How social stigma and lack of access to sanitary pads make menstrual cycle a nightmare for women in Afghanistan

It is a cold December morning in Kabul, but Zarmina (name changed) and her four sisters-in-law, who live under the same roof, welcome me affectionately. They live in Demazang area of Kabul city, a bustling residential locality not too far from Kabul Zoo, City Park and Afghan parliament house.

Like a quintessential Afghan family, famous for their warmth and hospitality, I am escorted inside a room and offered green tea and cookies. One by one, the female members of the family gather in the room. After some shilly-shallying, a conversation picks up about the security situation in Kabul and what the new government needs to do to combat corruption. In Afghanistan, political awareness is incredible and everyone has an opinion on latest events.

Zarmina’s mother-in-law, a cheerful lady, is busy on her sewing machine, but carefully listening to our conversation. Once the initial hesitation is broken, I decide to pick conversation about the theme of my story. My very first question leaves them blushing. All of a sudden, they try to excuse themselves, pretending to be busy.

Zarmina also blushes, but she seems willing to talk about the subject that is considered a taboo in the conservative Afghan society. She runs her eyes around to check if there is any male member in the room or in the lobby of their small house. Feeling reassured, she agrees to talk to me. In a voice barely audible, she begins the conversation about her experience of menstrual cycle.

Menstruation, although a natural and normal process for any woman, is considered a taboo in most conservative societies, especially in South Asia. In Afghanistan, any discussion revolving around menstruation is tantamount to committing a blasphemy. Menstruating women and girls generally pretend as if they are not going through their regular periods. So, naturally, it is difficult for women like Zarmina to even talk about their menstruation experiences.

Zarmina, 20, is the mother of two children. Elder one is from her first husband who was killed in a bomb explosion in Kabul and younger one is from her second husband, who is blood brother of her first husband.

For Zarmina, her menstrual cycle is a nightmare. Her husband is a manual labourer, who earns barely 200 Afs a day, which is equal to 3 USD. The money he earns is insufficient to cover their household expenses. So, buying sanitary pads becomes a difficult proposition for her. Like other women, she uses pieces of old and shabby cloth in place of sanitary pads. “If we had sufficient money, I would have bought (pads), but right now I have no other option but to use old pieces of cloth, which is little soft,. she says.

A small percentage of women in Afghanistan, mostly those living in big cities, have access to sanitary pad which are exported from China, Turkey or Iran. The price of these pads ranges between 20 and 90 Afs. Rest of the women mostly use pieces of old cloth during their periods.

According to Dr. Nizamudin Jalil, Reproductive Health Coordinator at the Ministry of Public Health, it is a complicated health issue in Afghanistan. “There are no clear statistics about women’s access to sanitary pads in Afghanistan, which makes it difficult for the government to pursue the matter,” he says.

Lack of access to sanitary pads
In the big cities of Afghanistan, although sanitary pads are expensive or are of low quality, yet they are easily available to those who can afford it. But, as we move beyond cities, situation turns grim. Some of the women in rural areas have no idea about sanitary pads and its importance.

Cloths or cloth pads may be a sustainable sanitary option, but it must be hygienically washed and dried in the sunlight, believe experts. Sunlight is a natural sterilizer and drying the cloth pads in sunlight sterilizes them for future use. They also need to be ironed and stored in a clean and dry place for recuse. In Afghanistan, owing to their lack of knowledge about hygiene management during their periods, lack of facilities, high illiteracy level (85 percent of women are illiterate) and social constraints; majority of women don’t dry the pieces of sanitary cloth in sunlight neither iron it or keep it in clean places for reuse.

“Drying it in sunlight can be a big source of embarrassment, as everyone in the house will get to know that I am menstruating, so I wash all my cloths collected from five days of my cycle together,” says Zarmina. “To wash every used piece of cloth, every day, I have to use more washing powder. I dry them in the darkness of night and before the sun comes out, I collect them,” she adds.

It is believed that the risk of infection is higher than normal during menstruation because the blood coming out of the body makes a pathway for bacteria to travel back into the uterus. Some practices are more likely to increase the risk of infection, for example the use of unclean pieces of cloths can support the growth of unwanted bacteria that could lead to infection.

Habiba, a social activist from Jalalabad, who has extensively travelled to different districts of eastern Nangarhar province, explains how women deal with these issues in that part of the country. “In rural districts of Nangarhar and other eastern provinces, where I have travelled, women don’t even have proper-undergarments, so they use old pieces of the cloth, rounding it in their pajamas (trousers), which is very uncomfortable for them as they also work in agricultural fields, helping the male members of their family,” says Habiba.

