Growing up in Connecticut, Sophia Grinvalds would pick a line with a female cashier when she went shopping for tampons, just to avoid making her purchase in front of a male employee.
But when she ended up working in Africa after graduation, she said she quickly realized that the "sense of fear or embarrassment" that comes along with menstruation and access to supplies in the U.S. can have bigger consequences for women and girls there.
Grinvalds had been living in a remote village in Uganda for five months when she was met with an unpleasant surprise: Her period arrived, but her feminine-product supply had run out.
"I did what any sensible person does," she recalled. "I sent my boyfriend into a village to go and find me some pads."
After coming up empty at the local depots — six-foot-by-six-foot wooden shacks that sell everything from eggs to soap — her now-husband, Paul, hitched a ride on a motorcycle to find a merchant that had Grinvalds' needed supplies in stock. An errand that would have lasted 30 minutes or fewer back home in the U.S. ended up taking Paul more than three hours.
That "rude awakening" about the availability of supplies prompted Grinvalds to ask some schoolmistresses she knew what local women and girls did to manage their monthly periods. A "waterfall of information" followed.
For the women and their female students, menstruation was "more of a barrier to participating in daily life than just a physiological daily experience," Grinvalds recalled. Without access to reliable menstrual products, school and work suffered.
Soon, a new venture producing and distributing pads in developing countries was born. Five years later, AFRIpads estimates that its products have now reached 750,000 women and girls.
That's made all the difference for girls like Amet, a scholarship student at Wurko Secondary School in rural Ethiopia.
With few resources for managing her monthly flow — other local girls used rags and layered underwear to prevent stains — Amet started staying home when her period arrived. “I didn't want to have a leak at school,” Amet recalled. “It would have been so embarrassing.”
Then she got a reusable pad through a program supported by AFRIpads partner Lunapads, a Canadian company that produces reusable feminine products.
“Having them made my life much easier,” Amet, who remained in school as part of the Class of 2015, shared in a recent testimonial.
AFRIpads, run by Grinvalds and her husband, and other companies providing supplies such as pads and period cups to young women in need, represent just one piece of a growing international effort to keep girls throughout the globe in school by providing them with supplies, facilities, and knowledge to manage their periods.
It’s difficult to estimate exactly how many girls are not attending school as they enter puberty because of this basic experience — and there are multiple factors that play a role in keeping an estimated 62 million girls out of the classroom worldwide. But in some developing nations, it's a major problem. According to one widely cited UNICEF statistic, one in 10 schoolgirls in Africa misses school or drops out altogether because of her period.
In Sierra Leone, researchers found that 21% of girls reported skipping class because of their periods. In Afghanistan, that rate jumped to 30%, the 2012 study by UNICEF and Emory University researchers found.
But whether it’s in Bolivia, Nepal, or Uganda, the educational and other barriers faced by girls once puberty hits share similar root causes: limited access to affordable, reliable feminine products, inadequate bathroom and waste facilities at schools, and, at the most fundamental level, an information gap in understanding the changes that come with adulthood.
“It’s such a basic thing. Everybody gets their period,” said Helen Walker, communications and partnerships officer for AFRIpads. “You cannot imagine how difficult it is for these girls.”
Those factors were examined more closely this week, during the fourth annual "WASH in Schools: Empowering Girls’ Education” virtual conference on menstrual-health management. The conference, sponsored by UNICEF and Columbia's Mailman School of Public Health, featured presentations on research and programs in countries across the world, including Bangladesh, Indonesia, Mongolia, Sri Lanka, and Uganda. A range of solutions — and challenges — were discussed during the daylong gathering.
“There is sort of this hope for a magic bullet, like the perfect pad, that will solve this,” Marni Sommer, a conference organizer and associate professor at Columbia University who has studied menstruation-health management for more than a decade, told Refinery29.
But even a never-ending supply of the perfect pad wouldn’t address broader issues, she said, such as the fact that girls and teachers don’t have adequate private restroom and sanitation facilities, and that they lack enough information about what’s happening inside their bodies. Advocates working on the issue agree.
“A holistic approach is definitely what’s needed,” Walker said. “You need to have the pads, you need to have the proper facilities around it, you need to have the education. It’s all linked.”
Basic infrastructure issues continue to be a hurdle to increasing access to education. A 2009 UNICEF survey of schools in Tanzania found that just 11% of schools had enough toilets. Roughly half of those facilities had working water.
A striking two-thirds had no place for disposing of sanitary products. Even subtle design changes, such as providing separate bathrooms for boys and girls, and installing sinks in locations where girls can wash blood off their hands in private, can make a big difference, Sommer said.
Another major barrier is making menstruation less taboo — and better understood. Periods have long been treated as something to be kept secret in many cultures
"What we see often is just such a wide range of information being passed to girls and women," Grinvalds said. "You have girls who are very well informed, may come from households where their moms tell them what to expect…but then you also have girls who get their period and they think there’s something wrong with them because they are bleeding."
Some communities are rife with rumors that tampons and disposable pads are bewitched and will cause infertility, Walker said. In Tanzania, Sommer learned the story of a girl who thought she was deathly ill when she experienced her first period. The father of one girl in Ethiopia wanted to beat her when he learned what was happening.
“It’s traumatic enough to see blood for the first time, let alone think you’re dying or be afraid you’re going to get beat up,” said Sommer, who has created a book on puberty to share with girls, boys, parents, and teachers in the developing world. Hundreds of thousands of copies, tailored to match the language and cultural norms in the target country, have been distributed so far.
The lack of information about menstruation has an impact on more than just girls' access to education. It can also contribute to child marriage — an issue that touches more than 700 million women and girls worldwide. Grinvalds said the arrival of a girl's period is sometimes seen as a sign that she is ready to become a bride or mother. Some girls are taken out of school as a result.
With varying levels of education, income, and cultural sensitivities at play, getting the right supplies to girls in need can be difficult. In addition to selling its products directly, AFRIpads works with NGOs, relief agencies, and other partners to distribute its pads, which are manufactured in Uganda to provide jobs and economic opportunities to local families.
Those partners include Lunapads, the reusable feminine-product company that created its own Pad4Girls program. Co-founders Suzanne Siemens and Madeleine Shaw said they learned of the problem from an activist named Isabella Wright in 2000.
“Isabella actually wrote us a letter in 2000 and basically said, 'Did you know that girls in the developing world don't go to school because they don't have any products to deal with their periods?'" Siemens said, "It never occurred to us, and then when we were told, we realized, yes this is obvious and an issue."
Lunapads now dedicates a portion of its proceeds to providing feminine products to distributing feminine products in developing countries. They've worked with international partners, including AFRIpads, to distribute an estimated 85,000 pads to 14,000 women and girls.
Even as they celebrate stories of success, those active on the feminine-product-distribution front agree that the solution must be multifaceted.
“The assumption that there’s a one-size-fits-all solution is one of the barriers," Shaw said. Introducing disposable products into communities without proper garbage disposal facilities, for example, will create other issues around sanitation. If girls don't have access to fresh water, they can't wash their reusable feminine products. Pads of any form aren't of use to girls who don't have underwear.
“Everybody has a preference of what kind of product they like or what size they need," Shaw said. "Just like anything else, it's very personal."
Sommer and others looking for solutions hope that understanding — along with increased activism and awareness — will lead to more support of research to better comprehend the current situation and the impact of programs in place now. The issue, she said, "strikes a chord and a sympathy" among women who can identify with the near-universal experience of having a period.
“For most of us, there are toilets, there is information, you keep [it] secret, but you manage it without a problem," she said. "It really resonates."