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Periods, textbooks and plastic cups

11 Oct 2023

This blog was originally published for International Day of the Girl 2021, written by Dr Isioma Okolo.

This International Day of the Girl, I think it’s important to address the shame and stigma around periods, and the impact this is having on inequality as a whole – both globally and here in the UK.

In many societies, menstruation marks a transition into ‘womanhood’. I wonder if this is when little girls become threats to the world. There are widespread cross-cultural taboos around periods related to shame and uncleanliness.

Many of you will have a period story (or two). It may be a story of newness, being caught off guard, transition, and embarrassment. These stories and memories accompany us to the hidden isles of pharmacies and chemists on our quest for ‘sanitary’ products to manage our menstrual ‘hygiene’. Stories are shrouded in mystery and shame which we inherit from our sisters, mother, aunties.

Period parity is essential to achieving the Sustainable development goals

Achieving gender equality is one of the sustainable development goals. Globally, in 3 of 4 countries  girls and boys have equal primary school attendance rates 5. According to UNESCO, before the 2020 COVID 19 pandemic, 63.2% of girls in all low income countries around the world finish primary school (world bank)3,4.

In the UK, girls are actually missing school because they’re menstruating, with 66% reporting that they have missed part of or a full day of school because they have worries about leaking, anxiety around people finding out or general embarrassment.  Participation in sports dwindles and a young girl’s confidence can be impacted by their experience of menstruation.

Globally, girls who stay in school are more confident, less likely to experience child marriage, domestic abuse and suffer long term health issues. Furthermore, if they choose to, they are more likely to have fewer children and can invest resources in their future generation6,7

Period poverty threatens education, equity and the environment

A survey from Plan international UK found that 1 in 10 girls in the UK were unable to afford period products. During the COVID-19 lockdowns this increased to 3 in 10 girls.

For this reason I applaud policy changes such as the Scottish 2020 Free Provision of Period Products Bill . This was passed unanimously and mandates that local authorities provide free period products. Schools and colleges also must ensure period products are provided to their students, alongside education for both boys and girls on what a period is and what girls can expect from their period.

Reusable period products are cheaper, safe, and acceptable alternative to girls

I would like to highlight two qualitative studies which illustrate this. First from Uganda and the second from Nepal. The first study (conducted following  Menstruation and Poverty Trial) compared Ugandan schoolgirls experiences of menstruation in order to understand the pathways of effect for interventions like puberty education and reusable sanitary pads12.

The second study evaluated the acceptability and feasibility of using reusable menstrual cups amongst schoolgirls in Nepal13.

In both studies, both forms of reusable period products were acceptable to the school girls. They described feeling more confident and reported higher school attendance.

A further qualitative study explored the views of school girls, school boys and community and school teachers in Zambia around menstrual hygiene14. It highlighted three important factors that allow girls have dignified periods:

  • Access to affordable and comfortable period products
  • Access to water, hygiene and sanitation (WASH) facilities in schools
  • Access to a friendly and safe environment that does not lead to embarrassment, fear of being teased and ability to ask questions about their periods.

While choosing eco-friendly and reusable products is encouraged, it’s important women and people who menstruate use products that also suit their lifestyle and this should not create barriers for them.

We must end period stigma, and ensure that everyone who menstruates can access dignified, affordable and sustainable period products.


  1. Dr. Isioma Okolo discusses “The Birth Lottery” – Harvard Public Health Review: A Student-Run Peer-Reviewed Journal. Accessed October 5, 2021. 
  2. Puberty. Accessed October 4, 2021. 
  3. Globally, periods are causing girls to be absent from school. Accessed October 5, 2021. 
  4. Primary School Age Education. UNICEF DATA. Accessed October 2, 2021. 
  5. Finsgate S +44300 777 9777 PIU, London 5-7 Cranwood Street, Uk E 9lh. Menstrual Health Day: Global period poverty and stigma worsen under lockdown. Plan International UK. Published May 28, 2020. Accessed October 3, 2021. 
  6. How am I expected to be a wife to someone my father’s age? UNFPA ESARO. Published August 2, 2017. Accessed October 3, 2021. 
  7. How Good Menstrual Hygiene Keeps Girls Learning. UNICEF USA. Accessed October 5, 2021. 
  8. Mortality Visualization | IHME Viz Hub. Accessed October 5, 2021. 
  9. ENVIRONMENSTRUAL RESOURCES HUB. Wen. Published May 21, 2007. Accessed October 5, 2021. 
  10. The True Cost of Your Period. Pandia Health. Published October 24, 2018. Accessed October 5, 2021. 
  11. Period Products (Free Provision) (Scotland) Bill. Published online 2020:12.
  12. Hennegan J, Dolan C, Steinfield L, Montgomery P. A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for future research and practice. Reprod Health. 2017;14(1):78. doi:10.1186/s12978-017-0339-9
  13. Pokhrel D, Bhattarai S, Emgård M, von Schickfus M, Forsberg BC, Biermann O. Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study. Reprod Health. 2021;18(1):20. doi:10.1186/s12978-020-01036-0
  14. Chinyama J, Chipungu J, Rudd C, et al. Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC Public Health. 2019;19(1):16. doi:10.1186/s12889-018-6360-2
  • Clinical and research
  • Gynaecology