It's Only Blood_Shattering the Taboo of Menstruation Read online

  A few years ago in Sweden, a group of social democratic politicians (all women) put forth a motion about government control of the chemical contents of menstrual products. Among other things, the motion referred to an American study that showed measurable levels of toxic substances in tampons. Carina Ohlsson, member of the Swedish parliament and chair of Social Democratic Women in Sweden, was one of the people behind the motion. She says that the issue was raised locally in several meetings of the social democratic women’s wing.

  ‘We’ve also discussed the development of menstrual products and costs, but not much has happened. When we’ve talked about outreach activities like seminars, many respond with hesitation. Are we really going to talk about menstruation? It’s actually strange that such a taboo still exists.’

  It is obvious to her that menstruation is a political issue, tied to both gender equality more generally and to sexual and reproductive health and rights specifically. But the motion was rejected.

  Only after the publication of an Argentinian study in 2015 did the Swedish Chemicals Agency announce that they plan to take a closer look at menstrual products. The Argentinian researchers found glyphosate in tampons, a substance that is used in herbicides and designated ‘probably carcinogenic’ by the World Health Organization.

  In an interview on the Swedish public radio show Plånboken (‘The Wallet’) in 2016, Frida Ramström from the Swedish Chemicals Agency said that the levels of glyphosate may be ‘extremely low’, but there is still reason to take the investigation further as menstrual products are something ‘that many [people] use, and so close to the body’. Her explanation for why menstrual products have not been on the Swedish Chemicals Agency’s radar before is that they have not been brought to attention as a major problem by agencies in other countries or in the research community. Until now.

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  There are many more aspects of menstruation and health besides those that fall under menstrual protection and hygiene. Menstrual pains are another. Muscle cramps in the uterus that can cause pain from the pelvis, nausea, headaches, and diarrhoea affect between 70 and 90 per cent of those who menstruate – numbers that reasonably make menstrual pains a public health issue. It is at its worst for those between 20 and 25 years old.

  For some, this means that several days are crossed off the calendar every month when life is put on hold and it is impossible to work or go to school. In the US, it is estimated that the number of working days lost due to menstrual pains amounts to 600 million per year, to a value of 2 billion US dollars. Menstrual pains are thought to be the leading cause for women’s absences from both workplaces and schools.

  Endometriosis partly falls into the same category, with severe pain during menstruation. It is a chronic condition that afflicts around 10 per cent of those who menstruate. In endometriosis, the uterine lining – which is shed and expelled during menstruation – is located outside the uterus. The pain can in some cases lead to fainting and force the afflicted to remain in bed for several days. It can also be more difficult to get pregnant.

  In Sweden, it takes on average between seven and ten years to get a diagnosis. It was only at the start of 2016 that the Swedish government decided to task the National Board of Health and Welfare with drawing up national guidelines for the treatment of endometriosis. At the time, the board had reached the conclusion that knowledge within the healthcare sector was inadequate and that the patients referred to specialists were too few. Over and over again, the patients themselves have warned that they are not being taken seriously.

  The Endometriosis Foundation of Africa (EFA), a non-governmental organisation in South Africa, has highlighted that it is even more difficult to get help for those who live in low-income countries. In addition to the lack of knowledge, treatment is way too expensive. Once again: poverty, disease, and inadequate access to healthcare go hand in hand – at both a societal and an individual level. According to EFA, there is also a widespread misconception in many African countries about endometriosis as a Western problem that does not affect African women.

  Nomakhya Mgcina at the EFA writes in an email that it is a misconception based in heavy under-reporting. In turn, this can partly be explained by the taboos that surround both menstruation and infertility. Women choose silent suffering over stigmatisation. For the person who actually receives a diagnosis, the chance of getting help at an affordable cost is likely to be ‘very small’, writes Nomakhya Mgcina.

  When I ask Catherine Onyango at ZanaAfrica, one of the organisations working with menstruation in East Africa, what they do when they meet people who suffer from severe menstrual pains, she notes despondently that they can do nothing more than refer them to the healthcare system. She knows that it is often a pointless suggestion.

  ‘For those who live in the countryside, it’s generally too far and too expensive. Most probably suffer in silence,’ Catherine Onyango says.

  Female genital mutilation adds another dimension to pain during menstruation. Estimates indicate that it affects 130 million people, most of them in Africa and the Middle East; but it is also common in Asian Indonesia. Genital mutilation involves various procedures. In some cases, parts of the clitoris and labia are cut off. In others, the clitoris is ‘pricked’ with a sharp object. In cases of infibulation, when the clitoris and labia are cut off completely and the skin is sown together, leaving only a small opening, it becomes difficult for the menstrual blood to get through, which causes pain.

  Between ovulation and menstruation, another health-related phenomenon occurs, that which goes under the acronyms PMS or PMDD. The former, premenstrual syndrome, is the milder version from which an estimated 30 per cent of those who menstruate suffer. The latter, premenstrual dysphoric disorder, is more serious and affects between 2 and 5 per cent. Among other things, the premenstrual syndrome and disorder may come with a state of dejection, anger, anxiety, mood swings, tiredness, and difficulties sleeping. In PMDD, the symptoms resemble anxiety disorder and depression, in some cases involving suicidal thoughts. It lasts for between three and fourteen days. Every month.

