Why Menstrual Products Should be Free for All

I believe change is possible. I envision a world where those in remote rural areas, as well as other disadvantaged communities like mine, can have their periods with dignity.

In this world, young people would not have to miss out on classes because they have no proper menstrual products. For many young girls, menstruation is an addition to the long list of gender disparities they face every day of their lives. I find it almost unbelievable that having to go through a period without appropriate products can infringe on the most basic human rights of girls – including access to education.

In Zimbabwe, many girls in remote rural regions, and other disadvantaged areas such as farming communities, stay at home for the entire length of their periods.

This is primarily because of the fear and shame that exists around leaking in front of others. Sometimes girls use discarded cloth, but this does not offer sufficient protection on their long walks to school. It is these fears which prompt them to stay home and miss out their classes. If girls miss out on classes, they won’t be able to excel in their studies, which not only impacts negatively on the girl herself, but on her community as a whole.

The education of girls is undeniably one of the primary focus areas of development efforts, as female school achievement is believed to have long-lasting and far-reaching economic effects. Sustainable Development Goal 4 aims to achieve inclusive and equitable quality education for all by 2030. To meet this aim, I believe that it’s imperative to provide free menstrual products for all.

The difficulty of using cloth while on your period is that you need to wash, dry and change the cloth. However, many schools don’t have facilities where girls can wash themselves and change their cloths, and there is nowhere to hang cloths to dry. This helps to explain why many stay home once a month, and demonstrates the importance of free provision of menstrual products to girls from disadvantaged communities in Zimbabwe and elsewhere around the world.

Stigma and gender disparities are still rife within many communities in Zimbabwe, and it should be noted that the subject of menstrual health remains a taboo. Parents don’t discuss it with their children, which leaves girls to suffer from pain and shame in silence.

In my community, there are many negative cultural attitudes associated with menstruation, including the idea that menstruating people are ‘contaminated’, ‘dirty’ and ‘impure’.

Stigma puts young girls in particular in an extremely difficult position – if they don’t have proper menstrual products, they leak. If they are seen with stained clothes, they risk being socially segregated.

I believe that one day, people from disadvantaged communities like mine will be free to experience their periods with dignity. Girls will be able to attend school, excel in their studies and, above all, stand and fight against stigma and discrimination. I believe that this begins with access to free menstrual products for all.

Menstrual Pain is a Public Health Matter

Menstrual health is a topic that is often neglected and ignored. In particular, the issue of menstrual pain can be overlooked because of the stigma that surrounds it. However, I recently read an article in Cosmopolitan magazine about period pain. It mentioned Professor John Guillebaud, of University College London, who described the severity in pain as being “almost as bad as a heart attack”.

Despite this, many doctors dismiss menstrual pain as irrelevant when a patient brings it up. As a practicing doctor, I have come across patients in casualty complaining of period pain. Shamefully, I admit that I have trivialized these women and their pain. Because of my own internalized sexism, I have choosen not to believe them or expected them to just ‘deal with it’ (it’s all part of womanhood, isn’t it?). I believe many other doctors, both male and female, have harboured similar thoughts. As a result, women to wait longer for medical attention and sometimes receive inadequate pain management.

Menstrual pain interferes with the daily life of one in five women.

The two main causes of debilitating pain are primary dysmenorrhoea and endometriosis. It is often difficult to differentiate between the two because they can present with similar symptoms. Endometriosis can be difficult to diagnose – in some instances the diagnosis process can take up to a decade. Doctors have struggled to find the specific medical causes for primary dysmenorrhoea. This may be related to the poor quality or low volume of sufficient scientific and medical research into menstrual pain.

I believe menstrual pain is ignored or completely disregarded by our society and culture. At times, males cannot relate because they cannot share the experience. As women, we are not taught not to discuss menstruation openly and to keep the great physical and emotional distress we may have to go through to ourselves.

In the workforce, menstrual pain is seen as a hindrance – yet another reason to deny women equality in the workplace. In schools, girls and young women are shamed for their pain and as a result, many choose to stay at home if the intensity increases.

