What is period poverty?

Period poverty refers to impoverished menstruators lacking access to feminine hygiene products (FHPs) and menstruation-related information and infrastructure.⁽⁴⁾ Menstrual products include a range of alternatives, such as disposable and reusable sanitary pads, tampons, and menstrual cups.⁽⁵⁾ Menstruation-related information includes fact-based guidance on menstruation, puberty, and sex education. Related infrastructure includes safe and hygienic sanitary, handwashing, and waste-disposal facilities. The Office of the High Commissioner for Human Rights of the United Nations has characterised the dire implications of period poverty as a human rights violation.⁽⁶⁾

Implications

The implications of period poverty include socio-economic exclusion, health problems, and environmental degradation.^{(7)(8)(9)(10)} Many women and girls affected by period poverty endure menstrual absenteeism, and are forced to resort to using potentially harmful alternatives. Menstrual absenteeism also has the ripple effect of compromising impoverished menstruators’ educational and economic participation.^{(11)(12)(13)(14)} Even more concerning is that the alternatives available to them include cow dung, leaves, and rags.^(15)(16)(17) These alternatives sometimes bear health risks for the users, such as reproductive health problems, urinary tract infections, and toxic shock syndrome.⁽¹⁸⁾ For example, inserting dirty rags into the vagina and prolonged use of sanitary products increase the risk of infections.⁽¹⁹⁾

Taboos and myths related to menstruation further compound impoverished menstruators’ social exclusion and health risks.^(20)(21) In many cultures, these taboos and myths portray women and girls as ‘dirty’ during menstruation.^(22)(23) These societies impose restrictions on menstruators, including dietary limitations and exclusion from social activities and ceremonies.^(24)(25) Although menstruation is a natural physiological process, it is often not discussed in families and communities,⁽²⁶⁾ thus perpetuating the myths and taboos.

In addition, impoverished menstruators often lack safe infrastructure, posing health- and environmental degradation risks. For example, over 3 000 schools in South Africa have substandard sanitary facilities.⁽²⁷⁾ Incidents of children drowning in pit latrines at schools^(28)(29)(30) highlight the shocking state of the sanitary infrastructure of many impoverished schools. These schools often lack safe, hygienic, private, and sex-segregated sanitation facilities,⁽³¹⁾ including appropriate facilities for disposal of menstrual waste. Menstrual waste includes the “by-products of menstruation and menstrual management and includes items such as sanitary pads, tampons, human bodily excretions, product wrapping, and toilet paper”.⁽³²⁾

The extent of the problem

Not only does period poverty have dire consequences, it is also prevalent. Globally, approximately 500 million women and girls are affected by period poverty every month.⁽³³⁾ In South Africa, an estimated 2.6 million schoolgirls and countless women are affected.^(34)(35)(36) While low-cost FHPs are sometimes available, some consumers are so poor that they cannot afford even the most basic products.⁽³⁷⁾

The role of South African women entrepreneurs

In less industrialised countries, such as South Africa, entrepreneurs play a pivotal role in alleviating many socio-economic challenges,⁽³⁸⁾ including those related to period poverty.^(39)(40)(41) In South Africa, period poverty has sparked several entrepreneurs’ interest, and some have responded to the challenge.^{(42)(43)(44)(45)} Given their shared experience of menstruation, women are more likely than men to empathise with impoverished menstruators, evident in the number of women entrepreneurs involved in efforts to provide FHPs to impoverished women.^(46)(47) Many of these entrepreneurs’ roles encompass operational and activism elements.

Operationally, these entrepreneurs’ endeavours usually include manufacturing FHPs, which are then distributed to impoverished menstruators free of charge. A combination of commercial sales to donors and contributions from people with means funds these efforts. Donors include corporates, professional bodies, private individuals, and NGOs. The entrepreneurs distribute the FHPs at events held at sites such as schools, NGOs’ premises, churches, homeless shelters, orphanages, and places of employment. These entrepreneurs manufacture and sell FHPs locally, thus at the same time creating employment opportunities for historically disadvantaged individuals.⁽⁴⁸⁾

In parallel, many of these entrepreneurs are involved in activism. For example, they conduct feminine health and hygiene training at the events where they distribute FHPs, to provide information and tackle the taboos and myths associated with menstruation. Typically, the training addresses information on puberty and menstruation, sex education, product use, and care instructions. In delivering the training, many entrepreneurs consider contextual and cultural factors, such as water availability for washing hands, reusable FHPs, and perceptions regarding intravaginal product use and virginity.

Through various coalitions, these entrepreneurs are positively impacting period poverty and menstrual health management. For example, some founders participated in the Menstrual Health Management Symposium, lending their voices to addressing period poverty.^(49)(50) In addition, some entrepreneurs played a key role in formulating the SABS standards for reusable sanitary products.⁽⁵¹⁾ These standards enable entrepreneurs who manufacture reusable FHPs to compete for government tenders to supply impoverished schools.

The role of government

South Africa’s state-led initiatives tackling period poverty have had varying degrees of success and timeliness. On the one hand, the state has adopted a leadership role. For example, the Department of Women, Youth and Persons with Disabilities, together with the United Nations Population Fund, co-hosted Africa’s first Menstrual Health Management Symposium.^(52)(53)(54) The symposium brought numerous stakeholders from the African continent together to advance the achievement of the goal of ending period poverty.^(55)(56)(57)

On the other hand, South Africa’s state-led initiatives have sometimes lagged behind those of leading nations, and some have been ineffective. For example, Scotland was the first country to offer FHPs free of charge to all.⁽⁵⁸⁾ Shortly thereafter, New Zealand also offered FHPs at all schools.⁽⁵⁹⁾ The South African government, however, until a few years ago, continued levying taxes on the sale of FHPs, lagging behind several of its African counterparts in abandoning this practice.⁽⁶⁰⁾ In addition, the South African government’s policy to supply FHPs free of charge applies only to schools with mainly impoverished learners.⁽⁶¹⁾ Yet, there may also be impoverished learners, such as bursary holders from impoverished families, in the remaining schools.⁽⁶²⁾

Notably, during the last quarter of 2018, the Minister of Finance announced two reforms: (1) sanitary pads would be zero-rated for value-added taxation, and (2) sanitary pads would be distributed free of charge to poor female learners in South Africa.⁽⁶³⁾ However, even with the support of enacted legislation and allocated funds, implementing the reforms remains less than satisfactory.^{(64)(65)(66)(67)(68)} For example, funds intended for period poverty alleviation were mismanaged.⁽⁶⁹⁾ Such inefficiencies and corruption place additional demands on external actors such as entrepreneurs who endeavour to alleviate period poverty.

Conclusion

Period poverty’s prevalence and dire yet avoidable implications demand interventions by numerous stakeholders, including entrepreneurs and government. Women entrepreneurs play a pivotal role in alleviating this problem. Importantly, through the process, they often create employment for historically disadvantaged women, thus alleviating another dire social problem. Therefore, the government should more actively and urgently direct efforts towards supporting these women entrepreneurs.