“But as women, we realise that menstrual products are actually one of the most important things in our lives….”
Human of Medicine #47
This publication is in conjunction with the public health initiative by MMI aimed at raising awareness among Malaysians. Further information can be found at @mmi_social on Instagram.
Dr Fatimah Al-Attas is a staunch advocate for period poverty in Malaysia, with countless advocacy movement participations and interviews under her belt as of 2024. Sociology and Anthropology have always been her calling, from her undergraduate degree from International Islamic University Malaysia to her PhD from Victoria University of Wellington, New Zealand. She specialises in gender inequality issues and is currently teaching at the Department of Sociology and Anthropology in her alma mater in Gombak.
If you stopped someone on the street and asked them what period poverty was, what do you think their answer would be? Odds are they would say something along the lines of: “people who are too poor to buy pads.” And they wouldn’t be wrong, but the real definition is much broader. Period poverty essentially refers to the condition in which a person is unable to manage their menstruation due to various reasons. The first reason could be due to a lack of access to education. As women age, their bodies undergo many changes from puberty to menopause, so it should be a given that they have to learn about their menstrual cycle so that they know how to handle those developments when the time comes. Instead, I’ve interviewed a few girls who recalled panicking at the sight of their first period and thought they were dying because they didn’t know how else to explain the sudden rush of blood. What’s more, I’ve also encountered women going through menopause who had no idea why their cycles had stopped. The second, more common reason could be a lack of access to menstrual products. These can be anything from sanitary pads to tampons to menstrual cups. A good menstrual product must allow women to go out and participate in society like everybody else. I’ve heard cases where other substitutes have been used; for example, in rural Sabah, girls put on coconut husks or old newspapers or stuff paper in old socks so that they can go to school because they didn’t have enough funds to afford pads. The third reason could be a lack of access to medical help and attention. When we feel unwell, we go to the clinic, right? The same principle should apply to menstrual health. Medical assistance should be within reach and affordable so that when they feel something is wrong with their bodies, women can get help in time. Unfortunately, that’s not what normally happens. For instance, a common occurrence is that women get told that painful periods are normal and they should just bear with it when excessive pain could be an indication of something more serious, like endometriosis. The fourth reason is the lack of good disposal management and proper wash facilities, which may not be available in remote areas. Access to clean water, soap and sanitary bins as well as a toilet that affords privacy, can be a luxury to the underprivileged. The fifth and final one is a lack of understanding and discrimination towards women due to the fact that they menstruate. Periods are often seen as shameful, messy, and unclean in parts of society, even culturally in some instances. As a result, many women experience difficulties managing their menstrual cycles with dignity and tend to cover up their struggles because they are scared of being humiliated. These are all very real concerns that make up the period poverty problem.
The issue of period poverty is much more nuanced than most people realise. It’s a multifaceted problem that manifests on many levels and can’t just be solved by handing out free pads to the needy. A huge part of the problem lies with our culture of concealment around periods. There’s often a hush bubble around menstruation in our society, and this has been ingrained since childhood. Young girls are taught alternate terms to refer to their periods, like ‘ABC’ or ‘my big aunty’. Adolescents ask friends to help check for period leaks by subtly walking a few paces in front of them. Not even a clean, sanitary pad is allowed to see the light of day. Menstruation turns women of all ages into ninjas, stashing their pads away out of sight in bags on the way to the washroom. So, because of this whole cultural concealment, a lot of the necessary conversations about periods and the issues surrounding them are neglected. As a result, understanding period poverty becomes tricky, and a lot of women hide their difficulties because they may feel embarrassed to talk about it openly, much less ask for help. One of the most extreme cases I have encountered was a lady who chose not to eat because she realised that if she didn’t, her period would stop. She was experiencing a loss of income, and she knew she couldn’t afford sanitary pads, so she stopped eating. That triggered some form of malnutrition that disrupted her menstrual cycle. Another more popular instance of period poverty that has been highly criticised is women choosing pregnancy over menstruation in order to save money from buying pads. To the average Malaysian, their justification may sound absurd: how could the cost of a baby outweigh the cost of a sanitary pad? But of course, there’s a larger explanation for this, and it’s not as simple as calculating the expenses of a pad versus a child. We need to understand the context of life for women in these situations, especially those in remote areas. Having children is often celebrated and seen as a blessing, as opposed to needing money on a monthly basis to buy pads. Some of the mothers have even expressed that when they have children, they feel like their sense of worth as women is also increased. They are praised for bringing new life into the world instead of feeling bad that they must fork out money to buy pads again. Thus, we can see how this is all part of a larger menstrual health and reproductive matter.
