Men­stru­al pe­ri­od symp­toms may be linked to near­ly nine days of lost pro­duc­tiv­i­ty every year through pre­sen­teeism, a peer-re­viewed in­ter­na­tion­al study has stat­ed.

But the re­al im­pact on women and so­ci­ety is un­der­es­ti­mat­ed and poor­ly ap­pre­ci­at­ed, say the re­searchers in the largest study of its kind which was pub­lished in the on­line jour­nal BMJ Open.

The study set out to eval­u­ate lost pro­duc­tiv­i­ty as­so­ci­at­ed with men­stru­al symp­toms, as mea­sured by time off from work or school (ab­sen­teeism) and work­ing or study­ing while feel­ing ill (pre­sen­teeism) in 32,748 Dutch women be­tween the ages of 15 and 45.

Those sur­veyed were asked if their symp­toms had prompt­ed them to take time off from work or school and/or had af­fect­ed their pro­duc­tiv­i­ty while work­ing or study­ing, as well as how of­ten this had hap­pened.

Ac­cord­ing to the study, those sur­veyed said that their blood loss last­ed an av­er­age of five days.

In all, around one in sev­en re­spon­dents (just un­der 14 per cent, 4,514) said they had tak­en time off from work or school dur­ing their pe­ri­od, with near­ly 3.5 per cent (1,108) say­ing this hap­pened dur­ing every, or near­ly every, men­stru­al cy­cle.

The av­er­age amount of sick­ness leave tak­en came to just over one day a year.

Re­searchers con­clud­ed that, “Men­stru­a­tion-re­lat­ed symp­toms cause a great deal of lost pro­duc­tiv­i­ty, and pre­sen­teeism is a big­ger con­trib­u­tor to this than ab­sen­teeism.”

“Tak­ing all the symp­toms in­to ac­count, it seems like­ly that the re­al im­pact of (men­stru­a­tion-re­lat­ed symp­toms) is un­der­es­ti­mat­ed in the gen­er­al pop­u­la­tion.”

But it is not open­ly talked about, the re­searcher added.

This sit­u­a­tion is, how­ev­er, not on­ly tak­ing place be­yond our bor­ders.

And as such from next month the Crown Her project will be launched to help tack­le the is­sue.

Crown Her is a non-gov­ern­men­tal or­gan­i­sa­tion ini­tia­tive spear­head­ed by The Su­per­mar­ket As­so­ci­a­tion, ini­tia­tive mem­ber Dr Nadi­ra Ram­bo­cas part­ner­ing with the T&T Med­ical As­so­ci­a­tion, Ro­tary Clubs of Pi­ar­co, San­gre Grande, St Au­gus­tine and St Au­gus­tine West and The Greater Tu­na­puna Cham­ber of In­dus­try and Com­merce.

“In or­der to lend the high­est cre­dence to the Crown Her ini­tia­tive, a pro­posed aca­d­e­m­ic study crouched with an aca­d­e­m­ic frame­work un­der the guid­ance of peer­less in­sti­tu­tions such as the Uni­ver­si­ty of the West In­dies, will seek to pro­duce the rel­e­vant da­ta to re­flect pe­ri­od pover­ty as an is­sue of great na­tion­al con­cern,” Maria Mo­hammed-Ma­haraj stat­ed.

“The study will en­sure that the re­sults are re­pro­ducible as well as min­imis­ing any bias where the study is to be un­der­tak­en,” she stat­ed.

Crown Her stat­ed that it is aim­ing to ad­dress the is­sue head on.

“On a world­wide ba­sis, one in every two women lack the es­sen­tial san­i­tary prod­ucts due to their high costs. This in­equitable sit­u­a­tion, cou­pled with in­ac­ces­si­bil­i­ty, has been made more ap­par­ent dur­ing this cur­rent COVID-19 pan­dem­ic. Many women are forced to search for al­ter­na­tive means, in­clud­ing clothes and blan­kets or un­san­i­tary items in or­der to man­age their in­evitable men­stru­al cy­cles,” the Crown Her project states.

“To­day, un­for­tu­nate­ly, these women are forced to view these men­stru­al prod­ucts as more of a lux­u­ry when it should be con­sid­ered a nec­es­sary com­mod­i­ty,” it stat­ed.

