The Problem with Free Menstrual Pads

Sanitary pads are expensive. And in some parts of the world, hard to come by. So why not give pads away for free?

It’s an idea that a number of governments have considered this year. Several African countries, including Kenya, Uganda and Zambia, have taken steps toward giving free sanitary pads to girls. In August, Botswana joined the club. And it’s not just happening in low- and middle-income countries. In July, the Scottish government launched a project to distribute tampons and pads to women who can’t afford them.

For some governments, the goal is to boost school attendance for girls. Perhaps free pads would make it easier and more comfortable for girls to manage their periods at school. Others hope that the pads could reduce anxiety about periods — less worry about stains or how to get the next pad, for example.

While menstrual health researchers say it’s encouraging that more countries are talking about periods at the highest levels of power, some question the motivations.

Some critics in Kenya chalk up the plans as campaign promises, and aren’t sure the government will follow through. In June, Kenyan President Uhuru Kenyatta signed an amendment about sanitary pads into law, less than two months before the country’s presidential election. The law said the government would give pads to all girls in public schools who’ve reached puberty and make sure they have a way to dispose of the pads.

Jane Otai, an adolescent health advisor in Kenya for the Johns Hopkins University-affiliated nonprofit Jhpiego, commends the new law. But the timing of its signing tempers her enthusiasm. “Any promises coming from politicians at this time — you take with a pinch of salt,” she says. “My worry is: are they going to follow up on these promises?”

In Uganda, the answer was no. In April, the government backtracked on its plan to give out pads. The reason: a tough economic climate, said President Yoweri Museveni.

Infuriated, Ugandan activist and academic Stella Nyanzi spoke out. On her Facebook wall, she wrote a message directed to the president, his wife and his supporters: “For the children, I refuse your silence, your inertia and your sweet hollow words.” Her sharp criticism landed her in jail, NPR’s Eyder Peralta reported.

And though governments have said that giving pads to girls will improve school attendance, researchers say this step may not be enough to keep them from missing school.

Giving out pads is only part of what needs to be done to help girls manage their periods. It’s not a “silver bullet solution,” says Bethany Caruso, a postdoctoral fellow at Emory University.

“In addition to sanitary pads, we have issues of water and sanitation within the schools,” Otai says. “If the toilets are not habitable, girls will find it difficult to get to school and be able to continue their education if they cannot visit the toilet during her monthly period.”

Toilets — and having a safe, private place for girls to change their pads — get a lot less attention than sanitary pads, says Marni Sommer, a professor at Columbia University’s Mailman School of Public Health.

In schools with latrines, it can be embarrassing for girls to throw their pads into the pit, and other people — like boys — might see the pads and tease girls about them.

To address that issue, some girls use reusable pads so there are no issues with disposal. But this method has its own set of problems. Girls need a little bag to take the pads home to be washed.


That crucial detail was forgotten in an effort to give out reusable pads to girls at a refugee camp in Tanzania, says Sommer. “The [girls are] going to be embarrassed about what to do with their used pad,” she says.

“You think you’ve thought of everything, but they hadn’t thought about the little baggie to go with the reusable pad,” says Sommer. “There’s an essential need to consult girls. What do they need? What do they think?”

Courtney Columbus is a multimedia journalist based in the Washington, D.C. area. She covers science, global health and consumer health. Her past work has appeared in the Arizona Republicand on Arizona PBS. Contact her @cmcolumbus11.


For those of you who have been following this blog over the past few years, you know that I am passionate about all things related to women’s health care. Considering that my job as an Ob/Gyn physician is intimately interwoven with this topic, it is only to be expected that my children are exposed to my opinions during conversations at home. They also hear about my experiences in Haiti and are often recruited to assist with the construction of reusable menstrual pad kits that are distributed to young Haitian girls to encourage them to remain in school after they start menstruation.

May 28th (5-28) is Menstrual Hygiene Day and is dedicated to creating awareness around an often taboo subject. The 5-28 has significance in that most women bleed for 5 days every 28 days. Although Western civilization has made great strides in the past few decades around menstrual health education, the stigma and embarrassment for young girls persists. My daughters and I were finishing a restaurant meal when we noticed that the girl leaving the table next to us had a large blood stain on the back of her dress. We looked at each other with horror while having a hurried discussion about whether it was less embarrassing to run after her and inform her of the stain vs. letting her find out herself. The decision was made as we heard the door of the restaurant close behind her and our chance was lost. Would we have wasted time in discussion if the bleeding had stained her clothes from a large cut on her leg? The blood is the same but the source so much different.

