The Unseen Barrier: Period Poverty in Pakistan

Introduction

In a country with no shortage of social issues, menstrual health has never been a priority. In Pakistan, it is often seen as a personal or female problem, while being considered inconsequential. However, the cost of this ignorance is that women across Pakistan, coming from all walks of life, experience what is known as three-dimensional period poverty. This phenomenon encompasses not only being financially unable to afford menstrual products but also the inability to fulfill menstrual health and hygiene needs due to deeply rooted social stigma, lack of education, and missing infrastructure.

At its most fundamental level, these dimensions reveal the inability to manage menstrual health with dignity. Menstrual Hygiene Management (MHM), which includes the products and practices used during menstruation, is severely compromised for a significant portion of the Pakistani female population. Therefore, in the unique socio-political context of Pakistan, it has a multifaceted impact on the lives of women, and this issue warrants urgent attention.

Impact of Period Poverty

Impact on Education

The impact of education is such that it contributes to a rise in school absenteeism due to fear of staining, embarrassment, and lack of facilities, all of which impact performance and participation. A study conducted on schoolgirls revealed that out of 108 students, 72.22% reported missing school due to their periods. Another study in Mardan concludes that roughly one-third of schoolgirls drop out of school when they begin menstruating in some rural districts.

Additionally, reports show that 1 in 3 schools in the country lack basic sanitation facilities, which directly constrains girls’ ability to manage menstruation at school and contributes to absenteeism and dropout. Furthermore, menstrual products are often scarce in restrooms and nurses’ offices. Most girls can recall asking a fellow student if they had a pad they could borrow, which is why most girls carry one even when they’re not expecting their period.

Even in more advanced institutions, only a select few restrooms offer period products, and these are rarely free. Instead, they are typically dispensed through vending machines at a cost. This is something I observed at institutions like IBA and SZABIST in Karachi. I stood before a vending machine and asked my friend, “Shouldn’t these be free?” She responded that if they were, people would just take them all or take them to give away, even when they didn’t need them. This is a sentiment I have come across before.

But the question remains: what is wrong with that? Given that sanitary pads are out of reach for more than two-thirds of Pakistani women, and with rising poverty levels, shouldn’t we offer support to these women and grant them the dignity they deserve? Additionally, considering the taboos and shame surrounding the topic, it is highly unlikely that someone would resell these products. Men would hesitate to touch them, and allowing their sisters to sell them publicly would be seen as a dishonor. In a country where girls still struggle to receive an education, this lack of infrastructure proves to be a crushing setback.

Impact on Productivity & Work

In the workplace, women have cited severe menstrual pain, lack of clean or private toilets, and inability to take medical leave as causes of workplace discomfort during their menstrual cycle. With women comprising only 22.8% of the workforce, they’re more likely to have a male supervisor and less likely to have conversations with them about needed breaks or time off due to pain. The presence of male coworkers is a cause of stress, as women feel immense pressure to hide any sign of weakness during their period and its related discomfort, fearing embarrassment or being ridiculed.

As women have to work twice as hard to cover half as much ground as men, they cannot risk being mocked with statements like, “Is it that time of the month?” Despite the Factory Act mandating separate, screened toilets for female workers with clear signage and hygiene facilities, most workplaces fall short. Women are hesitant to use a restroom that they share with their male coworkers, especially during their period.

For a 9-hour shift at a well-known bank, a former employee I know was provided with only one restroom, which was shared by both men and women. She was not comfortable using a unisex bathroom and chose to avoid it for her entire shift. This led to her developing a urinary tract infection (UTI). These are precisely the reasons why a survey revealed that 74% of women struggle to complete tasks during menstruation and 46% miss performance targets. The lack of infrastructure and workplace stigma exaggerate the problem, making the lack of MHM turn into economic setbacks.

Impact on Health

The health risks associated with poor menstrual hygiene are substantial and underestimated. When menstrual products become unaffordable or inaccessible, most women resort to unclean cloths or other unsanitary alternatives, increasing the risk of infections. They become more susceptible to bacterial vaginosis, rashes, yeast infections, urinogenital infections, fungal infections, urinary tract infections, and potentially cervical cancer, as well as psychological problems such as anxiety and stress.

Additionally, there is a 70% higher risk of reproductive tract infections, something that 97% of gynecologists agree on. These cases skyrocket during natural disasters in Pakistan. Pakistan suffered from immense flooding in 2022, leaving many women exposed to life-threatening conditions, where women have to reuse old clothes washed in contaminated water. In the case of Rasheeda, a Sindhi woman, she was in such a condition that doctors advised her uterus be removed to stop the infection from spreading to the rest of her body. Moreover, girls are left uninformed about different ways they can reduce their menstrual pain, either by medicine or exercise, due to the fear that it will negatively impact their cycle.

Menstrual Products

Although I have frequently used only sanitary pads as an example of menstrual products, they come in many different types. These include both reusable and disposable products, such as tampons, menstrual cups, menstrual discs, cloth pads, and period underwear. Pads dominate the menstrual product market in Pakistan, while tampons and menstrual cups are rarer, particularly in smaller towns. The two leading brands hold an estimated 84% market share, with P&G’s Always historically monopolizing the market, although local brands like Butterfly and Embrace have emerged as competitors.

But only Tampax deals with tampons. Tampons are also, on average, more expensive than pads. In different research conducted around the world, tampons and pads have been found to contain heavy metals whose effects on the human body are being studied, while the different chemicals found are known to cause disturbance to the endocrine system. Moreover, recent studies in the UK indicated that one pack of disposable pads from three leading brands contains as much plastic as five plastic bags and takes up to 500-800 years to biodegrade. As pads are the primary menstrual product used in Pakistan, these developments urge us to find alternatives to disposable menstrual products, which would prove better not just for ourselves but also for the environment.