In some other parts of the country, sanitary pads are so expensive that not everyone can afford them. Gul Aram, a housewife from Chura district of central Uruzgan province, in a telephonice interview expressed happiness that during her recent delivery, for the first time in her life, she got to know about sanitary pads after government hospital provided her one. “It has been just few months, we can find sanitary pads in markets of Uruzgan but it is little expensive,” says Aram. “One sanitary pad costs 200 Afg, (4 USD) and one pack containing 5-7 pads costs 1400 Afs (25 USD), making it unaffordable for many women from lower economy bracket. I was lucky to get one pad on my child delivery from the government hospital.”

But there are also women who neither use sanitary pads, not even pieces of cloths. “Some of our patients, who are nomads, don’t even use pieces of cloth during their periods, they wear big pajamas (trousers) and traditional Afghani dress during their periods to hide it,” says Nasreen Nawabe, a doctor at a private hospital in Kabul. “For almost 5 to 7 days, they don’t change their dress. The cloth they wear is generally big, which absorbs all the blood but is highly unhygienic and risky for their health.”

Menstrual cycle a social taboo in Afghanistan
It is not simply about access to sanitary pads, but also about social taboos that have made menstrual cycle a shame and a nightmare that no one wants to talk about here in Afghanistan.

“Afghan society being deeply conservative and patriarchal, lack of literacy and education among women, lack of awareness in society, age-old social norms, unwritten rules and practices, perception of the society towards men and women, services provided by the government, wrong interpretation of religion are some of the reasons that has made this natural issue of women’s life and health a social taboo,.” says Mohammad Nazir Farhang, a Kabul-based sociologist.

There is a perception among Afghan women and girls that during their menstrual cycle they should not bathe or wash their genitals or else they will have “gazag,” (means they will become infertile). They also believe they must not eat fruits like orange, pomegranate during their periods, which according to Dr. Nawabe are just erroneous societal beliefs.

Ministry of Public Health, which is responsible for providing health services, has not had any clear and specific national-level awareness program on women’s menstrual hygiene management. In Afghanistan there are only 373 gynaecologists, out of whom 249 are working in Kabul.  At least 9 provinces do not have a single gynaecologist.

How school-going girls deal with their periods
Kabir Haqmal, spokesperson in the Ministry of Education, provides statistics about school in the country. “Throughout the country, there are 17400 schools out of which 1500 are all-girl schools and rest of them have two shifts, half day for girls and half day for boys,” says Mr. Haqmal. “Only 65 percent schools have buildings and only 32 percent teachers in Afghanistan are female”.

The 65 percent schools having buildings have toilets that are not designed in a way more comfortable for female teachers or students to use, and there is no space where female students could rest during their periods.

In 2010, the Ministry of Education, in coordination with UNICEF, conducted an assessment of drinking water and sanitation facilities in schools. Their assessment was a grim reminder that menstruating girls and women face problems on multiple fronts. “At least 30 percent female students stay home on days they are menstruating. Girls also reported menstrual-related restrictions regarding food, reduced participation in sports and limited opportunities to bathe. The majority of girls, 62 per cent, were found to manage their periods using old pieces of cloth; 30 per cent of the girls used new pieces of cloth and 8 per cent used sanitary pads. All girls reported knowing the importance of washing their hands after changing materials, but only 20 per cent reported having access to soap. For girls who attend school during menses, the environment presents challenges to managing their periods comfortably, such as shortages of water and the location of incinerators for disposing of used materials,” said the report.
However, some positive initiatives have been taken. Ministry of Education has started focusing more on this issue, recognizing it as a challenge, especially since it reduces attendance of female students.

“With the help of partner NGOs, especially UNICEF, toilets in 400 sample schools have been designed specifically to address the problems of female students, and in these 400 schools, a rest room has also abeen designed where girls can rest if they have pain during their periods. Further, these issues will be considered before constructing schools in future,” says Dr. Mohammad Salim Hamadi, Head of Health Department in the Ministry of Education.
Access to sanitary pads and basic healthcare services to girls is a challenge for a country like Afghanistan as it is turning into a barrier for right to education of female students. For Afghanistan, it is high time to take issues of women’s health and hygiene more seriously as Rula Ghani, the First Lady, has vocally spoken about it in recent months.

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