Let’s begin with the obvious: Every woman in the history of humanity has or had a period. Each month, her uterus sheds its lining, sending blood flowing out through her vagina (unless she’s pregnant, in which case she gets a lengthy reprieve). This process is as natural as eating, drinking and sleeping, and it’s beautiful too: There’s no human race without it. Yet most of us loathe talking about it.
When girls first start their periods, they embark on a decades-long journey of silence and dread. Periods hurt. They cause backaches and cramps, not to mention a cloud of emotional ickiness—and this goes on every month, for 30 to 40 years. In public, people discuss periods as often as they discuss diarrhea. Women shove pads or tampons up their sleeves on their way to the bathroom so no one knows it’s their “time of the month.” They get bloodstains on their clothes. They stick wads of toilet paper in their underwear when they’re caught without supplies. Meanwhile, ad campaigns sanitize this bloody mess with scenes of light blue liquids gently cascading onto fluffy white pads while women frolic in form-fitting white jeans.
In a 1978 satire for Ms. magazine, feminist pioneer Gloria Steinem answered the question that so many women have asked: “What would happen, for instance, if suddenly, magically, men could menstruate and women could not? The answer is clear—menstruation would become an enviable, boast-worthy, masculine event: Men would brag about how long and how much,” she wrote. Steinem envisioned a world where “men-struation” justifies men’s place pretty much everywhere: in combat, political office, religious leadership positions and medical schools. We’d have “Paul Newman Tampons” and “Muhammad Ali’s Rope-a-Dope Pads” and a new model for compliments:
“Man, you lookin’ good!”
“Yeah, man, I’m on the rag!”
Nearly 40 years later, Steinem’s essay still stings because “menstrual equity” has gone almost nowhere. Today, tampons and pads are taxed in most states while adult diapers, Viagra, Rogaine and potato chips are not. Men can walk into any bathroom and access all of the supplies they need to care for themselves: toilet paper, soap, paper towels, even seat covers. Women, however, cannot. In most schools, girls have to trek to the nurse’s office to ask for a pad or tampon, as if menstruating is an illness rather than a natural function. In most public and private places, women are lucky if there’s a cranky machine on the wall charging a few quarters for a pad that’s so uncomfortable you might prefer to use a wad of rough toilet paper instead. No change? You can pay for a parking spot with a credit card, but have you ever seen such technology on a tampon machine in a women’s bathroom? The situation for prison inmates and homeless women is far direr.
Even if you do have access to tampons, the Food and Drug Administration (FDA) does not require companies to list the ingredients—yet the average woman has a tampon inside her vagina for more than 100,000 hours over her lifetime. Tampons may contain “residue from chemical herbicides,” says Sharra Vostral, a historian at Purdue University who wrote Under Wraps: A History of Menstrual Hygiene Technology. “We do not really understand the health consequences, because we are not testing for them in relation to tampons.”
If all this sounds unfair, try getting your period in the developing world. Taboos, poverty, inadequate sanitary facilities, meager health education and an enduring culture of silence create an environment in which girls and women are denied what should be a basic right: clean, affordable menstrual materials and safe, private spaces to care for themselves. At least 500 million girls and women globally lack adequate facilities for managing their periods, according to a 2015 report from UNICEF and the World Health Organization (WHO). In rural India, one in five girls drops out of school after they start menstruating , according to research by Nielsen and Plan India, and of the 355 million menstruating girls and women in the country, just 12 percent use sanitary napkins.
“In today’s world, if there’s nobody dying it’s not on anyone’s agenda,” says Venkatraman Chandra-Mouli, a WHO scientist who’s worked in adolescent health for the past 20 years. “Menstrual problems don’t kill anyone, but for me, they are still an extremely important issue because they affect how girls view themselves, and they affect confidence, and confidence is the key to everything.”
For something that has over 5,000 slang terms (shark week, Bloody Mary, red wedding), the period is one of the most ignored human rights issues around the globe—affecting everything from education and economics to the environment and public health—but that’s finally starting to change. In the past year, there have been so many pop culture moments around menstruation that NPR called 2015 “the year of the period,” and Cosmopolitan said it was “the year the period went public.” We’ll never have gender equality if we don’t talk about periods, but 2016 signaled the beginning of something better than talk: It’s becoming the year of menstrual change. There’s a movement—propelled by activists, inventors, politicians, startup founders and everyday people—to strip menstruation of its stigma and ensure that public policy keeps up. For the first time, Americans are talking about gender equality, feminism and social change through women’s periods, which, as Steinem puts it, is “evidence of women taking their place as half the human race.”
