‘But we have some retailers here in Nairobi. I think it can be a good thing to show that the menstrual cup can be found in shops, even though not many buy it.’
Amaia Arranz orders a coffee and ponders why so few menstruation organisations use the menstrual cup.
‘I actually don’t understand why they’re so hesitant. Sure, it requires more information and training, but a morning is still enough.’
She is from Spain and responsible for ‘strategic partnerships’ at Ruby Cup, which was founded by three Danes but has its main offices in Berlin. Ruby Cup both sells and donates menstrual cups – one donated for every cup sold – through local organisations in East Africa. It is also through these organisations that they offer menstrual hygiene education in schools in Kenya, Tanzania, and Uganda.
A menstrual cup is what it sounds like: a small cup that is inserted into the vagina where it collects menstrual blood. Most are made of silicone, but there are also others made of rubber or a rubber-like plastic. It typically needs emptying after around eight hours. The menstrual cup requires that you can wash your hands carefully and rinse it with water. It should be stored somewhere dry, clean, and airy. Many menstrual cup manufacturers also recommend that the cup is boiled after every period of bleeding. In Sweden, the menstrual cup gradually came into use in the beginning of the 2000s, but has mainly in recent years spread outside the small crowd that discovered it 15 years ago.
‘When we visit the schools, we check whether they are able to wash their hands and if they can boil it at home. Otherwise, one option is to agree with a teacher to allow them to boil menstrual cups at school.’
Boiling the cups can be complicated. Sometimes there is only one pot per household and there may be resistance against using the same pot for cooking as for the menstrual cup. For many, finding moments alone is difficult, and handling the menstrual cup in front of others is often too embarrassing. The laborious boiling is also a common objection, raised by several menstruation organisations.
‘But it’s actually possible to clean the cup with the sterilising tablets used for baby bottles. You just put the menstrual cup in a glass of water with one tablet. And they aren’t very expensive,’ says Amaia Arranz.
For those who live in places where access to water is at its most limited, this too can be problematic. So far, Amaia Arranz and her colleagues have opted out of those areas in their work with the menstrual cup. Another group that may find it difficult to use menstrual cups is those who have been subjected to genital mutilation. For some, it is not physically possible to insert a menstrual cup, for others too painful.
When the African Population and Health Research Center in Kenya carried out a study of attitudes and acceptance of the menstrual cup among a small group of students in Kenya, it turned out that the difficulties concentrating in school decreased significantly with the menstrual cup, as the students no longer feared getting stains or smelling. In many cases, they also did not have to think about changing menstrual protection during the school day. In the long run, it was a relief not to have to think about menstrual protection for the following month. One drawback was the lack of water in the bathrooms, both at home and in school. Another was the lack of private spaces where one can find the peace and quiet to take out, empty, and reinsert the menstrual cup.
But what about the fear of ‘losing one’s virginity’ – that is, ideas about a hymen that must be kept intact until marriage? That too is a common objection I hear against the menstrual cup.
‘We have actually barely encountered this as an obstacle, even though it happens that teachers ask questions about whether their students will still be virgins. I think we live in a more modern society than many people imagine,’ Amaia Arranz says.
Ruby Cup also works with education that goes beyond menstruation itself through their local partner organisations. The lesson that menstruation, puberty, the body, relationships, and sex cannot be separated has been taken to heart by the entire menstrual movement. Just like the importance of an informed choice regarding how to manage menstruation.
‘But the good thing about the menstrual cup is that they don’t have to worry about menstrual protection for the ten years that the menstrual cup lasts. They also don’t have to think about where to wash, dry, or throw away menstrual protection. All they need is water and sterilising tablets.’
I ask the same question that I put to Wanjiru Kepha and Valentine Samoei at Huru: Why is the government in Kenya not interested in the menstrual cup? And I get the same answer: corruption. Amaia Arranz talks about a scandal that erupted in the autumn of 2015, when it turned out that the government had budgeted 6,000 shilling, almost 55 US dollars, per pack of pads that was to be distributed among those who had been affected by flooding in connection with the weather phenomenon El Niño.
‘There is also much ignorance about how it works in practice. Like when they hand out disposable pads in areas in the countryside where people don’t have access to underwear. How are they supposed to use the pads then?’
It is a dilemma that Huru solves with panties in their menstrual packs, and Ruby Cup with menstrual cups.
* * *
Kala Charlu in Bangalore, India, does not know what to do with the machine she has bought for producing pads. The pads are not working optimally.
‘Fluff comes off, the absorbency is mediocre, and they don’t have wings,’ she says with concern.
The machine and the pads are an innovation from the now well-known entrepreneur Arunachalam Muruganantham from southern India, who is portrayed in the documentary Menstrual Man (2013). The story about the Menstrual Man began in 1998, when Arunachalam Muruganantham realised that his wife used dirty pieces of cloth as menstrual protection. He started experimenting with different materials for making pads and tested them himself using animal blood. After a while, others in their home village began to look askance at the foul-smelling man with the blood-stained clothes. But eventually, he managed to create a machine that produces pads and has sold more than a thousand, both in India and abroad. The idea is that a group of women in a village or district can buy the machine and produce pads themselves. Arunachalam Muruganantham won back the respect of his community and became world-famous in the bargain, talked about on both the BBC and Al Jazeera.
