For Radha dinner is served at seven. She crouches down behind a shed, a good distance from her house, then waits. She knows what the menu will be: boiled rice, the same as yesterday and the day before. She knows that it will be her little sister who serves it to her, throwing the rice onto the plate from a height, the way you would feed a dog.
In Jamu, this village in western Nepal, Radha’s status is already an inferior one. She is ironsmith caste, a low person. When she menstruates, her status drops further. She is only sixteen, yet for the length of her period, Radha can’t enter her family house or eat anything but boiled rice. She can’t touch other women, not even her grandmother or sister, because contact with her will pollute them. If she touches a man or a boy, he will start shivering and sicken. If she eats butter or buffalo milk, the buffalo will sicken and stop giving milk. If she enters a temple or worships in any way, the gods will be furious and take their revenge by sending snakes or some other calamity. Radha is allowed to go to school; many girls are not.
Where Radha lives, menstruation is dirty, and a menstruating girl is a powerful, polluting thing. A thing to be feared and shunned.
After dinner, Radha prepares for bed. Darkness falls fast in Jamu, and without electricity the villagers follow old rhythms and sleep with the dark. Radha’s parents are both absent: this village, like many in Nepal, has spit out its menfolk, mostly, to be migrant workers elsewhere, but also some women, like Radha’s mother. Most Indians know that Nepalese make good security guards. Gulf Arabs know them as construction workers, often dead ones who are crushed in stadia and scaffolding. So Radha lives with her grandmother and her sister, in a house of women. Their home has a solar-powered light, as does the one opposite, where I’m staying with my traveling companions: Anita, the communications and gender officer for WaterAid Nepal, and our photographer, Poulomi. Our hostess is the local schoolteacher. She seems nice.
The solar light is no use to Radha this week because her bed is elsewhere. She leads me over the thoroughfare of pebbles and rocks that passes for a road, suitable only for motorcycles, walkers, and snakes. We hike up a steep hill, through long grass, to a small lean-to structure. It looks like an animal shed, but it is smaller and meaner, its planks rough and scrappy, its shelter imperfect. This is where Radha must sleep because she is menstruating.
In the local dialect, Radha is now chau. Originally meaning “menstruation” in the Raute dialect of the far western region of Achham, it has come to mean “an untouchable menstruating woman.” This linguistic melt has also happened in English: “taboo” derives from either the Polynesian tapua, meaning “menstruation,” or tabu, meaning “apart.” The system of keeping girls and women apart is known as chaupadi (padi means “woman”).1 The shed is a goth. Radha hates it, whatever its name. “I’m forced to stay there. My parents don’t let me stay at home. I don’t like being there, it’s dark, there’s no light. In the winter it’s cold. I feel so scared.”
In the winter, Radha sleeps on the tiny enclosed ground floor, no bigger than a crawl space. The summer accommodation is an earthen floor on a platform above, four foot square, which is open to the elements except for a grass roof. There is not room even for one person to lie down, but tonight there will be three. Radha’s relative Jamuna is also menstruating, and she’ll be sleeping here along with her one-year-old son. Radha appreciates the company, as Jamuna’s presence may be some protection against drunken men who conveniently forget about untouchability when it comes to rape. The stigma keeps women silent, but rapes of those confined to these sheds are common enough to appear as occasional items in newspapers in faraway Kathmandu, and common enough for some women to look down or away whenever I ask them about it. Also common are snake attacks and deaths. (During my visit I see three snakes in three days. Large ones.) In early December 2016, fifteen-year-old Roshani Tiruwa lit a fire to keep warm in her chaupadi shed and suffocated.2 The following summer, Tulasi Shahi was fatally bitten by a snake as she slept in her uncle’s cowshed in western Nepal.3
Sometimes there are four or five women in Radha’s family shed, an unthinkable number. There are always other options, though never the safety and warmth of her own home. Farther along the plateau, I watch with disbelief as a fourteen-year-old girl shows me her sleeping arrangements for the night: the bare ground outside her family’s house. She has rigged up a mosquito net, tying it to posts just high enough so her body can lie horizontally under it. She will sleep on dirt and discarded corn husks. A bed of rubbish. It’s only the third time she has had her period and already she is resigned. What can she do?
* * *
Jamu is remote. We take a two-hour flight from Kathmandu to Nepalgunj on Buddha Air, during which I watch and listen with stupefaction as an old woman asks for the window to be opened so she can spit, then—as the window doesn’t open, thankfully—spits all the way to our destination into a bag, with gusto. After that, there is a four-hour drive on a road that is mostly potholes linked by afterthoughts of tarmac. Occasionally Anita gets out and builds makeshift bridges out of boulders so our jeep can cross unexpected torrents. Finally we are tipped out with our packs at a river, where we wrap electronics in plastic safety and wade through thigh-high water because there is no other way. We are in the midwestern part of Nepal but not Himalaya country. Hills, not mountains. Lush greenery, not rocks and sheer drops. It is one of the most beautiful places I have ever seen, and I am here to look for one of the ugliest things I have ever heard of.