Menstruation wasn’t always so taboo. In ancient and matrilineal cultures, it was a mark of honor and power, a sacred time for women to rest and revive their bodies. Today, no one is going to the spa or taking a few days off of work to celebrate her period. Menstruation has been cloaked in shame for centuries, but that silence was broken for a brief moment in 1970 when Dr. Edgar Berman, a member of the Democratic Party’s Committee on National Priorities, suggested that women could not hold office because of their “raging hormonal imbalances.” His comments were directed at U.S. Representative Patsy Mink of Hawaii, who had implored her party to focus on women’s issues. Berman asked people to imagine a “menopausal woman president who had to make the decision of the Bay of Pigs,” or the president of a bank “making a loan under these raging hormonal influences.” Mink ridiculed his “disgusting performance,” forced his resignation—and, for a very brief time, women’s periods had the floor. Then 46 years went by without any change.
In January, President Barack Obama may have become the first president to discuss menstruation when 27-year-old YouTube sensation Ingrid Nilsen asked him why tampons and pads are taxed as luxury items in 40 states. Obama was stunned. “I have to tell you, I have no idea why states would tax these as luxury items,” he said. “I suspect it’s because men were making the laws when those taxes were passed.”
Nilsen’s interview went viral, as has her frank approach to one of the most whispered-about issues in American culture and politics: menstruation . “Something that affects people every single day the president didn’t know about! And it’s because it’s one of those things that just gets buried,” she says. “That’s a reflection of how women’s bodies are viewed even today by our government and society.”
If pop culture is your barometer, periods broke into late-night TV in February when Samantha Bee went on The Late Show with Stephen Colbert and riffed on all the ways a female comedian can refer to her “bathing suit area,” as Colbert put it. Bee was just days away from becoming the only woman in late night TV with her show, Full Frontal With Samantha Bee. After reminding Colbert just how much he enjoys talking about the male anatomy (“caucus,” “huevos rancheros,” “Penissippi”), she offered her own list of euphemisms for lady parts, including “Department of the Interior,” “the place where I keep my keys” and “the velour bouncy castle.”
Bee’s bit about “hoo-hos” and “ha-has” didn’t come out of nowhere. Over the last year, a steady stream of pop culture moments propelled menstrual equity—aka period feminism, bathroom equality or simply “life,” as Steinem quips to Newsweek—into the mainstream. Musician Kiran Gandhi ran the 2015 London Marathon without a pad or tampon, crossing the finish line with a large red stain between her legs. When artist Rupi Kaur posted a photo of herself on Instagram, fully-clothed and with a stain on her pants and sheets, the image was “accidentally” taken down. Twice. Comedy Central pair Keegan-Michael Key and Jordan Peele schooled men on periods: “What if we told y’all that once a month, half the human race is in pain? And the other half don’t wanna hear shit about it?” Donald Trump must have missed that skit, because he spawned the hashtag #PeriodsAreNotAnInsult when he complained about tough questions from GOP debate moderator Megyn Kelly, saying she had “blood coming out of her wherever.” From awareness-raising hashtag campaigns (#TheHomelessPeriod, #HappyToBleed, #FreeTheTampons) to a Change.org petition to lift the tampon tax to 20-year-old Arushi Dua asking Mark Zuckerberg to launch an “On my period” button on Facebook to help fight menstrual stigmas in India, periods are having a moment.
This movement has been so widespread that Whoopi Goldberg is now launching a line of medical marijuana products to ease menstrual cramps. Women are using their periods to protest Indiana Governor Mike Pence’s extreme anti-abortion legislation, calling, emailing and tweeting him with detailed updates on their daily flow. Jennifer Lawrence answered the ubiquitous “Who are you wearing?” question with a story about menstruation, telling Harper’s Bazaar that she chose her red cutout Dior gown for the 2016 Golden Globes because the show coincided with her period and she wanted something that was “loose at the front…. The other dress was really tight, and I’m not going to suck in my uterus.”