When my daughter informed me that she was combining both of the above experiences into one argumentative essay for her final AP Composition Essay, I had to smile and then pity the male teacher who was to be subjected to her strident opinions. This same teacher (late 30’s) admitted that he has never purchased feminine hygiene products for his wife and had no advice for sources of information to help support her argument that luxury taxes should be abolished on tampons and pads. Because of the work of humanitarian organizations such as WASH in developing world countries and women’s health advocates in this country, resources for information were plentiful.  I have included the first part of her essay below.

Luxurious Taxes

Toothpaste, sunscreen, chapstick, shampoo, condoms, viagra. All daily items, all exempt from taxes. Daily essential items that are categorized as a necessity and aren’t taxed. Items thought to be a luxury, however are taxed. Flowers, cell phones, nail polish, TVs, computers, and jewelry. They add pleasure to your life. Those items are bought by choice and personal interest. What defines whether an object is declared a necessity or a want? Does the gender of a buyer for an object affect the tax, non-tax ruling? Tampons are taxed, but females need them to tend to their monthly periods. Taxes should be removed on tampons in every state. They are looked upon too lightly and assumed to be more of a extravagance and less of need. They are the “pink tax”.

My mom is an OBGYN and she sees female patients on a daily basis that revolve around period defects. Patients are suffering from heavy streaming periods and other dysfunctions that are uncomforting. They have to change tampons more frequently than an average person. Changing tampons every hour is inconvenient and costly.  My mom works with women to try and assist them in feeling more comfortable with the unnatural feeling periods and other dysfunctions of being female and save them time and money from buying so many tampons. However seeing a doctor about menstrual issues becomes even more costly when trying to fix your awkward period malfunctions. Women are feeling embarrassed and uncomfortable.

Tampons. They are declared a luxurious item in thirty-eight states of the United States. On holidays, taxes are removed on some everyday items, however, tampons and pads are still taxed on those special occasions. Tampons are still looked upon as a non-essential item, as if they are used by choice. As if women choose to go out and buy a $7 box of wonderful cotton plugs. As if women choose to have periods every month for an average of thirty-six years of their life. As if women choose to spend close to $2,000 on such a “luxurious” item as a small cylindrical object made of cotton. As if women are being spoiled with an item to protect their blood from leaking out. What a treat.

Tampons aren’t flowers. People wouldn’t buy a box of tampons for their friend’s birthday. Tampons are a common piece of feminine hygiene that keep blood from spilling out uncontrollably and make periods a little less worse. Periods are a naturally occurring part of a female’s life that they can’t prevent, not to mention the berserk side effects of mood swings, cramps and cravings. Tampons and pads have to be used to prevent blood from pouring out and leaking everywhere, time after time after time.  Every second you feel uncomfortable blood shedding; every minute you’re hesitant of leaking; every hour you’re contemplating if you need to change tampons; every day you’re in fear of the current of your flow; every week you wonder when it will be done. Periods aren’t a choice. Tampons aren’t a choice. They are a need. Tampons are calculated to be needed for 456 periods, 38 years, and 2,280 days (2015, Kane) of a female’s life. Tampons are a female necessity.  

Although her grade for the entire essay was high, the one critique by her teacher is evidence that we still have some work to do in this country when it comes to education around menstrual health. He penned ” too graphic”.


The work that needs to be done in developing world countries is even greater.  There is a growing awareness that less stigma around menstruation results in better lives for both boys and girls. Girls that stay in school beyond the age of menstruation because they have access to a private bathroom as well as menstrual pads, also have fewer children and are better able to secure a job to support their family because they have obtained a higher level of education. My involvement with the sewing center at Helping Haiti Work has reinforced what I have seen researched. The need for menstrual protection supplies in schools is recognized, but the thirst from teachers and students for education is even greater. Our Haitian seamstresses have been provided with women’s health training and given charts and pelvic models to use in their educational sessions. For $16 a day they will assist in the distribution of the reusable menstrual pad kits and provide 3-4 hours of education to teachers and students.


My hope is that a future granddaughter will pen a similar essay to the one above for her ancient history class and use our current experiences as the beginning of the end when it concerns the menstruation taboo.


