“In 2010, I was a part of an international group of Christians working on a project in Geneva, Switzerland. Once our task was completed, we went shopping for gifts for people back home. We visited a megastore that had just about everything under one roof. We were all taken aback when a Zimbabwean colleague proceeded to fill a trolley with all kinds of grocery items, prominent among which were sanitary pads. She explained to us that what we considered basic items were very difficult to get in Zimbabwe. The economy had been so ravaged that something as necessary as sanitary hygiene products were not available or were unaffordable. For several days every month, she was unable to attend work as, invariably, she had no pads. Needless to say, we all got together and filled another trolley with goods, especially pads, to send home with our sister. That was the beginning of my awareness of and interest in issues of menstrual justice, particularly as this is affected by various religio-cultural beliefs and practices.
Last week I spoke with “Marion,” a guidance counsellor in an all-girls school in Jamaica. She grew up in rural Jamaica in the late 1990s. Her neighbours had four daughters. Every month, like clockwork, these girls would come begging for dried banana leaves or newspapers. It wasn’t until years later, as a guidance counsellor, that she heard one of her students talking about making one sanitary pad last an entire period by topping it up with toilet paper. It was then that her neighbours’ plight became intelligible to Marion and period poverty had a face…many faces”.
These two vignettes focus our attention on the peculiarities of poverty and injustice that inhere to female embodiment. Women and girls across the globe are “not just poor but bloody poor” since they face various oppressions related to menstruation and its management. This discussion responds to these challenges, taking its title from a newspaper article entitled, “Not just poor, bloody poor”, which draws attention to the plight of girls and women in Jamaica, who face period poverty in a context of economic need and cultural stigma, often leading to adverse emotional, health, occupational and educational outcomes. It briefly explores the question of menstrual poverty within a menstrual justice framework for Jamaican and Zimbabwean women.
The central tenet of the menstrual justice approach is that menstruation is a physiological process directly linked to psychosocial and cultural–religious aspects. Its objective is twofold: First, it seeks to make explicit all aspects of women’s lives that are linked to menstruation beyond fertility and reproduction. Second, it helps to delineate the links between this complex web of thought and practices and women’s experiences of indignity, discrimination, inequality, and injustice. It considers the specific ways in which the sociocultural–religious discourse of menstruation and its associated practices are reflected in national policies that effect violations of women’s human rights, discrimination, and inequality. In doing so, the approach directs attention to the role of the political institutions and state policies in this process.
Menstrual injustice is structural intersectionality because it is the manifestation of “public policies, institutional practices, cultural representations, and other norms” that result in oppressive power that privileges and disadvantages persons based upon their location at the intersection of gender, race, class, gender identity, sexual orientation, age, and ability. Menstrual justice, therefore, involves an intersectional response, in dialogue with the woman’s position in relation to power structures.
Period Poverty and Menstrual Hygiene Management in Jamaica and Zimbabwe
“Period poverty,” which refers to the inability to access or afford sanitary ware, impacts the quality of life of women and girls across the world, and is very real. It is a public health crisis, which has been exacerbated by the Covid pandemic. In 2018, the HerFlow Foundation in Jamaica conducted a survey of seventh grade students in 27 schools. They found that 44% of students surveyed were affected by period poverty; of these, 24% visit the guidance counsellor for assistance monthly, 20% stay home from school, and 13% use alternative materials such as old fabric and tissue, or reuse pads. The use of these unhygienic alternatives are damaging to the mental and physical well-being of girls.
A 2017 policy brief by the Research Department of the Zimbabwe Parliament found that 20% of girls miss school because of issues related to menstruation, including lack of sanitary wear, poor or girl-unfriendly sanitary facilities, lack of information on how to manage the process and the resulting shame and low self-esteem that arises from bullying, social exclusion, and other shaming activities. Their education and development is undermined simply for being girls.
Menstrual hygiene management (MHM), which refers to the way that girls and women keep clean and healthy during menstruation and how they acquire, use and dispose of sanitary materials, pertains to overall menstrual justice. MHM includes the often taken-for-granted ability to access soap and water to clean the body as required and having facilities to dispose of used menstrual management materials. As one Jamaican woman living in a community plagued by lack of water lamented, “It’s not nice to be on day one of your [menstrual] cycle and not have enough water to flush your toilet every time you use it…It is unbelievable that there is not more attention being paid to this crisis, because it’s one thing for a man to pee in the backyard and tidy up himself every other day, but how do they expect women to live?”