There are changes that need to take place regarding menstrual pain:

  • Increased awareness around menstrual pain and its causes
  • More open discussions about menstrual health in the media, schools, offices and GP rooms to remove the stigma around menstruation
  • Consideration of menstrual leave
  • Increased scientific research
  • Access to adequate and safe pain management for women
  • Recognition of menstrual pain as a public health matter

Menstruation is a normal biological process and we should not shame people for it. We must not neglect menstrual pain or matters surrounding it. We need to open dialogue and provide more medical information on menstrual pain to help the many women who suffer silently.

Taking Premenstrual Dysphoric Disorder (PMDD) Seriously

Premenstrual syndrome (PMS) is a common experience for many women. The most common symptoms include bloating, fatigue, headaches, and mood swings. As annoying and bothersome as these symptoms can be, most women are able to endure this monthly disturbance without any major issues.

But PMS can turn into a debilitating and even life-threatening disorder that is unfortunately not nearly as well-known as it should be – premenstrual dysphoric disorder (PMDD).

The disorder is recognized by both the American Psychiatric Association and the World Health Organization. Current estimates indicate that PMDD affects 1 in 20 women or individuals assigned female at birth of reproductive age.

The symptoms of PMDD are similar to those of PMS, but much more severe. They also include loss of interest in daily activities, difficulty concentrating, anger, sudden mood swings, and severe anxiety and/or depression. Symptoms can even lead up to suicidal thoughts and/or attempts.

Several women have shared the struggle of living with PMDD with the BBC. They talk of experiencing bursts of anger, suicidal thoughts, and even being sanctioned to psychiatric hospitals. With treatment, however, the women shared that they are able to live happy and fulfilling lives, despite PMDD.

Lack of awareness of PMDD is likely the main obstacle for treatment.

I myself only heard of it for the first time around a year ago. A survey commissioned by the Society for Women’s Health Research revealed that 45% of respondents never talked about PMS with their doctors. Worse yet: 24% of respondents who claimed having severe PMS symptoms were unaware of PMDD, and feared that their doctors would not take their complaints seriously.

To diagnose PMDD, as there is no specific test, a doctor must first eliminate other possible causes for symptoms. The doctor will want to rule out thyroid disorder, anxiety and mood disorders, and chronic fatigue syndrome, for example. These can all cause similar symptoms to PMDD. To be considered PMDD, symptoms must show up during the week or two before a woman gets her menstrual period, and subside shortly after the period begins.

Treatment options vary, from hormonal treatment with birth control pills, to taking the class of antidepressants called SSRIs (selective serotonin reuptake inhibitors). Since PMDD only shows up around the time before a menstrual period, it may take a few cycles for treatment to take effect, but with adequate treatment and support, it’s possible to live well with PMDD.

Women’s health, especially surrounding menstruation, remains a taboo and stigmatized topic, even in developed countries.

We need a major culture change to start taking women-specific health issues as seriously as other health issues. I believe this change must start with us, women, in breaking the shame and stigma that may live within ourselves. How many times have we been ashamed of our own periods and PMS symptoms? I know I have. Change begins with us. We should be proud of our biology, know our bodies, talk openly, take our symptoms seriously, seek medical help, fight for the treatment we deserve, and encourage other women to do same.

If you think you may have PMDD, please reach out for help, especially if you’ve been experiencing suicidal thoughts. Talk to a trusted family member of friend and seek medical help as soon as possible. If you have PMDD, we welcome you to share your experience with us, so we can break the stigma together!

Motherhood in Conflict: Grace’s Story

Stories of motherhood and the female experience during war are often excluded and unexplored. This neglect shows in the little attention such stories get in the public discourse and in policy agendas. But without these stories, we miss the voices that are so important for development.

Many of the mothers I met while I worked in Uganda became a mother at a time when the conflict between Museveni’s government and the Lord’s Resistance Army (LRA) was in full swing. They started their journey of motherhood when murder, abduction, mutilation and rape were common practices.

