A young girl’s journey through puberty is often rocky and marked by fear and embarrassment, to say the least. The struggles of learning how to use menstrual pads and tampons, of painful cramps, bloating, and raging hormones are all deeply engrained in the memories of most girls. All of that is compounded by adults – women, more often than not – who shush their daughters, their nieces, their younger sisters, pestering them to keep it quiet. Because periods make boys uncomfortable; because periods are not meant to be a topic open for discussion, but a pain to be suffered in silence even when they are still learning how to navigate it.
...in the Arab world there is an issue around the subject of menstruation.
For young girls who are displaced, vulnerable, or living an unstable home life as a refugee, the experience of “growing into a woman” and learning more about one’s body and coming to terms with it, is practically nonexistent. Their experiences with their periods can be so difficult that they begin to miss school, and eventually might even drop out completely. According to research conducted by Girl Effect, a non-profit organisation tackling global poverty, 1 in 10 girls in Africa miss school or drop out entirely because of their periods. At the country level, the statistics can be higher; in Afghanistan, the figures rise to 3 in 10 girls.
Battling these odds, however, is the Days for Girls organisation, an international organisation founded by CEO Celeste Mergens over a decade ago in 2008 after taking note of the dearth of access to menstrual sanitary products at an orphanage she worked with in Nairobi, Kenya, where she learned that girls would have to sit on pieces of cardboard in an empty room for entire days each month due to the lack of any products.
...girls would have to sit on pieces of cardboard in an empty room for entire days each month [when they were menstruating] due to the lack of any products.
With bases in 128 countries, its first location in the Middle East is Lebanon. Launched in 2015, DFG Lebanon increases access to menstrual care and attempts to shatter the stigmas around periods and encourage girls and women to speak about menstruation freely and without shame. This location allows for the organisation to provide to the largest Syrian refugee population in the world – Lebanon is currently home to an estimated 1.14 million Syrian refugees – access to sanitary menstrual products as well as a means of generating income, by teaching women to make their own pads in an enterprise program, addressing what is both a rampant social and health issue at the same time.
“We all know that in Lebanon - and in the Arab world in general - there is an issue around the subject of menstruation. The topic is always kept a secret, no one knows anything about it, only the girl and her mom, and that is only if the mother has some educational and cultural awareness about health that she can teach her daughter,” says Khayrieh Al Assad, country director of DFG Lebanon.
The Days for Girls menstrual pad kit. Photo courtesy of Deseret News.
The DFG team gathers Syrian women who are willing to learn how to make the washable pads, which last three years and are comprised of waterproof shields made out of plastic, with wings on the sides and pockets on each side. They also come with an absorbent fabric liner which is inserted into the pockets and can be removed for washing. They conduct an 8-day training session with the women, followed by general sessions held on the days where they distribute menstrual pad kits to girls and their mothers in refugee camps, where they discuss menstruation, sex, reproduction and physical anatomy, and how to maintain personal hygiene, especially during menstruation.
The dollar they’d need to buy a pad, they need it for bread. They’ll go buy bread. Or medicine. Or pay rent.
The pads come packaged in a kit that includes a spare re-usable pad, 8 spare liners, 2 pairs of underwear, a cycle calendar for period tracking, a washcloth and soap for cleaning, and a plastic bag where the dirty pads can be placed with water and soap and then emptied of the water. The pads are also made with colorful, patterned fabric, chosen for their discreetness and to eliminate any embarrassment on behalf of the women upon hanging them out in the air to dry. That embarrassment is not limited to the appearance of anything that might look like a white menstrual pad with blood stains (a sight which women try to avoid causing as much as possible), but also includes, for younger girls, gathering up the courage to even ask for a pad, especially under the extenuating circumstances of life in camps and due to the general secrecy around the subject.
“Young girls are afraid of saying 'I need [a pad]' so they feel like those 7 days are like a plague, whether there is pain or she doesn’t have the pads she needs, but why? Those 7 days, if you count how much they add up, can take up around 8 years of your life,” says Al Assad. Of the mounting issues that meet refugees in cases of displacement, access to menstrual healthcare is one of the most pressing and intimate, and the lack of it puts them in excruciating pain and embarrassment, as well as puts their futures in jeopardy; the rare days of regular school life are interrupted by the onslaught of the “crimson wave” that ends up becoming not only a disruption, but a dead end. And in an unstable home and school life, Syrian girls and women not only suffer from menstrual inequity, but from psychological trauma and period shame that exacerbates the problem even further.