It Absorbs the Worry…Then Kills You
U.S. consumers spent $3.1 billion on tampons, pads and sanitary panty liners last year, according to Euromonitor, and the global sanitary protection products market reached $30 billion. Y et in the last century, there have only been three significant innovations in the field: disposable sanitary pads, first marketed in the late 19th century and updated with adhesive in 1969; commercial tampons in the 1930s; and menstrual cups, which became popular in the 1980s. “If this isn’t a reflection of how women’s bodies are viewed, I don’t know what is!” says Nilsen. “How could something this important not change over 40 to 50 years?”
Before pads and tampons, women folded soft gauze or flannels and pinned them to their undergarments when they had their periods (“on the rag”). All that changed in the 1920s with Kotex sanitary pads, although they were only a cosmetic improvement. “They’d move, shift, chafe. People talked about getting their skin rubbed raw,” says Vostral. “There were big tabs, and you needed an elastic belt. You had to do gymnastics to get them on.”
In 1931, a Denver physician named Earle Cleveland Haas invented the modern tampon and cardboard applicator. (He also invented the diaphragm.) As women pursued more physically demanding jobs during World War II, their need for comfortable, discreet, reliable products grew. Between 1937 and 1943, tampons sales increased five-fold, and 25 percent of women regularly used tampons in the early 1940s.
Mainstream American culture gradually embraced fem-care products. Women started using tampons more than pads, and feminists heralded the tampon as a liberator. “No one was thinking about safety hazards. They were just grateful to have a product that plugs it up, literally,” says Chris Bobel, president of the Society for Menstrual Cycle Research and an associate professor of women’s and gender studies at the University of Massachusetts Boston. It was only in fringe, arty circles that people were pushing boundaries on tampon etiquette; feminist artist Judy Chicago’s 1971 “Red Flag” captured a grainy, close-up shot of Chicago pulling a bloody tampon out of her vagina. (Many assumed they were looking at a bloody penis, proving her point about period taboos.)
In 1975, Procter & Gamble began test-marketing a tea bag-shaped, super-absorbent tampon called Rely (tagline: “It even absorbs the worry”). They were made of synthetic materials, and the key ingredient was carboxymethylcellulose (CMC), a compound that boosted absorption so much that the tampon could theoretically last for an entire period. “I’ve talked to many people anecdotally who said, ‘I loved those tampons!’ It was a fabulous new design,” Vostral says. But others found Rely tampons painful to remove: “They absorbed so much fluid that they ripped the internal vaginal skin when you pulled them out.” Another problem: The teeth at the tip of the plastic applicator sometimes cut women.
They were also potentially lethal: CMC and polyester in tampons dried out women’s vaginas, creating the ideal breeding ground for the toxin-producing bacteria Staphylococcus aureus. In 1980, 890 cases of toxic shock syndrome (TSS) were reported to the Centers for Disease Control and Prevention (CDC), and 91 percent of them were related to menstruation. Thirty-eight women died. At the time, around 70 percent of American women were using tampons, and while Rely had one-quarter of the market, it was responsible for 75 percent of TSS cases, prompting widespread panic. Other super-absorbent tampon brands were implicated, including Playtex and Tampax, but Rely was the only one recalled in September 1980. All tampon manufacturers faced lawsuits over TSS, but over 1,100 were leveled against P&G. In 1982, the FDA required tampon manufacturers to warn consumers about the link between tampon use and TSS. By June 1983, the CDC had learned about 2,204 cases of TSS. It wasn’t until 1989 that the FDA required manufacturers to standardize tampon absorbency levels and include warnings on tampon boxes.
In the 1980s and ’90s, the safety profile of tampons improved and the incidence of TSS plummeted, but there were still 636 cases of menstrual-related TSS between 1987 and 1996, according to the CDC, 36 of them fatal. While CMC was no longer used in tampons, an explosive 1995 Village Voice article revealed a new threat: Dioxin, a carcinogen that’s “toxic to the immune system” and linked to birth defects, had been found in some commercial tampons. The article slammed the FDA for sitting on memos revealing this link and for not testing tampons.
In a small victory for activists, the tampon industry reformed some bleaching practices to reduce the dioxin risk to trace levels, but problems remain. The FDA does not require companies to disclose the ingredients in tampons and pads, which means we know more about where our clothes are made than we do about what women put inside their vaginas. The average woman uses about 12,000 tampons in her lifetime, and that’s a conservative estimate, says Philip Tierno, a professor of microbiology at New York University School of Medicine who was among the first to link TSS with the synthetic materials in tampons. “The FDA says dioxin is a trace, but it adds up when you’re talking about decades of use.” Viscose rayon, which is made from sawdust, is still used in tampons. As Tierno puts it, “it turns out to be one of the best of the bad ingredients.”