What Causes Period Poverty?

Insufficient Knowledge of the Menstrual Cycle

A study from Lahore reveals that 98% of girls in Pakistan receive menstrual education, if any at all, from their mothers or elder sisters, who themselves may lack accurate knowledge. Myths and misunderstandings, such as the idea that taking a shower on the first day, eating spicy foods, or drinking cold water during menstruation must be avoided at any cost, spread as a result.

This misinformation was found even in healthcare workers who should know better in a comparative study conducted between general women and healthcare workers in Karachi. It found that 77.8% of the general population and 66.1% of healthcare workers avoided bathing on certain days during menses. This ignorance continues to be extended across generations, given that menstrual health education is not included in the school curriculum. Whenever the topic of menstrual education in schools is brought up, it is shut down immediately, as the Pakistani government and people have a strong stance against it.

Perhaps we can draw inspiration from UNICEF’s approach to address this issue. In a poll of nearly 700 women and girls from around the country, 49% did not know about menstruation before their first period, and the IO took to Pakistani schools to address this lack of knowledge. UNICEF trained teachers to conduct sessions about menstrual hygiene management at a local school in Bahawalpur. The young girls at the school acknowledged that, thanks to the sessions, they knew what to do when they experienced their first period and were even able to share the knowledge with their family and friends. The school also observed an overall decrease in absenteeism among both students and teachers, which had a positive impact on the environment.

Taboos & Culture of Silence

Menstruation is considered private and is viewed as shameful due to religious and cultural norms. Many girls are too embarrassed to even discuss it with their mothers, and the word “period” is forbidden to be heard by men and boys. There are many examples, such as when a project where students attempted to break the taboos surrounding menstruation using pads with messages at BNU was condemned as “behaya” by many on social media.

An NGO by the name of Mahwari Justice set out to aid flood victims of 2022 by providing relief with proper menstrual hygiene. It faced backlash as some deemed their efforts unnecessary. Similarly, 26-year-old Sana Lokhandwala received death and rape threats for a poster that read, “We want period-friendly Pakistan,” which she displayed in the 2019 Aurat March in Karachi.

This taboo is enforced through the widespread availability of brown paper bags, meant to conceal menstrual products from men, yet ironically, they are handled and scanned by cashiers, who are almost always men. It is also enforced by prohibiting any media coverage of the subject, such as the Indian film Padman in 2018. This widespread culture of silence limits education and dialogue, and promotes period poverty while preventing policymakers from recognizing menstrual health as a public health concern.

Financial limitations

Menstrual products are unaffordable for a large share of Pakistani women. For families struggling to meet their basic needs, sanitary products are a luxury. One woman from Chitral revealed that during menstruation, most women would resort to using old pieces of cloth because purchasing sanitary pads from the market was both expensive and embarrassing, as most shopkeepers are men.

A pack of sanitary pads costs about 250-300 rupees, an unaffordable price for most in poverty, and a “luxury tax” of 12% was imposed by the government on sanitary products in May 2022. This luxury tax is part of the larger imposed “pink tax” on products marketed towards women. The pink tax refers to the practice of charging higher prices for products targeted at women compared to their male counterparts, despite no additional costs or value added, but just because they are for women or girly.

While this is a global phenomenon, it reaches Pakistani markets on products such as sanitary napkins, clothes, razors, shampoos, etc. In a society where even the basic demands of women are looked at as unnecessary, this tax proves to be an added hurdle in the journey of women to live with dignity.

Government Neglect

Despite global frameworks by the WHO and UNICEF, Pakistan lacks a comprehensive national policy addressing MHM and period poverty. The issue is repeatedly disregarded as a personal matter that should be handled by the girl and her family, not by legislators. The NGOs and IOs, such as Her Pakistan, founded by Sana Lokhandwala, carry most of the burden.

With Pakistan’s healthcare and education systems already under pressure, menstrual hygiene is deprioritized in favor of issues seen as more “urgent.” There is no provision for subsidized sanitary products in government-run health programs. Instead, these products are taxed as luxury items. While in the workplace, the absence of protections such as paid menstrual leave or mandatory provision of sanitary facilities persists. Pakistan is yet to introduce menstrual leave or ensure universal access to free sanitary products, unlike Spain or Scotland.

There are a few promising interventions. In Chitral, for example, UNICEF trained local women to produce and market reasonably priced sanitary pads, reflecting community-led solutions. Through advocacy, groups like Her Pakistan & Mahwari Justice challenge taboos and improve menstrual education and awareness. Nevertheless, the scope of these efforts is still restricted, and they cannot replace national policy initiatives to tackle period poverty.

Conclusion

Around the world and in Pakistan, period poverty exists as a barrier between women and a better life. It restricts activity, education, work, and dignity beyond being just a health issue. Cultural taboos, government inaction, and financial barriers further deepen the crisis, while the constant hush culture has negative impacts on young girls’ self-image.

With the return of floods in 2025 and the impending extreme weather events, the country’s most vulnerable are at the front once again. It is imperative that women receive proper menstrual hygiene management so we can prevent cases like Rasheeda’s. Almost half of its population, the women and girls of Pakistan, deserve to live healthy and shame-free lives. Through education, advocacy, infrastructure improvements, and inclusive policymaking, we can create a future where a woman’s freedom encompasses saying the word “period” aloud without stigma.

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