The Menstrual Cycle and the Pink Tax

By Shaymaa Sami

In most countries in the Middle East and Africa, menstrual supplies have become a luxury. Economic impoverishment has cast a shadow over women and girls, leading them to give up their menstruation necessities, voluntarily or forcibly.

In this text, we discuss the relationship between poverty and the menstrual period, two terms that are probably not as precise as should be. The term menstrual period is often used to refer to menstruation. Poverty, on the other hand, is usually used to absolve dominant entities and institutions of the deliberate impoverishment policies and practices towards people.

We speak with female defenders and activists of Syria’s afflicted revolution, through the absurd situation in Lebanon. We move to an Egyptian dictatorship that is dragging its country with unprecedented speed into poverty. We end with a peaceful revolution in Sudan turned into a bloody war by its Generals.

Civil wars and bloody conflicts are being waged by a world teeming with male authoritarianism. Its burdens bring about impoverishment, suffering, and human tragedies, to be memorized by the body, even after a while. Their impact doubles on women, girls, and marginalized females.

“Humanitarian aid doesn’t care about the needs of women in the camps. As if we are able to stop menstruation in times of war! Even sex, pregnancy, and childbirth, we can’t stop them. “Everything happens forcibly in the context of war, and women bear the consequences.”

Menstrual cycle… The unspoken bleeding

Women in the Middle East and Africa suffer from gender-based violence and are particularly punished for their gender. Violence, stigmatization, and discrimination amounting to denigration and treating her as “unclean” during menstruation. They are prohibited from touching certain objects or from entering holy places.

Women and girls are forced to remain reticent about their bodies, in particular, treating menstruation as a “shame”, not a biological function. As a result of this masculine imposition, which forces them to consider menstruation shameful, women and girls are painfully scarred by the “stigma”. They find themselves surrounded by this “shame” that has haunted them since the first red spot appeared on their panties.

If menstruation is a biological function, it not only burdens women psychologically, it is a serious issue too if personal hygiene is neglected, which can affect sexual and reproductive health. The situation is further exacerbated if their country witnesses political turmoil or they were financially incapable.

No detergents, no sanitary pads, and sometimes even no water!

According to a 2021 UNICEF report, 100 million children in the Middle East and North Africa (MENA) region lack access to safe drinking water supplies. Three out of 10 families have no basic handwashing facility.

With the increasing numbers of refugees or displaced, and people in need of humanitarian assistance in the region, ending menstrual poverty is crucial, especially for individuals and groups who are unable to access the necessary facilities and health care.

In conditions of war and impoverishment, there is no ability to bathe regularly, or even to have access to potable water. Some women are forced to relieve themselves in the open because of the lack of sanitary facilities. Women are also forced to reduce the amount of food and drink to reduce the number of times they go to the toilet, but during menstruating periods, it becomes more difficult.

About the conditions of the camp, we asked Hasnaa Barakat, a Syrian resident of northern Syria who has been a women’s rights activist since 2014.

“The situation in the camps is terrifying,” Hasnaa said. When I was in the camp, most women used cloth as a substitute for sanitary pads. Unfortunately, international aid organizations do not take into account women’s menstrual needs. In the camps, there is no water. Women have to use the same cloth for a long time. They wash it once, without detergents or disinfectants for bacteria. Then it’s used again.”

Women pay the price

She also elaborated on her personal situation, saying: “I left school even though I was first in class because of the revolution and the war. We feared for our lives if we went to school. The best possibility was arrest if they didn’t kill us. My father was a judge in the regime and resigned immediately after the revolution, in protest against what had happened. As a child, I bore the consequences of this decision. I dropped out of school and got married at the age of sixteen. I had my first child when I was 18 years old; a child with a baby! There is no water for bathing, for washing clothes after menstruation, or for postpartum hygiene.”

“There were no places to buy medicines or sanitary products. I did not choose to have children in wartime, but how can I prevent pregnancy without contraception? Besides, even when it is available, it is very expensive. I didn’t choose to marry in the first place. I was a brilliant teenager who dreamed of becoming a doctor. I didn’t make the war; it was the war that made me. I became a single mother of two children. Now, I am working with the international community to support other women and girls who are victims of war.”

During her work with various international organizations, Hasnaa did not find enough attention to women’s sexual and reproductive health. Sanitary pads, contraceptives, and menstrual supplies are not provided in war zones or camps. Even after shops and pharmacies reopened, most women and girls cannot afford them because of the impoverishment imposed on them.

