Catastrophic floods highlight Pakistan's recurring poverty

MEach of the more than 8 million women of reproductive age affected by Pakistan’s unprecedented floods are resorting to desperate measures to manage their periods. A woman in hard-hit Balochistan province who called volunteers in distress reported using tree leaves.

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

The floods inundated a third of Pakistan and displaced more than 33 million people. The waters have killed more than 1,400 people and destroyed hundreds of thousands of homes, as well as bridges and roads. More than 660,000 people still live in relief camps and makeshift homes.

On Monday, Prime Minister Shahbaz Sharif said the country was grappling with food shortages. Aid organizations are rushing to provide aid to affected areas, but supplies of menstrual products are often neglected. This is partly due to the stigma surrounding discussing periods in Pakistan, according to Mahnoor.

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“When people associate shame with menstruation, people also don’t talk about menstrual issues,” she tells TIME.

That is why Mahwari Justice chose such an uncompromising name for himself: Mahvari simply means “periods” in Urdu, the national language of Pakistan. As the floods intensified, the group redoubled its efforts to deliver menstrual products to Pakistani women, knowing that the deluge could lead to higher frequency of reproductive and urinary tract infections, making safe menstrual practices even more difficult.

Mahwari Justice has so far delivered 20,000 menstrual kits to those in need, and Mahnoor and her co-founder Anum Khalid are invited to talk about their efforts on the BBC. Together with similar organizations, they also helped generate a general discussion about the most effective way to help women in flood-affected areas.

“It’s something that is very easily overlooked because for many people, and especially for countries like Pakistan – where the laws are made by men, when the aid work is led by men – there is no discussion about what a woman,” says Sana Lokhandwala, co-founder of HER Pakistan. The group has so far distributed more than 7,000 menstrual kits and partners with volunteers, community mobilizers, activists and other organizations to distribute additional essentials such as food, shelter and clothing.

A displaced woman stands in a tent in a makeshift camp near a flooded area after heavy monsoon rains in Rajanpur district, Punjab province on September 4, 2022. (ARIF ALI/AFP via Getty Images)

A displaced woman stands in a tent in a makeshift camp near a flooded area after heavy monsoon rains in Rajanpur district, Punjab province on September 4, 2022.

ARIF ALI/AFP via Getty Images

The needs of rural women in Pakistan

Even before the floods in Pakistan, misconceptions about menstruation were prevalent.

Dr. Sidra Nausheen, assistant professor and vice chair of research in obstetrics and gynecology at the Aga Khan University Hospital in Pakistan’s largest city, Karachi, has worked for many years in rural communities to raise awareness about proper menstrual cycle management. She has met girls and women who don’t shower for a week or avoid drinking hot or cold drinks for fear it will disrupt their periods. Some women would be locked in a room until their period ended. Many girls did not attend school during their periods due to the lack of menstrual products.

“Menstrual hygiene is something that, especially in Pakistan, no one talks about,” Nausheen told TIME. In such an atmosphere, inaccurate information can flourish. “A lot of women don’t know what’s going on with their bodies.

When Mahnoor and Khalid first started Mahwari justice, they researched other disaster relief efforts to learn about the most effective ways to deliver menstrual products. They also spoke directly to women in rural areas to find out which items would be most useful.

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Then they came out with three types of kits. One contains a pack of sanitary napkins and underwear, the second contains small towels and underwear, and the third consists of cotton pads. Diagrams accompany the kits showing the correct way to use the products.

Different circumstances determine which elements are most effective. Lokhandwala of HER Pakistan explains that if the floods have not receded, cloth towels can cause problems as there is no clean water to wash and dry them.

“Cloth mats might work in a community if they’re still living in homes and have laundry supplies, but they might not work in relief camps,” she says.

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

In this photo taken on May 18, 2019, Pakistani woman Hajra Bibi makes a sanitary napkin with a sewing machine at her home in Buni village in Chitral.

AAMIR QURESHI/AFP via Getty Images

Menstrual support for women in Pakistan

Doctors, aid workers and public health advocates have long called on Pakistan to abolish it luxury tax on menstrual products. “Women don’t feel luxurious these days,” says Khalid.

“Menstrual kits [and] sanitary napkins should be free, but the taxes on them are so high that people can’t afford them,” says Dr Alia Haider, a doctor currently working in relief camps. “It is the state’s responsibility to provide us with a healthy life – health should be free.”

But until menstrual products become available, many Pakistani women will have no choice but to rely on private organizations and volunteers for help managing their periods.

Read more: Tampon shortages are the supply chain problem no one is talking about

From 2019 to 2021, Nausheen and her colleagues at the Aga Khan University Hospital conducted fieldwork on menstrual hygiene among women aged 14-49 in Dadu district, Sindh province, an area heavily affected by the recent floods. About 40% of the 25,000 women surveyed in Dadu did not use sanitary napkins or napkins during their periods, instead repeatedly changing and washing their soiled clothes.

“Many didn’t know about reusable pads or the availability of pads. They thought it was very expensive and “we couldn’t afford it,” Nausheen says.

Nausheen and her team taught the women how to sew pads from cheap, absorbent cloth available in the local market. Now about 90% of the women who participated in the study use such pads. Many also make and sell them – even during catastrophic floods.

Khalid of Mahwari Justice says, “Menstruation never stops during any calamity.”

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Write to Sanya Mansoor c [email protected].

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