It’s Only Blood – What Every Woman Should Know About Period Poverty

As much as the public conversation around menstruation has improved in recent years, there’s still a lot we don’t know and don’t talk about. In the UK, US and Europe, activists have demanded the removal of the "tampon tax" and women have fought stigma by putting their periods on show. In other parts of the world, the conversation is less advanced; access to menstrual products can be difficult for women and girls in the global south, while long-held myths around menstruation can confine women to the home, or even put them in danger.

In her new book, It’s Only Blood, Swedish journalist Anna Dahlqvist ambitiously sets out to explore menstruation on a global level, particularly where shame intersects with poverty. She hears from girls in Uganda how their periods put them off going to school and from activists in Bangladesh about why menstrual cups aren’t taking off as an answer to disposable pads. By talking to women about their periods, she starts to unravel the secrecy with which we shroud them.

Below, we speak to Anna about her intentions in writing the book, and what she discovered along the way.

I am editor-in-chief of a magazine on sexual politics called Ottar, but I’ve also been a freelance journalist for 16 years. I wrote my first book in 2012, about abortion bans in Europe. So my focus has been gender equality and reproductive rights, but the book really started with me being upset when I read about how girls in South Africa couldn’t get an education because they couldn’t handle their periods at school. I felt that, in this patriarchy, we’re seen as miracle makers when we get pregnant or give birth, but the necessary part of that – periods – is something we’re told we should be ashamed of or hide. I was driven by anger at this hypocrisy!

So first we can look at it as a lack of material resources. You need products and for a lot of these girls there’s no way to afford disposable pads. In Uganda, a pack of pads costs you one US dollar, which is a daily income in a slum area in Kampala. You could use cloth, but to make it work you need access to clean running water, and that’s not a given. Nor is soap, which is expensive. You need school toilets that are working, with a lockable door, a waste bin, or a place you can wash your cloth, and dry it. These things often don’t exist.

The other thing is the quote I start the book with – a girl in Kampala tells me the boys tease the girls on their periods, and I said: 'Don’t you get angry?' And she said 'No. Because we don’t keep clean.' But they haven’t been able to! The blame falls on the girl, not the person making fun or teasing her. We need information and knowledge about what menstruation is and how to handle it. There’s a gap there. A lot of girls there told me all they know is to keep it a secret, try to keep clean and stay away from boys, so at school, all they can think about is, 'What if there are stains?' 'How can I stand up to answer a question?' 'What if the cloth falls out?' The girls I interviewed in Uganda described this emotional stress, not just on the days of the period but the days before. It makes it difficult to concentrate but also affects your self-esteem.

There are menstrual rules across the world; some are more moralistic than others, but not everyone in a specific country or area would follow them. The main one everywhere is no stains, no seeing the pad or cloths or cup, and no talking about it publicly, specifically to boys or men. Some more specific rules relate to religion, like bans on entering religious buildings. That’s been a big problem in India, where you can be banned from temples if you’re menstruating, although some women enter anyway. Others related to cooking and food, like in Senegal and Zambia, where you’re not supposed to cook or touch certain foods.

And then there’s this idea of separation. We see this in India and Nepal, where there are menstrual huts that you are sent to sleep in during your period. People suffocate to death in them. Sexual violence can occur if girls are alone in them. They are small and they don’t have electricity, they can be too hot or cold. And this is just besides the fact that it’s really horrible to be singled out as not pure enough to be around other people. So these rules often mean you cannot move around freely as you want to or make decisions for yourself. They become oppressive and reinforce ideas that menstruation is dirty or shameful or abnormal.

It’s a complicated topic, but one thing that became clear is that the rules all spring from the same idea. Whether in Sweden or Nepal, they are various expressions of shame and secrecy, and it’s not something that happens far away, to someone else; it’s here in my world in Sweden. I can’t say the rules I mentioned above are bad for everyone, but they can become oppressive to the individual or threaten their safety. The bottom line is human rights: the right to choose to be free from discrimination if that’s how you see it, and the right to make your own choices.

There was so little research because it’s not really a prioritised area, nor is menstrual cramps. This says something broader about how we look at women’s health. Those who are menstruating are not in power on a global level, and we are silenced from talking about it. So if we haven’t got the power and we don’t talk about our menstrual health, how can we demand better healthcare or research? The little research there is has shown that if you use a cloth it can lead to infections, that can lead to complications around pregnancy, higher risk of miscarriage, or life-threatening illnesses like HIV and cervical cancer.

Well, a reusable pad is more efficient than a cloth, as it’s better at absorbing blood and you can attach them to the panties by clips. The women I met in a village outside Bangalore said they had been trying out different kinds of menstrual protection, and for them the choice would be the reusable pads because they did not have the possibility to deal with waste. But the schoolgirls in Africa wanted disposable pads because it was too complicated to manage reusable pads, in terms of washing and drying them properly. Some NGOs give out cups, which work if you have water to wash it. Environmentally, it’s a great thing because it’s reusable – but how do you make sure only one person uses it? That’s a problem that can lead to the spread of disease. They can also be difficult to use if you have experienced FGM. Cups are financially viable in the long term but expensive the first time you buy them. So it depends who you are and what resources you have. I’m thinking the best thing would be disposables that are biodegradable, produced locally, and not too expensive.

Governments talk a lot about giving out pads in schools. We have seen this from high schools in Brooklyn to schools in Kenya and India. The problem is, it’s not really getting to the basis of the problem. It’s easy to do and it’s visible to voters. But these pads last a while and then the supply is gone. Nothing has changed. We need to fill the infrastructure surrounding it. In Kenya and India this has also been an opportunity for corruption – politicians and the people selling the pads drive up the prices. We need more sustainable programmes.

Contact your local politicians and get engaged with NGOs working in this area. But ask yourself: What kind of project is it? Do they have the bigger perspective in mind? Another thing we can all do that I think will have a greater impact than we could imagine is to start talking about menstruation in your private life, take away that shame and embarrassment. We need to take periods from a private matter to a public matter, so we can deal with these issues on a structural level as a society. I’m really optimistic from what I see happening at the moment – it’s like a menstrual awakening, the start of real, practical change.