March 03, 2020 7 min read
A period product that has been around for decades is now being considered by experts as a possible solution to period poverty.
First introduced in the 1930s, menstrual cups have gained popularity in recent years as new more comfortable iterations of the product have come to market.
While environmentally conscious women praise menstrual cups for their sustainability experts say they might be also be a viable solution for women in low income countries that can’t afford to buy monthly period products.
That’s according to a recent study published in the Lancet Journal of Public Health—which looked at 43 different studies on menstrual cup use among more than 3000 girls.
“We started looking at menstrual cups in primary school girls in Kenya and we thought if primary school girls can use menstrual cups and they are safe and effective then everyone can.”
Professor Penelope Phillips-Howard is an author of the Lancet study and a professor at the Liverpool School of Tropical Medicine.
She’s led several studies on period poverty in low and middle-income countries, many of which were included in the Lancet review.
“So our first study was in Western Kenya in a rural area and we looked at menstrual cups versus sanitary pads versus control.”
Phillips Howard and her team found lower rates of sexually transmitted infections among girls who used menstrual cups than those who used sanitary pads.
While the study wasn’t large enough to make a causal connection, Phillips Howard says the reduction in STIs could be linked to a decrease in transactional sex.
“We increasingly understood that when they were very impoverished the girls some of them were forced into having transactional sex to buy sanitary pads.”
According a study, 1 in 10 girls in Western Kenya said they had had traded sex for money to buy pads.
But having a cup could change that.
The average global price of a menstrual cup is $23. While that’s more than one month’s worth of pads or tampons, it comes out to just cents per month over the cup’s 10-year lifespan.
“One cup vs 2 packs of pads every month. 2 times 12 times 10 is a lot cheaper. About 70% of the cost."
Those savings could have huge impacts. The monthly cost of managing a period is a significant financial burden for girls and their families. Lifting that burden could reduce the negative consequences of having a period, like trading sex for pad money.
While reusable pads are alsoa cost-effective alternative to disposable period products, menstrual cups have an important advantage.
“The capacity of a cup is greater than you would have with a pad, tampon, period underwear.”
That’s Christine Brown. Her company, Kind Cup, recently made a donation of menstrual cups to health centers serving low income women in the United States.
“So just being able to have a larger capacity gives so much more flexibility of how you can use your day and how you can use your time. Which provides a lot more freedom for people as well.”
For women with ready access to a private bathroom the increased capacity of a menstrual cup is an added convenience. But for women living in low-resource settings, it’s a game changer.
In many low-income countries private restrooms aren’t available in public spaces. Even in the United States, where public restrooms are seemingly abundant, homeless women have reported having to change their tampon or pad in public spaces—like Nancy, who appeared on a previous episode of the podcast.
“I used to have go behind dumpsters, go behind a tree and change real fast. (So you’d have to change your tampon or pad behind a dumpster?) Oh yeah, I did it a lot."
Nancy was homeless for 23 years and frequently struggled to buy tampons and pads every month.
For these women, having a period product that can stay in the whole day and still do its job, means being able go to work or school without worrying about where and if they’ll be able to change.
OBGYN Ayesha Shaikh says that would be a huge relief.
"The girls at school are not worried about what's going to happen, they're not thinking about their menstrual cup. They're thinking about school."
Dr. Shaikh has a private practice in Santa Barbara and is a member of Direct Relief’s medical advisory board. She practiced in India for over a decade.
“In India, where I practice before from 1964 to 1980 it. You do have women coming into the hospitals using leftover saris from their mother as a menstrual hygiene product.”
Many women, she says, stayed home during their periods to avoid leaking in public.
"They can't go out to the fields because how will they be able, they change their cloth that they using."
Because menstruation is seen as being unclean by certain religions, Dr. Shaikh says many of her patients were ostracized during their periods and kept from participating in day to day activities.
“A girl, when she gets into menarche, that is the onset of a first menstrual period, is kept separately, away from the family. Away from food that's being offered to the other members of the family. She's kept in a separate room, is offered food separately, is not allowed to get out and see other family members, including her, especially men, because it was looked upon as something that was bad.”
According to Dr. Shaikh, these kinds of practices aren’t going to change because of a period product.
“I think the menstrual cup would help for girls and women who can use it and go to work, go to school. It's not going to change the religious ideas or thoughts about mensuration.”
In the United States, stigma also presents a challenge for women experiencing period poverty.
According to Nurse Practitioner Brittany Adamson, menstruation is viewed by many as a taboo, making it difficult for women to voice their needs.
“Young girls who maybe live just with a dad or an uncle who are low income, struggling to buy food. Um, often girls are embarrassed to ask for money. Um, you know, if they're young, you know, 11, 12, they have their period and they often don't want to ask for money for these supplies, or even discuss this with maybe a male family member that they are living with.”
Adamson is a clinician at Planned Parenthood Mar Monte. She serves primarily low-income women in the greater Sacramento area.
“(Do you see patients at planned Parenthood that are struggling with accessing monthly period products?) Yes, yes, I do. Um, multiple times a week, patients ask for a supply of pads to go home.”
While she says many can pick up a small number from their school or local shelter, they can't secure enough for their whole cycle.
To fill the gap, they make do with cheaper, more accessible materials.
“They would use a cardboard or toilet paper or, um. Socks from a dumpster. Somebody once told me when she had a terrible rash.”
While a menstrual cup that’s reusable could help solve this problem, she says the product has limitations.
Cups require regular cleaning which can be a challenge for women that lack stable housing.
Adamson says many of her patients live out of cars, motels, or rely on their relatives and friends for housing. For these women, maintaining a menstrual cup might pose a challenge.
“Women that don't regularly have access to a stove and clean water to boil, to sterilize the cup and to let it air dry and to wash it with the right soap, and to buy the right cloth pouch to store it in. Um, I think it's just maybe more of, um, not a, I don't want to say burden, but more about a maintenance sort of schedule, than their already chaotic and busy lives can manage."
While the reasons women experience period poverty are varied, so are the solutions.
Adamson suggests federal governments provide period products for free through public health programs.
Others, like Phillips Howard, emphasize the need to change public perceptions about menstruation.
“Men can talk about it, boys can talk about it, you stop the teasing, girls could leave class, women could leave their offices and change and not feel ashamed so getting rid of the stigma and taboo around it.”
Regardless of their differences, most experts can agree that ending period poverty is a bigger job than a menstrual cup can achieve.
"The product is not a solution on its own. It’s a contribution.”
Thanks for listening to this episode of the podcast. For Direct Relief, I’m Amarica Rafanelli.
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