Motherhood in a IDP Camp

One of these women is Grace*. Now a 50-year old married woman and proud mother of 6 children, Grace was only in her twenties when she and her children, including a baby, fled to a camp for internally displaced persons. The intensifying activity of LRA rebels in her community made it impossible to stay home safely. Though the camp was run by the government, and was supposedly a place to seek refuge, she felt very unsafe:

‘There was no hope of life. I thought I was going to be killed at any time … You cannot lock the house, you come back [to the camp] and you find faeces in bags thrown in your house. There was a lack of food … and if you don’t follow time [related rules] the soldiers beat you.

When the war finally ended Grace and her family went back to their village. Sadly, though, life did not get much better for Grace.

‘Post-conflict’ Motherhood

Though the war has ended, it is inaccurate to speak about peace; the term ‘peace time’ wrongly implies a life free of violence and suffering. Even the term ‘post-conflict’ wrongly signifies a shift away from conflict and violence. To the contrary, many Ugandan women’s lives are characterized by ongoing experiences of violence.

Violence has to be understood in a very broad way and include the violence that results from social structures, such as poverty, patriarchy and ability. Grace is badly impacted by all of these.

The poverty in which she finds herself has determined many, if not all, of her life choices.

Because of it, she is withheld from seeking the specialist care she needs:

‘At times I get pain at my belly and at the side of my belly … When I dig for so long and even uprooting potatoes; I get the problem of the uterus. Up to now, [the] uterus always comes out. I was referred to look for a doctor who can help me but I had no money.’

The fact that Grace does not have enough money to go to the hospital is a result of several issues. Some of these are general, such as a drought. Specific for Grace however, is that she is limited in the amount of work she can do due to her displaced uterus and the resulting pain. Besides that, Grace is also the co-wife of an alcoholic husband:

‘I have a problem at home here, my husband is a drunkard. At this moment the marriage is not good, because I am the second wife to him … I am living with my children and he lives with the first wife. When I harvest crops which I could sell in order to support my family, he comes and sells it and uses the money on his first wife’

Grace’s story painfully shows the struggles that many women in Uganda face today. It highlights how suffering and psycho-social ill-being result not solely from experiences of war and poverty, but to a large degree from being a woman.

Grace Fights Back

Despite all that she faces, Grace is regarded as a role model and an example of a woman living a holy life. This is because Grace stands up against her husband’s violence.

Yesterday he wanted to fight me over the soy bean, but I am now stronger than him (laughing). I have a courageous life. If the man is fighting me, I just follow him with law, I call people.’

In times of marital conflict, Grace calls her brothers-in-law, and if that does not work, she steps to the clan chief.

Though her actions are far from all-encompassing solutions to her struggles, her courage is inspiring.

Due to her perseverance, Grace is understandably a role model in her community – she sparks hope for a different future for many Ugandan women.

*Grace is a pseudonym. The image accompanying this article does not depict the woman who told this story.

Abuse & Violence Rates Rise Amid Global Lockdowns

Many countries around the world are in complete lockdown. Millions have been forced to stay at home, self-isolate or socially distance themselves to combat the ongoing threat of coronavirus (COVID-19).

The pandemic is creating an environment of high stress, anxiety and depression for millions of people. It’s taking an economic and social toll. It is also leading to increased rates of domestic violence. In times of crisis or natural disaster, children’s and women’s health and safety are the most severely compromised. In our current situation, this pattern is compounded by limited access to safe centers, shelters and health services.

National lockdowns have exposed many who experience abuse within their homes to danger on a daily basis.

In addition, strict quarantine measures have restricted people’s ability to report abuse. The majority of domestic violence victims are women. However, others such as LGBTQI individuals also face the risk of being abused or thrown out of their homes.

Current statistics show a worldwide surge in the number of reported gender-based violence (GBV) cases. There are increased incidences of domestic abuse and violence being reported from Brazil to China to Germany to the United States. Like the virus itself, this is a global issue.