As such Crown Her has stat­ed that one pos­si­ble so­lu­tion in al­le­vi­at­ing pe­ri­od pover­ty and there­by con­tribut­ing to pos­i­tive fe­male health is by re­duc­ing or elim­i­nat­ing costs as­so­ci­at­ed with these fem­i­nine prod­ucts.

“This, how­ev­er, re­quires gov­ern­ment col­lab­o­ra­tion in elim­i­nat­ing tax­es or en­sur­ing at least one san­i­tary prod­uct be made free for all men­stru­at­ing women,” it stat­ed.

“To get this done this would in­volve, con­duct­ing a sur­vey to de­ter­mine need and cost as­so­ci­at­ed with these prod­ucts from var­i­ous stra­ta of the men­stru­at­ing pop­u­la­tion, draft­ing of leg­is­la­tion to en­sure this pro­pos­al is vi­able and sus­tain­able whilst en­gag­ing the var­i­ous rel­e­vant Min­istries in en­sur­ing fem­i­nine prod­ucts are made ac­ces­si­ble to all,” the Crown Her project has stat­ed.

Scot­land was the first and on­ly coun­try to of­fer free men­stru­al prod­ucts.

“It has been shown that at least one free fem­i­nine or men­stru­al hy­giene prod­uct will not on­ly en­hance phys­i­cal health but will al­so pos­i­tive­ly im­pact on so­cial and eco­nom­ic health as well. Women will no longer need to iso­late them­selves, com­pro­mise their phys­i­cal health, avoid school or work due to lack of the nec­es­sary tools need­ed dur­ing their menses, bud­get or sac­ri­fic­ing from their earn­ings and there­fore can con­duct their dai­ly lives care­free and par­tic­i­pate with dig­ni­ty,” it stat­ed.

Crown Her stat­ed that many girls and women buck­le un­der the pres­sure of bills that come with han­dling their month­ly men­stru­al cy­cles.

“The av­er­age fe­male ex­pe­ri­ences ap­prox­i­mate­ly 500 men­stru­al cy­cles in their life­time and ac­cord­ing to in­ter­na­tion­al da­ta and from per­son­al ex­pe­ri­ence can spend up to $100 a month to over $1,200 a year on men­stru­al prod­ucts alone. This equates to over $45,000 over her re­pro­duc­tive life­time (av­er­age range of menses 12 years to 50 years),” it stat­ed.

“Alarm­ing­ly, this cost is sig­nif­i­cant­ly greater ow­ing to var­i­ous oth­er ex­pen­di­ture as­so­ci­at­ed with hav­ing a men­stru­al cy­cle such as: doc­tor’s vis­its, pain and ac­ne med­ica­tion and birth con­trol use,” Crown Her stat­ed.

Crown Her, there­fore, stat­ed that over a life­time any woman can spend over $126,000 or more.

“As such, the on­set of menses means a new ex­pense, risk of in­fec­tions, and even days off school or work,” it stat­ed.

Crown Her stat­ed that for too many women, ac­quir­ing these prod­ucts is a lux­u­ry and not a com­mod­i­ty.

“Most gov­ern­ments have failed to re­alise that fem­i­nine hy­giene is a na­tion­al health is­sue: a nat­ur­al bi­o­log­i­cal process that many fe­males have lim­it­ed con­trol. With the on­set of the COVID-19 pan­dem­ic, this pres­sure has risen tremen­dous­ly with our strug­gling econ­o­my. It has es­pe­cial­ly be­come a huge ex­pense for those fam­i­lies on the low­er eco­nom­ic stra­ta,” it stat­ed.

“It should there­fore be a cru­cial mat­ter that should be ad­dressed by gov­ern­ment to as­sist our women. Men­stru­al prod­ucts are es­sen­tial and ba­sic ne­ces­si­ties for women and lack of ac­cess can lead to health is­sues, low pro­duc­tiv­i­ty, and less par­tic­i­pa­tion with dig­ni­ty,” Crown Her stat­ed.

Crown Her com­mend­ed Dwayne Bra­vo on his san­i­tary nap­kin ma­chine ini­tia­tive and the var­i­ous non-gov­ern­men­tal or­gan­i­sa­tions such as Help­ing Her foun­da­tion and the PNM women’s league for as­sist­ing in pro­vid­ing af­ford­able and free men­stru­al prod­ucts to our women.

