It's Only Blood

Shattering the Taboo of Menstruation

Zed Books Ltd

Contents

STAINS

'Don't you get angry when the boys laugh and tease you?'

'No.'

'But why not?'

'They're laughing because the girls can't keep themselves clean.'

It is said as a matter of course, a simple stating of facts. Those who laugh are not doing anything wrong. The girls with the blood stains are. They simply have themselves to blame if they fail to hide the menstrual blood. If they cannot keep themselves clean.

Saudah herself has never been in that situation, never stood shameful in front of the others in the classroom. But she is well aware of the risk and of her own responsibility. Every month, she tries hard to make sure that the blood, which so persistently demands attention, remains invisible.

That it is private, not something that should be noticed or that she should talk about, was one of the two things she first learned about menstruation. The other was that she has to stop spending time with boys when she gets her first period. The importance of secrecy and of staying away from boys. I will hear it again – as a whisper, a sharp admonition, a self-evident piece of information.

* * *

Fourteen-year-old Saudah lives in Bwaise, one of the poorest areas in the Ugandan capital, Kampala. She is sitting in the schoolyard shade. It is an awkward situation – for her as for any other teenager. Much of what Saudah feels and thinks about menstruation she will probably keep to herself. I can expect fragments, filtered through the demand for secrecy. She does not want her 'auntie', the adult relative she lives with, to find out what we are talking about. As long as the principal of the school is listening curiously nearby, Saudah replies dutifully, though in monosyllables.

The chorus from the classroom for the youngest children breaks the silence over the empty yard, a small patch of trampled, rock-hard orange sand. Land is a hard currency here in Bwaise, which is known for extensive trafficking in sex and drugs. Many people live on less than 1 US dollar per day. That is also the price of a pack of eight menstrual pads in Kampala. An estimation of how much that would be for me: around 100 US dollars. Would I pay that? I don't think so. In Sweden, the price of eight menstrual pads corresponds to roughly 2 US dollars.

Saudah is wearing a school uniform with a purple polo shirt, striped tie, and dark blue skirt. She measures carefully against the skirt to show the size of the pieces of cloth she uses as menstrual protection. When she got her first period two years ago, she cut them out from an old dress. It was dark blue, just like the skirt. She folds the fabric in several layers to make sure it will hold the blood and winds it around the seat of her panties, to make it stay in place. Her nightmare is not just that it might leak, but also that the bloody cloth could fall out from under her skirt. That it could land on the concrete floor in the classroom or on the hard sand in the schoolyard.

She wishes fervently that her auntie would give her money for disposable sanitary pads.

'I've asked several times, but she just says no. It's impossible.'

Saudah's mother lives in the countryside, her father is dead, and her auntie provides for Saudah and her brother with money sent from the family.

The purchased disposable pads, many of the same brands as the ones sold in stores in Europe, have an adhesive on the bottom and on the sides or 'wings'. The pads are only a few millimetres thick, made of cellulose that absorbs liquid. They do not need to be washed and dried.

'It would be so much simpler,' says Saudah, who after the first guarded answers is speaking more freely about the hassle with the cloth and the disposable pads she longs for.

The principal has gone back to the office.

When Saudah is on her period, she walks home during the lunch break. She gets water from the pump in the yard, which is surrounded by two rows of houses accommodating more than 50 people. One room per family. Behind one of the buildings, two communal latrines are located. She prefers not to walk there in the evening or at night, as the risk for sexual violence becomes very real when darkness falls over Bwaise. They have a bucket for emergencies.

She brings the water into the room where she lives with her auntie and brother. If she is lucky there is soap at home, but usually not. Sometimes she borrows soap from a neighbour. Carefully, to avoid getting blood on her thighs, she removes the cloth that she has wound around the seat of her panties. She then scrubs the fabric as best she can to remove the blood. It is stubborn; blood clings hard to textiles. And it is difficult to see whether the fabric is clean. The lighting is poor and the room only has one small window. Saudah puts the cloth on a hanger inside the house, somewhere it cannot be seen. Behind a piece of clothing or under the bed. Carefully, she winds a new piece of cloth around her panties before walking back to school.

When I ask how she feels about the cloth, she does not turn to the two interpreters. She looks directly at me and replies in English rather than her native language, Luganda: 'I feel bad.' That's it.

'I feel bad' turns out to mean much more than that it is lumpy, uncomfortable – and wet, as Saudah says, because the fabric does not soak up the blood very well. The 'bad' is mainly about the fear. What if.

'What if I get a stain? What will happen when I stand up? What if it falls out? Those days, I can't think about anything else in school.'

