Expensive sanitary pads: Agony of girls using clothes for menstruation
High cost of sanitary pads, aided by economic hardship and poverty, may expose Nigerian teenage girls to infections and infertility amid lack of access to water supply as they now resort to the use of old pieces of fabric, and other unhygienic practices when observing their menstrual periods. ANGELA ONWUZOO reports
Sitting on a bench in front of their compound, the crowded type typically known as‘ face-me-I-face-you’ in Bariga, a suburb in Lagos State, with her left hand supporting her jaw that hot Saturday afternoon, Faith was lost in thought and starred into space.
Running through her mind is where the next meal will come from and the inconveniences she will endure during her next menstruation, which is days away, due to lack of access to safe sanitary pads.
Faith’s family, which had been struggling before the surge in economic hardship in the country now survives on one meal per day.
The 17-year-old SS2 student usually lends her mother a helping hand in her fufu (cassava-pounded meal) business when she returns from school.
After struggling to assist in preparing the fufu in their one-room apartment and also hawking in the neighbourhood, the business is still unable to provide the money needed to procure her sanitary pads every month.
Since October 2023, menstruation has become a nightmare for the teenager not because of the severe pain she endures for the four days it will last, but due to the unhygienic practices she was forced to embrace due to lack of access to sanitary pads.
Faith told PUNCH Healthwise that she gets troubled and traumatized whenever her period is around the corner as she finds it uncomfortable using clothes to absorb the blood amid a lack of access to clean water supply.
“I stopped using sanitary pads during my menstruation in October 2023. It became so expensive that my mother could no longer afford them. Sanitary pads are now so expensive that children of the poor like us can hardly afford them.
“My mother used to buy them for me before the price hike. But the money she makes from her business presently can barely put food on our table let alone buy sanitary pads since the prices of food items and household goods have become very expensive in the country”, she said with a pale look.
Period poverty
Faith’s experience is known as period poverty, which the United Nations Population Fund says is the struggle many women and girls in low-income countries face while trying to access menstrual products.
Experts say menstruation (also known as ‘period’) is a normal biological process experienced by millions around the world each month.
This happens when the uterus sheds blood and tissue from the uterine lining and leaves the body through the vagina.
UNFPA states that a woman menstruates for an average of 2,535 days in her lifetime or almost seven years out of 39 (Five days per 28-day cycle).
An emotional Faith said the country’s harsh economy had inflicted poverty on her family as her father had been unable to return to his transport business since September last year due to a lack of funds to repair his faulty vehicle.
Looking gloomy, the young lady said the inability of her parents to provide the much-needed sanitary pads during her menses due to poverty was worse than the menstrual pain she experiences any time she is observing her period.
Using clothes for menstruation
She recounted, “Before when a pack of sanitary pads with three pieces inside was sold for N200, my mother bought them for me because she could afford them.
“She used to buy four packs for me. And sometimes when I experienced heavy flow, she would buy five packs. My concern then was the pain and not the pad.
“ But now a pack of sanitary pads sells for N500, and I need at least four packs for the days my period will last every month. Right now, she can’t afford it. That N500 per pack is the least you can get in the market. Others are sold between N800 and N2,000.”
Overcome by emotion, she burst into tears, saying, “When it became obvious that my mother could not afford the cost of sanitary pads anymore, she cut one of her wrappers into four pieces and gave them to me to use for my menses going forward. So, that is what I have been using since October 2023 till today.”
The teenager who does not have access to a water supply further lamented, “I find it weird and frustrating washing those menstrual clothes though the blood is from my body. The sight can be traumatizing and distressing because we are talking about human blood here.
“The worst is that we have no well or borehole in our house, and rarely have cart-pushing water vendors frequent my area. So, I have to carry a big bucket of water perched on my head, fetched from several streets away with the menstrual pain. This is the only way to get water to wash them.”