My first encounter with period poverty happened when I was doing community work with my students back in 2018. We were handing out food packets to the homeless, and one of the ladies asked if we had brought any sanitary pads. That made something click in my head— as individuals privileged enough to have our basic needs fulfilled, the primary focus tends to fall on food whenever we think about poverty. But as women, we realise that menstrual products are actually one of the most important things in our lives, especially since they arrive every month with bloodstained fanfare. The incident sparked my interest in period poverty, specifically in Malaysia. I had heard of period poverty cases in other countries before but never really thought of it as a problem on our sunny shores. So, as any academician would do, I started looking for recent publications or research done on this phenomenon, and to my surprise, there weren’t many publications or data about it. People knew about gender inequality and wealth disparity, but when it came to period poverty, where those two issues met on a Venn diagram, there was a severe lack of awareness on the subject. This pushed me beyond my usual boundaries of just doing research and into the realm of advocacy. I started out by interviewing some NGO friends involved in period poverty initiatives to see what the movement needed, and then a few dialogues here and there. One of those stories caught the attention of mass media during the pandemic, beginning with RTM and Wanita Hari Ini, and the campaign just grew and grew from there.
Since the concept of period poverty is not something most Malaysians were familiar with, we didn’t have any national-level data, and it was difficult to find a reference person to talk about what period poverty was at the time. So I sort of just stepped in to explain and raise awareness on it, and eventually I became a reference person for period poverty. Transitioning from sociology researcher to media advocate required me to not only find confidence in myself to speak up, but how to answer questions effectively to maximise impact and also to acclimate myself to different sorts of interviews because TV interviews, radio programs and newspaper columns are very distinct in how they work. Through my experiences, I gained an understanding of the dynamics between media and researchers and how we can cooperate to address national issues. It’s not enough for me as an academician to only publish papers in academic journals and call it a day. In the case of period poverty, we want quick changes to happen, we want awareness to spread, we want realisations to hit, and for those things to be possible, we have to break out of our comfort zones and work collaboratively in order to create real impact. That’s one of the valuable lessons I’ve learned along the way, and I’m still learning every day.
I see the period poverty eradication initiative as having at least three parts. The first part is, of course, awareness. You need to know the problem exists before you can try to do anything about it. Given that Malaysia has not had enough awareness, whether it is academically or politically or just at the public level, that is where the bulk of our resources are focused. We pushed for it through various means: mass media, NGOs, university programs, etc. Youth groups have always been the most effective ones to spread the word, and at this point in 2024, we are watching more younger-led initiatives championing period poverty. I’ve also worked with fellow researchers from other fields who have been inspired to look into period poverty from their own areas of expertise, such as medical sciences, behavioural issues, and knowledge level, meaning that we will be able to expand our national database on period poverty through different lenses. I’ve collaborated with others who built modules for the purpose of educating marginalised groups on period poverty in different languages too. I have never seen the movement as a one-woman fight, and I think it’s wonderful that more individuals are taking up arms as we continue to address this issue moving forward. The second part will be implementing or initiating any kind of change. I’ve been fortunate enough to be able to talk to policymakers and parliamentarians across different parties to discuss period poverty. Regardless of which party, I believe that as long as they understand what period poverty is and how it affects our people, I think that’s good enough so that they can push for policies that support period poverty eradication. We’ve observed some good examples in terms of policy and changes at the national level, for example, the introduction of Kit SERI in Budget 2022. There were funds allocated for Kit SERI, a care pack including both disposable and reusable pads as well as an educational session on period poverty, to be distributed in schools and rural areas. We also saw the Ministry of Religious Affairs include sanitary pads in their food banks during the lockdown. Furthermore, I think there has been a more recent development in trying to ensure that schools are equipped with sanitary pad dispensers, so if students don’t have pads at home, they can access them in school for free. The final part will be monitoring and evaluation. We need to establish that period poverty as an issue to be continuously addressed and that we are taking steps in the right direction to solve it. It’s not supposed to be a phase, something that is only cared about when it’s popular and dropped when people become less loud about it. Achieving this calls for more concrete data collection, such as the average age which Malaysians start to menstruate. This is so that we can make data-driven policies for our women and have information to compare with after its implementation to assess its effectiveness. We also need to cement period rights for menstruators in our country in order to combat social stigma and increase awareness on the importance of menstrual health. In my opinion, that is the main challenge: ensuring that the changes promised are effective and lasting, not just publicity stunts to gain public favour.
