The United States is only just starting to get periods — or, at least, acknowledging that products for "that time of the month" aren't optional for menstruating women.
In 40 states, plus the District of Columbia, pads and tampons are subject to sales tax. Earlier this year, when President Obama was asked why they haven't been exempted like other necessities, he said, "I suspect it's because men were making the laws when those taxes were passed."
But there's a movement to fight these taxes, and several states have eliminated them. Next up: New York, which has just passed a bill that's awaiting Gov. Andrew Cuomo's signature.
Meanwhile, one country is way ahead of the U.S. when it comes to understanding that pads and tampons shouldn't be taxed.
Kenya repealed its value added tax on pads and tampons back in 2004 to lower the price consumers pay. And since 2011, the Kenyan government has been budgeting about $3 million per year to distribute free sanitary pads in schools in low-income communities.
That's not to say Kenya is an ideal place to get one's period. Many Kenyan girls still don't have access to sanitary products, so they use unhygienic materials like chicken feathers, cheap mattresses and newspapers to fashion makeshift pads, says Megan White Mukuria.
Mukuria is the founder of ZanaAfrica Foundation, which delivers health education — and sanitary pads — to help girls stay in school. A girl who is embarrassed to stain her uniform (or has an infection) is one who is likely to skip class and eventually drop out, Mukuria explains. UNESCO estimates that more than two million Kenyan girls need support in order to get menstrual hygiene products.
Nonetheless, Mukuria says Kenya should be proud of its progressive menstrual policies — which wouldn't have been possible without political pressure. She gives a lot of credit to the country's female leaders as well as the men who have taken on this issue. She cites the late Mutula Kilonzo, a former education minister, who recalled that during his childhood in the 1950s, he was always trying to keep up in school with one boy and one girl — until the girl got her period. She dropped out in seventh grade.
"He was angry about this. He missed the competition," says Mukuria, noting that the experience made him want to do something about the issue, especially when it continued to be a problem more than half a century later.
Government involvement — along with the support of NGOs and media coverage — have noticeably improved the menstruation situation for girls in Kenya, says Catherine Onyango, who leads ZanaAfrica's advocacy efforts. In the past few years, she's even noticed a shift in the language people use around the issue. When talking about a sanitary pad, men used to call it "this thing that is used by women," she says. But now, they're not afraid of the word "pad." Onyango says: "The way we discuss school books, we can discuss it."
They can also celebrate it. WASH United, an international NGO dedicated to issues of water, sanitation and hygiene, launched Menstrual Hygiene Day in 2014. Kenya marked the occasion with a public event for thousands of schoolchildren. (You can read an account in this issue of Shared Sanitation, Hygiene, Information and Tales.)
As part of last year's event, Kenya's Ministry of Health announced it would create a national menstrual hygiene management policy. The plan was to have it completed in time for 2016's Menstrual Hygiene Day — coming up quickly on May 28 — although it won't quite be ready, says Beverly Mademba, who's head of programming for WASH United's Nairobi office. It's taken longer than expected to finalize the draft document.
But the fact that such a policy is in the works at all is an important step, adds Mademba, who believes it will ensure that these issues won't be viewed as a "passing fad."
And the fact that the government has reached out to WASH United and other groups to help craft this policy is one of the best aspects of working on menstrual hygiene in Kenya, Mademba says. "When I need to check in on something, I just call the director's office," she says, referencing Dr. Kepha Ombacho, who has championed the menstrual hygiene cause within the government.
Despite all of this attention, everyone agrees there's much more work to be done in menstrual hygiene in Kenya. Before the tax was repealed in 2004, Mukuria says, a pack of eight sanitary pads cost about $1.20. Now, it's closer to a dollar — but that still puts them out of reach for most women. "More than half of the population lives on less than $1 a day," Onyango says. To fathers — who typically control a family's budget — these products are simply not a priority.
Mademba has spoken about the high costs with manufacturers, who complain that while finished products aren't taxed, the materials used to make them still are. "So maybe that needs to be rethought," Mademba says.
As for the program to distribute pads in schools, it hasn't been nearly as effective as hoped, Mukuria adds, because there's no structure in place to track what happens to the pads — or make sure they get to girls at all.
"Most of the problem is that teachers just steal them," Mukuria says. "With schools that don't have proper storage, it's tough. Things just go missing." When pads are kept in a secure place, that can lead to different concerns. Girls may then have to go each month to an intermediary, perhaps reluctantly. "It's not uncommon to have a man in charge," she adds. "At best, that's humiliating."
Mukuria's take on the progress so far? "Kenya is good at adopting best policies. But implementation has been a challenge."
What could help, she says, is international recognition of the problem. Mukuria notes that menstrual health is not directly mentioned in the United Nations Sustainable Development Goals despite its connections with several of the agenda items (including gender equality and clean water and sanitation).
"It's a basic human right to manage your body with dignity," she says. In Kenya, the lack of sex education means girls are often shocked when they first get their period. Mukuria met one who thought she'd contracted Ebola, while Onyango tells the story of another who assumed someone had pricked her in the middle of the night.
"But even in the U.S., we have difficulty talking to girls about what's happening in their bodies," Mukuria says. And for the many Americans living in poverty, it's tough to pay for sanitary pads or tampons — like other toiletries, menstrual hygiene products aren't covered by SNAP (Supplemental Nutrition Assistance Program).
Conditions in Kenya are far from perfect, adds Gina Reiss Wilchins, CEO of ZanaAfrica Foundation. Still, there are lessons in what's been accomplished.
"The country is prioritizing young women and girls," she says. "If the Kenyan government can put pads in schools, why can't the U.S. do that?"
Maybe it can. One promising sign for the future: In New York in March, 25 public high schools installed dispensers in bathrooms that give out free tampons and pads.