“We don’t have good, reliable data that tells us the things we’re putting inside our body, in the most absorbent part of our body, for days at a time, for 40 years, are safe or not,” says Bobel. “It’s symptomatic of the silence around menstruation.”
In 1997, U.S. Representative Carolyn Maloney of New York introduced the Tampon Safety and Research Act (now the Robin Danielson Feminine Hygiene Product Safety Act, named for a woman who died of TSS in 1998) to require the National Institutes of Health to research the health risks associated with menstrual hygiene products, as well as urge the FDA to disclose the list of ingredients in tampons, pads and other period supplies. Since then, she has reintroduced the bill eight times; it’s currently sitting with the Energy and Commerce Subcommittee on Health. “It is very difficult to get a bill passed, especially when it concerns women’s health. The safety of tampons is not something that is on the minds of many members of Congress,” says Maloney, speaking through a spokesperson. “I believe one day we’ll get this legislation passed.”
Until then, startups like Lola and Conscious Period offer women what Big Business doesn’t: transparency. Commercial tampons are made of some combination of cotton, rayon and synthetic fibers, but Lola tampons are made from 100 percent natural cotton. “In the absence of real hard, current data, we’d rather put something that we understand in our bodies,” says Jordana Kier, who co-founded the company with Alex Friedman. Since launching last year, Lola has raised $4.2 million and attracted tens of thousands of customers. One box of 18 tampons costs $10 (or two for $18) and can be customized by how many light-, regular- and super-absorbency tampons a customer wants.
Conscious Period sells nontoxic, 100 percent organic, hypoallergenic, biodegradable cotton tampons. Cotton is the third-most sprayed crop in the world, co-founder Margo Lang explains, but the organic cotton in Conscious Period’s tampons is free of chemicals, dyes and synthetics. They cost $8.50 for a box of 20, and for each box sold, they give a box of organic pads to a homeless woman. (No, pads aren’t the cheap way out. Homeless women say pads are easier for them to change, can be used longer and pose fewer health risks.)
“Not all women are susceptible to TSS, but they have to be aware that it’s a possibility with any tampon. I’d put my money on 100 percent cotton, no synthetics,” says Tierno. “All cotton provides the lowest risk, whether organic or nonorganic, but manufacturers refuse to go to all cotton because they’d have to adjust all their machines.”
If you’d rather keep things on the outside, Vancouver, British Columbia–based Lunapads sells menstrual pads, panty liners and underwear for periods, pregnancy and light bladder leakage, as well as the Diva Cup. “Lots of brands are now making products that are organic and all cotton,” says Nilsen. “If they can do it, everyone else can do it too.”
‘Free for All, All the Time’
Across the U.S., you can buy food, doodads and necessities without being taxed: Pop-Tarts in California, BBQ sunflower seeds in Indiana, Mardi Gras beads in Louisiana, Bibles in Maine and coffins in Mississippi. But in these and 35 other states, menstrual products are taxed anywhere from 4 to 10 percent. “The tampon tax is part of an overall economic system in which the dry cleaner charges more for a blouse than a shirt—in which men are assumed to be buying necessities and women are assumed to be buying luxuries,” Steinem says.
Of the 10 states that don’t tax tampons, five have no sales tax (Alaska, Delaware, Montana, New Hampshire and Oregon) and five have specifically exempted menstrual products (Maryland, Massachusetts, Minnesota, New Jersey and Pennsylvania). This year, Chicago removed the city’s sales tax on these products. Earlier this month in New York state, the Senate joined the Assembly in unanimously passing legislation to eliminate the tampon tax; once the minor differences in those bills are aligned, the legislation will go to the governor for his signature.
In New Jersey, a bill was recently introduced that would add menstrual cramps to the list of qualifying conditions for medical marijuana. Last summer, Canada axed its national goods and services tax on period products, and the U.K. and France, among other countries, are working to reduce or end the tampon tax.
40 of the 50 U.S. states tax menstrual products. Hover over each state to reveal items that are exempted from sales tax in these states. Click to enlarge.
Guardian columnist and Feministing founder Jessica Valenti wrote one of the first high-profile critiques of the tax in her 2014 piece “The Case for Free Tampons,” where she charged that “women’s feminine hygiene products should be free for all, all the time.”