“Humanitarian aid does not take care of the needs of women in the camps. As if we are able to stop menstruation in times of war! Even sex, pregnancy, and childbirth. We can’t stop it. “Everything happens forcibly in the context of the war, and women bear the consequences.”

“Since the war began, the situation has become catastrophic. We can’t even wash the clothes we use during menstruation. In some places, such as the Nuba Mountains, women use tree bark.”

Economic impoverishment and pink tax

Lebanese human rights activist and journalist Nahla Salameh spoke about similar challenges in Lebanon. “We don’t have war or revolution now. That’s true, but we have a collapse. There are no state institutions. This has caused economic collapse, impoverishment, and financial and social problems.”

Nahla linked between the general economic situation and women’s exposure to economic violence resulting from the wage gap, and the availability of job opportunities and promotion. “Women receive lower wages and positions than men. As economic violence escalates and the cost of living rises, violence escalates, and supporting a family becomes difficult.”

Consequently, she explained, the burden of this violence falls on menstruation and causes social and health crises for women and girls in Lebanon.

Relatedly, Plan International and Female, a feminist association in Lebanon, published a study on menstrual poverty in Lebanese, Palestinian, and Syrian communities.

The study showed that “41% of women and girls reduced the number of sanitary pads used during menstruation, or used them longer due to the crisis.” While “76.5% expressed the difficulty of accessing menstrual supplies, due to the sharp increase in prices.” The study confirmed that “87.9% of women and girls changed their purchasing behavior, to correspond to the continuous increase in the prices of sanitary pads.”

Menstrual requirements within the health insurance

“Since the war began, the situation has become catastrophic. It’s not just about sanitary pads, which, even if available, are at high prices. It goes beyond it to basic utilities such as water and electricity. We are not even able to wash the clothes we use during menstruation. In some places, such as the Nuba Mountains, women use tree bark.”

This is how Sudanese human rights activist Asjad commented on the catastrophic situation in Sudan, stressing that “in times of crisis, women are forced to put their needs off the ground. This is by virtue of traditions, customs, and education, all of which agree to stigmatize women who take care of their personal needs as selfish.”

“We, feminists inside Sudan, are forced to put aside our own needs. There is no room to talk about basic topics such as sexual and reproductive health, because of the intense preoccupation with the war created by men.”

Before the war between the army and the RSF broke out, Khartoum had moved a step forward. This was after the pressure of civil society to improve the conditions of women and preserve their rights since the revolution.  In 2021, the Health Insurance Authority in Khartoum State announced the inclusion of “sanitary pads” under the insurance umbrella. This has not been effectively implemented. The war wiped out the decision. Civil society’s hope for a safe life and due rights for the Sudanese people, especially women and girls, has waned.

An ounce of prevention is worth a pound of cure… and is more cost-effective!

“Preliminary care is more cost-effective than treatment. It also saves from pain,” said Dr. Jaidaa Farouk Makki, professor of neurology and psychiatry and consultant in sleep disorders. She pointed to the physical and psychological damage inflicted on women by having to neglect health care during menstruation. She also warned of the consequences of women and girls being forced to use alternative means that are unsafe and unhealthy due to impoverishment and marginalization.

In her interview with Sharika Wa Laken, she also pointed out that “women suffer from physical diseases, due to the lack of health care.” “This is a serious problem, which increases the chances of skin and vaginal infections,” she said.

“Reducing water is dangerous, as it will increase the likelihood of kidney inflammation. The absence of water causes acute or chronic kidney failure. As far as I know, there is no evidence of an increased risk of cancer. But there are other problems, such as endometriosis.

“If sanitary pads are not used at an average rate — a clean pad every 4 hours a day, the risk of endometriosis increases. Moreover, if there is difficulty in accessing personal hygiene products and resources such as bathing and the use of disinfectants and sterilizers, it can lead to chronic pain, as well as the possibility of infertility.”

Activist Hasnaa Barakat too confirmed that the same problems among women were observed while visiting refugee camps in Syria.

“During the Syrian revolution, I noticed a significant increase in sexually transmitted and reproductive diseases in women. This is due to the lack of resources available to them to take care of personal hygiene during menstruation.”

Add to this, “the lack of awareness about the importance of sexual and reproductive health due to impoverishment factors and the fact that this responsibility falls exclusively on the shoulders of women. Men also do not use condoms, either out of personal preference or because they are not available at all. In addition to multiple sexual relations, without taking precautions to prevent the transmission of sexually transmitted diseases and infections. and other practices harmful to sexual and reproductive health.”