A critical advantage of Arunachalam Muruganantham’s pads is that they can be produced at a low cost. They have undoubtedly been well received by many women in India. But Kala Charlu is looking for higher quality, even though she and her organisation MITU Foundation so far have been producing and distributing pads in schools in Karnataka according to Arunachalam Muruganantham’s model. Now, they are thinking about starting to produce cloth pads themselves.
‘I’ve been contacted by various companies that want us to distribute their pads, but I’m not going to become a billboard for them. Absolutely not,’ says Kala Charlu.
She and her husband lay the table with rice, lentil stew, and idli – a kind of steamed cake made from fermented rice and lentils, served with various dips. Outside their apartment, darkness falls over Bangalore. Lakshmi Murthy joins us for dinner. Together with MITU, she is carrying out a study of the pros and cons of disposable and cloth pads. The study is part of her research at the Indian Institute of Technology in Mumbai. The cloth pads that she has designed go by the name of UGER and are part of a larger project with the ambition of breaking the menstrual shame, increasing knowledge, and raising awareness about sustainability at the same time.
‘As a designer, I have always been drawn to social issues and especially those related to menstruation. There are so many social, cultural, and material problems around menstruation in Rajasthan, where I come from. It’s a very conservative part of India.’
Quite soon, we come to the realisation that the cloth pads I bought at the menstruation conference in Boston six months ago were designed by her. They are white on the inside with irresistible purple and turquoise floral patterns on the outside. Now that I have gotten used to wear
ing cloth pads at night, the plasticky disposable pads do not feel comfortable at all.
Lakshmi Murthy and Kala Charlu bicker jokingly about the various pads while we eat. But in the end, they are primarily interested in what menstruators want when they have received information about the options and what they involve.
‘Those who have access to the media through TV, phones, and computers know what’s available. But that access depends on whether there is electricity and mobile phone signal where you live and whether you have money to top up your phone – if you can afford to buy one at all. When we hold menstrual education workshops, we have to explain what’s available and give objective information. Knowing is a right,’ Lakshmi Murthy says.
Then she lists what she sees as the biggest problems with disposable pads: they often contain various plastics that eventually end up in seas, lakes, and other waters, and if they are burned, harmful smoke is formed. The cloth pads made of cotton, on the other hand, are reused for a time and, if subsequently buried in the ground, they eventually dissolve without leaving behind harmful plastics.
‘In the long run, a good alternative is perhaps the menstrual cup. Though it might not suit all cultures and contexts,’ says Lakshmi Murthy.
Kala Charlu is curious about the menstrual cup, but unsure of whether it would really work among the students in Karnataka. One of her colleagues at MITU, whom I met earlier during the day, thought that it seemed difficult and a little scary.
The menstrual cup is available on the Indian market but is not a best-seller. One problem, according to those who have launched the brand SheCup, is the fear of inserting things into the vagina – both tampons and menstrual cups. Particularly before marriage. Virginity norms and the view of sex come into play. The price is another obstacle. One menstrual cup costs approximately 10–45 US dollars. Even though it pays off in the long run, this is an unattainable lump sum for many. When 960 women in the countryside in Bihar, North India, tried disposable pads and menstrual cups as part of a study, most of them preferred the pads, though a third could imagine continuing to use the menstrual cup.
But what about the pieces of fabric that most menstruators in India use today? What is it that makes the cloth pads so much better? Partly, the opportunity to attach them. Then there is the absorbency, which is improved with seams that are meant to ‘direct’ the blood towards the centre, but also by the material.
‘Nowadays, many use saris and other clothes made from polyester and similar materials because cotton is too expensive. These don’t absorb the blood and don’t breathe the way cotton does,’ Lakshmi Murthy says.
* * *
A warm light falls on Chennaveerana Halli. The shadows lie long and the few villagers who are outside – Manjula and the other women in the village, those who could not agree about the temple ban during menstruation – sit on benches by their houses, talking. They are testing disposable and cloth pads for the study that Lakshmi Murthy is conducting together with the MITU Foundation.
Manjula is wearing a blue sari with big yellow flowers. In her living room, there is a TV, a fan, colourful wall decorations, and two beds. We are sitting on the purple rug in the middle of the room.
‘The pads are better than the fabric. But I’ve never used anything else before. I didn’t even know they existed,’ Hanumakka says.
Lakshamamma agrees. It is much simpler, regardless of whether the pads are disposable or made by cloth.
Manjula is what is called a ‘community health worker’ in the village. It means that she is charged by Karnataka’s health services with providing a basic supply of medication and making sure that everyone gets vaccinated. She is also the contact person in connection with the pad study.
She walks over to the wardrobe and takes out one of the pieces of cloth she usually uses as menstrual protection. It was once black, but has become greyish over many washes. She holds it up and demonstrates how she folds it several times. Often, she has to change three or four times per day.