Horrified conservatives fired back: If women had access to free tampons, what would come next—cars and food? Don’t you want the government out of your uterus? Some have professed concerns about theft (girls will steal all the tampons!), vandalism (girls will stick pads everywhere!) and recouping lost revenues.
“These are excuses,” says New York City Councilwoman Julissa Ferreras-Copeland, who introduced a New York City bill aiming to put free tampons and pads in all public school bathrooms, homeless shelters and prisons. “You'll never walk into a bathroom in a public office without toilet paper. You’d be like, ‘What the hell?’… I have yet to hear someone say, ‘Well, what’s the budget on all these [free] condoms?’”
California Assembly members Cristina Garcia and Ling Ling Chang introduced a bill in January to exempt women’s menstrual products from sales tax. If it passes, women in that state will have $20 million back in their wallets—the equivalent of just one-hundredth of 1 percent of California’s state budget, says Garcia, who has gone from being mocked as “Miss Flow” and “Miss Maxi” to adding 30 co-authors to the bill, including men and women from both parties. “California is a pretty blue state. When I first introduced the bill, my progressive colleagues shut me down,” she says. “We’re talking about blood, but I can’t even say that out loud because it makes them so uncomfortable and squeamish. The closest I get to the word ‘blood’ is reminding them it’s not a blue liquid…. It’s taken a lot of work and hand-holding.”
This year, U.S. Representative Grace Meng of New York persuaded the Federal Emergency Management Agency to allow homeless shelters to buy feminine hygiene products with federal grant funds. She’s also working to ensure women can buy menstrual products with their flexible spending accounts. In Columbus, Ohio, Councilwoman Elizabeth Brown wants to put menstrual products in pools and recreational centers. Michigan, Virginia and Wisconsin are among the other states that have introduced legislation to eliminate the tampon tax. In Utah, an all-male panel voted 8-3 against the proposed Hygiene Tax Act. In Tennessee, a similar bill was rejected.
“Anyone who doesn’t think the tampon tax is a problem either isn’t a woman or hasn’t been poor,” says Jennifer Weiss-Wolf, a vice president of the Brennan Center for Justice at NYU School of Law and leading writer and advocate for menstrual equity. She’s been an architect of the U.S. policy campaign to squash the tampon tax. As she wrote in the 2015 book Legal Change: Lessons From America’s Social Movements, real, lasting social change requires more than just viral videos: “It is necessary to win in the court of public opinion and to win in a court of law.” The tampon tax is well on its way out. Since the start of 2016, 14 states have introduced tampon tax legislation, and those efforts are still alive in 12 states. “That’s 14 of 40 states—a third! That’s also really fast,” Weiss-Wolf says. “Name another issue in this country that has bipartisan support in such a bold, open way.”
The Nike of Menses
“I’m wearing the boy shorts!” Miki Agrawal says, standing up and pulling down her form-fitting houndstooth pants to reveal sleek black underwear. We’re sitting in Agrawal’s tiny office at the Center for Social Innovation in downtown Manhattan. Photos of grapefruits hang from the walls and colorful underpants hang from a rack dangling above our heads. They look like they could be the latest style of Calvins, but they’re Thinx, the high-tech, period-proof underwear Agrawal invented with her twin sister, Radha, and their friend Antonia Saint Dunbar.
Thinx underwear absorb the blood from a woman’s period so she doesn’t have to wear a pad or tampon (except on her heaviest days, when an extra layer of protection is recommended). Agrawal explains that her patented underwear are anti-microbial, moisture-wicking and leak-proof, keeping women feeling dry, and can absorb up to two tampons’ worth of blood. That means more comfort, fewer tampons and less pollution: “There are over 20 million combined tampon applicators, pads and menstrual products that end up in a landfill every year,” she says. Thinx come in six styles and cost $24 to $38 a pair. They’re washable, reusable and, according to the many journalists who’ve tried them, they work. Thinx donates a portion of every sale to the Uganda-based AfriPads, which teaches women to make and sell reusable pads. Agrawal is also launching Thinx Global Girls Clubs, which will give out subsidized menstrual products and teach health education, self-defense and entrepreneurship.
Agrawal came up with the idea in 2010, when she met a 12-year-old girl in South Africa. “I asked her why she wasn’t in school, and what she said to me completely changed my life. She said, ‘It’s my week of shame,’” Agrawal recalls. The girl explained that when she gets her period, she stays home from school. “I tried using leaves and mud and plastic bags and old bits of mattresses and old rags,” Agrawal remembers her saying. “None of it worked, and eventually I just stopped going.”