“Whilst, we ap­plaud that these prod­ucts are in­deed VAT (Val­ue Added Tax) ex­empt­ed, we would how­ev­er ap­peal to the Min­istry of Youth and Gen­der Af­fairs, the Min­istry of Health, The Di­rec­tor of Women’s Health, The Of­fice of the At­tor­ney Gen­er­al and the Min­istry of So­cial De­vel­op­ment T&T to en­sure at least one fem­i­nine men­stru­al prod­uct be made avail­able free,” it stat­ed.

Crown Her stat­ed that it recog­nis­es that the im­ple­men­ta­tion of free fem­i­nine prod­ucts by the rel­e­vant au­thor­i­ties will in­volve a long process.

“We rec­om­mend that these be made avail­able on the cur­rent­ly ex­ist­ing CDAP (Chron­ic Dis­eases As­sis­tance Pro­gramme) to en­sure that this process is amenable and fea­si­ble. We note that CDAP which costs ap­prox­i­mate­ly $11.2 mil­lion (Joint Se­lect Com­mit­tee Re­port, 2019) and is man­aged by Nipdec (Na­tion­al In­sur­ance Prop­er­ty De­vel­op­ment Com­pa­ny Ltd) that ten­ders for phar­ma­ceu­ti­cals and whose ad­ver­tised fi­nan­cial re­ports in­di­cat­ed a prof­it of $27.2 mil­lion in 2019,” it stat­ed.

“There­fore, the in­tro­duc­tion of at least one fem­i­nine hy­giene prod­uct on the CDAP pro­gramme should be eco­nom­i­cal­ly fea­si­ble util­is­ing our fe­males’ birth cer­tifi­cate PIN or Na­tion­al Iden­ti­fi­ca­tion Card,” Crown Her stat­ed.

Sorop­ti­mist In­ter­na­tion­al Es­per­ance

Al­so adding their voic­es to the is­sue of pe­ri­od pover­ty is the Sorop­ti­mist In­ter­na­tion­al Es­per­ance team.

Es­per­ance is a French word that trans­lates to hope in Eng­lish.

And pro­vid­ing “hope” is ex­act­ly what Rab­bia Khan of Sorop­ti­mist In­ter­na­tion­al Es­per­ance says is the aim of the ini­tia­tive.

“We fo­cus on women and girls we want to trans­form the lives and sta­tus of women and girls by pro­vid­ing the three Es: ed­u­ca­tion, em­pow­er­ment and en­abling op­por­tu­ni­ties,” Khan said.

Khan said the pe­ri­od pover­ty ini­tia­tive falls un­der the Health and Food Se­cu­ri­ty Gen­der Par­i­ty and Eco­nom­ic Em­pow­er­ment of women.

“Be­cause if a woman feels se­cure in her­self she can have greater po­ten­tial,” Khan said.

Khan said the is­sue of men­stru­a­tion af­fects about 3.5 bil­lion around the world month­ly.

And pe­ri­od pover­ty is a con­cern.

“So we do have the prob­lem but it is a very qui­et prob­lem,” she said.

“We have many girls and women who can­not af­ford to buy these prod­ucts be­cause they are quite ex­pen­sive and that was why I was ap­peal­ing to the gov­ern­ment to re­move cus­toms du­ty or even sub­sidise be­cause women prod­ucts are es­sen­tial but it is seen as a lux­u­ry item,” Khan said.

Khan said there is cur­rent­ly no re­lief from the is­sue.

“Some women ac­tu­al­ly miss work and some women may be ashamed to say why they are stay­ing at home whether it is be­cause they can­not af­ford it,” Khan said.

“Now women who are work­ing will al­so have that prob­lem but some­one would have a lot of pain dur­ing men­stru­a­tion and that is en­dometrio­sis,” she said.

En­dometrio­sis is an of­ten painful dis­or­der in which tis­sue sim­i­lar to the tis­sue that nor­mal­ly lines the in­side of your uterus—the en­dometri­um—grows out­side your uterus.