A 2010 government survey found that up to 58 percent of women in Nepal’s far west regions reported having to live in a shed while they were menstruating.4 But Jamu is in the midwestern hills, where the survey judged rates of severe discrimination (staying in a shed; being given separate food) to be less than 10 percent.5 I expected to find progress here. It’s easier to get things to lowlands, even by foot with no vehicle access. Things like emancipation and equality and the idea that women and girls shouldn’t be banished to unheated sheds because of their biology. So I was worried, with that unforgivable concern of someone who wants a story, that the chaupadis would be gone.
Three more river crossings, an hour of walking, then we reach the village of Narci, one of our stops en route to Jamu. There is a chaupadi shed outside the first house, then the second, then every other one. Either the 2010 surveyors didn’t like river crossings or people lied to them. Some sheds contain possessions: a comb stuck in the thatch or a bottle of red nail polish. Some hold schoolbooks, ready to be studied by girls who manage to spend all day mixing with boys at school without causing scourges or sickening. Many of the chaupadi restrictions are rigorous: whether girls can go to school is more flexible. The cowsheds and storage barns are well kept, with corn husks drying for winter. They are swept and clean. Not the chaupadi sheds: they are too small to sweep.
A group of women gather to talk. One said, Where would you like to sit? We move to the ladder that leads to the residential part of the house, on the first floor. But she stops us. “I can’t come, I’m on my fifth day.”
We sit outside on the ground instead. We are all women: us with our nosiness and notebooks, the villagers sitting patiently, ready for another round with the well-intentioned. One woman sits with a scythe in her hand. Her name is Nandakala and she is also menstruating. She says, along with the others, that chaupadi is necessary. If menstruating women don’t observe the taboos, bad things happen. A buffalo could climb a tree. Men would start trembling and fall ill. Snakes will be brought by the sin. A woman becomes animated at this: “Yes, it’s true. A big snake came into my house. We all saw it.” Another says, “If I touch something, I’ll get ill, so why should I think chaupadi is a hardship?” Chaupadi keeps them safe. In this group setting, nobody protests. It is our tradition, they said. It’s what our parents and grandparents did, so it’s what we do. I ask what they say when people come and tell them chaupadi is wrong. Do they admit to being in favor of it? “We won’t lie. We’ll say what we’ve said to you.”
But as she has her picture taken in her chaupadi shed, a hundred yards away, Nandakala is more frank. She isn’t worried about rape. The men have all left to work in India or Dubai: who is left to do the raping? She tells Poulomi, “Of course I hate it.” In the winter it’s cold. In the summer it’s hot. The restrictions are stifling and unfair. “Why should the gods punish us? Why should women be punished? But what the hell can we do?”
In the next village, we stop at a house with a view of the rushing Bheri River, so blue and wild. In this cluster of houses, 90 percent have a chaupadi shed. In one, there is a cup and bowl belonging to a female guest who had just left. They will stay in the shed until the sixth day, then be cleansed with fire and taken into the house. The guest must have been unmarried: married women have to observe chaupadi for only three days, not the full five or six. The woman of the house told us, “I don’t believe in this but my mother-in-law does.”
This is not a simple story of patriarchal men imposing evil restrictions on suffering women. Chaupadi is driven by women. It is perpetuated by the grandmothers and the mothers-in-law and the mothers. Nandakala, brave in private, moved to Mumbai with her husband for six years, where they didn’t practice chaupadi. And so he fell ill. He got eye pain, knee pain, he shook. I made him sick, said Nandakala. The taboo was wrong yet true. So now she does chaupadi.
In the next village, a schoolgirl on her period talks to us. We know she is menstruating because she won’t come near us. She says, “I can’t go into the house, I can’t touch water, I’m not allowed to touch men.” Yet she must do chores. She must fetch the shopping. “I have to say I’m menstruating and the shopkeeper throws the stuff at me.” Sometimes she doesn’t use words but shows him, somehow, her unwillingness to take something from him and he understands. Yet she has touched boys at school and nothing happened. “Of course menstruation is dirty,” she said, sitting in her chaupadi with her schoolbooks that should have told her different. “It’s a dirty thing.”
* * *
Twenty-one liters, give or take. That is how much menstrual blood I’ve discharged over the past thirty-five years.6 I’ve never done that calculation before now, because why would I? I’m not supposed to celebrate, calculate, or in any way highlight my menses. Nor am I supposed to use that old-fashioned word, though I like its lyricism (it comes from “monthly”). Some other words: Uterus. Yuck. What a horrible word. Vagina: even worse. Menstruation sounds like a disease. Menarche, endometrium: what do they even mean? Euphemisms are everywhere. Having written a book on sanitation, I’ve become expert at them. Languages have always contained them. Not many diaries or records exist that record what women felt about or called their periods, but the historian Sara Read, in a survey of menstruation in early modern England, gathered a few names: the Visit, the Courses, Terms, Those, Monthly Sickness, Time Common to Women, Months, Gift, or Benefit of Nature.7 Euphemism: “To use a favorable word in place of an inauspicious one.” Euphemizing is the opposite of blaspheming. The same magic was supposed to work when the Cape of Storms was renamed the Cape of Good Hope, yet it stayed just as stormy. Perhaps that wishful thinking is why menopause is known as “the change,” a bland word that holds none of the distress and despair of endless hot flashes, depression, brain fog, and eradication of libido. Or maybe euphemisms are a way of sticking women’s health in the dark and unspoken corner where it’s supposed to belong.