Agrawal leans back in her chair and sticks her hand in a bag of popcorn. “There’s a period problem in the first world and a period problem in the developing world. Why no innovation? Why is no one talking about it?”
While Thinx and other like-minded startups, like Dear Kate, are giving menstrual products their first real makeover in half a century, prudish mindsets are making it hard to progress past all the blue liquid. When Thinx submitted an ad campaign to New York’s subways—featuring modestly posed models in underwear and tank tops alongside artful images of juicy grapefruits and falling egg yolks—the reviewing agency, Outfront Media, called the images “inappropriate.” Thinx eventually made it to subway walls, yet Agrawal says the company has been r ejected by New York City Taxi TV and elevator bank TVs. “ We can’t be on morning talk shows,” she adds. “They don’t want to say ‘period.’ It’s nuts!”
Colombian-born Diana Sierra is waging her own fight for menstrual progress by designing underwear that directly responds to the needs of girls and women in developing countries. A couple of years ago, Sierra left her industrial design job at Panasonic when, surrounded by facial steams and massage machines, she realized she was designing “for the 10 percent of people who can pay for this stuff. Ninety percent of the population are worthy of good products, but they don’t have this income, so they’re not seen as a good market,” she says.
In 2014, she launched Be Girl, a design company that creates high-performance menstrual pads and underwear. She got the idea during a United Nations internship in rural Uganda, where she taught locals how to turn arts and crafts into businesses. “I had 11- and 12-year-old girls knocking on the door saying they wanted to be part of the workshop.” A teacher explained why they weren’t in school—they were menstruating. Stunned, Sierra hacked sanitary pads using material from an umbrella and mosquito net. “I come from a developing country, so we’re super-resourceful,” she says. Sierra’s parents were farmers (her father now works in construction, her mother in elder care), but thanks to a scholarship for students from “tough economic backgrounds,” she went to college and got an internship in New York City. She then spent 12 years working at leading global companies like Smart Design, Nike and LG.
Sierra knew girls in Uganda used pieces of cloth to absorb their period blood, so she built underwear with a leak-proof mesh pocket that can be filled with cloth or other clean materials. Since last year, BeGirl has distributed over 15,000 pairs of reusable underwear in Uganda, Rwanda, Tanzania, Malawi and 10 other countries. Be Girl underwear are as bright and cheerful as Victoria’s Secret intimates, and for each sale, the company donates a pair to a girl in need. “You cannot assume just because someone has low income, someone has low expectations or low aspirations,” she says. “I want to be the Nike of menstrual health…. It’s not just giving a girl a panty or pad. It’s giving knowledge, so she can own her body and make informed decisions.”
While sifting through survey results from product pilot tests, Sierra found a dusty page from a girl in Mbola, Tanzania. Answering the question, “What do you like most about the menstrual pads?” the girl wrote that she was “so happy because she knew someone somewhere loved her,” Sierra recalls, “because that person made something so beautiful that she was so proud to be girl.” And so the name of Sierra’s company was born. “Here you have a girl continents away telling you that something as simple as a sanitary pad is giving her...a sense of dignity and pride,” she says. “Being able to run, walk with confidence, be comfortable and clean…. That’s all you want as a designer, that assurance that what you’re doing matters.”
The Menstruating Man
Organic and all-natural cotton tampons shouldn’t be a first-world privilege, but they are, and the fight against tampon taxes, while worthy, doesn’t matter if tampons aren’t available where you live and your culture shuns menstruation. In many countries, periods are like curses. Girls and women cannot cook, touch the water supply or spend time in places of worship or public areas when they’re menstruating. In Africa, one in 10 girls misses school during her period every month. Seventy percent of girls in India have not heard about menstruation before getting their periods, and four in five girls in East Africa lack access to sanitary pads and related health education. In Nepal, some rural families still follow an ancient tradition called chaupadi, banishing girls and women to sheds when they have their period.
“Most girls learn about their periods the day their periods start,” says Chandra-Mouli of the WHO. He recounts a story he hears time after time: “I started having periods at school. Spotting on my clothes. Giggling in class. I didn’t know what was happening. My panties felt wet. My teacher made me wait in the staff room. I thought my insides were rotting. My mother came and wrapped me in a towel, took me home, put me in a bath and said, ‘You’re a woman now. Don’t go out and play with the boys.’”