She keeps as still as possible to make sure that the menstrual cloth and the blood inside remain in place. I can't think about anything else. For the most part, she avoids any kinds of sports.

At home, I try this with a worn-out sheet. Cutting and folding. The first thing that strikes me is how red the blood looks when it is not absorbed immediately. After a few hours I begin to worry about my trousers, but more annoying is the fact that the cloth is moving up towards my backside when I walk. And that the wet and cumbersome fabric is making me notice my period so clearly. Which I otherwise, with a tampon, forget.

Should I wash the fabric afterwards? Try to get the blood out? I cheat and throw it away.

Saudah fiddles with the red pencil case on her lap. She stretches out the skirt that is already completely smooth, like the rest of the uniform, and explains what happens when someone is 'caught' menstruating. How the boys tease and laugh, sometimes other girls too – especially the younger ones. They simply call or whisper: 'She's on her period.' A power sentence. No more is needed to maintain the fear. At worst, a stained skirt can haunt its owner for months.

* * *

A kind of 'menstrual etiquette' that involves keeping the menses more or less secret, especially in front of boys and men, is not unique to Uganda. It is a universal understanding that seems to mark people who menstruate all over the world: there is something to hide here. But this notion takes on a whole new weight when, as a consequence of scarce resources, there is a lack of the material conditions needed to manage and hide the menses: effective menstrual hygiene products, water, toilets, waste bins, private spaces. For a 14-year-old with a thick layer of cloth as menstrual protection and school toilets without running water, it becomes laborious to try to live up to this etiquette, to say the least. A 14-year-old who, moreover, is not told much about her period except that it should be kept secret and that it restricts her from being around boys.

Nine hundred million people live in extreme poverty, according to the World Bank's definition. Close to 80 per cent live in Africa, south of the Sahara, and in South Asia. If we remove the word 'extreme', far more than 900 million people around the world have to manage everyday life on very limited resources. What are menstrual products to them? A luxury. Just like privacy, soap, and clean water. In East African Uganda, a fifth of the population do not have access to clean water. Out of the total population, 38 million, that amounts to almost 8 million people. Half of the 1.7 million residents of Kampala live in slums like Bwaise, where most of them get their water from contaminated sources. With rapid population growth and ever-increasing migration from the countryside to the cities, these areas are growing fast.

In international studies about students and menstruation in countries with widespread poverty, emotional stress is the most prominent theme. Worrying about shame and humiliation makes it hard to concentrate, to keep up with lessons, and to perform well on tests. Not rarely, the stress transforms into a strong fear that marks the days before and during menstruation and prevents those who are on their periods from participating in various activities. They sit still, trying to tell: Is it coming now? Am I leaking now? The body becomes an enemy, a cause of shame, which seems impossible to control.

A survey among students in Ethiopia showed that half of them have trouble concentrating during menstruation. Students in Sierra Leone have explained that they try not to answer questions in the classroom when they are menstruating – to avoid standing up. In a Kenyan study, a girl is quoted saying that during her period 'her whole mind will be centred there' and that she cannot feel free.

Students in the Philippines explain that they wear double panties and shorts, preferably black, under their school uniforms to make sure that there will be no leaking. Indian schoolgirls describe how the school days disappear beneath their worries about menstruation.

There are plenty of examples from studies that together provide a fairly unequivocal picture of menstruation as a draining stress factor. Menstruating students not only describe stress and fear, but also alienation and loneliness. Month after month. It is a vulnerability with its basis in gender, amplified by the economic position.

* * *

Phiona is 17 years old and goes to the same school as Saudah. She is showing me the school's toilets, behind a wall almost two metres high and with small square-shaped holes, a kind of window without glass that lets through both light and unwanted eyes. There are three toilets for boys and three for girls, cubicles with holes in the concrete floor. With 364 students, that amounts to 60 students for every toilet.

To change menstrual protection here is not an option, neither for Phiona nor for Saudah. They would never do that. It is too dirty and not sufficiently private. The doors cannot be locked, not even properly closed. Inside the cubicles there is no water, nothing except the hole in the floor. One must wash under the communal tap in the yard. When we walk past, two of the youngest children are standing there, four-to-five-year-olds in school uniforms splashing water at each other, laughing.

For those who use pieces of cloth as menstrual protection and cannot afford to throw them away, there is no place to rinse them out. Those who throw away their menstrual protection can do so in the latrine – the hole in the floor – but at the risk of a subsequent visitor seeing the blood. On the other hand, it is difficult to store both new and used menstrual protection in school without the risk of being teased. Someone could see, or just understand. Just like someone could open the door. And what if you get blood on your hands? Are you supposed to walk across the yard to the tap?

