In a small cottage in Hussain Hazara Goth in Karachi, Malka* lives a humble life with her husband and children. She stitches clothes to contribute to their household expenses. After delivering her sixth child soon, her biggest challenge would be to meet the needs of her children.

In the family’s limited income, postpartum care and hygiene management are the last things on Malka’s mind. Malka has never seen maternity pads and uses old pieces of cloth to manage her postpartum bleeding and periods. When she received a pack of maternity pads as a gift from one of her baajis [clients], she realised what a blessing they could be.

“I envy women who can afford to use sanitary pads,” she says. “But when primary needs are haunting you, what you want for yourself becomes more of a luxury.”

Like Malka, many women in Pakistan cannot afford to buy period products. Period poverty is commonly known as lack of access to menstrual products, education, water, sanitation and hygiene (WASH) facilities, and waste management.

Periods do not stop in disaster situations and, along with physical and mental challenges, the stigma that shrouds menstruation further prevents individuals from talking about it. Now campaigners are targeting ‘period poverty’

Studies indicate that an estimated 500 million people have been impacted by period poverty across the world. In Pakistan, inflation is at an all-time high, and there is a serious lack of awareness and sanitation facilities. Considering this, chances are, we all know someone who has been through period poverty.

Menstruation is stigmatised in many parts of the world, including Pakistan, says Dr Nasreen Majid, a consultant in obstetrics and gynaecology at Memon Medical Institute Hospital. In fact, talking about anything involving women’s private parts is a taboo, be it contraception or breast problems. “Women even believe in myths that they are not allowed to eat certain foods or shower during menstruation,” she says.

Many girls are compelled to miss school during menstruation either because of the lack of menstrual products or facilities to manage their periods at school. Eventually, most of them drop out and are forced into marriage right after puberty.

Saaji*, from a remote village of Balochistan, was married off at 12, after her first period was over. “Girls in our clan are usually married early, but my daughter was just a child,” her mother Fatima* says regretfully. Saaji didn’t have her second period, as she got pregnant soon after her marriage, Fatima sighs.

At 22, Saaji now has six children and multiple deficiencies, but is happy because her husband loves and respects her, care she feels her mother never received from her father.

The onset of menstruation is usually described as a traumatic event by girls, which comes with the likelihood of immediate marriage and raises fear, distress and worry among them, a study conducted by Unicef reveals. Since menstruation is considered a sign of a girl’s ‘readiness for marriage’, the elders quickly fix the marriage to make sure the second menstrual period occurs in her husband’s house. Mothers and their daughters sometimes try to hide the onset of periods from men in the family in order to avoid early marriages.

“The fact that menstruation can be a life-altering event for some women shook me to the core,” says Sana Lokhandwala, a menstrual health leader and co-founder of HER Pakistan, an organisation working to ensure access to quality menstrual health education and products in Pakistan. She decided to break the culture of silence around menstruation and embarked on a journey of raising awareness about menstrual health and hygiene management with her sister Sumaira.

During its early years, HER Pakistan conducted a menstrual hygiene drive in Rehri Goth, a neglected neighbourhood on the outskirts of Karachi. “Women there were not aware about how to manage their periods,” says Sana. “They used to bleed in their shalwars, and wear black ones to hide blood stains. The girls’ school had no washroom.

“The lack of awareness about menstruation is intergenerational,” Sana believes as, in many cases, the mothers are not aware of good hygiene practices and have limited information to pass on to their daughters.

“[The] women [we met] were curious to know about various menstrual products and materials and how to use them appropriately,” says Sana, whose team received a great response during their awareness drives in rural areas. “Men encouraged women to attend those sessions, waited outside for them, and helped us carry our boxes to our cars.”

On the contrary, opposition and criticism were thrown at her by the so-called educated lot. Sana participated in Aurat March 2019 holding a placard which read, ‘We Want a Period-Friendly Pakistan’. “Before I even reached home, my mobile phone was abuzz with threats and intimidating messages, including rape,” she says.

Sana describes period-friendly Pakistan as a place where people are not threatened to talk about menstruation and, during their periods, women feel confident and are treated with dignity.

Menstrual hygiene management is usually missing from the agendas of disaster response agencies. Anum Khalid and Bushra Mahnoor, two university students and WASH activists from Saraiki Waseb and Attock respectively, realised the need and initiated the Mahwari Justice movement to provide menstrual relief kits to flood-hit women.

“Women were using tree leaves and dirty pieces of cloth and some did not even have underpants,” says Anum about the flood-hit women she reached out to.

Every day, the young campaigners receive pleas from affected women to send them menstrual hygiene kits, but people criticise that these kits are not a necessity, as women of these areas use cloth, not sanitary pads. “Most of them demand sanitary pads, in fact, as they are easier to use,” says Anum.

However, Mahwari Justice caters to every woman. “We have designed four types of menstrual relief kits, based on biodegradable pads, reusable cloth pads, big sheets of towel and sanitary pads, which are sent to relief camps through doctors who assist women if they have any problems,” Bushra explains.

Anam and Bushra initiated the Mahwari Justice movement on Twitter last June, and have supplied menstrual hygiene kits to more than 50,000 women so far.

Last week, Sana and Sumaira Lokhandwala spoke at the first-ever global forum on period poverty in Australia, where 42 leaders from across the world set goals to end period poverty. While menstrual health is not specifically stated in the Sustainable Development Goals targets, the World Health Organisation (WHO) urges governments to safeguard the rights of people who menstruate and ensure they have access to menstrual products, information, water, sanitation, disposal facilities and competent and empathic care.

“It is not hard to learn empathy,” says Sana. You just have to spend one period cycle without menstrual products to feel the pain of those who cannot access it.”

**Names changed to protect privacy*

The writer is a freelance journalist and tweets @Tanzeel09

Published in Dawn, EOS, October 16th, 2022