Ending Period Shame and Poverty in Asia

A poster promoting a live theatrical performance called “Menstrual Human Library” in Beijing, hosted by Period Pride, a nonprofit organization in China focused on menstrual health and hygiene. (Image courtesy of Period Pride)

In 2010, British-Japanese artist Hiromi Ozaki (better known as “Sputniko!”) created a device that mimics the bleeding and discomfort caused by the female menstrual cycle. Ozaki designed the chastity belt-like metal device for men or others who wanted to understand the experience of menstruation. When the installation with music video, “Menstruation Machine - Takashi's Take,” went live on YouTube, viewers around the world acknowledged on social media and in other forums that societies have underestimated the impact of menstruation on women. As part of an exhibition in Germany, the artist explained that the starting point for her creation was, “What does menstruation mean, biologically, culturally and historically, to humans?”

Although most women have to live with menstruation for nearly 40 years, people rarely discuss it in Japan, a country that ranks 120 out of 156 countries in the World Economic Forum’s 2021 Gender Gap Index. In fact, menstruation is close to a taboo subject. When someone purchases sanitary products at a Japanese convenience store or supermarket, for example, the checker will always wrap them in an opaque paper bag, assuming it is embarrassing to be seen with them.

Early in 2021, Plan International Japan, an international NGO that works to empower children and women, surveyed 2,000 Japanese women between the ages of 15 and 24. The results highlighted the stigma, or “period shame,” associated with menstruation. Many respondents shared that they were embarrassed to buy sanitary supplies themselves or to ask their parents or guardians to buy them for them. And almost 30 percent of respondents said they were embarrassed about their period when colleagues or classmates found out about it.

Period Poverty in Japan and China

At the same time, girls and women around the world are also facing severe shortages of sanitary products, sharp rises in product prices, and a lack of access to basic information and services, in part due to COVID-19. This phenomenon, often referred to as “period poverty,” is not reserved for women in developing countries. In the same survey mentioned above, one out of three respondents said they have hesitated or were unable to buy sanitary products for reasons including "low income" and "sanitary products are expensive."

Period poverty also received considerable attention in China last year, when a customer posted on social media two screenshots from a product page on Taobao, China's largest online shopping platform. The screenshots showed a packet of 100 brandless, package-free sanitary napkins selling for just 22 yuan ($3), one-fifth of the standard market price. Within two weeks, the post had 1.38 billion reads and had triggered 237,000 discussions. Some viewers warned that these incredibly low prices might be an indication of low quality. One person responded, “I wish I had another choice." But while these kinds of safety concerns are often valid, many women continue to purchase low-quality products online. This reflects simple economic calculations. The discussions of Taobao’s ultra-low-cost supplies revealed that buyers include rural women living in remote areas, cancer patients, and young students whose parents are struggling to pay their tuition.

According to an analysis by the School of Journalism at the People’s University of China, Chinese women spend up to 1,040 yuan ($160) a year on sanitary napkins, including a 13 percent sales tax. This can be a heavy burden, especially for the 610 million people in China (as of 2020) who still earn less than 1,000 yuan ($154) per month. China proclaimed victory in eliminating extreme poverty last year. However, it’s important to discuss period poverty in the context of relative poverty, where certain people cannot afford to actively participate in society, or benefit from the activities and experiences most people take for granted. Many viewers of the social media posts admitted that they had never questioned the cost of menstrual products but, after reading the discussions, realized that they were out of reach for many people. Some discussions focused on whether sanitary products should be tax-exempt or free to women in need, as occurs in some other countries. 

Period poverty in China is exacerbated by poor-quality products, environments that do not support hygiene, and a lack of education on managing menstruation, especially in rural areas. A recent report on the rural counties of Gansu Province by the Women's Studies Institute of China (Chinese Women’s Study Journal, Vol 6, Nov 2020) found that many counterfeit and imitation brands of sanitary napkins distributed in local markets do not meet national quality standards. Toilets in some rural schools do not have lights, doors, or running water, making female students more reluctant to change their pads at school, and many families and boarding schools do not have access to bathing facilities. In addition, students, parents, and teachers do not have enough knowledge about menstruation. The report concluded, “After ensuring that poor women have basic access to sanitary products, it is now more important to focus on how to solve the issue of managing their periods in a private, safe and dignified manner.”

Yet while a revised “Law on the Protection of Minors” enacted in June 2021 has made sex education mandatory for both girls and boys, it will be some time before schools put it into practice.

Business-Led Efforts to End Period Shame

The good news is that a global movement is building to end period shame and poverty. In 2020, Scotland passed a bill introduced by parliament member Monica Lennon to distribute free sanitary products to all women. In the United States, advocacy groups have successfully pushed to eliminate taxes on sanitary supplies in numerous states. Menstrual politics are one expression of women’s growing economic and political decision-making power, and government and business leaders are responding to and collaborating with grassroots movements led by young women and powered by social media. Innovative approaches are emerging in countries around the globe, and Japan and China are no exceptions.

Unicharm, Japan’s largest manufacturer of sanitary products, redesigned its sanitary product packaging to make a statement against period shame. (Image courtesy of Unicharm)

In Japan, women in the private sector have taken the first step. In 2019, Chikako Nagai, brand manager of Unicharm, the largest manufacturer of sanitary products in Japan, led the #NoBagForMe social media campaign, which aimed to reduce period shame through better packaging. “The initial idea was, if we could design cool packaging for tampon products, that would eliminate the need for paper bags,” recalls Nagai. The campaign attracted a lot of attention from ordinary women, and the company held a vote for the most popular tampon package. As a result, the use of Unicharm tampons by young people between the ages of 18 and 24 increased by about 200,000 in one year. It also drove conversation about menstruation on social media, including calls for men to gain a better understanding of menstruation, and sparked a series of lectures on menstruation at partner companies. "Menstruation has been ignored in our society,” says Nagai. “If only we could become a society where people could speak up about how to make menstruation more comfortable.”