Education! Education!

In addition to marketing the Days for Girls reusable menstrual pad kits, our seamstresses have been busy providing education to young women utilizing the Ambassador of Women’s Health teaching that they learned last year. Last week, two of our seamstresses from Ranquite traveled 3 hours to Cap Haitian and then another four hours by motorcycle to Pilette. The program was sponsored by Haiti Marycare and was celebrating young women as part of an empowerment program. The instruction was well received and more events are planned for the future.

The Importance of Health Education


Yes, that is a picture of a uterus and ovaries that Abbie, public health nurse from MN, is using in her recent education at a sewing school in Cap Haitian. An unexpected benefit of our sewing program is that we have found a huge need for basic education regarding anatomy and reproduction. “I could have stayed for two days answering all of the questions these women had after only a 30 minute presentation”  were the words I heard from Abbie when she returned from Haiti earlier this fall. Days for Girls has a large flip chart with diagrams that we have been using for this teaching that involves not only anatomy, menstrual health hygiene, basic reproduction knowledge and healthcare but also human rights. Abbie spoke to two different groups for a total of 25+ women. Each woman was asked to speak to two of her friends about what she had learned. Two of our seamstresses are being taught how to be ambassadors and will be teaching this same material at schools and churches.

In order to continue these programs, in addition to our original microloan program, we need monetary donations. Please consider a donation as part of our primary fundraiser, Give to the Max Day. Simply clicking on the button on our home page will take you to the donation page.


Helping Haiti Work is teaching others

Two of our seamstresses, one from Ranquitte and another from Limbe, will be traveling to SE Haiti this fall to deliver 100 reusable menstrual pad kits to Haitian nursing students as well as providing a day of instruction in menstrual hygiene. This will help our seamstresses to realize that our efforts extend beyond the borders of their villages and give them confidence in providing instruction. One of the women who is most eager to learn more about this program has limb deficiencies that have not limited her ability to become an accomplished seamstress.IMG_3195IMG_2586untitled

Helping community health workers in Tanzania


Our website has generated interest from other groups that are working with women from developing countries to help them help themselves. We were recently contacted by Empower Tanzania, an NGO that works to improve the health of communities in rural Tanzania. They support a group of 35 community health workers that work in 21 villages and with 15,000 people each month, providing education in public health. The women in rural Tanzania share many of the same problems as women in Haiti – lack of availability of feminine hygiene products. 35 feminine hygiene kits, constructed by our Minnesota seamstresses, were shipped to Tanzania – one kit for each community health worker. The kits were also used as part of a video production that discusses personal hygiene. If the menstrual pad kits are acceptable to the rural woman, plans on being made to construct a similar sewing program as Helping Haiti Work, whereby women in the Gender Based Violence program construct the pads and distribute them via the community health workers.

Keep visiting our site for more information on this project as well as updates on new loans in Haiti. Via social media, we are touching more lives than just those women involved with Helping Haiti Work. unnamed[5]

Haitian seamstresses give back to the community

DSC01138While we were in Haiti this winter, we spent time teaching sewing skills to Haitian women as well as taking the time to educate them about menstruation, female body parts and hygiene. We donated 50 reusable menstrual pad kits that had been sewn in Minnesota and asked the women to pass on the education to local school girls as well as distribute the kits. Since menstruation is very seldom discussed even among adult women, this took much encouragement before the seamstresses felt comfortable talking to 12 and 13 year old girls. But once they saw the smiles on the faces of the girls when they received their kits, the women were more encouraged to continue with the education component of the program. They have now provided education for girls in three different schools and have become more comfortable with the conversations.

While the Haitian seamstresses continue constructing kits that will be sold in Haiti, women from Minnesota are giving generously of their time and resources in constructing the extra kits that will be distributed to Haitian schoolgirls, while also providing them with a health lesson. FullSizeRenderFullSizeRender (2)Our fundraiser on March 12th featuring the band Morpheus will be an opportunity to help us to financially support these efforts, as well as our traditional microfinance loan programs. Over 70 people are already attending – join the crowd for a great night of entertainment. Details on our home page when you click on the picture of the band.


