Michael Abrahams | The cost of menstruation

With the exception of those afflicted with certain disorders and conditions, or taking certain medications, or who have had certain gynaecological surgical procedures, the vast majority of biological females in the reproductive age range will have to contend with menstruation, usually on a monthly basis.

Throughout history, women have used various methods to contend with menstrual bleeding and the pain that may accompany the episodes. In ancient Egypt, tampons made out of papyrus were used. In ancient Rome, wool was the preferred material. Regarding menstrual cramps, methods such as herbs and herbal teas, balms, and alcohol were utilised.

Nowadays, more sophisticated menstrual products are available such as sanitary napkins (pads) and tampons, which are disposable, to reusable menstrual cups and underwear although in some areas cloth is used. But these, especially the disposable products, come at a cost. According to the telemedicine platform PlushCare, around the world, a month’s supply of period products, including painkillers to manage menstrual cramps, ranges from US$1.09 in El Salvador to US$34.05 in Algeria. Canadians spend up to CA$6,000 on menstrual hygiene products throughout their lifetime, with the same products costing up to CA$12,000 in rural communities.

However, many people struggle to afford these necessities. Every month, more than two billion people around the world menstruate, and at any one time, 800 million people across the globe are menstruating. However, according to the World Bank, an estimated 500 million people who menstruate worldwide experience period poverty, which refers to the lack of access to safe and hygienic menstrual products and inaccessibility to basic sanitation services or facilities as well as menstrual hygiene education.

GENDER-BLIND POLICIES

And certain gender-blind policies and tax laws, such as the ‘pink tax’ on feminine products, do not help. For example, in many states in the US, Viagra (for erectile dysfunction) is classified as a tax-exempt health product while sanitary products are classified as luxury goods and taxed at the highest rate.

There is another economic cost regarding menstruation: decreased productivity at the workplace. A study published in the British Medical Journal in 2019 examined productivity loss due to menstruation-related symptoms. The researchers found that 13.8 per cent of participants reported absenteeism during their menstrual periods, with 3.4 per cent reporting absenteeism every or almost every menstrual cycle, with the mean absenteeism related to a woman’s period being 1.3 days per year. But it is not only absence from the workplace that decreases productivity. Presenteeism (productivity loss while present at work or school) plays a role, too. Eighty point seven per cent of the respondents reported presenteeism and reduced productivity, with a mean of 23.2 days per year. An average productivity loss of 33 per cent resulted in a mean of 8.9 days of total lost productivity per year due to presenteeism.

The costs for menstruation are not just economic. There are social consequences for many who menstruate as well. In some regions, girls and women are banished to menstrual huts while seeing their periods as they are deemed unclean at this time. For example, in some parts of Nepal, the tradition of chhaupadi is observed whereby menstruating females are temporarily evicted and sent to a small hut or shed called a chhaugoth, external to the family home, for the duration of their menses. The practice originated from Hindu mythology and is observed because menstrual blood is believed to be impure and harmful to others, and menstruating women are cursed and untouchable, hence their separation from others.

PREVENTED FROM REGULAR TASKS

Menstruating girls and women are prevented from regular duties and tasks, including prayer, visiting temples, bathing in or drinking from public water sources, eating certain foods, entering kitchens, and touching particular objects and people. While confined to these huts, females are exposed to multiple hazards, including stings from scorpions and bites from snakes, hypothermia, and pneumonia. Women are often exposed to frigid temperatures and try to keep themselves warm by lighting fires. However, the lack of adequate ventilation in these small spaces places their lives at risk, and deaths from smoke inhalation, hypoxia, and burns have been reported, as well as incidents of rape and sexual assault.

Another consequence of menstruation is the interruption of education. In the United States, one in five teenagers has, at some point, struggled to afford sanitary products, a situation that has the potential to affect school attendance. In India, adolescents miss an average of five days a month because of inadequate menstrual protection, and an estimated 23 per cent of girls in that country drop out of school when they start menstruating. In areas where girls are banished during menstruation, they are absent from school at these times. Important examinations may also be missed, and this practice has prevented many girls from progressing to tertiary-level education. This disruption of education will often lead to decreased income, increasing their poverty risk.

Menstruation incurs an economic cost and social consequences not only on the people who menstruate but also on society. Measures should be employed to reduce these costs such as increasing the availability of feminine products in schools and reducing or eliminating the tax on feminine products where such taxes exist. Paid menstrual leave may also ease the economic burden on women who have abnormally heavy or painful periods and find it difficult to function in the workplace at these times. Also, public education regarding menstruation, to reduce the stigma associated with it, is of value as the taboo nature of the process can be a barrier to women seeking help for menstrual issues when they arise or even contribute to their demise, especially in regions where menstruating females are shunned.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.