Examining Period Poverty

A worker trims and stacks sanitary pads before they are lined and sewn at the Afripads factory.
A worker trims and stacks sanitary pads, Source: Yahoo Images.

Period poverty is the lack of access to sanitary products, menstrual hygiene education, toilets, handwashing facilities, and or waste management. The term also refers to the increased economic vulnerability that women and girls face due to the financial burden posed by menstrual supplies. In least-developed and low-income countries, access to hygienic products such as pads, tampons, or cups is limited. This means that girls will often resort to using proxy materials such as mud, leaves, or animal skins to try to absorb the menstrual flow. As a result, such women are at a higher risk of developing certain urogenital infections, like yeast infections, vaginosis, or urinary tract infections. This becomes an issue because while the majority of women are of reproductive age, the majority of these women and girls are unable to practice proper hygiene practices. Consequently, women and girls around the world, especially in developing countries, face numerous challenges in managing their menstruation. Furthermore, some/many women are forced to approach this normal bodily function with silence due to stigma, as some communities consider menstruation to be taboo.

What causes period poverty?

One cause is that pads and other supplies may be unavailable or unaffordable. This means that women are often forced to choose between purchasing sanitary pads and different basic needs, or they may live in areas where there is no access to hygiene products at all. More importantly, young girls may lack access to toilet facilities with clean water to clean themselves while on their periods. In addition, discriminatory cultural norms make it challenging to maintain good menstrual hygiene as women often have to hide, or the community may not put enough effort into establishing hygiene facilities or practices around them. Also, some women and girls lack the necessary education and information about menstruation and good hygiene practices because topics around menstruation and proper hygiene practices are rarely discussed in families or schools.

What is more, other girls may experience menstruation with little or no knowledge of what is happening. This makes it harder for women to adopt sanitary practices because most remain unaware of recommended hygiene practices. In many communities, menstruating girls and women are still banned from kitchens, crop fields, or places of worship. There is also the issue of forced secrecy in communities where girls are exposed to ‘menstrual etiquette.’ This etiquette encourages the careful management of blood flow and discomfort and the importance of keeping menstruation hidden from boys and men.

A Human Rights Issue.

It is important to consider gender inequality, extreme poverty, and harmful traditions as the source of menstrual hygiene deprivation and stigma. This often leads to exclusion from public life, heightened vulnerability, and creates barriers to opportunities such as employment, sanitation, and health.

Some of the human rights that are undermined by period poverty include,

  • The right to human dignity– When women and girls cannot access safe bathing facilities and safe and effective means of managing their menstrual hygiene, they are not able to manage their menstruation with dignity. Menstruation-related teasing, exclusion, and shame also undermine the right to human dignity.
  • The right to an adequate standard of health and well-being Women and girls may experience negative health consequences when they lack the supplies and facilities to manage their menstrual health. Menstruation stigma can also prevent women and girls from seeking treatment for menstruation-related disorders or pain, adversely affecting their health and well-being.
  • The right to education  Lack of a safe place or ability to manage menstrual hygiene as well as lack of medication to treat menstruation-related pain can all contribute to higher rates of school absenteeism and poor educational outcomes. Some studies have confirmed that when girls are unable to manage menstruation in school properly, their academics and performance suffer.
  • The right to work  Poor access to safe means of managing menstrual hygiene and lack of medication to treat menstruation-related disorders or pain also limit job opportunities for women and girls. They may refrain from taking specific jobs, or they may be forced to forgo working hours and wages. Menstruation-related needs, such as bathroom breaks, may be penalized, leading to unequal working conditions. And women and girls may face workplace discrimination related to menstruation taboos.
  • The right to non-discrimination and gender equality Stigmas and norms related to menstruation can reinforce discriminatory practices. Menstruation-related barriers to school, work, health services, and public activities also perpetuate gender inequalities.

What is being done?

In spite of the issues presented, it is essential to acknowledge that a lot is being done around the world to help eradicate period poverty.

For example, UNFPA (United Nations Population Fund), has various approaches to promoting and improving menstrual health around the world. Some of them include,

  • UNFPA reaches women and girls directly with menstrual supplies and safe sanitation facilities. In humanitarian emergencies, UNFPA distributes dignity kits, which contain disposable and reusable menstrual pads, underwear, soap, and related items. (In 2017, 484,000 dignity kits were distributed in 18 countries.)
  • The UN organization also promotes menstrual health information and skills building. For example, some UNFPA programs teach girls to make reusable sanitary napkins. Others raise awareness about menstrual cups.
  • Furthermore, the organization aims to improve education and information about menstruation as human rights concerns. This is done through its youth programs and comprehensive sexuality education efforts, such as the Y-Peer program.
  • UNFPA also procures reproductive health commodities that can be useful for treating menstruation-related disorders. For instance, hormonal contraceptive methods can be used to treat symptoms of endometriosis and reduce excessive menstrual bleeding.
  • Similarly, UNFPA is helping to gather data and evidence about menstrual health and its connection to global development. For instance, UNFPA supported surveys provide critical insight into girls’ and women’s knowledge about their menstrual cycles, health, and access to sanitation facilities. A recent UNFPA publication offers a critical overview of the menstrual health needs of women and girls in the Eastern and Southern Africa region.

