Lack of money, access and sanitation exacerbates menstrual poverty on Marajó Island

Simone de Souza Menezes, 44, lives with her daughter and husband on the banks of the Mutuacá River, on Marajó Island (PA), in the house she moved to with her partner about 30 years ago, when they got married. They live on around R$150 a month, entirely dedicated to buying food.

Therefore, the family cannot afford menstrual hygiene items, such as sanitary pads. When menstruation arrives, the women of the house resort to pieces of cloth.

“We don’t have the money to buy it, so we’re already used to using the cloth”, says Menezes.

The fabrics are sometimes washed to be reused, sometimes discarded and replaced. Without a bathroom and running water, the residents of the region bathe, wash clothes and dishes in the waters of the river.

With insufficient income for all household expenses, they supplement their food by fishing and hunting animals.

The lack of money, access to shops and adequate sanitation for the necessary care during the menstrual period put Simone and her daughter, Jessica, 23, within the spectrum of menstrual poverty.

The phenomenon, intensified in regions of extreme poverty, is understood as the lack of access by transgender women and men, for example, to menstrual hygiene products, adequate sanitation and sufficient knowledge to deal with menstruation.

To reach an area where Menezes and other riverside dwellers would find pharmacies and other businesses, such as the central region of the municipality of Curralinho, also on Marajó Island, it’s about two hours by boat.

In the tributaries of the Pará River, where part of the population lives, any establishment is rare. To buy menstrual hygiene items, when possible, residents go to small shops in nearby communities, halfway to ​the center of City.

Depending on the vessel, it takes about six hours by boat from Belém, capital of Pará, to Curralinho. The city of about 35 thousand inhabitants has a look marked by houses on stilts that blend in with the vegetation and the waters of the rivers.

The northern region of the country is one of the most affected by menstrual poverty. According to data from the survey “Impact of Menstrual Poverty in Brazil”, carried out by the Always brand in partnership with the research platform Toluna, 36% of women in the region have gone through periods when they could not buy menstrual hygiene products. In second place is the Northeast, with 33%.

For this survey, 1,124 women aged 16 to 29 were interviewed through an online questionnaire, in all regions of Brazil, between February 20 and March 6, 2020.

The North is also the region where women most missed classes because they did not have the money to buy tampons, representing 36% of the total, according to the survey. The Midwest has the second highest score in this problem, with 30%.

The research also shows that, in the absence of sanitary pads, 80% of Brazilian women mainly use toilet paper. Fabrics appear as substitutes for 24% in the country. In the North, where the scenario is more critical, the percentage of cloth use jumps to 53%.

Another study on the subject, carried out by the Semper Livre brand, shows that the North region, in addition to being the most affected by menstrual poverty, is the one with basic sanitation in the most precarious conditions. It has the largest number of homes (36%) where the water comes from a well or spring, as well as the largest number of homes with a septic tank (55%).

It had been about five years since Maria Gonçalves Pastana, 47, had not had a period when she had a hemorrhage. With no pads available, the solution to stop the bleeding was found in pieces of cloth taken from hammocks. At the end of the cycle, she usually burns the scraps in the back of her house.

Pastana lives on the banks of the Tamaiuiu River, about an hour by boat from Curralinho, with four children and her husband. They live on about R$400 a month. They prioritize the purchase of food, but also try to buy sanitary pads for Camila, one of the couple’s daughters.

Even when she menstruated regularly, the mother already gave up the product so that the girl could use it. Last time was no different.

“I couldn’t even afford it, because there were other things for us to buy. So I just used cloth. I used more net cloth because it’s softer than other mesh cloths”, he says.

To alleviate the lack of access to menstrual hygiene items, the Mulheres Livres group, made up of 29 women from Curralinho, makes periodic deliveries of sanitary pads and other items in hygiene kits. The group was founded in November 2020 as a response to the femicide of Leila Arruda, a PT candidate for mayor of the municipality, who was stabbed to death by her ex-husband.

Each kit has absorbent, deodorant, shaver, soap, toothbrush and toothpaste. The group takes advantage of the meetings where the products are distributed to the residents to talk about issues that afflict women in the region, such as domestic violence.

“Right after her femicide [Leila Arruda] we made an act of protest, asking for justice. After this act, we saw that it was not possible to just protest when a woman died. We had to take actions aimed at saving women from abusive relationships and trying to avoid femicide”, says Cibelle Natália Santos, founder of the group.

On a visit to the Três Bocas community, on the Mutuacá River, about two hours from the central region of the municipality, the group gathered, for example, around 80 women and adolescents.

After two hours of discussion, the leaders left by boat towards the riverside houses who could not attend or did not know about the meeting, giving information about their work, distributing the kit and showing how to identify and report cases of domestic violence.

Celia dos Santos was one of those who received the group’s hygiene kit. She, her nine siblings and their parents live in a house on the top of the Mutuacá River. They live on the income that their father earns by harvesting açaí and selling wood. Outside the fruit harvest season, they complement their diet by hunting animals such as monkeys and sloths.

Like the other four sisters, Celia uses pieces of cloth as a sanitary pad. Once used, she often throws it away – she prefers to get another one rather than wash and reuse. With no bathroom at home, she does her personal hygiene on the banks of the river.

For Ana Paula Gonçalves, master in public health and professor at the Faculty of Nursing at UFPA (Federal University of Pará), although there are several causes for menstrual poverty —such as lack of access to hygiene items, basic sanitation and information— poverty is the main driver of this problem.

The professor says that national public policies would be good resources to mitigate the effects of menstrual poverty even in more remote areas, such as riverside communities in the North region.

This would be the case of the bill vetoed by President Jair Bolsonaro (PL) in October 2021. It provided for the free distribution of sanitary pads to low-income students enrolled in public schools, homeless women, in extreme vulnerability, prisoners, seized and carrying out socio-educational measures.

By vetoing the distribution, the federal government claimed that the bill’s articles do not indicate the source of funding or compensatory measure, which would violate the Fiscal Responsibility Law. The veto will still be analyzed by Congress.

For Gonçalves, in addition to the free delivery of sanitary pads, measures to mitigate menstrual poverty should aim at tax exemptions on hygiene items related to menstruation.

“We also hope that all these bills that are being structured actually manage to implement policies to raise awareness about menstruation and universal access to sanitary pads, whether in the SUS, in schools or in more distant units, such as districts and municipalities”, he says.

_{Isabella Menon, from São Paulo, collaborated.}