Such access to water takes on a particular urgency in nations like Jamaica and Zimbabwe where there are high levels of un- and underemployment, constant devaluations of local currency, which erodes the spending power of all, but especially the poor and marginalised, whose access to basic commodities is limited and worsened by the pandemic. Zimbabweans, in particular, face widespread hunger; petrol, water and electricity shortages; unpaid civil servants; currency shortages, among other serious disadvantages.
Many girls get little or no information on the “embarrassing” oftentimes-taboo topic of menstruation. They are largely unprepared for the experience and have little information on what is happening to their bodies. In many communities in Zimbabwe, for example, menstruation remains a taboo topic; words like “menstruation”, “pads”, etc. cannot be mentioned in public, much less discussed with or in the hearing of men. Girls are the victims of much teasing and shaming by male colleagues, who do not understand behaviour changes due to menstruation, as well as the cultural beliefs and practices that present menstruating women as unclean and to be avoided. In Jamaica, some men will not eat from a woman who is menstruating. Women and girls are excluded from social activities, including church, during their cycle, in some rural Zimbabwean communities. Furthermore, heavy flows are believed to be a sign of moral looseness or an overindulgence in sexual intercourse; so women and girls are further shamed by beliefs which have little or no scientific or moral foundation.
A Rights Issue
Irregular attendance at school redounds negatively to the empowerment of women and girls. Clearly, issues surrounding MHM have served to undermine the Rights enshrined in the Zimbabwean Constitution and the Jamaican Constitution and Bill of Rights. The attainment of Sustainable Development Goals, which includes quality education for women and girls (Goal 4), gender equality (Goal 5), and clean water and proper sanitation (Goal 6) are similarly affected. Undoubtedly, the high price of sanitary products promotes the exclusion of women and girls and is not in line with Goals 3 and 5 on gender equality, good health and wellbeing. More fundamentally, Section 17(1a) of the Zimbabwe Constitution states, “the State must promote the full participation of women in all spheres of the Zimbabwean society on the basis of equality with men”. Further, Section 29 of the Constitution also requires the State to ensure the provision of basic, accessible and adequate health services throughout Zimbabwe. At the same time, too many Zimbabwean girls and women are unable to “enjoy” basic healthy menstrual functionings; too many are unable to manage their menstrual cycle safely with dignity and privacy in the school environment. There is an issue of justice at stake.
Policy at the level of the government sets the tone for and provides the impetus for full development of all, especially the women. Both Jamaica and Zimbabwe are committed to the Millennium Development Goals, especially regarding poverty reduction, gender equality, education, sexual and reproductive, and maternal health. Education for girls is key to reducing the cycle of poverty. As things currently stand, with girls losing so much time each month due to menstrual hygiene issues, there is a direct link between the menstrual cycle and the cycle of poverty. Ineffective management of the menstrual cycle leads to poor educational attainment, the main means of social and economic mobility for many women, and so they are mired in the cycle of poverty. Failure to access sanitary products affects health, development and the economy.
The provision of free or subsidized sanitary wear is one solution to period poverty. This is part of a process of gender responsive budgeting, which removes Pink Taxes “that undermine human development and the dignity of women, especially those in rural areas”. In so doing, the Government would “prioritise integration of gender across all sectors of the economy critical for achieving equitable, sustainable and inclusive social economic development”. Indeed the government should calculate the cost of not doing that. “Government will still somehow pay more, through social expenditure, for every girl who missed their dreams because they failed or dropped out of school due to period poverty. Prevention is therefore better than cure!”.
In Jamaica, the PATH programme should provide support for menstrual products for girls. Several Jamaican foundations, businesses and individuals have begun to offer free menstrual products to women and girls in schools, government homes, prisons, and clinics in response to the indignity of menstrual poverty. Importantly, they have begun to raise awareness of period poverty and reproductive and health rights.