The United Nations Children’s Fund states that poor menstrual hygiene can pose physical health risks and has been linked to reproductive and urinary tract infections.
Psychological torture.
Faith lamented that each day of her period comes with trauma and psychological torture as the use of clothes not only restricts her moment when they get soaked but also causes embarrassing itching in her private part.
‘Sometimes, when I am soaked, I will start feeling some itch in my vagina. But I do not experience the vagina itching when I use sanitary pads”, Faith told PUNCH Healthwise.
Besides irritation, the use of clothes during menstruation also impacts her education negatively.
“I rarely pay attention in class whenever I am observing my menses because I am always worried that the blood will stain my uniform,” she muttered looking downcast.
“Clothes can’t absorb blood like sanitary pads. I can’t change when I am soaked in school because our toilets are dirty. We don’t have a regular water supply. I can’t even sit comfortably in class when I am menstruating. I am always isolated until my period is over.”
Faith’s mother, who does not want her name published for fear of stigmatisation; told our correspondent that survival would not have been this difficult for her and her four children if the husband’s motor business did not suffer a setback.
Double jeopardy
Generally, menstrual pain is harrowing, but having to deal with a lack of access to sanitary pads or products whilst menstruating seems like double jeopardy.
Regrettably, this is the reality of many teenage girls in Nigeria today, as the economic situation has plunged families struggling to survive before the removal of petrol subsidy in May 2023 by the Federal Government, further into untold hardship.
This is even worse in rural areas, where primitive cultural practices are still rife and women and girls are sometimes denied access to their rights.
The consequences of unhygienic practices during menstruation occasioned by lack of access to sanitary pads are, however, made worse by the lack of water, sanitation, and hygiene facilities in schools.
Endless trauma
Bose,15, who lives with her parents in the Alimosho area of Lagos, told PUNCH Healthwise that using clothes to observe her period can be frustrating,
“Imagine having a painful period, and lacking access to menstrual products. It can be traumatizing. I use clothes for my period because sanitary pads are expensive and my parents can’t afford them. While I am struggling with menstrual pain, I will still go and fetch water with the pain to wash the clothes. The experience is horrific”, she moaned.
The SS1 student, whose father is a wielder and mother, a soft drinks hawker in one of the markets in the area, said she was told by to improvise with clothes during her period like some of her peers whose parents can no longer afford sanitary pads.
“My mother advised me to start using clothes cut into pieces to observe my period as pads have become so expensive,” she said shyly.
Another teenager from the Mushin part of Lagos, Joke, whose voice broke at intervals while narrating her ordeal to our PUNCH Healthwise said she and her two younger sisters on their own, resolved to use clothes for their periods when they realized that their mother, a widow and vegetable seller, was buying pads for them on credit.
The 19-year-old, said, “Before, when pads were not this expensive, the three of us spent about N3000 to buy pads every month. But now that the price has gone out of the reach of the poor, we can’t afford it.
“My mother will have to spend over N7,000 every month to buy us the number of pads that will serve for the month in addition to the cost of painkillers that we need to relieve menstrual pain. Where is the money when we are struggling to eat once a day?”
About eight other teenage girls from Orile, Ketu, Shomolu, Ibeju-Lekki, Badagry, and Ikorodu parts of Lagos, who spoke with PUNCH Healthwise shared similar disturbing and frustrating experiences of using pieces of fabric to observe their menses over the exorbitant prices of pads.
16-year-old Aisha from Kogi State said she misses school any time she has to use clothes cut to size for her menstruation.
Sanitary pads
She recalled that the use of clothes was encouraged by her mother when pads became so expensive and unaffordable.
The SS3 students blurted out angrily, “One day I went to school and the cloth that I used got soaked and stained my uniform. I wasn’t even aware that my uniform was stained with blood. It was my classmate that alerted me to it. I felt very bad and embarrassed.