Young girls are afraid of saying 'I need [a pad]' so they feel like those 7 days are like a plague
Menstrual equity, a concept referring to equal access to hygiene products and education about reproductive and menstrual health, has recently been introduced in the United States, growing a movement in its tracks. People are pushing for the end of "period poverty," which is the lack of access to sanitary products, menstrual hygiene education, toilets, hand washing facilities, and waste management. From activists writing books about the way periods have been perceived throughout history, to a runner who ran at the London marathon as she bled without using menstrual products, people in various parts of the world have started to be more vocal about opposing period shame and menstrual inequity.
Among refugees, things are more complicated. Women buy cheap pads due to their financial constraints, and their poor quality causes irritation, foul odors, and at times painful rashes and infections. "Some shops sell the pads at a very cheap price – if you see it, there’s no way you would buy it. The cotton crumbles in your hands, after 5 minutes of usage it smells horrid, so it’s just impossible to use. It’s not a solution," says Al Assad.
Women who suffer from the irritation and pain that comes along with those pads are prompted to go to doctors, and according to Al Assad, the doctors are not able to help - the problem will not be solved as long as the pads used are of cheap quality. “Some women go to doctors who’d tell them their biggest problem is the pad they buy, that they have to buy healthy pads. Okay, doctor, how much does a healthy pad cost? And how much do they cost for a family of 5 daughters every month? You’re talking about a big portion of their budget every month, no one will be persuaded to do that. The dollar they’d need to buy a pad, they need it for bread. They’ll go buy bread. Or medicine. Or pay rent.”
Photo courtesy of Days for Girls Malawi.
Acknowledging the financial burdens of Syrian refugees, Days for Girls offers the pads - which will help them save the costs of countless amounts of menstrual pads every year - for free in distribution sessions, but the micro-enterprise aim of the project is to also help women build a sustainable enterprise that will help others save large amounts of money that are paid on pads each month. After learning how to make the pads, they are supported by the DFG teams in creating and sustaining a business - there are standardized guidelines, instructions, and registration processes for every micro-enterprise - and eventually become certified by the organization after completing the requirements. They are either supported by DFG alone, or by both DFG and other peer organizations that then adopt DFG programming and partner up with them to provide additional support.
most women say that the kids receive sexual education at school and that there is no need to keep opening up this subject.
The enterprises target people in the Syrian women's areas and communities, where women who do have the means of buying pads can save on the monthly expense by buying the kit. These enterprises are also able to eliminate the amount of waste that results from non-washable pads. Especially in the context of Lebanon’s garbage crisis, which can be traced back to the start of the civil war and is only gaining momentum, the use of disposable pads, monthly and by millions of women, is environmentally hazardous. Landfills in the U.S. alone are reported to contain 20 billion disposable pads annually, and most tampons and pads also contain bleached, nonorganic cotton, and rayon, a fiber used to add comfort, which are known to contain pesticides and herbicides including dioxin, a toxin which the World Health Organization has identified as hazardous to the immune system, likely to cause reproductive problems and cancer.
Tampons and menstrual cups, which are placed inside the vagina, are not accepted by many Muslims who believe that the hymen must not be broken
This pad then is a loophole around many issues at once: inaccessibility to menstrual care (and knowledge), limited financial capabilities, waste, pollution, and health issues in general. If all of that is not enough, there is also an unintended benefit to the gathering of women, either for the sessions or to make the pads. Intimate gatherings encouraging women to speak up about topics otherwise kept quiet ends up cultivating community and feelings of familial warmth in a context where it is sometimes desperately needed.
The infamous "trash mountain" in Sidon, or Saida, Lebanon. Photo courtesy of Business Insider.
“Every morning, each woman brings her own coffee, one woman brings biscuits, another brings a cake they’ve baked, you’d think they’ve known each other all their lives. What’s more is they’ve all lived the same reality; they all came to Lebanon, they have all lost a family member or someone close to them, they all live in camps or a home life that is unstable – a shop or a parking garage, not in stable homes – so every morning they share and talk about their problems and they help each other in really clever ways. They’ve become like a family,” says Khayrieh.