Sanitary pads are not provocative or profitable goods

In Egypt, the economic crisis worsened after the inflation. Women had suffered wage discrimination before the crisis. But the crisis has widened the wage gap.

“Most women work in low-paid self-employment jobs or work in occupations not included in the formal economy and not covered by labor law, such as domestic work and handicrafts. These professions are not covered by health insurance. All these factors have made women the most affected by impoverishment,” said Egyptian lawyer and feminist activist Nasma Al-Khatib.

Speaking to our platform, Nasma Al-Khatib explained: “how women and girls bear the grunts of economic impoverishment and legal discrimination.”

According to a 2021 World Bank report, “Egypt’s poverty rate is expected to be about 29.7 percent of the population in the same year. That is, about 30% – about 32 million – of the population lives below the poverty line. Although there are no statistics specifying the exact number of women within that percentage, indicators reveal that the majority are women, due to various factors. Women have limited access to education, employment, and access to health and financial services and resources.”

“Because of the high prices, companies producing sanitary pads have increased their prices,” Al-Khatib said. She stressed the need to “consider sanitary pads a priority that must be supported by the state, rather than private companies’ exploitation of the economic crisis for profit, at the expense of public health.”

According to the health median, “If a woman uses 6 sanitary pads per day, for an average monthly period of five days, this means, she consumes 30 pads per month. This is equivalent, depending on the company and the type of pad, to an average of (50-100) pounds. That is, from (3.4– 6.9) US dollars. At the same time, Egypt’s minimum wage is about 3,500 pounds per month, or about $116.6.”

Menstrual poverty.  From the burden of impoverishment to the burden of terminology


In most Arabic-speaking countries, dozens of initiatives have emerged in recent years. With different titles and one topic: the need to support sanitary pads and menstrual supplies for women.

In 2018, Save the Children (UNICEF) adopted the term “menstrual poverty” – the relationship between poverty levels and their impact on the menstrual period. However, its literal translation into Arabic does not serve the intended purpose of the term.

Linguistically, some people think that the term refers to problems with the regularity of the menstrual period, or the intensity of bleeding during menstruation.


According to a simple survey conducted during the preparation of the investigation, the majority unfamiliar with feminist terminology believe that the term refers to women’s health problems. This confusion is due to the literal translation of the term. But it has recently become more acceptable and recognizable, due to feminist awareness campaigns. However, coining an Arabic term that directly refers to the problem can help us get what we want.

Alternative terms include, for example, the Arabic equivalence of menstrual burden, period burden, menstrual tax, the economic cost of the menstrual period, impoverishment of women and menstruation.

It is useful to reconsider the Arabic term and to reach a middle ground that connects the right that crosses languages and borders and the different tongues of peoples that determine the meaning in tongues and minds.

Initiatives to provide sanitary pads and countries that have triumphed in favor of women’s rights

Since the term was adopted in 2018, feminist efforts and lobbying for awareness have resulted in several successes in several countries.

Scotland was the first country in the world to make menstrual supplies available free of charge in November 2020. India and Australia have both abolished the tax on women’s health products.

In France, sanitary pads are provided free of charge to female university students. In most countries of the Global North, sanitary pads are available free of charge in public toilets and workplaces.

In Britain, sanitary pads are distributed to female students in schools. The same phenomenon has also begun to spread in the UAE.

In the Middle East and Africa, feminists, collectively and individually, continue to push for their rights to health care and basic menstrual necessities. For example, the “Speak Up” initiative, a feminist initiative in Egypt. It called for sanitary pads to be available inside toilets in public places.

In March 2019, the Egyptian Initiative for Personal Rights (EIPR) launched a large-scale campaign entitled “The Menstrual Cycle in Prisons”. The Tadween Center for Gender Studies, in cooperation with the Sanad Women’s Legal Support Initiative and the Barah Amen Foundation, also launched a campaign entitled “A necessity, not a luxury”.

Also in Lebanon, the “Dawrati” initiative, (My Period) and the “Nashaftoulna Damna” (You Desiccated Our Blood) campaign were launched to reduce menstrual poverty.

Morocco’s Free Women’s Union also launched a campaign to provide Moroccan women with sanitary pads.

The “Fota Tasoddo Khana” (A Pad Fills the Blank) initiative was established to politicize menstruation and stop menstrual poverty in Sudan.


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