Nursing Clio

When you were 14, if you had your period, but your parents couldn’t buy you pads or tampons, would you have gone to school? It’s unimaginable, right? It would have been too gross and humiliating to even consider. Better to pretend to be sick, and deal with the missed work and the bad grades.

In many parts of the world, that’s exactly what happens. And that means that girls don’t get educated, even where they have access to schools. They miss school for several days every month, getting further and further behind in their studies. Many are so embarrassed by this that eventually they drop out. They don’t just miss out on an education; they also lose the one real chance they had to escape poverty, to build a decent life for themselves where they can afford what it takes to educate and empower their own daughters.

Educating girls produces enormous, positive ripple effects. Educated girls marry later, are better able to plan and space their children, and generally have fewer children. This means that they can give each child healthier food, better health care, and a longer education. A woman with an education and a smaller family is more likely to work for wages. Her knowledge and her wage-earning give her more status in the family, and women are especially likely to invest their earnings in their families.

When girls are denied an education, they are more likely to be married off as children, and either not know about modern contraception or not have access to it. Their own health is in jeopardy from repeated childbearing, often in difficult conditions. They are less likely to vaccinate their children, and cannot afford medical care for themselves and their children. They can’t work for wages because of their family responsibilities. They can’t afford to educate their children. So the cycle is repeated, and the woman, her family, and her community suffer.

For want of a sanitary napkin, a kingdom is lost.

Is that overly dramatic? Perhaps. And yet, it makes the important point that while menstrual hygiene might appear to be a trivial issue, one small “horseshoe nail” in a battle against global poverty, it can’t be dismissed. Without the tools to manage menstruation, girls are left out, and without educated women, nations are in trouble.

In some places, tapping in that one small horseshoe nail can make an immediate difference. Six years ago, Megan White Mukuria was trying to figure out what she could do to improve women’s lives in Kenya. Problems related to poverty in Africa can appear discouragingly intractable. A cure for AIDS is probably a ways off, and a miracle cure for endemic government corruption seems even less likely. In a place like Kenya, though, where girls are already allowed and encouraged to attend school, Mukuria saw an opportunity for a simple contribution with a big payoff: affordable and available menstrual pads. With a little ingenuity and a modest financial investment, a developing country could create a source of affordable, locally-produced, environmentally sustainable menstrual pads for its girls and women: a brilliantly low-tech solution to a prime barrier to women’s advancement.

So for the past 6 years, Mukuria has worked tirelessly to create a business model, develop relationships with Kenyan health educators, schools, political leaders, and businesses, and test prototype products and programs. She has quantitatively demonstrated that providing sanitary napkins and underpants keeps girls attending school for more days each year. It is easy to imagine extrapolating Megan’s model far beyond Kenya.

When Megan invited me to become a Thought Partner to her organization, Zana Africa, I was thrilled to get on board with her effort. A mutual friend had introduced us because of my first book, The Modern Period: Menstruation in Twentieth-Century America.[*] In it, I showed how new menstrual products and attitudes played a crucial, if (mostly) invisible, role in allowing Americans to become “modern.” And in the United States, “modern” is code for “middle class.” I interviewed women and men born from the first years of the twentieth century all the way through the 1980s, and immersed myself in Kotex’s archives. My interviewees explained to me that to become modern, it was important that women have a way to make their periods impinge as little as possible on their daily lives. They wanted menstrual products that prevented leaks, smells, cramps, chafing, and self-consciousness. They also wanted matter-of-fact, thorough education that prevented surprises and embarrassment. Kotex, Tampax, Always, Midol, and sex ed in schools and pamphlets gave them what they wanted: reliable bodies that allowed them to study, work, and play to their fullest. These “modern” bodies gave American women the confidence and the self-presentation that they believed were crucial to their move up the economic ladder.

We might critique this particular “modern” model for menstrual care: what about having more respect for a natural process, and allowing women some leeway to take care of their bodies in different ways from men’s? Are we overrating the value of keeping women’s bodies “under control?”

In an American context, I am happy to have that debate, but when I look at Mukuria’s work in Kenya, I am reluctant to quibble with the “modern” approach. Mukuria has found that girls desperately want the support to be in school when they are menstruating. We ought to support our Kenyan sisters in making their periods modern if that’s what they want. In any case, it will be their own version of modernity, especially if we follow Megan’s lead, and support local production rather than pushing imports. They will choose which methods are preferable (for example, tampons and other methods needing vaginal insertion may be hygienically unfeasible or raise concerns about sexuality and virginity). But having the basic ability to not leak, or chafe, or get an infection from an unwashed rag, is clearly a good thing. I hope we can do what it takes to make modern periods available to women in Kenya and elsewhere in the developing world.

[*] Now on half-price sale direct from the publisher; use code HTMP for $19.95 e-book.

For further reading:

Buckley, Thomas and Alma Gottlieb. Blood Magic: The Anthropology of Menstruation. Berkeley: University of California Press, 1988.

Freidenfelds, Lara. The Modern Period: Menstruation in Twentieth-Century America. Baltimore, MD: Johns Hopkins University Press, 2009.

The Menstrual Cycle: A Feminist Lifespan Perspective, prepared by the Society for Menstrual Cycle Research.

United Nations Girls’ Education Initiative website and blog.

Feature image: “Matunduzi School, Girls Education Support Initiative, Malawi 2012” (IM/Creccom partner initiative, Photo by Erik Törner). Used under a CC BY-NC-SA license.