Another example of a business taking the lead is Isetan, one of Japan's leading department stores. In February 2021, it opened a pop-up shop focusing on women's physical and mental well-being. The shop featured “femtech” products, which use a broad range of technologies to improve the menstruation experience, One example is period underwear, which replaces the need for sanitary napkins. Mayuko Kuwabara, who planned the event, explains, "I think it is meaningful to propose a variety of female products that can change the way women live, in an open space like a department store, where anyone can visit.”

In fact, a growing number of women entrepreneurs in Japan are working to develop new lines of period underwear. BeA (short for “Girls Be Ambitious”) Japan is a pioneer in this field and held a crowdfunding campaign in 2020 to cover research and development expenses. It set a modest goal of 1 million yen ($10,000) but ended up raising more than 100 million yen ($1 million). "We were so surprised!” says Kumi Takahashi, COO of the company. “You can really feel the expectations and enthusiasm from women in Japan. We want to create a society where women can have more freedom and do what they like to do.”

In China, a social enterprise run by women in their 20s and 30s, called Relief, is also producing period underwear. Designer and founder Emma Chen hopes her products will increase women’s confidence, help address period shame, and ultimately lead to greater equality. "For girls in every generation,” she says, “it is important to be able to discuss menstruation openly and to have a variety of choices of menstrual products, as well as to have the right to choose their own life.” They also stand to have a significant environmental impact, given that women consume 130 billion sanitary napkins in China each year. Reusable period underwear can greatly reduce this massive amount of nonrecyclable waste.

The Driving Force of Young Women

In both China and Japan, young activists are leading this movement. For example, a group of women under 30 with backgrounds in design thinking, arts, and anthropology are behind Period Pride, a nonprofit organization in China focused on menstrual health and hygiene. In 2020, shortly after the social media post of package-free sanitary napkins went live, Period Pride partnered with several women’s groups and scholars to create policy recommendations for the China State Council Women and Children Working Committee. The committee was soliciting public opinion for its Outline of Women’s Development in China (2021-2030), a set of development plans unveiled in September 2021 that are expected to play a vital role in promoting gender equality and prioritizing children and women in China. Period Pride’s recommendations for government include:

• Conducting national and local research on menstrual hygiene and health issues
• Improving sanitation infrastructure in public places
• Ensuring that women have access to clean water, and can dispose of menstrual waste in a safe and dignified manner
• Strengthening inclusive sex education for people with disabilities and gender diversity
• Encouraging the use of environmentally friendly menstrual products and improving environmentally friendly menstrual waste disposal

Women share stories related to their experience of menstruation at a Period Pride theatrical roadshow. (Image courtesy of Period Pride)

To celebrate 2021’s International Women’s Day, Period Pride launched an online campaign called #NothingToBeAshamedOf that gained more than 9.2 million views within 72 hours. Created in partnership with China Alliance of Social Value Investment, an international nonprofit platform in China initiated by 50 philanthropic institutions, the campaign invited participants to openly share the hygiene products they used in daily life, as well as personal stories related to menstruation, such as the panic they felt at getting their first period or the experience of seeking medical help for polycystic ovary syndrome. Participants realized that they were not alone in having negative experiences, feelings of shame, and even trauma, and that they should not be blamed for them. Campaign organizers also put together information cards, and invited influencers and experts to spread them online.

Another Period Pride initiative invites proposals for products and services that address the issue of period poverty and period shame. Applicants from universities in China and abroad submit creative proposals and product prototypes that a panel of gender experts, nonprofit leaders, and impact investors review. The panel selected two proposals—a girl-friendly school toilet and a theatrical roadshow based on the perspective of different-age women and their period stories—to implement next year.

In Japan, a college-student organization that operates under the hashtag #EveryonesPeriod launched a petition in 2019 to reduce taxes on sanitary products, which the Japanese government taxes at a higher rate than items categorized as “essential goods.” Meanwhile, Renhō Saitō, a member of the National Diet’s House of Councillors (the upper house of Japan's bicameral legislature), was inspired to take up the issue after a visit with Colabo, a grassroots organization that supports teenage women. “Seeing female members of the organization who are devoting themselves to support young women who are suffering from poverty, I decided to do what I could to tackle period poverty even though menstruation issues are regarding as stigma in Japan,” she explained. 

In March 2021, at the budget committee meeting of the House of Councillors, legislators Sayaka Sasaki and Renhō (as she is commonly called), raised questions around the taxation of sanitary products. Their voices, inspired by the efforts of young women leaders, pushed the remaining female legislators—10 percent of the House of Representatives and 23 percent of the House of Councillors—to declare that the government could not ignore period poverty. The administration of Prime Minister Yoshihide Suga responded by agreeing to include sanitary products as part of the COVID-19 emergency relief plan, and since then, several local governments have started distributing free sanitary products.

East Asia has experienced faster growth and poverty reduction than any other region in the past half-century. This has contributed to narrower gender gaps, most notably in education and health, but challenges remain. It will take more than growth and development to reach equality across all dimensions and for all women. Addressing period stigma—an often invisible problem that is central to the daily life of half the world’s population—is critical to social progress, and the first step is bringing attention to it. More women at all levels of decision-making and society need to speak out, loud and clear. Period.

Read more stories by Noriko Akiyama, Fan Li & Wenqian Xu.