As a community, we need to step up on period poverty awareness. It’s not something meant to be left solely in the hands of the government. Real change requires systemic reforms, and it needs to be championed at every level. Awareness is always a good place to start, but I feel we can begin branching out into specific areas involving education, health, or facilities. Part of the initiative is emphasising that public spaces should care for women and their menstruation, that periods are not something we can control, and there’s no shame in that. That being said, we need to encourage more people to speak up about period poverty and share what they are going through. Plus, we always hear so much about innovation, technology and sustainability, but our period management methods have barely changed in the twenty-first century. Women make up almost half the population and menstruate for about 30 to 40 years. Yet disposable sanitary pads remain the most popular menstrual product, despite environmental concerns and complaints from users on pad rashes. We can go to the moon but our pads are still like that? Therefore, there’s definitely massive room for innovation to make menstrual products cheaper, more comfortable, and more environmentally friendly. Subsequently, we have to understand period poverty in the Malaysian context because we live in a multi-ethnic, multi-religious country, so our beliefs and culture definitely have an impact on how we deal with menstruation. We need to identify our main gripes with period poverty and how to address it instead of copying other countries’ policies. For example, in some countries, they provide free pads for everyone. However, if we implement that here, we should bear in mind the Malaysian mindset of hoarding free items, so those pads might not even reach those who really need them. Additionally, I think there are a lot of things that medical professionals can actually do to help the cause. The first thing that comes to mind is promoting public understanding of menstrual-related medical conditions like endometriosis, where painful periods are a key indicator and leaving it undiagnosed could cause fertility concerns. I believe when it comes to health matters, individuals in the medical field are most suited to push the facts forward. Also, when I discuss period poverty cases that I’m working on with doctors or acquaintances with medical backgrounds, they will tell me, “Oh, I’ve seen this before”, and share how they have met patients who have not had access to sanitary pads or don’t know what a period is. In my opinion, due to their occupation, doctors are able to see different sides of people’s lives that most others don’t, like observing firsthand how poverty and their living conditions affect them. Moreover, since they have direct communication with patients, there's an opportunity to gather data for research there too. So, recognition and validation of the existence of these problems among doctors and others in the medical field is vital.
Lately, I’ve stepped back a bit from the media in terms of endorsing period poverty eradication to focus more on the academic and research side of it. Throughout my advocacy, I’ve been lucky enough to be able to converse about period poverty with a diverse range of people and have my message be positively received. I have had the chance to discuss the issue with politicians, doctors, corporate representatives, fellow academicians, people of all ages and races, and I think that I have been very fortunate to not have experienced any serious challenges in my campaigning. On the other hand, I’ve heard from NGO friends and also seen advocates being verbally abused or bullied on the internet for talking about period poverty. I recognise that it may be because of the title that I carry, and in a way, it motivates me to use my platform to keep speaking up about period poverty. Perhaps when we have a title, people tend to listen more, therefore it becomes part of our responsibility to use our influence wisely. We should utilise our advantage to uplift and provide the means for individuals to share their stories. Personally, I am always willing to support whenever younger advocates want to talk about period poverty, whether it is assistance with what it means or news on what are some recent developments on the issue. As best as I can, I try to give them my time and resources to aid them so that they are able to speak confidently about period poverty. I find it very optimistic that the younger generation is passionate about combating period poverty, especially now that there are more diverse voices among them who are fighting to be heard. That being said, I hope that there are more opportunities given for those who experience period poverty to come out and open up about their stories and concerns without being stigmatised for it. At the same time, I anticipate that there will be more doctors and medical professionals willing to shine some light on their encounters with period poverty. From a personal perspective, I aspire to work with other specialists from different interdisciplinary fields relating to period poverty too. Thus far, I haven’t done anything on innovation yet but I do hope that, even through this article itself, there will be colleagues interested in collaborating to pursue research to address period poverty issues from that aspect. Furthermore, in regard to local policies, strong and lasting changes would be the way forward for me, since awareness is building steadily between our community leaders. On top of everything, I hope that collectively, we can join hands as Malaysians to push the boundaries in our battle against period poverty.
Eason Kong Qi Zheng is a first year medical student at Monash University Malaysia.
By believing that nothing is impossible, he wants to challenge himself to continue seeking new knowledge through medical research.
Tan Wen Weyn is a second-year daydreamer in a lab coat at National Defense University Malaysia.
After a long day of fighting off sleep demons in her 9 to 5 classes, you can usually find her on her bed staring at a blank Word doc or stealing kills in the Land of Dawn.
Consent has been obtained from the interviewee for the purpose of this publication. The author has rewritten the article with permission from the interviewee.
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