of toxic trio of three connected and reinforcing issues. So firstly, the high cost of period products. Secondly, a lack of education about what makes a healthy period. And then thirdly, the deep stigma that still surrounds periods all around the world.

Adam - Given that we are in the middle of a global pandemic, what are the consequences for young people now with this?

Ema - There's huge consequences always to this issue. And then we've seen them kind of increase during this lockdown period. So period poverty has a huge and very real impact on girls’ lives. So a key example of this is on education. We see that girls are embarrassed around kind of leaking, or not having access to products, or being bullied. And so they're missing out on school because of their periods. And this is happening all around the world. So we see that 70% of girls in Malawi - a country in Southern Africa - are missing one to three school days per month due to menstruation, which is more than they miss due to malaria. So it is really significant. And period poverty is also putting girls physical, sexual and mental health at risk. So damaging their self image, their self esteem. Because of this kind of period stigma and lack of education, that's meaning that they don't access doctors in the same way and because they're embarrassed. And so it's causing late diagnoses of serious conditions, such as the ones you've been talking about on the programme. So it's brilliant to kind of be opening up those issues.

But then in lockdown, we've seen this compound, particularly around the issue of access to products. So we found that girls are struggling to afford and access the products that they need. We know that families are facing tough financial choices all around the world right now. And it's meaning that more women than ever are having difficulty accessing the products they need. We surveyed girls and found that 3 in 10 girls since lockdown began, had been having issues, affording the period products that they need, which is sad to hear.

Katie - I was talking to a colleague, Ema, earlier in the week about access to toilets as well, not just period products. How are charities like yours trying to support people at the moment?

Ema - Yeah. So there's a whole range of different things that we are doing. So you spoke about toilets there. So kind of firstly, on the global side, we're doing things like constructing girl-friendly toilets in schools and communities, and access to water and sanitation facilities. And trying to support girls so that they no longer need to use unhygienic materials. Also, when an emergency hits like a natural disaster or also COVID, we're providing essential dignity kits, which include period products because these are often kind of forgotten about in emergency response.

And then in the UK, we're doing lots of different things to raise awareness around period poverty and break down the stigma. It's an issue we've been working on since 2015. We did a big research report called Break the Barriers to get more people understanding this issue and getting people talking about it. And then we've done campaigning to the government to call for change around the education curriculum, around access to products. We even secured a kind of period emoji after girls told us that they felt that this would help them better communicate on this issue. So we're kind of trying to tackle it holistically across those three different areas that I discussed in that toxic trio, the access to products, the education and the stigma.

Adam - You mentioned the stigma there. How pervasive is that period stigma, now, in 2020?

Ema - Unfortunately, it's still really pervasive. So it's been there for centuries. But it's still there now. So whilst periods are a normal bodily function and a universal fact of life wherever you live in the world, sadly the shame and stigma still comes with them. So there's a sense that periods are kind of dirty or disgusting or make women weak. They're shameful, they need to be kept a secret. So we've kind of been indoctrinated to think that a perfectly natural bodily function is kind of abnormal in some way. And because it's predominantly affecting girls and women, it's a gender equality issue really. So we know that one in five girls have experienced teasing and bullying because of their period, and that one in five admitted that they didn't actually know what was happening when they started their period, which shows how much this stigma is still pervasive in 2020, because it's not being talked about enough for girls to understand what's happening when they started their period. And it's an issue globally as well. So 48% of girls in Iran believed in a survey that menstruation was a disease. And then there's extreme examples of this period stigma that are still practiced in 2020. So an example of that would be a practice called chhaupadi in Nepal, in which girls and women on their period are considered impure and unclean. And they're banished from the household and made to live for the duration of their period in makeshift huts, outdoors, which exposes them to lots of health and safety risks. So unfortunately, even though we think maybe there's lots of more progressive thought around lots of different health issues in 2020, this is still a key issue. And it's called a lot the final taboo. And it's definitely still there.

Katie - The thing is, better menstrual education and awareness is just better for everyone, whether you have ovaries or not, it's better for society. So what progress do you think, Ema, is being made in terms of access to education around periods, whether you menstruate or not?

Ema - Yes. We've definitely seen a lot of progress on this issue. So there's been a kind of growing and active periods activism movement in the UK and around the world. And from that we saw calls that Plan International UK and others supported to the government to call for the relationships and sex education curriculum to be amended, which we have seen happen. And so there is now discussion around what a healthy period is on the curriculum. And it will be interesting to see how that new curriculum is rolled out, especially in the post lockdown Covid situation that we're in now, seeing how education is prioritised in different ways.

But as you mentioned, it's really important that everyone learns about periods. I think the idea that it's something that just girls should learn about really reinforces a lot of the stigma and the secrecy and it being it kept as something just for girls. And so it's important that in all areas of life and with all people, we're having education on this topic. So it's not just traditional school things. I think this programme has been a kind of really good example of education and information sharing about this issue that can go out to everyone in society. And everyone in society has a role to play in breaking this stigma down.

Katie - Caroline, I want to bring you back in here because of course not all women have periods. And equally, not everyone who has a period is a woman. So how well do health professionals understand the experiences of menstruation for people who don't necessarily identify as women?

Caroline - So I think that the primary duty of a doctor is to the number one care and safety of their patient. And that should be separate to their beliefs. And just bear in mind that our patients come from very diverse backgrounds and beliefs. So I would like to see doctors just taking an open view, taking the lead from the patient and then dealing with those issues as the patient sees them.

Katie - And Ema, does this relate to the issues around access and stigma that we were talking about earlier?

Ema - Yes, definitely. So I think we need everyone in society to be part of that process of breaking down the stigma. And we need to be really inclusive in the language we use and recognise, as you've said, there are trans-men and non-binary people that are experiencing periods as well as lots of women who, for example, for health reasons or being pregnant or post-menopausal, or being trans-women, are not experiencing periods. And sometimes this is where the stigma can be the deepest. So we definitely need to be inclusive in the language that we use and recognise that this is a complex issue. And that no two period experiences are the same.

Katie - So we've mentioned education, we've mentioned stigma, and cost is still a major factor in this problem. Are we going to see the end of the tampon tax, do you think?

Ema - Yep. So the government has committed to ending the tampon tax. That's the tax that sees period products as a luxury item, so there's a 5% tax on them. And so the government in the spring budget committed to the end of that, which is a big step forward in gender equality. And we should see that being removed from January, 2021. But it's important to recognise that won't go that far in tackling period poverty. It saves about 40 pounds per woman over her lifetime. And so we need to see more action towards ending period poverty, even though that is a forward step.

Katie - Caroline, we started the topic of periods by talking to you about some of the basic biology. And now I want to come to you for the close. Is there anything else that you would like to add?

Caroline - Hannah brought up a very good point about periods and the hormonal changes during the month. 90% of women will get some sort of changes in the run up to a period. So we all recognise a bit of breast tenderness, a bit of bloating. PMS and PMDD are just much worse, and often with severe depression as one of the symptoms. So if I had one key message from today, it would be that your periods should be entirely manageable. And if you are running your life around your periods, then your periods aren't normal.