 Further Recommendations

While there exists a lot of support to help end period poverty, there is still a lot that can be done to improve access to sanitary products, menstrual hygiene education, toilets, handwashing facilities, and, or waste management. Human Rights Watch and WASH United recommend that groups which provide services to women, evaluate their programs to determine whether a woman or girl has,

  • Adequate, acceptable, and affordable menstrual management materials;
  • Access to appropriate facilities, sanitation, infrastructure, and supplies to enable women and girls to change and dispose of menstrual materials; and
  • Knowledge of the process of menstruation and options available for menstrual hygiene management.

Practitioners engaged in programming or advocacy related to menstrual management should also,

  • Have an awareness of stigma and harmful practices related to menstruation in the specific cultural context where they are working.
  • Support efforts to change harmful cultural norms and practices that stigmatize menstruation and menstruating women and girls;
  • Address discrimination that affects the ability to deal with menstruation, including for women and girls with disabilities
  • Be aware of and incorporate human rights principles in their programming and advocacy, including the right to participate in decision-making and to get information.

Moreover, women and girls must have access to water and sanitation. This will allow the establishment of private areas to change sanitary cloths or pads, clean water for washing their hands and used fabrics, and facilities for safely disposing of used materials or drying them if reusable.  It is also imperative that both men and women have a greater awareness of menstrual hygiene. This means that training and learning courses should be made available for women and young to teach them the importance of menstrual hygiene and the proper practices. Likewise, educating boys on the challenges and struggles girls face could help reduce stigma and help them become more understanding and supportive husbands and fathers. Less work has been done in this area, but the benefits of educating boys about adolescence for both themselves and female students are increasingly being recognized.

It is essential to acknowledge that there is still limited evidence to understand women’s use of sanitation and menstrual management facilities. Therefore, there is a need for individuals to pay special attention to the needs of women and girls all over the world.

Barriers to the Mental Health Care of Sex Trafficked Victims.

A woman with her eyes closed and hands on her cheeks
Source: Mental Health, Yahoo Images

This blog uses direct quotes from survivors that may be explicit for some readers.

What is Sex Trafficking?

The U.S. Department of State defines sex trafficking as “the recruitment, transportation, provision, or the obtaining of a person for a commercial sex act. The commercial sex act is induced by force, fraud, or coercion, where the survivors are pushed to perform such acts while under 18 years of age”. Sexual trafficking relies heavily on the control of the victim’s vulnerability. According to the Trafficking Hotline, about 10,949 cases of human trafficking were reported in the year 2018 alone. Among those cases, 7,859 account for sex trafficking (approximately 71.78%). Those who are survivors of human trafficking report experiencing severe cases of abuse and extortion sex practices. As a result, these individuals’ lives are continuously exposed to physical and sexual trauma.

So how does sex trafficking occur? After individuals are lured by their traffickers, victims are absorbed into the underground and uncontrolled sectors of the economy where wage, health, and safety law violations routinely happen. In these sectors, individuals are hooked into prostitution, pornography, and other forms of the commercial sex industry. Those who have survived human trafficking explain how hard it is to escape the trafficker. For example, in an interview with Kristina Kuzmic, Oree describes her experiences as a victim of human trafficking,

Warning Explicit Content.

And he grabbed me by my hair and drugged me down the street. My knees was scraping the floor. There was other women out there, nobody did anything. When you have been forced to sleep with 7 to 15 men and be raped and be 11 years old, I was like slowly dying. And after the first night, you suppress those feelings because any inch of hope that you have, any sense of “I can get out,” any feeling of “There’s a God,” any feeling of “I don’t deserve this,” you get beat, You ain’t going to survive out there. By the time I was 12 years old within a year, I was already raped over 4,000 times.”

In Oree’s case, she explains that she was not able to get away from her trafficker until a man named Jim Carson came to her rescue when she was 14 years old. In her interview, Oree emphasizes, “It was never a choice. It’s not a choice for these kids…they are children whose dreams and innocence was stolen and snatched from them.” Regardless of the form of their exploitation, trafficked victims suffer extreme abuse that often results in physical and mental trauma.

