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Floods Highlight Period Poverty in Pakistan

Many of the more than 8 million women of reproductive age affected by Pakistan’s unprecedented floods have been turning to desperate measures to manage their periods. Balochistan was hard hit and one woman called out to volunteers for help. She reported using tree leaves.

“It was heartbreaking,” says Bushra Mahnoor, one of two college students who in July founded Mahwari Justice, a grassroots movement to distribute menstrual products to women in need.

Over 33 million people were displaced by flooding in Pakistan, which has seen a third of the country submerged. Floods have caused more than 1,400 deaths and damaged hundreds of thousands homes, bridges, and roads. Over 660,000 people still live in temporary shelters and makeshift houses.

Shahbaz Sharif was quoted as saying Monday, “The country is facing food shortages.” Relief organizations are rushing aid to affected areas—but supplies of menstrual products are often overlooked. That’s partly because of the stigma around discussing periods in Pakistan, according to Mahnoor.

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“When people associate shame with menstruation, people also do not talk about the problems associated with menstruation,” she tells TIME.

That’s why Mahwari Justice chose such an unapologetic name for itself: Mahwari simply means “periods” in Urdu, Pakistan’s national language. In order to ensure safe and healthy menstrual practice, the group intensified their efforts to distribute menstrual product to Pakistani women.

Mahwari justice has already distributed 20,000 kits of menstrual hygiene to people in desperate need. Mahnoor and Anum Khalid, Mahwari’s co-founder, have been invited on BBC Radio 4 to discuss their achievements. They have helped to create a discussion on the best way for women affected by floods, along with other similar organisations.

“This is something that gets neglected really easily because for a lot of people, and especially for countries like Pakistan—where laws are made by men, when relief work is led by men—there’s no discussion around what a woman needs,” says Sana Lokhandwala, co-founder of HER Pakistan. This group has distributed more than 7k menstrual kit and works with community mobilisers, activists and volunteers to provide additional necessities such as shelter, food and clothing.


One woman is seen standing in a tent near the flood zone after heavy rains from Rajanpur, Punjab province, on September 4, 2022.

ARIF ALI/AFP via Getty Images

The needs of Pakistan’s rural women

Pakistan had many misconceptions about the periods before the flooding.

Dr. Sidra Nausheen, an assistant professor and vice chair of research in obstetrics and gynecology at the Aga Khan University Hospital in Pakistan’s biggest city Karachi, has been working for many years in rural communities to raise awareness about proper menstrual management. Many women and girls have refused to bathe for longer than one week. They also avoid hot or cold beverages out of fear that it might disrupt their menstrual cycle. Some women were forced to stay in a locked room for their period. Because of lack of products for menstruation, many girls did not attend school during periods.

“Menstrual hygiene is something that in Pakistan especially nobody talks about,” Nausheen tells TIME. False information is easy to thrive in this environment. “Lots of women don’t know what’s happening to their bodies.”

Mahnoor and Khalid researched other relief efforts in disaster areas to determine the most efficient ways to provide menstrual supplies when Mahnoor started Mahwari Justice. To find the most useful items, they spoke to rural women.

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They came up with three types of kits. The first contains underwear and sanitary napkins, while the second has small towels and underwear. While the third is made up of cotton pads, it also includes a set of cotton pads. These kits include diagrams to show you how to use your products.

Different conditions determine what items work best. Lokhandwala, of HER Pakistan, explains that if flood waters haven’t receded, cloth towels may present problems as there is no clean water to wash and dry them.

“Cloth pads might work in one community if they are still living in homes and have washing supplies, but might not work in relief camps,” she says.

In this picture taken on May 18, 2019, Pakistani woman Hajra Bibi makes a sanitary pad with a sewing machine at her home in Booni village in Chitral. (AAMIR QURESHI/AFP via Getty Images)

Here is a picture of Hajra Bibi, a Pakistani woman who makes a toilet paper with her sewing machine. It was taken in May 18.

Getty Images – AAMIR QURESHI/AFP

Pakistani women need help with their menstruation

Pakistan should remove the luxury tax it imposes on menstrual products. This has been supported by doctors, public health activists, as well as relief workers. “Women don’t feel luxurious during these days,” Khalid says.

“Menstrual kits [and] sanitary napkins should be free but the taxes on them are so high people cannot afford it,” says Dr. Alia Haider, a doctor currently working in relief camps. “It’s the responsibility of the state to give us a healthy life—health should be free.”

However, until the cost of menstrual products becomes affordable for Pakistani women, they will be forced to turn to volunteers and private organisations for assistance in managing their periods.

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From 2019 to 2021, Nausheen and her colleagues from Aga Khan University Hospital conducted fieldwork on menstrual hygiene among women aged 14-49 in Dadu district, Sindh province—an area hit hard by the recent floods. Nearly 40% of Dadu’s nearly 25,000 women were not using pads or napkins to regulate their periods. They instead changed their clothes every day and would wash them.

“Many weren’t aware of reusable pads or the availability of pads. They thought it was very expensive and ‘We can’t afford it,’” Nausheen says.

Nausheen taught her group how to make pads using a local, inexpensive cloth. 90% of those who completed the survey now use such pads. Many are also making and selling them—even during the catastrophic floods.

Says Khalid of Mahwari Justice: “Periods never stop during any calamity.”

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Send an email to Sanya Mansoor at sanya.mansoor@time.com.

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