These systemic issues won’t be solved with a pair of high-tech underwear. “I spent time in Uganda, Kenya and India shadowing organizations working to address these issues,” says Bobel of the Society for Menstrual Cycle Research. “They understand there is no silver bullet, but it’s a material solution that funders love, and it’s concrete and scalable. What’s not getting challenged is the actual culture of menstrual secrecy and shame.”
If product is the sexy solution, the practical path ahead is also the harder one: “Figure out low-cost, sustainable infrastructure solutions,” says Marni Sommer, an associate professor of sociomedical sciences at the Columbia University Mailman School of Public Health who’s been studying global menstruation for a decade. “If you can break taboos and start getting info to girls and transform some infrastructure so there are safe, private places to manage without worry about being attacked, embarrassed or dirty, that will make a big difference.”
A man known as India’s Menstrual Man is chipping away at this problem. Arunachalam Muruganantham grew up in south India, the son of poor handloom weavers. In 1998, soon after marrying his wife, he realized she was using soiled cloths to manage her period. When she explained that she couldn’t afford to buy sanitary pads as well as milk for their family, he decided to do something.
For years, he experimented with materials and prototypes. He tried to convince his wife to test his products, then he asked local medical students, but they all refused, so Muruganantham tested the sanitary pads himself. He filled a rubber bladder with animal blood, attached a tube that led into his underwear, and spent five days wearing a pad. “The messy days, the lousy days, that wetness. My God, it’s unbelievable,” he said in his 2012 TEDx Bangalore talk.
After six years of research, he built a machine that makes sterilized sanitary napkins—but not before his neighbors thought he’d lost his mind and his wife left him (they’re now back together). Today, he has 2,500 machines in India and a few hundred across 17 other countries. His pads retail for 3 cents a packet, and the machines cost $2,500 each, both below market rates. In 2014, Muruganantham was named one of Time ’s 100 most influential people in the world, and his machines have enabled women to launch their own businesses. As he puts it, “by the women, for the women, to the women.”
Swati Bedekar, a scientist from Gujarat, India, bought one of Muruganantham’s machines in 2010 after visiting desert communities and witnessing girls sitting on stones or pots filled with sand to catch the blood from their periods. She wanted to help them, but the women who used her machine complained that the foot pedal led to back pain. So Bedekar tweaked the machine, simplifying the process, altering the design of the pads and adding wings for comfort. Yet there was another barrier: In most Indian cities and villages, there are no regulations for waste disposal, and used sanitary products are often wrapped in paper or some kind of plastic and thrown out with the trash. Stray dogs often rummage through the waste, and some men worry that women might use the pads for black magic. Bedekar’s husband, Shyam, invented a terra-cotta incinerator that looked like a garden pot and could burn used pads discreetly, quickly and without electricity.
Today, Bedekar has 40 groups of women using her revamped machine to make and sell 50,000 pads a month under the name Sakhi (it means “friend” in Hindi). Inspired by the Ice Bucket Challenge, a fundraising campaign for Lou Gehrig’s disease that went viral in 2014, Bedekar launched the Hygiene Bucket Challenge, where she asked people to buy a bucket’s worth of Sakhi supplies. With the help of her nonprofit Vatsalya Foundation, she gave 6,000 girls a year’s supply of menstrual products in 2015.
While much of the innovation in India focuses on small businesses, ZanaAfrica Foundation provides sanitary pads and reproductive health education to 10,000 girls across Kenya each year. In 2004, Kenya became the first country in the world to eliminate sales tax on menstrual products, but there is still much work to be done. “Menstruation contributes to 1 million adolescent girls in Kenya missing up to six weeks of school each year,” says Gina Reiss-Wilchins, CEO of ZanaAfrica Foundation. “They’re dropping out of school at two times the rate of boys starting at puberty.” In March, the foundation’s social enterprise arm, ZanaAfrica Group, which manufactures menstrual products for girls and women in East Africa, received a four-year $2.6 million grant from the Bill & Melinda Gates Foundation to fund a groundbreaking study examining the impact of providing pads along with girl-centered reproductive health information.
“If every girl in Kenya finished secondary school, there would be a 46 percent increase in the country’s [GDP] across her lifetime. There are so many barriers: poverty, abuse, child marriage, pregnancy. Getting your period should not be a barrier,” says Reiss-Wilchins. “We are a quiet little revolution.”