Traffickers use various means, such as pregnancy, to coerce trafficked victims, This ensures that the individual is emotionally bound and remains dependent on the trafficker to meet her own and her child’s needs. In an interview, Rebecca Bender, another survivor of sex trafficking narrates her experiences as follows,

“When you have a trafficker that’s at home with your child and says, if you don’t bring home $1500, you’re going to find your daughter out on the corner. I think I was probably more frightened to go home than I was to be in the room because if you got robbed, it was your fault for being stupid. If you get raped, it was your fault for not watching your back. Anything that happened to you was typically your fault, and you incurred more punishment for allowing these things to happen.”

Trafficked victims, like Bender, often blame themselves for their situation, therefore making it even harder for them to escape their traffickers. Some other reasons victims find it hard to leave include:

  1. Threats of violence against the victim’s family and loved ones.
  2. Traffickers requiring their victims to repay all debt (real or not real) before they can be liberated.
  3. Traffickers manipulate victims to believe they love them.
  4. Victims may be unfamiliar with the language of the country they are in and often do not know how to get around.

Sex Trafficking and Mental Health.

Prolonged captivity has been found to cause psychological trauma and contribute to the development of post-traumatic stress disorder (PTSD). This is because traffickers instill psychological trauma through terror, helplessness, and continuous destruction of the victim’s self-esteem. Constant death threats and physical abuse, followed by inconsistent and unpredictable outbursts of violence, results in significant mental health consequences for trafficked victims. For PTSD, symptoms either present themselves within the first three months after a traumatic event or can go for months to years without showing any symptoms, making it harder to detect and diagnose. In addition to PTSD, victims of human trafficking have been found to suffer from other anxiety and mood disorders, including panic attacks, obsessive-compulsive disorder, generalized anxiety disorder, and major depressive disorder. There is also an increased risk for the development of dissociative disorders.

Substance abuse disorder is also at the top of the list. While some victims of trafficking may report prior substance addictions, the majority of victims who reported alcohol and drug use said they began using drugs after they were in their trafficking situations. Other victims report being forced into drugs by their traffickers or using drugs as a coping mechanism.

Types of Treatment.

Understanding the effects of human trafficking on the mental health of victims requires long-term comprehensive therapy. Some of the evidence-based treatment options for PTSD include:

  • Cognitive Therapy
    • Challenges dysfunctional thoughts based on irrational or illogical assumptions.
  • Cognitive-Behavioral Therapy
    • Combines cognitive therapy with behavioral interventions such as exposure therapy, thought breathing techniques.
  • Exposure Therapy
    • Aims to reduce anxiety and fear through the confrontation of thoughts or actual situations related to the trauma.
  • Eye Movement Desensitization and Reprocessing
    • Combines general clinical practice with brief imaginal exposure where a client is asked to imagine feared images or situations, and cognitive restoration. Rapid eye movement may be induced.
  • Stress Inoculation Training
    • Combines psycho-education with anxiety management techniques such as relaxation training, breathing retraining, and thought stopping.

Barriers to Treatment.

Language barriers and transportation issues may hinder adequate treatment. Service providers express that clients who speak other languages have difficulty receiving care or even seeking care. More importantly, transportation barriers may result in missing appointments, which interferes with treatment. When looking at language, culture also plays a role. Just because someone speaks the same language as the victim, does not necessarily mean that services offered will be culturally appropriate. While speaking the same language as clients can help with service provision, other pieces of one’s culture are often overlooked. For example, some cultures may require that women only see women providers, and therefore it becomes difficult when the only provider available is male. In addition, some victims may also fear talking about their experiences because of fear of stigma and shame. Traumatic events may also affect the memories and may negatively influence the individual’s ability to recall events. Lastly, longer wait times for psychotherapy and funding cuts continue to be a challenge to both mental healthcare professionals and patients.

How Can Treatment be Improved?

I believe it is important to offer trafficking-specific training to professionals. This will help increase awareness of trafficking as well as inform the staff of available resources. Acknowledging the gender of patients when writing out assessments is also important because it will lead to better practice by providing more treatment options for victims. There is also the need to examine both social and psychological factors when responding to mental health needs. This will help improve communication between services as well as offer more insight into what type of treatment one should receive. Furthermore, there is a need for more research to help explore the ways in which healthcare professionals identify victims and determine what kind of care one receives. This will allow for the generalization of mental health practices and procedures into other disciplines. While there is still plenty to improve, it is important to note that there is work being done to enhance the mental health care of trafficked individuals.

The information above does not fully cover what victims of human trafficking experience before, during, and after they escape their traffickers. If you see something suspicious, call the Blue Campaign with your tip and be sure to include the car tag and vehicle description.

Call: 1-866-347-2423

Rape Hotline: 1-800-656-4673

Trafficking Hotline: 1-800-373-7888

Suicide Hotline: 1-800-273-8255