Awareness, Education, Advocacy
In the area of educational policy, menstrual hygiene is not comprehensively incorporated in school curricula. Emphasis is placed on reproduction but not on the practical things girls need to learn in order to manage menstruation thus reducing health risks while promoting their dignity and rights. Nonetheless, there are initiatives such as the WASH in Schools programme operating in Zimbabwe that are encouraging even as they need to be urged to prioritise MHM. However, the lack of appropriate policy support at the level of government has stymied the sharing of good practices and the sustainability of these initiatives. A multi-ministerial collaboration from among the ministries of health, education and gender as well as private sector and donor partners would be important in crafting the supportive policy environment needed. Integrated programmes comprising nutrition and health, and menstrual hygiene management, among others, should be included. On World Menstrual Hygiene Day Women’s Health Network Jamaica highlights the impact of poor menstrual hygiene, focussing on limited access to menstrual hygiene products and poor safe water and sanitation systems which threaten educational and occupational opportunities, and the health of women and girls, especially in poor communities.
At the same time, it is necessary to have the kind of infrastructure and sanitation facilities in schools and workplaces designed with the needs and interests of girls in mind. Currently, both facilities and hygiene practices in Zimbabwe are inadequate. Some of the standard girl-friendly facilities would need to include gender-segregated toilets with screens or walls in front and locks for privacy and security; water available in latrines and showers with units for discreet disposal of used sanitary materials; showers with drainage that does not allow waste water to flow in the open. Access to pain medications and a sick bay would also be important. Notably, women and girls should be encouraged to migrate to reusable pads which are more affordable in comparison to disposables, while being more environmentally friendly, and making a contribution to the economy and the livelihood of women and girls who make them.
The concerns around menstrual justice and ending “period poverty” relate to dignity, health and opportunity for women and girls. It is both an outcomes and a rights issue. Currently, lack of knowledge and adequate information continues to disempower girls and reinforces the belief that menstruation is a shaming and shameful event. Women and girls do not need to feel embarrassed about the changes occurring to their bodies rather they need support to manage these occurrences in a healthy fashion, especially through the provision of safe and affordable menstrual hygiene products. Currently, a natural process like menstruation can impact negatively on girls’ performance in school often leading to them dropping out of school, having fallen so far behind from days missed. This further disempowers these girls and sinks them and their families deeper into poverty. At the same time, lack of information on the issue continues to breed a disempowered generation of women. Attention to menstrual justice empowers women and girls and improves their opportunities to succeed in school and contribute meaningfully to their lives, families, and communities. This is the reason for the call for multi-sectoral engagement on the issue. Menstruating is not a choice but a matter of dignity and justice.
 Margaret E. Johnson speaks of menstruators – women, girls, transgender men and boys, and nonbinary persons – suffering from the oppression of menstrual injustice. (“Menstrual Justice,” UC Davis Law Review 53.1 (November 2019). This discussion speaks only of women and girls, while not suggesting that the plight of others are insignificant.
 Candiece Knight, “Not just poor, bloody poor…,” Jamaica Observer, Tuesday, February 25, 2020
 M Sommer, BA Caruso, M Sahin, T Calderon, S Cavill, T Mahon, et al. “A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools”. PLoS Med 13.2 (2016): e1001962
 The article refers to a student nicknamed “Repeater-Gaye” (a cruel play on her name, Peta-Gaye), who was so called because she “was known for repeating dirty uniforms, could not afford a pad and had resorted to washing and reusing a face rag to protect her uniform from the heavy flow.” She could well have been called “Repeater-Gaye” if she was forced to repeat a grade because of poor performance for having missed so much school.
 Annie McCarthy and Kuntala Lahiri-Dutt, “Bleeding in Public? Rethinking Narratives of Menstrual Management from Delhi’s Slums”. In The Palgrave Handbook of Critical Menstruation Studies, edited by Chris Bobel, Inga T. Winkler, Breanne Fahs, et al. (PalgraveMacmilan, 2020), p. 512.
 Margaret E. Johnson, “Menstrual Justice”.
 Brittany Jackson, Periods should not be a full stop on education, Jamaica Observer, Thursday, March 17, 2022.
 Jackson, Periods should not be a full stop
 Christine Mafoko, Menstrual Hygiene Management: A Challenge for Female Pupils in Rural Schools in Zimbabwe. Zimbabwe Parliament. Research Department. POLICY BRIEF No. 4 – October 2017.