  Just like patients with endometriosis, many of those who suffer from PMS or PMDD say that it is difficult to get help, that the healthcare system treats them with both nonchalance and ignorance. Nor have researchers been able to map exactly how the premenstrual syndrome and disorder work.

  No one knows. No one listens. Ignorance and indifference are common denominators for the entire family of menstruation-related ill health: menstrual pains, endometriosis, PMS, PMDD. There is no doubt that it is an exceptionally underexplored area in relation to the very large group who are affected – like the infections connected with menstrual management. Not to say alarmingly low priority. It is as if it does not even belong in the medical sphere.

  ‘Stepmotherly handled’, says Marie Bixo, professor of obstetrics and gynaecology at the University Hospital of Umeå in northern Sweden, in an interview in the Swedish journal Medical Science. ‘Only 50 years ago, it was considered self-evident that women are more sensitive individuals, so any discomfort around menstruation went with [being a woman] and did not need to be relieved.’

  Marie Bixo notes that women’s ill health is still not prioritised within research. One reason is that it is considered difficult to study women precisely because they are affected by hormonal cycles. That which is to be explored is dismissed as disruptive to research in a devastating catch-22 that is upheld by the silence.

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  MILLIONS OF MENSTRUATING TEXTILE WORKERS

  They are called ‘joot’, the small leftover pieces of fabric that end up on the floor of the textile factories. They are not big enough for T-shirts, dresses, or even pockets. Instead, they become menstrual protection for the millions of menstruators who work in the textile industry in Bangladesh. They take a fistful of joot and push it down their panties.

  ‘You see the piles of joot as soon as you enter the factories,’ Nazneen Huq says. Based on her gestures they appear to be large
piles, V-shaped like steep mountains.

  They are usually placed in one of the corners, layer upon layer of fabric scraps. And the further into the pile, the darker and moister it gets.

  ‘They’re like hothouses for bacteria, fungi, and mould. Moreover, there are cockroaches and other insects crawling around on the factory floor and into the piles.’

  Nazneen Huq has seen countless textile factories from the inside. Her organisation, Change, runs a project with the aim of improving the health among women in the textile industry in Bangladesh. So far, they have visited 88 factories.

  ‘I ask why they don’t use pads. They say they can’t afford it, you know, poor women in Bangladesh don’t like to spend money on themselves. The rest of the family takes priority.’

  Many also say that they are too shy to walk into a pharmacy and ask the staff, who are most often men, about pads. But the primary cause, according to Nazneen Huq, is that they see pads as a luxury product and therefore not appropriate for a textile worker with very limited resources. Pads are something the rich can treat themselves to, not a necessity for the one who menstruates.

  * * *

  Around 90 per cent of the approximately 4 million people who work in textile factories in Bangladesh are women. They play a crucial role for the country’s economy. The textile industry is the engine behind the economic growth that has remained at around 6 per cent per year for more than 20 years. During the same period, the poor proportion of Bangladesh’s 160 million inhabitants has dropped from 60 to 30 per cent, today around 48 million. That is what is typically called a ‘success story’, one of the positive examples used by the UN in summaries of the fight against poverty over the last few years.

  At the same time, the jobs in the textile factories have gained in status.

  ‘Parents are no longer only supporting education for boys, because they see that girls can get jobs too. And nowadays young men want to marry girls from the factories,’ Nazneen Huq says.

  Everything can change. And sometimes it happens fast.

  In the textile industry’s early phase, in the 1980s, women who worked in the factories were viewed with disdain. Most of them – then like now – came from the countryside. Back home in the villages, their parents risked becoming outcasts. It was shameful to leave the home for the solitude of the cities. Women had to be controlled and needed chaperones – if they were to go outside at all. On the marriage market, they were pariahs. Now, if anything their contributions to the household funds make them ‘assets’, Nazneen Huq explains.

  ‘Why did the norms change? How could it happen so quickly? I think the men simply failed to put food on the table. The women stepped up and took responsibility.’

  Is it a good job? It depends on who you ask. The textile factories in Bangladesh compete with their cheap labour and the work environment is infamous, not least after several deadly fires and an accident in 2013 that caught much attention, when 1,200 people died under the collapsing masses of the textile factory Rana Plaza.

  At the same time, it is one of few opportunities for the women of the countryside to have their own income. In 2013, the minimum wage was raised by more than 70 per cent to the equivalent of around 70 US dollars per month. Work environment standards have also become stricter, and inspections more frequent.

  ‘Now, more demands are being put to the management, they can’t do whatever they want. In the past, it was for example common that the foremen hit the textile workers, but we don’t hear of that anymore,’ says Nazneen Huq.