“This happened around November last year and since then, I stopped going to school on the second day of my menses when I usually experience a heavy flow. “
Eberechi, 20, who lives with their parents in Aba, Abia State could hardly find words to describe how she feels using tissue paper when menstruating.
She said, “In January when the prices of sanitary pads became so high with a pack I normally buy for N500, selling for N1,200, my mother asked me to use tissue paper because it is cheaper than pads.
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“So, since then, I have been using tissue papers to observe my menses. But you can’t compare tissue papers to sanitary pads. When tissue papers get soaked, they will break into pieces. It is inconvenient to use tissue paper for menses because the blood can easily leak and stain your dress.”
In Rivers State, a 17-year-old teenager, Elizabeth became traumatised after her mother told her to start using pieces of fabric for her menses.
She narrated, “I have been using a sanitary pad since I began seeing my menses in 2021. My parents were able to buy them for me and my older sister.
“But when sanitary pads became so expensive, my mother asked us to look for an alternative so that they could meet other needs in the house.”
A distraught Elizbeth described their experience as what one typically sees in Nollywood movies.
“So, my elder sister suggested we use clothes that some of her classmates whose parents can no longer afford sanitary pads have resorted to the method for their periods. But it has not been easy because we don’t have access to water supply in my area and we need a lot of water to keep those clothes clean whenever we are menstruating”, she lamented.
500 million lack access to menstrual products – UNFPA
Worldwide, the UNFPA says an estimated 500 million people lack access to menstrual products and adequate facilities for menstrual health even as menstrual health is key in ensuring that individuals have control over their bodies and can make informed decisions about their reproductive health.
They also do not have adequate facilities for menstrual hygiene management like clean water and toilets.
Obviously, for these vulnerable girls and their families from Kano, Adamawa, Oyo, Enugu, and other states across the country, whose names were changed in this PUNCH Health report to protect their privacy, survival has been tough due to sanitary pad hike.
Unfortunately, this has become the horrid reality they have been facing in the last eight months.
Unanimously, they appealed to the federal and state governments and other stakeholders to provide free sanitary pads for adolescent girls to enable them to realise their potential in the pursuit of quality education.
High cost of sanitary pads
To graphically capture the distressing experiences faced by these hapless teenage girls, PUNCH Healthwise embarked on a market survey and it was discovered that the cheapest sanitary pads were beyond the reach of many girls.
Depending on the brand, a pack of pads that were sold for N300 before, now sells for N700, while the one sold for N500, is now N1,000.
Also, a pack of pads that used to be bought for N1,000 is now N2,000, while that of N1,500 sells for N2,500.
Risk of urinary tract infections and infertility
Physicians say this unfortunate development calls for concern, warning that the use of clothes and tissue papers for menstrual periods exposes girls to many health risks including urinary tract infections.
A renowned Professor of Obstetrics and Gynaecology, with over 40 years of experience in healthcare delivery and development work, Oladapo Ladipo, told PUNCH Healthwise that girls using clothes and tissue papers for menstruation are at risk of infections that could lead to infertility later in life.
Ladipo, who is the co-founder of the Association for Reproductive and Family Health said, “The use of tissue papers and pieces of clothes is not ideal because of the risk of infection.
“Girls should not be using tissue papers for menstruation. How much will it absorb and they are not clean enough like the tampons? It may absorb but the risk of infection is there.
The maternal health expert warned, “When they get infected in the genital tract, if it gets to the upper reproductive tract, they may have pelvic infection.
“And if that happens, the two fallopian tubes may be blocked, and later on, they will face infertility problems when they get older and are married. So, we need to avoid that.”
The gynaecologist stressed that using sanitary pads is ideal for menstruation.
Little impact from VAT exemption
As part of efforts to address period poverty, the Federal Government in 2020 exempted locally manufactured sanitary towels, pads, and tampons from value-added tax.
The move which earned the FG several accolades from female activists, appears not to be having any effect four years after as prices of sanitary products continue to soar.
Economists say the exemption will have little impact because the product is a consumption tax and not a production tax.