 Ayanda Jozane, “Eswatini: Menstrual Dignity has a price tag”. Gender Link, Date: December 5, 2018. http://genderlinks.org.za/news/eswatini-menstrual-dignity-has-a-price-tag/
 Candiece Knight, We want justice (and water), Jamaica Observer, Monday, September 09, 2019. https://www.jamaicaobserver.com/all-woman/we-want-justice-and-water-_173587
 Gavin du Venage, “Zimbabwe residents go hungry as currency policy bites,” The National. July 25, 2019. https://www.thenational.ae/business/economy/zimbabwe-residents-go-hungry-as-currency-policy-bites-1.890105
 Anna Kasafi Perkins, “Blood clot, ras clot and bun bow clot: Lovindeer takes on female bodily taboos in Jamaica”. In Breaking Down Binaries: tidal shifts in the study of the languages, literatures and cultures of the Greater Caribbean and beyond, edited by Nicholas Faraclas, et al.. (Puerto Rico/Curacao: University of Curacao, 2018): 63-78. Anna Kasafi Perkins, “Shi Wi Use Har Blood Tie Him”: A Theological Interrogation of Cultural Beliefs about Menstruation and Female [Im] morality in Jamaica.” In Memories of Caribbean Futures: reclaiming the precolonial to reimagine a postcolonial languages, literatures and cultures of the Greater Caribbean and beyond 2, eds. Nicholas Faraclas, et al. (Puerto Rico/Curacao: University of Curacao, 2017): 349-359.
Anna Kasafi Perkins, “God (Not) Gwine Sin Yuh”: The Female Face of HIV/AIDS in the Caribbean and a Theology of Suffering.” In Calling for Justice throughout the World: Catholic Woman Theologians and the HIV-AIDS Pandemic, eds. Mary Jo Izzio and Mary Doyle Roche (Continuum Press, 2009): 84-96.
 Theresa Nyava, “Removal of duty and VAT on sanitary wear imports not an end in itself,” Bulawayo 24 News. November 23, 2018 (2018a). https://bulawayo24.com/index-id-opinion-sc-columnist-byo-150251.html
 Increasingly, awareness of the issue of “period poverty” has come to the fore in the so-called developed world, with the United Kingdom now allocating a million and half pounds in response. Scotland, Kenya and South Africa have moved to make sanitary wear freely accessible to school girls. Barbados, which recently became a republic, has made the move to remove value-added tax from sanitary items in a bid to “to ensure that women and girls could afford to purchase the essential items and thereby reduce or eliminate period poverty”. Under pressure from women’s advocates, the Zimbabwean minister of finance pledged to remove duties and value-added tax from sanitary wear in December 2018.
 Thandeka Moyo, Zimbabwe: Women’s Menstrual Cycle tied to Cycle of Poverty, Gender Link, October 31, 2012. https://genderlinks.org.za/programme-web-menu/zimbabwe-womens-menstrual-cycle-tied-to-cycle-of-poverty-2012-10-31/
 Theresa Farai Nyava, “Remove pink tax on menstrual products to foster gender responsive budgeting,” Bulawayo 24 News. November 6, 2018.
 Theresa Nyava, “Removal of duty and VAT on sanitary wear imports not an end in itself,” Bulawayo 24 News. November 23, 2018. https://bulawayo24.com/index-id-opinion-sc-columnist-byo-150251.html
 Theresa Nyava, “Back to school, back to period poverty!” Bulawayo 24 News. January 8, 2019 (2019a). https://bulawayo24.com/index-id-opinion-sc-columnist-byo-153124.html
 The Programme of Advancement Through Health and Education (PATH) is a conditional cash transfer (CCT) programme funded by the Government of Jamaica and the World Bank aimed at delivering benefits to the most needy and vulnerable in the society. https://mlss.gov.jm/features/path/#:~:text=The%20Programme%20of%20Advancement%20Through,was%20introduced%20islandwide%20in%202002.
 Savannah Scully and Rudolph Stevens, “Women’s Health Network promotes menstrual hygiene for women & girls,” Jamaica Observer, Monday, June 14, 2021.