  Later, she explains how sexual harassment is widespread. How the foremen, most of whom are men, seize the opportunity to grope when ‘demonstrating something’ to the female workers. Those 70 US dollars are still very far from fair wages. There are plenty of reports about factories that cheat when it comes to security, even after stricter requirements have been imposed.

  * * *

  Honking and ringing fill the streets of Dhaka. Short signals from cars and rickshaws – a kind of bike taxi – with the purpose of indicating: ‘Here I come, move over.’ Not out of irritation, but rather as a way of managing the traffic chaos in the Bangladeshi capital. Close to 15 million people live here in one of the world’s most densely populated cities.

  Near the offices of the organisation Change, in one of the wealthier parts of town, there is also clattering and banging from construction sites. A new house seems to be going up on every block, like trees of steel and concrete in different stages of growth. The construction workers who are doing the clattering and banging until late in the evening are men, just like all the rickshaw drivers on the streets of Dhaka. While women who seek their fortune in the big city end up in the textile industry, many of the men drive one of the 600,000 rickshaws that crowd the streets.

  Nazneen Huq has moved the organisation here from her home, where they first started with various ideas for empowering women. Looking more closely at the role menstruation plays is just one of several issues they are working with at Change. There is a small Dala horse – a traditional carved and brightly painted wooden horse from Sweden – in the bookcase in her office, a gift from a former visitor. She tries to remember who, without success.

  Before I have time to start asking questions, she is the one wondering why I want to write about menstruation. She sounds exacting, like a stern teacher. I feel a little nervous when I explain how angry I get when we praise childbearing but make menstruation something shameful, or simply ignore that menstrual products, water, toilets, waste bins, and knowledge are required for those who menstruate to have access to education, work, or – well – just life on equal terms with those who do not menstruate.

  That’s all right, she says and nods (approvingly, I think to myself with relief). Then she begins to talk about her first period.

  ‘When I got my period I was only nine years old, but I didn’t even notice at first. I wasn’t paying attention to what was going on in my underwear. I was too busy playing. It was my mother who saw the blood stains and told me.’

  Her first period was apparently not a big affair. But during the coming years, Nazneen Huq asked herself several times: Is God a man? Is that why he makes it so difficult for women? Nazneen Huq has thought about menstruation, and she has brought it with her into the work for women’s rights. Yet she was privileged, with access to menstrual products and a mother who told her how menstruation works.

  For those who menstruate in one of the close to 5,000 factories in the textile industry, joot is usually the solution. Nazneen Huq and her co-workers think that it is one of the reasons why roughly 70 per cent of those who participated in their initial study in 2010 had some form of genitourinary infection. They asked further questions and discussed the results with medical experts, but found nothing else that could explain why the infections were so numerous.

  Perhaps it is because the leftover pieces of fabric are damp and dirty? Another conceivable cause is the toxic chemicals that have turned out to be common in clothes delivered by the textile industry. According to tests performed by the organisation Greenpeace, the levels of toxicity are substantially higher before the first wash. Perhaps it is simply connected with the fact that joot is not very absorbent? There are good reasons to suspect that the dubious menstrual protection is a factor, that urinary tract infections, fungal infections, and bacterial vaginosis are what itches, stings, and burns.

  In an article by Rose George from 2014, published in the British magazine New Statesman, 25-year-old Sarita explains that she and the other textile workers in a factory in Dhaka get joot from the cleaners who sweep it up. She says that it only lasts half an hour for her and the fabric itches. In the same article, a textile worker explains that she gathers joot from a waste bin in the room where the fabric is cut. She and her colleagues speak of recurring infections.

  I never enter a textile factory in Dhaka myself. Since a few months before I arrive in Bangladesh, the security situation has deteriorated. Plans for large-scale terror attacks aimed at foreig
ners are said to have been averted. The terror organisation Islamic State has claimed responsibility for two murders and one attempted murder of foreign citizens. Violence is also expected in the wake of a death sentence against one of the members of Jamaat-e-Islami, the Islamic party in Bangladesh.

  The tense security situation is the only explanation I am given when my attempts to visit a textile factory come to nothing. At the same time, they are probably not too keen on inviting another journalist who wants to look more closely at the work environment in the harshly criticised factories – regardless of the security situation.

  I only see them from the outside, observing curiously. Eve Garments is located in a residential area in central Dhaka. All that lets on that it is a factory, except for the sign, is the guard at the entrance and the fire escapes scaling the sand-coloured facade.

  On a livelier street, with shops and food stands, the Shana Group is located with its guard and the text ‘assembly point in case of fire’ painted on the wall outside the entrance. Both are close to Karail, Dhaka’s largest slum, where many of the textile workers live. The slum, however, I will eventually visit.

  * * *

  The problem with the fabric from the factory floor is not just the risk of infection, but also that the crumpled-up pieces of fabric are uncomfortable. They itch, cause rashes, and it is difficult to make them stay in place and keep the blood from leaking. The list of difficulties is recognised from schools around the world. For a textile worker, who is a cog in the big wheel of production, being able to leave in order to readjust, check, or change menstrual protection is not a given.