Poverty reigns
The World Bank said that with sluggish growth and rising inflation, the number of poor persons in Nigeria rose by 24 million between 2018 and 2023 to 104 million. The WB noted that four million fell into the hole of poverty in the first six months of 2023.
Also, UNICEF projected that about 25 million Nigerians will be at risk of hunger in 2024 unless urgent steps are taken.
The UN Food and Agriculture Organisation had also forecast that 26.5 million will face acute hunger this year.
Across Nigeria, the lack of access to menstrual hygiene products due to high cost has had a huge impact on many girls from vulnerable homes.
Vaginal infections.
In a 2021 study published in the African Journals Online titled, “ Menstrual hygiene management among adolescent school girls in Taraba State, Nigeria’ the researchers from the Department of Public Health, Faculty of Health Sciences, Taraba State University, Jalingo, said poor personal hygiene and unsafe sanitary conditions have primarily resulted in gynaecological problems among the adolescent girls.
“A preponderance of cases of infections due to lack of hygiene during menstruation has been reported.
“Hidden micro-organisms and vaginal infections have been reported to be caused by frequent use of unclean napkins or improperly dried cloth napkins before their reuse”, the researchers said.
Experts react
Different experts who spoke with PUNCH Healthwise on the issue also confirmed that it is unhealthy to use clothes and tissue paper for menstruation while calling on the government to make pads free for adolescent girls.
UNICEF Health Specialist, Dr Ijeoma Agbo, in an exclusive interview with PUNCH Healthwise, acknowledged that as a result of poverty, a lot of girls cannot afford sanitary or safe menstrual products.
She noted that lack of access to sanitary pads leads to poor hygiene measures during menstruation, warning that this could pose a serious health risk.
“Of course, when they use clothes and tissue papers, you see them coming down with reproductive and some urinary tract infections. It is mainly from poor hygiene.
“We know that poverty is an issue but we also advocate that the government for once should ensure that these girls have access to sanitary facilities; clean water, clean toilets, clean sanitation, and hygiene facilities”, the health specialist said.
Speaking also, the Executive Director, Public Health Sustainable Advocacy Initiative, Abiodun Ajayi, said the government should wake up to its responsibility and address the problem of poverty period for adolescent girls in Nigeria, which he observed had been worsened by rising poverty.
He said the government should include sanitary products in its palliative distribution, adding, “The government is making efforts to share food palliative but more often, they forget that palliative should not only be targeted at food. We have a future we need to protect and this future also deserves this palliative.
“The government should be holistic in its approach. In a family, we may have seven adolescent girls who menstruate every month. So, the government needs to find a way of empowering their parents financially. The government needs to make sanitary products available for girls.”
Agbo asked the government to make affordable sanitary products available for adolescent girls and also provide WASH facilities in schools.
“They should ensure that these girls have affordable sanitary products that they can use”, she added.
The UNICEF health specialist also recommended leveraging private organisations to support adolescent girls with safe menstrual products in schools.
Meanwhile, a Professor of Obstetrics and Gynaecology, Oladapo Ladipo said, “Since people are not able to buy sanitary pads because of poverty, the government should make them free for young adolescents in particular in schools.
“ Fortunately we have a new Minister of Health now who is very dynamic and I think the Federal Government is pro-health.
“So, we hope that there will be a possible response to our recommendations to them. They are partnering with stakeholders and they have listening ears.”
On his part, Ajayi said while the government is distributing food palliative, they should ensure that pads are distributed as palliatives at strategic locations.
For the immediate past Provost, College of Medicine, University of Lagos and new Board Chairperson of the Medical and Dental Council of Nigeria, Professor Afolabi Lesi, non-governmental organisations can come in and subsidise the cost of sanitary products for girls.
“People have to step in. This is important and NGOs have to step in and make cheaper sanitary products available in schools and they can get it for free if possible”, he averred.