‘The pads don’t move around in the same way when I walk and I don’t have to be afraid that they’ll fall out,’ she says.
She is clear about preferring the cloth pads. The only drawback is the time she has to put into washing them. Manjula and the other women already have their work cut out for them during the day – working in the fields, cooking, gathering firewood, and milking cows.
But she does not want to see any disposable pads in the village. People throw them on the ground or into the lake. It is completely unacceptable. Kala Charlu describes the incinerator that they have funded at the school in the village, which is connected to the toilet by a pipe. Could that be something? Manjula is doubtful.
As we are leaving, we meet three young women who carry clothes in large baskets. Like so many others, they have been doing their washing in the lake Manjula spoke about. For others, it is a bathing site. A little further ahead, we catch a glimpse of the lake, a quiet mirror by the road to Bangalore.
9
THE STRUGGLE
It sounds self-evident. Menstruation should not be an obstacle to going to school, working, or simply participating in whatever one pleases. Moving freely. It should not be the cause of harassment and stigmatisation. Menstruation should not shut us in or hold us back. Not make us sick. It should not have to be more than what it is: a mucous membrane filled with blood that is shed and expelled from the uterus.
That is not the case. On the contrary. Menstruation leads to all of the above. It means that people are subjected to systemic human rights violations because they are menstruating. And every day, 800 million people menstruate.
The label ‘human rights violation’ may sound depressing, but with it something good also follows – the possibility to hold those in power accountable for not living up to their obligations. To demand change.
Of the countries in the world, 193 are members of the UN and thereby bound by the Universal Declaration of Human Rights. It is complemented by an abundance of additional documents and a number of legally binding conventions. Not everyone has signed the conventions and their observance often leaves much to be desired. But 160 states have, for example, ratified the International Covenant on Economic, Social and Cultural Rights. A total of 187 have promised to adhere to the Convention on the Elimination of all Forms of Discrimination Against Women. And all 193 member states pledge adherence to the Convention on the Rights of the Child. Four independent states are not members of the UN.
The word menstruation occurs very rarely in UN contexts, like in the world in which the UN operates. There are some references to ‘paying special attention to the needs of women and girls’ and to ‘gender-sensitive’ sanitary facilities, but this type of circumlocution is not common either. In one of the most crucial documents about sexual and reproductive health and rights, the Cairo Programme of Action, menstruation is not mentioned. In the UN’s lowest standard for the treatment of inmates in prisons, the opportunity to manage facial hair is explicitly mentioned, but not menstrual management. The silence at the highest human rights level is deafening.
That is also why this statement from the United Nations Human Rights Council is often cited in menstruation contexts: ‘the lack of access to adequate water and sanitation services, including menstrual hygiene management, and the widespread stigma associated with menstruation have a negative impact on gender equality and the human rights of women and girls.’ Menstruation mentioned twice in the same sentence is revolutionising at the UN level. That was in 2014. Against the background of the water and sanitation sector’s (WASH) leading role in the menstrual movement, it is less surprising that the connection between menstruation and human rights was brought up in that particular context.
* * *
In 2005, Archana Patkar was invited to a meeting in Oxford, United Kingdom, organised by the UN children’s fund UNICEF, among others. She was going to talk about menstruation, specifically from the WASH perspective. The organisers set the title.
‘You won’t b
elieve it,’ she says and pauses for effect. ‘It said: “Women’s health issues, and water, sanitation and hygiene education for schools”. Ha!’
By the time she stood there in Oxford, she had renamed her presentation ‘Menstrual Hygiene Management: Let’s Get Used to It’. The launch of the term in an official UN context became something of a milestone in the menstrual struggle.
‘But people were really shocked. At that time, it didn’t take more to get appalled reactions,’ Archana Patkar says.
She is at a conference on women’s health in Copenhagen. In the exhibition stand for the Water Supply & Sanitation Collaborative Council (WSSCC), the UN-affiliated organisation that she works for, there is a ‘menstruation tent’. WSSCC uses the tents during menstrual hygiene workshops in Asia and Africa. Pillows are spread out on the floor and a promise is written on the canvas: ‘We will break the silence around menstruation. We will not be shy, but proud. We will talk about it with our families and society at large.’
Archana Patkar has been fighting for menstrual rights for more than ten years now. One year before the meeting in Oxford, when she worked as a consultant, she and a few of her colleagues carried out a survey among prominent sanitation experts and engineers in the WASH sector. Not a single one of the 75 participants had brought up menstruation in their work.
Since then, a lot has happened. At the same time, Archana Patkar notes, it is embarrassingly silent at the UN.
‘There has been no progress whatsoever in how this issue is talked about. The human rights language is abstract, far from people’s reality,’ she says and points to the ceiling in the exhibition hall.
Archana Patkar was among those who worked hard to get the concept of menstruation included when the UN Agenda for Sustainable Development was formulated ahead of 2016. The 6th Sustainable Development Goal – about water and sanitation – is the result of their efforts, but it was a disappointment. Instead of mentioning menstruation, it says that a special focus on ‘the needs of women and girls’ is required.
It's Only Blood_Shattering the Taboo of Menstruation Page 12