Phiona has short hair and wears a bright yellow T-shirt with the blue skirt, as smooth and clean as Saudah's. When she got her first period she was 14 years old and had no idea what was happening.

'First it felt wet, and then I saw blood in my panties. I thought I had injured myself.'

Phiona looks away over the low rooftops of the school buildings when she speaks. Behind the roof, a mango tree reaches far higher.

Phiona's sister-in-law informed her that it was menses, gave her disposable pads, and explained how they work. That was the end of the conversation. Because she lived with her brother's family and rarely saw her mother or other relatives, Phiona had no one else to ask.

But disposable pads she got, and still does. In a country where a fifth of the population lives below the poverty line, that is unusual. Most use cloth – not least in a poor area such as Bwaise. Tampons are used very sparingly in Uganda and can only be bought in a few stores. Menstrual cups are even rarer.

When Phiona says that she cannot afford to use more than one pad per day, the interpreters, both from the middle class, react with indignation. One single pad! But they are supposed to be changed at least every five hours! Phiona calmly notes that she has to stay as still as possible, not run, and preferably not walk 'to not bleed as much'. She skips the dance class she otherwise attends after school. She explains that she gets anxious with the same calm and matter-of-fact tone. That's just the way it is.

'It actually starts several days before I get my period. I get nervous when I know that it's coming and run in and out of the classroom to check.'

Later, it continues with her fear that the pad might get too full.

'I keep away from boys as best I can. So they won't notice anything.'

If she menstruates during one of the periods when they have a lot of exams in school it becomes difficult, she says. Her thoughts wander to the heavy pad and she has a hard time focusing on the questions. Most often the teachers are male, making it impossible to explain why her concentration falters.

* * *

One disposable pad per day is not a rarity. In a study from Tanzania, students explain that they do not have a choice; they cannot bring extra pads to school because the boys could find them. With long distances to cover, they are sometimes away from home until the evening.

In both Uganda and Kenya, concerned staff members at organisations working with menstruation explain that disposable pads are used for as long as possible, sometimes more than 24 hours – which increases the risk of skin irritations and infection.

At a children's home in the Indian state of Karnataka, those who have had their first period say that they would never even think to change menstrual protection in school. For them, it is not a question of whether they can afford it; they receive menstrual pads from a non-governmental organisation. Nor is it about the risk of mockery and ridicule. No, the reason is that the toilets are too dirty and there is no water to wash with. In order to avoid visiting the bathroom at all, they refrain from drinking and hurry home around four o'clock. They laugh when describing how much they have to rush sometimes.

The lack of clean school toilets with water, waste bins, doors, and locks is a gigantic threshold for the person who menstruates. These are missing in 30 per cent of the world's schools, according to the UN children's fund, UNICEF. In the poorest parts of the world, this number rises to more than 50 per cent. For many, it is simply not possible to go to the bathroom during the school day.

Managing menstruation outdoors is more or less impossible – at least if you want to make sure to maintain the 'menstrual etiquette'. For those with different types of disabilities, the lack of adequate toilets is even more catastrophic. Shrubs and trees are hardly an option. Many girls also request separate bathrooms, so as not to be disturbed by the boys. They want somewhere to throw away or wash their menstrual protection. They want lighting so that they can see if it is clean and longer breaks to give them time. They want teachers who understand.

* * *

The fear of being subjected to harassment and humiliation because of one's gender – a gender that for most people involves the natural bodily function that menstruation is – can seem serious enough for politicians, non-governmental organisations, and the many UN bodies that promote human rights to react. When menstrual shame is combined with poverty, there are systemic violations of the right to dignity, the right to freedom from discrimination, the right to education, the right to health and to privacy – to name a few of the human rights that can be linked to menstruation. Power over the period is a necessity, a precondition for participation in public life.

But it was not the many consonant studies about worry and stress among students in countries like Uganda, India, Sierra Leone, Afghanistan, Pakistan, and Kenya that triggered the interest in menstruation at a higher level. During the same time, at the beginning of the twenty-first century, reports appeared that focused on another side of the problem: girls who were absent from school several days per month or even dropped out of school entirely when they got their periods. With absences and dropouts, menstruation became possible to connect to economic development. Slowly, something that for a long time had been placed at the very back of the private closet began to become politics. Menstruation politics.

'One could ask why those numbers are so important, when it's such an obvious human right. Girls and women should be able to manage their periods in a dignified and comfortable way,' Marni Sommer says, with an annoyed shrug of her shoulders.