Khan said the is­sue is so preva­lent that there is a reg­is­tered non-prof­it or­gan­i­sa­tion named the T&T En­dometrio­sis As­so­ci­a­tion (TTEA).

Sorop­ti­mist In­ter­na­tion­al Es­per­ance cur­rent­ly has a pi­lot project go­ing on in the Bar­rack­pore area with two schools.

Khan said Al­stons Mar­ket­ing Com­pa­ny Ltd (AM­CO) has helped the group pro­vide two packs of san­i­tary pads month­ly for 80 school­girls last term.

“We want to pro­mote not on­ly pe­ri­od pover­ty but pe­ri­od pos­i­tiv­i­ty. We want girls to re­alise that there is no shame, there is no taboo, you are not dirty at this time we want to em­pow­er them and make them feel pos­i­tive and find their po­ten­tial,” Khan said.

Khan said the Men­stru­pe­dia com­ic which is a guide to ed­u­cate peo­ple around the world about men­stru­al cy­cles has al­so been or­dered to help in their ed­u­ca­tion dri­ve.

End pe­ri­od pover­ty

The Al­ways #End­Pe­ri­od­Pover­ty cam­paign was of­fi­cial­ly launched on April 1 and will run un­til June 30.

AM­CO se­nior brand man­ag­er Tiffany George said dur­ing this time, con­sumers have the op­por­tu­ni­ty to get in­volved with the ini­tia­tive as every Al­ways pur­chase will trig­ger a do­na­tion.

For every pack of Al­ways pads pur­chased, Al­ways will in turn di­rect­ly do­nate to a girl in need.

This she said will help women who may have lost their jobs and may be pick­ing and choos­ing what they buy each month.

This year Al­ways said it aimed to do­nate over 160,000 san­i­tary pads to sev­en sec­ondary schools in T&T: Coryal Sec­ondary, Mor­vant Laven­tille Sec­ondary, Matu­ra Sec­ondary, Pe­nal Sec­ondary, Pa­lo Seco Sec­ondary, Guayagua­yare Sec­ondary and Spey­side Sec­ondary.

NGO Kids in Need of Di­rec­tion (KIND) will once again part­ner with Al­ways to as­sist with the dis­tri­b­u­tion of the san­i­tary pads, along with the as­sis­tance of the Help­ing Her Foun­da­tion.  

As part of the cam­paign, a host of so­cial me­dia in­flu­encers will be en­gaged to help in­crease aware­ness, ed­u­cate and ad­vo­cate for the needs of girls and women fac­ing pe­ri­od pover­ty.

Some of this year’s in­flu­encers are Anasha Tewari-Bridge­lal, Leah Her­bert, Megan Mo­hammed, She­nilee Hazell, The­ma Williams, Whit­ney Hus­bands and Kee­van Lewis.

George de­scribed the Crown Her ini­tia­tive as a “re­al­ly nice ini­tia­tive try­ing to bring a per­ma­nent so­lu­tion.”

STEPS IN­VOLVED IN PROCESS FOR THE CROWN HER PROJECT:

1. De­ter­min­ing the need for san­i­tary prod­ucts and en­sur­ing men­stru­al eq­ui­ty by con­duct­ing a prospec­tive sur­vey over a three month pe­ri­od. This sur­vey/study would in­volve fe­males us­ing a spec­i­fied age range from var­i­ous dis­tricts through­out T&T.

2. Sub­mis­sion of study re­sults to the rel­e­vant au­thor­i­ties and stake­hold­ers in­volved. The sub­se­quent for­ma­tion of a par­lia­men­tary sub­com­mit­tee to as­sim­i­late the rel­e­vant in­for­ma­tion, de­ter­mine fea­si­bil­i­ty in­clud­ing bud­get al­lo­ca­tion and draft­ing of the nec­es­sary leg­is­la­tion to be de­bat­ed in Par­lia­ment.

3. De­bat­ing in Par­lia­ment and sub­se­quent en­act­ment of the rel­e­vant leg­is­la­tion in­to the laws of T&T.

4. Procla­ma­tion of the es­tab­lished law and dis­sem­i­na­tion of at least one free ap­pro­pri­ate men­stru­al prod­uct to all fe­males es­pe­cial­ly to those in the low­er eco­nom­ic stra­ta.

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