The concept of menstrual and sexual education, however, is not so easily accepted by some of the women. While lack of knowledge about menstrual and reproductive health is endangering, they remain shrouded in secrecy and treated as social taboos. The DFG team organises sessions first for the mothers, where they discuss everything from puberty, menstruation, and personal hygiene to reproduction, sexual anatomy and sexually transmitted diseases. They ask for their approval at the end of the session to speak with their daughters and to hold the same session with them.
the sessions cannot be done for just the girls alone, because the problem does not end or even begin with the girls, it begins with the mothers who then teach their daughters to do the same
They are, however, often met with dismissive responses; for instance, most women say that the kids receive sexual education at school and that there is no need to keep opening up this subject. But as Al Assad explains, sex education in the Arab world is anything but sufficient. In Lebanon, sex education was withdrawn from the national curriculum in 2000 after criticism from some religious groups in the country, and attempts to reintroduce it to public schools have not been entirely successful, with lack of training and continuous complaints to teachers from parents about the subject, and no administrative support for the teachers. This problem is not restricted to Lebanon, with similar occurrences happening in Egypt in 2010, and a general lack of sexual education in most national curricula around the Arab world - barring the few private schools scattered across the region, admitting only a very small portion of youth who have the financial means to enroll, which offer biology courses and a - nonetheless limited - insight into sexual education.
“Yes, we do learn them at school, but just the headings and titles. Okay, my body will change. Period, end of discussion. The boys won’t ask, they’ll be too shy in front of the girls, and the girls won’t ask because they’re too shy in front of the boys. And the definitions that are given no one ends up asking anything about. If you ask them ‘what did you learn at school?’ They say, our bodies grow. Our hair grows. That’s it,” says Al Assad.
You can speak to a 13, 14 or even 19-year-old girl and she knows nothing about her period or how to properly deal with it.
What DFG then tries to achieve is the breaking of silence around menstruation that costs girls and women their well-being and, often, their futures - rather than having to go through the embarrassment of attending school without sanitary pads, girls can miss or drop out of school entirely - and they do so by addressing both the girls and their mothers. “If a girl’s having stomachaches during menstruation, the instant reaction is to shush her, her mother says, ‘okay take the pad, drink your tea, don’t keep talking about it,’ but why should she not talk about it? The girl is in pain. That’s why the sessions cannot be done for just the girls alone, because the problem does not end or even begin with the girls, it begins with the mothers who then teach their daughters to do the same,” says Al Assad.
An Ambassador of Women's Health (AWH) training session held by Days for Girls. Photo Courtesy of Khayrieh Al Assad.
“You can speak to a 13, 14 or even 19-year-old girl and she knows nothing about her period or how to properly deal with it. She can be engaged, ready for marriage, and still, she has no idea what’s supposed to happen between her and her husband.” The danger of educational organisations and programs that aim to spread awareness about sexual and menstrual health, though, is that they can be culturally insensitive, preaching ideas and practices that clash with the beliefs and practices of the people they try to reach. Al Assad emphasizes repeatedly that they must approach the subject very delicately so as not to cross any boundaries. “We’re not going to throw a party when girls get their periods. We’re not in America. Here, there's a huge difference. We don’t want them to be embarrassed and for the subject to be a taboo, but there are limits. We’re in an Arab Muslim society, not just Arab but Muslim, and we have to acknowledge that and take it into consideration.”
This also explains the design of reusable menstrual pads rather than menstrual cups, which are another more popular, safe, re-usable and economical alternative to menstrual pads and tampons. Tampons and menstrual cups, which are placed inside the vagina, are not accepted by many Muslims who believe that the hymen must not be broken, and that those products will be a threat to their practices and beliefs. The nature of these products disallows them from most Muslim communities, and menstrual pads become the more common and viable option.
Days for Girls is appropriate, then, in the context of the Arab world and among Muslim communities; it is culturally sensitive and attempts to eradicate the social taboo of periods, but does so while acknowledging the context and culture to which they preach.
The problem of inaccessibility, both to knowledge and to menstrual care, is dangerous enough anywhere, but in refugee camps and among Syrian women specifically, shame and displacement exacerbate these issues and create a hazard that ultimately becomes a burden larger than any young person, who is already in a situation of trauma and strife, can handle. These sustainable pads, then, address many of the issues that trouble Syrian women and tries to make their world a little easier and a little less hazardous than it already is.
Tackling everything from lack of access to menstrual products and period shame, to the dearth of sexual education in the Arab world, this organisation in Lebanon is making the world a little easier for Syrian refugee women, one pad at a time.
Main image courtesy of HuffPost.