Period poverty is real, and its consequences even more stark during the current COVID-19 crisis. Period poverty - the lack of access to sanitary products, menstrual hygiene education, toilets, handwashing facilities, and waste management - is global. An estimated 1.8 billion girls, women, and non-binary persons menstruate, yet millions of people across the world cannot manage their monthly cycle in a dignified, healthy way.

Crises, including COVID-19, exacerbate period poverty and make it more difficult for people to receive the information and resources they need to manage their periods, putting their health and wellbeing at risk.

On any single day during this health emergency, 800 million people are menstruating while dealing with the unique challenges this global pandemic creates. Women and girls with disabilities, and those most marginalised, are likely to be severely impacted by the pandemic, and their ability to manage their periods safely and with dignity significantly affected.

Period shame on the rise

Menstruating has long been a taboo topic, and even during COVID-19, harmful beliefs, myths and practices around menstruation have continued to surface. In China, for instance, people have reported hearing that menstruation increases vulnerability to coronavirus. Rumours were circulating in Tanzania about menstruation being a symptom of COVID-19, or that menstruating people are more likely to transmit the virus. These harmful myths increase the already-strong stigma surrounding menstruation around the world.

A recent study carried out by Plan International surveyed 61 professionals working in the field of menstrual hygiene management, water, sanitation and hygiene, and sexual and reproductive health and rights in 24 countries. Overall 24% of the respondents reported witnessing increased stigma, shaming or harmful cultural practices around menstruation.

“Sometimes [I feel shame]. Especially when I am not able to clean myself during water cuts. I feel embarrassed to walk around family.”

Young woman, Solomon Islands (Plan International)

Pervasive gender inequality, discriminatory social norms and attitudes, cultural taboos, poverty and lack of basic services result in menstrual health and hygiene needs being overlooked, even during “normal times”. In emergencies, all of these harmful effects are further magnified and exacerbated. This results in multiple negative impacts on the lives of those who menstruate: restricting mobility, freedom and choices; reducing participation in school, work and community life; compromising safety; and causing stress and anxiety.

Periods don’t stop for pandemics

COVID-19 is affecting the way in which people experience menstruation. Pandemic-related movement restrictions and health facility closures have decreased access to sexual and reproductive health services, including care for menstruation-related disorders such as endometriosis or migraines.

The economic fallout is also affecting access to menstruation supplies. As global supply chains are disrupted and smaller enterprises stop trading, delivery chains have slowed down, particularly in remote areas. One in three girls and women surveyed in the Pacific said that period products had become harder to find during the pandemic. When sanitary products are difficult to obtain, people may be forced to use unhygienic alternatives that can increase their risk of reproductive and urinary tract infections.

“Most of the schools have no clean and safe water hence most of the adolescent girls decide to stay at home during menstruation.”

Head of COVID-19 Response team, Tanzania (Plan International)

Access to critical information about menstrual health and hygiene has also been disrupted by the pandemic. Disruptions to school and health services are making basic information about menstrual health and hygiene less available. In addition, women and girls are less likely to have additional sources of information, due to their lower Internet access and literacy rates.

Access to clean and reliable water is essential for managing menstruation safely and hygienically. COVID-19 -related movement restrictions can pose challenges especially for women and girls who are often responsible for collecting household water. As the pandemic increases household water needs in water-scarce environments, and with lockdown reducing access to water, women and girls may not prioritise water for their menstruation and hygiene needs. With the lack of resources, basic items such as soap may also be difficult to find for handwashing. COVID-19 disruptions have also created a less hygienic environment for the disposal of products and waste management.

Period poverty also affects people who are hospitalised, in quarantine centres or undergoing self-isolation measures for COVID-19 as they may lack access to menstrual health and hygiene supplies and general water and sanitation facilities.

Essential items for health workers

Globally, women make up 70% of the health workforce, and are therefore also at the forefront of the COVID-19 response. Since the start of the pandemic, healthcare workers have been reporting a severe lack of resources to manage their periods. Between treating an overwhelming number of patients, not having menstrual supplies easily available, and following certain protocols for removing protective suits, changing pads and tampons isn’t always feasible.

Putting on and removing personal protective equipment (PPE) prevents quick changing of menstrual hygiene materials, leading health workers to sometimes bleed into protective suits, or potentially miss days of work. Moreover, the lack of access to water, sanitation and hygiene facilities at health centres prevents healthcare workers from managing basic hygiene including menstrual hygiene while at work.

Facility managers, and health systems overall, are often not aware of, or do not prioritise the menstrual health and hygiene needs of healthcare workers. Reportedly, when Hubei province, home to the city of Wuhan – the first epicentre of the virus – reached its peak of COVID-19 cases in January, one hospital received a donation of menstrual products. Although women make up 50% of doctors and 90% of nurses at the health centre, facility managers (mostly men) rejected the supplies as they were not seen as a “necessity”, claiming other medical supplies were more important.  Women were reportedly taking contraceptive pills in order to suppress their menstrual cycles. 

“Males generally do not support or see sanitary wear as an essential service and cultural taboos associated with menstruation have increased. Girls are not allowed to cook when menstruating according to the culture.”

Sexual and Reproductive Health and Rights Thematic Lead, Zimbabwe (Plan International)

Putting periods on the agenda

Sanitary and hygiene products are not a luxury or a “nice to have” bonus - they are essential for realising the rights and wellbeing of people who menstruate. Menstrual hygiene management must therefore be a core part of the overall COVID-19 response by governments and organisations. Healthcare workers and patients must have access to appropriate water and sanitation facilities and hygiene products as well as an adequate supply of menstrual supplies.

When a strong gender lens informing the pandemic response is missing, those hardest hit by the crisis cannot be effectively reached and their needs will not be met. Gender-responsive approaches and interventions for COVID-19 management are needed globally, and addressing period poverty must be an integral part of these efforts.

Addressing information gaps and decreasing the stigma around menstruation is also critical - during “normal” times and during the pandemic. Information about menstruation must be distributed together with other health information messaging, and targeted campaigns to address the persisting stigma and shame around menstruation are desperately needed. Menstrual hygiene management must be built into recovery responses, and also integrated to remote and online learning curricula when the pandemic closes down schools. The supply of sanitary products can be improved by supporting local businesses and microenterprises to meet demand and reduce their reliance on global supply chains.

Inclusive approaches are key to engendering meaningful change. In order to meet the needs of the most marginalised people, they must be part of COVID-19 planning and response at the local and global level - this includes adolescent girls, people living with a disability, those who identify in a sexual and gender minority, and those living in conflict settings.

Ultimately, transformative change can only happen when we not only tackle the practical barriers related to access to water, sanitation and hygiene products but also address discriminatory structures, practices, attitudes and mindsets. Addressing these strategic barriers and structural inequalities paves the way for stronger gender-responsive COVID-19 strategies benefiting all - also beyond the pandemic.