The South African Police Minister has announced that nearly 90 000 cases of GBV were reported within the first week of the country’s lockdown. Crimes of intimate partner violence, sexual abuse and molestation have been seen to rise in record numbers.

Some countries are coming up with measures to protect and safeguard those in vulnerable circumstances.

In France, some women are being housed in hotels. Pop-up centers have been set up in malls across the country. People can use these centres to report GBV when they go out to buy medication or groceries.

In other countries, helplines have been set up for women to use during this difficult time. In Spain, lockdown conditions have been lifted to allow people experiencing abuse to seek help without being fined. Shelters and safe havens are being created in many other countries as well.

The UN Secretary- General, António Guterres, made an appeal to governments worldwide. He implored them to take the matter of abuse during COVID-19 seriously and to implement structures to support women and vulnerable groups.

During this time, we can all play a role by creating more awareness.

We can reach out to municipalities, governments and NGOs to ask for support and safety measures to be applied in our communities. By doing so, we can better protect those at risk of abuse and violence.

Taking Care of my Gynecological Health Is a Feminist Act

Embarrassing. Gross. Painful. Uncomfortable.

These are just some of the words that come to mind when I think of all the things I’ve heard and read throughout my life about the experience of going to the gynecologist.

Since I’ve started taking charge of my own gynecological health, I’ve been thinking more about what these words. What do they mean in broader context of the female experience, the female body, and feminism in general?

My experience with feminism comes through academic and scholarly research, and through conversations with women from around the world about feminist issues. Through both, I’ve come to learn how important it is for women to be able to own their bodies.

The culture and religion around me have always told me that my body is bad, sinful and dangerous, and that I should somehow separate myself from it.

This message has had a particularly negative consequence in my life in relation to an anxiety disorder that began in childhood. Anxiety makes me feel out of control – and particularly out of control of how my body is reacting.

I’ve also been told by religion and culture that I should separate my body and my mind from my soul. Through my work in therapy and research however, I’ve been learning that I don’t have to separate these parts of me. They all work together to make me the person I really am. I cannot fully inhabit myself or fully be in the world if my mind, body and soul are disconnected.

And so, I’ve been learning how to inhabit my own body. Most importantly, I’ve been learning how to care for it – including for my gynecological health.

Uterus, cervix, vagina and vulva are not dirty or embarrassing words.

They are part of my body and of who I am, and to care for my overall health and well-being I must take care of them.

During my latest Pap test (also called a Pap smear or smear test), I experienced quite a lot of discomfort and even pain. (Most people don’t experience pain during these tests. However, there are some reasons why pain might occur, so it’s vital to be open and honest with your health provider.)

I spoke up as soon as I began to feel pain. I said it loud and clear and my provider heard me. She kindly apologized for the discomfort and pain I was experiencing and moved slowly while walking me through the whole process. She kept checking in on me – “How are you doing now? Are you hanging in there?” – and I kept speaking up whenever something hurt or became uncomfortable. In just a few minutes, the exam was over. The relief of knowing I had done something so important for my health was worth the temporary pain and discomfort.

At the end of the appointment, I felt proud of myself and empowered because I spoke up instead of keeping quiet when things didn’t feel right in my body.

Saying “That hurts!” was not just a good way for my provider to better care for me, but also for me to take some control of my body in a situation where I didn’t have full control of it.

Despite the discomfort, I felt connected with all parts of myself during the experience of my gynecological exam. Because of my anxiety, I had been doing a lot of grounding and breathing exercises to prepare. I made sure I was fully engaged in the conversation with my provider, listening to her advice and tips and answering her questions honestly and openly.

By taking time out of my day to focus entirely on myself and my body, I felt like I was finally validating my body’s existence and needs in all its complexities. The female reproductive system is a marvellously complex world of its own. I was speaking up against the voices that have told me that my body is dirty and shameful, and saying loud and clear, “No! My body is good and an essential part of me that deserves care and love.”

Taking control and care of my body are concepts that are becoming increasingly vital to how I live my life.

I wholeheartedly believe that doing so – even through something as routine as attending a gynecological exam – is a feminist act.