eriod poverty was recognised as a global health crisis in early 2010. The World Health Organisation and the United Nations International Children Emergency Fund have identified menstrual health as a health and human rights issue. According to the World Bank estimates, about 500 million girls and women worldwide lack access to menstrual products, adequate sanitation and health facilities required for menstrual health management. In December 2012, a joint monitoring programme (JMP), initiated by the WHO and the UNICEF in 1990, defined menstrual health management (MHM) as, “access to WASH (water sanitation and hygiene) facilities, an absorbent material for menstrual blood collection and water and soap for personal hygiene during periods for girls and women.” Menstruation health is critical for achieving several sustainable development goals (SDGs), mainly SDG 3 (ensure healthy lives and promote well-being for all at all ages), SDG 5 (gender equality) and SDG 6 (clean water and sanitation for all).

Three-dimensional period poverty is defined as, “the failure to meet a woman’s menstrual health and hygiene needs due to not just financial, but also social, educational and infrastructural failings.” Financial failings involve the inability to afford adequate sanitary products to manage menstruation, resulting in the use of unhygienic products such as cloth and leaves that may cause infections. The infrastructural aspect of period poverty is the lack of access to safe and hygienic WASH facilities that allow women to clean themselves and change their menstrual products when needed.

Educational period poverty is the lack of information provided to menstruating girls, leading them to adopt archaic or unhygienic menstrual practices. Many women harbour misconceptions, such as refusing to take medicines to manage menstrual pain because they believe it will negatively impact their menstrual cycle.

Social period poverty is the lack of societal acceptance of menstruation as a natural biological process. Many taboos and stigmas exist around the menstrual process that regard menstruation as impure and dirty and seclude girls and women. The secrecy around menstruation is not just a cause of incomplete information about the process but also a source of shame for the menstruating girl or woman. It can lead to girls isolating themselves from their peers, being absent from school and not participating in sports or other activities. As a result, girls may experience significant physiological and psychological discomfort.

In South Asia, the condition of three-dimensional period poverty is dire. It is observed that young girls often start their periods uninformed and unprepared. For many, their only source of information about menstruation is their mothers. Many women lack the means for self-care and support during menstruation, negatively affecting their ability to perform everyday tasks. In some parts of Nepal, girls are exiled from their homes for their menstruation (called period exile) because they are considered impure. In some parts of India, myths around menstruation portray the process as a symbol of impurity and shame. Working women in rural Bangladesh have reported poor mental health during menstruation due to the shame surrounding their condition. They would self-impose restrictions on their mobility due to this shame and fear. These taboos and stigmas restrict the disseminating of accurate information regarding hygienic menstrual practices, as women are shy to discuss them. Period poverty affects not only women’s personal well-being but also their productivity at their school and workplace. Evidence shows girls dropping out of school or missing up to five days every month due to their periods in India. In Bangladesh, working women have reported discomfort during menstruation, including backache, fatigue and mood swings, causing productivity losses at workplace.

In Pakistan, the employment-to-population ratio is only 21 percent for women, compared to 68 percent for men. This is alarmingly low. One of the factors contributing to this low participation rate of women is period poverty and the lack of the necessary educational, financial and social support that restricts the movement of women during menstruation. Research on period poverty in Pakistan is limited, but the research that does exist suggests high prevalence of three-dimensional period poverty in Pakistan. Many women in rural areas do not have access to safe and hygienic sanitary products or WASH facilities due to financial and infrastructural constraints. The situation is not much better in low-income urban areas, particularly slums. In marginalised communities, adolescent girls usually lack financial resources and menstrual knowledge, resulting in only a handful using sanitary pads. A majority rely on old and new, washed or unwashed cloth material. Social stigma and taboos surrounding menstruation continue to plague women and disable them from seeking out effective menstrual health management tools, prolonging their discomfort and making it more difficult to seek and maintain employment.

Safe and easy access to menstrual health and hygiene is a fundamental human right. Women feel more comfortable and confident when they can manage their periods in comfort and dignity.

In Karachi, a recent survey with low-income semi-skilled working women, including nurses, beauticians, healthcare workers and female security guards, showed that most women (52 percent) were unable to buy sanitary pads because they found these hygiene products too expensive or out of their financial reach. High menstrual pain, lack of access to segregated or clean toilets, inability to take medical leaves during periods and male coworkers at the workspace are associated with higher reported stress levels and lower productivity. During menstruation, 74 percent reported that they had trouble completing tasks, 46 percent reported missing targets, 57 percent reported a loss of focus at work due to worrying about leaking, 43 percent reported lower focus compared to other days, and 66 percent reported being late to work during periods. These numbers denote an alarmingly high contribution loss emanating from menstruation among working women.

Besides, a majority of the women were unaware of the existence of reusable menstrual products that could be cost-effective. The survey indicated that female healthcare workers are confident about the information they processed about menstruation; are more likely to take medicine to treat menstrual pain; and are more likely to visit the doctor when in menstruation-related distress. Those working in other jobs, such as parlour and security, admitted that they did not feel confident about their knowledge about menstruation. They expressed the desire to know more so that they might pass on this information to their daughters and break the cycle of the passage of incomplete menstrual knowledge. This highlights the need to invest in menstrual knowledge training at the workplace for female workers to promote behavioural change towards safe hygiene practices among working women.

The lack of access to clean toilets, absence of hand washing and waste management facilities are indicators of infrastructural period poverty at the workplace. In Pakistan, most working women face hindrances to accessing safe and hygienic facilities. Many do not have access to gender-segregated washrooms at their workplace. On top of this, toilets are poorly maintained due to inadequate sanitary staff. On the other hand, lady health workers face a unique challenge regarding menstrual hygiene as they are required to go from house to house every day, meaning they often spend the entire day without using the toilet and wait until they get home. These unhealthy practices and inadequate menstrual hygiene may expose these women to various physical health risks, such as reproductive and urinary tract infections. There is a need to provide such workers with mobile toilets, handwashing and waste disposal facilities.

Social period poverty is the most prominent among female workers. Most women hide their periods from their coworkers. They are not comfortable talking to a male coworker about their periods. That’s why they cannot take leave from the work during periods, if the boss is male, as they do not know how to explain it to their supervisors and managers. It is high time to normalise taking breaks at the workplace by female employees during periods if the need arises. Government as well as leading non-state organisations should come forward to launch menstrual hygiene campaigns through the media, as social change is a tedious and long-term process that requires repeat interventions.

Safe and easy access to menstrual health and hygiene is a fundamental human right. Women feel more comfortable and confident when they can manage their periods in comfort and dignity. Collective action is needed to raise awareness, ensure access to hygiene products and foster supportive workplace environment for enabling women to participate fully in the workforce.

Acknowledgement: This article is extracted from research funded by the Centre for Business and Economics Research (CBER) at the Institute of Business Administration, Karachi. The authors collaborated closely with the National Organisation for Working Communities, Karachi, to execute the project.

Dr Lubna Naz is an associate professor at School of Economics and Social Sciences and a research fellow at Population Research Centre at IBA, Karachi

Eisha Jawaid and Suman Lohana are students at IBA, Karachi