Menstrual Pads now in Ethiopia

I wish I could travel as much as our reusable menstrual pads! Jennifer Hall Johnson, an OR nurse from Maple Grove Hospital, took 4 of the pad kits with her on a mission trip to Zewditu Hospital in Ethiopia and they were a big hit with the OB nurses. Help us to construct more kits on Sat from 9-4 at Interfaith Outreach in Plymouth, so that our kits will soon have to have their own passport.


Days for Girls in Kenya

Secondary Girls Selecting DfG Kits, 9-24-15

Although we are operating in Haiti, we recognize that reusable menstrual pads are needed in other parts of the developing world. Evie Severyn, one of our supporters, makes frequent trips to Kenya and was asked on her last trip if she knew of a resource for obtaining menstrual hygiene products as school attendance of girls decreased once they started menstruating. During her recent trip in September she kept her promise to help. 120 kits, constructed at Messiah UMC,  were distributed to girls in 8-10th grade at Nyariginu Primary School, near Nanyuki, Kenya . Two women from a DFG training/sewing center 3 hours away (Chumvi)  met her at the school and spent time teaching the girls how to use the kits and properly care for them so that they would last the intended 3 years.  At the end of the presentation, one of the teachers emphasized that she would be checking attendance records monthly and expected to see a decrease in absences for each of the girls.

Secondary Girls with DfG Kits, 9-24-15

Kits loaded into tuk-tuk ready for transport to the school
Kits loaded into tuk-tuk ready for transport to the school

Domestic violence for one woman in Haiti


In recent reports, 30% of Haitian women have suffered acts of violence from partners or husbands. A third of surveyed Haitian women believe that a man may sometimes have the right to beat his spouse. Add to this that the Haitian justice system often victimizes the woman and rarely are charges brought forward. Unfortunately, these are not statements that are unique to Haiti; they are true for many developing world nations where women are often treated as second class citizens. Being an eyewitness to this reality for one woman during our most recent medical mission trip is much more moving than all the previous articles or books that I have read.
Unbeknown to the medical team, the woman had arrived at the hospital the night before after having suffered a stab wound in the back from her husband during a fight. Some family versions of the fight stated that she had started it by cutting her husband’s ear with a kitchen knife. The x-ray machine at our hospital was down due to remodeling, so the woman was sent across town to another hospital. She returned the following afternoon, in severe pain and with very labored breathing. I was flagged down by one of the Haitian family practice docs as we were packing our supplies for departure the next morning. Word of caution – If the American gynecologist can tell that something is wrong on your chest x-ray, you are probably in urgent need of medical attention as the last time I formally read a chest x-ray was 24 years ago. Her x-ray was significant for a collapsed lung on her left side and a fracture of her collarbone, caused by the knife wound in the back. She was fortunate to still be breathing but was at imminent risk of her heart shifting due to the collapsed lung. The team halted our packing duties and immediately shifted to duty mode. A few people were sent in search of a chest tube and vacuum device while others got the patient comfortable on the OR table. Events like this always make be proud to be part of a fabulous team – no job is too humble (ie searching among dusty shelves in a dark room with a flashlight for a chest tube) and individuals get comfortable dealing with tasks outside their specific expertise (ie gynecologist reading chest x-ray, dentist reading instructions on vacuum device and filling channels with water). Within an hour, the patient was breathing more comfortably and settled in her room, with strict instructions to her father to get help if the pump quit working. When the pump burnt out 11 hours later, he dutifully notified us and we substituted another pump. Two days later the chest tube was removed and the patient was discharged home – with her husband at her side. I am sure there was community discussion about her blame in the matter by starting the fight and at no time did she ask to press charges.
Studies have shown that domestic violence sharply decreases when the female partner is seen as a contributing financial partner to the household. If our patient had a small business and was increasing the family’s financial stability, her husband may have thought twice about wounding her with a knife, as it would impact her ability to work. Helping Haiti Work, a microloan program that my husband and I established in 2012, is attempting to right some of these imbalances for the women of Haiti. In my discussions with the loan recipients they have expressed that some of the indirect advantages of the program is that they are generally treated better by their spouses and the community, as operating a business brings them more authority. Trying to change cultural norms around domestic violence can take an extended time. Maybe we need to also look at short term empowerment of women so that they can influence the longstanding cultural norms.
Our fundraising for this program in 2014 will generate 40 new loans of $200 each for women on the waiting list. More women continue to wait. Please consider Helping Haiti Work in your end of year donations