This year marks the 10th anniversary of the first celebration of International Menstrual Hygiene Day – a global campaign which aims to recognize the importance of menstrual hygiene management (MHM). MHM refers to the access to menstrual hygiene products to absorb or collect menstrual blood flow, privacy to change materials, and access to disposal facilities of menstrual management materials.1
Although Menstrual Hygiene Day on May 28 has been observed for the past decade, the recognition of the importance and impact of menstruation on the lives of girls and women has only recently gained attention. After all, menstruation, MHM, menstrual poverty and menstrual stigma are topics that are on the margins of sexual and reproductive health and rights (SRHR).2
Aside from the terms of MHM, period poverty, and period stigma, there has been a rise of the concept called menstrual justice. Margaret E. Johnson describes menstrual justice as the counter to menstrual injustice, which she defines as the oppression of individuals who menstruate, including women, girls, transgender men and boys, and non-binary people, solely because of their menstruation.3
It is important to note that using the terms MHM, period poverty, period stigma, and menstrual justice does not imply that they are mutually exclusive. In fact, these concepts are interconnected and often overlap in addressing the broader issues surrounding menstruation. Recognizing this interconnectedness is crucial for a comprehensive approach to improving menstrual health and equity.
Period Justice in North Macedonia
Menstruation poverty became a topic in North Macedonia in 2018, when the first research on this issue came out, which contained shocking numbers – among which the fact that 15% of women do not use any hygiene products; however, only self-made textile, pads or even paper and newspapers.4 But this topic got its momentum in 2021, when the first comprehensive study “Menstrual Justice” by Tiiiit! Inc. and Reactor was published, which contains an assessment of the situation of menstrual poverty and recommendations for the improvement of policies. The study shows that 71% of the research participants have not heard of the concept of period poverty. At the same time, almost every third participant answered that at least once in their life, and half of the participants more than once, found themselves in a situation where they did not have money to buy pads and had to improvise with towels, toilet paper or other material.
What is the cost of menstrual health?
The financial burden of menstrual health is a significant yet often overlooked aspect of women’s lives, and understanding it is crucial in addressing gender equality. Altogether, the cost of menstrual products and pain medications throughout a woman’s reproductive years averages €3,2455. At first glance, this might not seem like a lot, but a person with average monthly salary in North Macedonia would need to work approximately 7.2 months in their lifetime to cover these expenses. And that is still less, compared to women earning minimum wage, who will need 1 year and 1.7 months6 to cover the same expenses. These figures underscore the significant financial impact of menstrual health on individuals’ lives.
Period Stigma
Aside from period poverty and the cost of managing menstrual health, which are essential aspects of the overall wellbeing of women, societal perceptions of menstruation as a biological process are frequently distorted by myths and misinformation. In North Macedonia, there is still no formal comprehensive sexuality education (CSE) in schools, resulting in a gap in providing age-appropriate, science-based information about SRHR and menstrual health. This lack of education perpetuates misconceptions and prevents individuals from gaining accurate knowledge about menstruation.
The study found that society continues to instill in girls the notion that having menstrual stains on their clothes or experiencing leakage is shameful. A significant 67%7 of respondents reported that this attitude was ingrained in them through socialization and parenting. Additionally, 41%8 admitted to concealing pads or other menstrual products when going to the toilet or shopping due to embarrassment. This behavior is even more prevalent among young people aged 18-19, with 54%9 reporting the same practice.
Experiencing their first menstruation (menarche) can be a life-changing moment for girls. Shockingly, more than half of the women surveyed reported feeling confused, one in three felt scared, and one in four felt ashamed upon experiencing it. Around a fifth of respondents even admitted to hiding the fact that they had started menstruating for some time. This reveals the widespread stigma and lack of open discussion about menstruation, which is troubling for the mental health and self-confidence of young girls.
Another study indicates that the stigma surrounding menstruation can also lead to adverse psychological effects such as embarrassment, shame, and anxiety among girls. This stigma also contributes to absenteeism from school, as girls may skip classes to avoid embarrassment following their periods – which can significantly impact the quality of life and future prospects of girls and young women worldwide.
The way ahead
Since 2021, there have been notable developments concerning period justice in North Macedonia. This year, the tampon tax was reduced from 18% to 5%, marking a step towards making period products more accessible for women and girls. However, this cost reduction, though beneficial, has been overshadowed by inflation and ongoing economic challenges, limiting its impact on household budgets.
Additionally, despite a decision by the Skopje City Council to allocate funds for free period products in high schools, this initiative has not been implemented for two consecutive years, remaining only on paper.
On a positive note, there is a growing recognition and understanding of period poverty and stigma and their effects. Menstrual justice has been included in the Action Plan for the National Strategy for Youth in North Macedonia for the first time, with commitments to provide free period products to all students in primary and high schools. NGOs, civic initiatives and the private sector have also shown increased interest in supporting and mainstreaming this issue further in the public space. However, the education sector lags behind, with a lack of formal CSE in schools as well as a curriculum that includes menstrual health and addresses period poverty and period stigma.
While individual and collective efforts are praiseworthy, tackling these ongoing challenges demands a comprehensive, systematic, multi-stakeholder approach to ensure that no one is left behind. With continued advocacy, policy implementation, and community engagement, we can create a future where period justice for all is a reality, eliminating barriers to menstrual health and empowering individuals worldwide.
Let’s start talking about periods!
Written by
Teodora Mileska, activist for human rights with a focus on sexual and reproductive health and rights and violence against women, and 3rd generation WAVE Youth Ambassador from North Macedonia10
- UNICEF (2019). Guidance on Menstrual Health and Hygiene. UNICEF, New York, USA ↩︎
- Thomson J, Amery F, Channon M, Puri M. What’s missing in MHM? Moving beyond hygiene in menstrual hygiene management. Sex Reprod Health Matters. 2019 Dec;27(1):1684231. doi: 10.1080/26410397.2019.1684231. PMID: 31816271; PMCID: PMC7888089. ↩︎
- Johnson ME. Menstrual Justice. ScholarWorks@University of Baltimore School of Law. Published 2019. ↩︎
- За слободоумни. МЕНСТРУАЦИЈАТА ВО ЗЕМЈАВА Е ЛУКСУЗ, 15 ОТСТО ОД ДЕВОЈЧИЊАТА КОРИСТАТ ВЕСНИЦИ НАМЕСТО ВЛОШКИ ОТИ СЕ СКАПИ – Сакам Да Кажам. Сакам Да Кажам. Published July 18, 2019. ↩︎
- Реактор – истражување во акција, Тиииии! Инк. Менструална правда Сеопфатна студија за пристап до менструална хигиена во Република Северна Македонија, проценка на состојби со менструална сиромаштија и препораки за унапредување на политики.; 2021. https://tiiiitinc.com/storage/studija_menstrualna_pravda_MK.pdf
↩︎ - ibid. ↩︎
- ibid. ↩︎
- ibid. ↩︎
- ibid. ↩︎
- https://wave-network.org/all-generations-wave-yas/ ↩︎
Featured image: Photo by Diana Vyshniakova on Unsplash