Once in India, I was puzzled when my friend Sabrina started talking about “chumming.” Chums are Indian periods. There are at least five thousand other terms, according to a recent survey carried out by the makers of a women’s health app called Clue, in partnership with the International Women’s Health Coalition. Here are a few: on the rag (a term that always made me look at student rag weeks in a different light), the curse, shark week, having the painters in, Aunt Flo, and the infinitely useful “time of the month.” Northern Europeans resort to fruit: lingonberry week in Sweden, strawberry week in Germany. The French supposedly call it ketchup week, which is disappointing: I’d have expected at least a gastronomic jus de something or other. You may want to applaud the creativity of these, but they are all just part of a linguistic scaffolding of shame and secrecy.8
Some other things I’m not supposed to confess: the time in an Indian restaurant in Paris when I bled all over a silk cushion, and I’m mortified twenty years later. All the occasions when I had no sanitary products and resorted to wads of toilet roll in my pants. The time when a school friend started her period and none of us told her she had bled through her pale-blue summer uniform. (I’m sorry, Sally.) For something so red and vivid as menstrual blood, it is very, very quiet.
Only half of it is blood, anyway. Every month I and two billion other women discharge blood but also epithelial endometrial layer, the underlying lamina propria, and vaginal and cervical mucus. Most is the lining of the womb, the thick and rich endometrium that is meant to host an embryo. In the words of a 1966 puberty education film, the endometrium makes the uterus “a soft, nesty place.” The whole process seems mechanically simple. But menstruation makes no sense. Evolutionary principles dictate that things that cost us should also benefit us. Yet we lose 30 to 50 milliliters of blood and tissue per month and get pain, bloating, depression, and attendant symptoms. What is the benefit? Other species don’t bother menstruating because they retain their womb lining. We are in a minority among species, and among mammals, to bleed every month. The only other animals known to menstruate are apes, Old World monkeys, the elephant shrew, and four varieties of bat including Desmodus rotundus9 (which I cite because it is a vampire bat, and its name means “two-thirds of the way around”).
There have been many theories. Maybe menstruation is the womb ridding itself of nasty toxins from sperm from all the sex we’re having. Except, levels of promiscuity don’t correlate with the amount of blood we lose: monkeys have sex like rabbits (which produce an endometrium only when they copulate, a practice I find entrancingly optimistic). But monkeys and apes bleed less than women. Or perhaps it is more economical for the body to rid itself monthly than to keep a constant endometrium, as many other species do.
A better and more interesting theory is the conflict hypothesis. Our endometrium is so thick and nesty because our embryos are so invasive and parasitical. According to this, humans are one of the rare species to have “maternal-fetal conflict.”10 In other animals, the embryo and its surrounding placenta attach only superficially to the womb lining. Human embryos are greedier: the embryo and placenta attach to the endometrium but then burrow through it, tearing open arterial walls and diverting them to pass blood to the growing embryo. In this way, the fetus has a direct line to the mother’s main blood supply. “It can manufacture hormones and use them to manipulate her,” writes the biologist Suzanne Sadedin. “It can, for instance, increase her blood sugar, dilate her arteries, and inflate her blood pressure to provide itself with more nutrients.”11 It can also, according to sexual health researcher Dyani Lewis, dampen a mother’s response to insulin so that “a greater slice of the circulating sugar pie is placenta-bound during its nine-month residence.”12 This is a hemochorial pregnancy, and it is a battle between two sets of genomes. Fetal genes want to ensure their own survival so suck up as many resources as possible.
Because the process of pregnancy is so taxing—I’ve never been pregnant and I’m exhausted reading about it—the uterus will be extremely choosy about which embryos get to inflict such a drain on the mother’s body. A total of 30 to 60 percent of embryos are discarded. Anything not up to standard is ditched, along with the endometrium. “You’ve probably read,” writes Sadedin, “about how the endometrium is this snuggly, welcoming environment just waiting to enfold the delicate young embryo in its nurturing embrace. In fact, it’s quite the reverse. Researchers, bless their curious little hearts, have tried to implant embryos all over the bodies of mice. The single most difficult place for them to grow was the endometrium.” The biologists Deena Emera, Roberto Romero, and Günter Wagner wrote that this “evolutionary tug-of-war between maternal and fetal genomes” was similar to virus-host interactions. Not everyone agrees with this hypothesis, and research into what placentas have done throughout history is difficult when they fossilize rather worse—that is, not at all—than bones. But whenever species have this kind of invasive pregnancy, and the “spontaneous decidualization” of the womb lining, they also menstruate.
It’s a persuasive theory, if an unsettling one. Disquiet and distaste are things you get used to when you read about menstruation.
* * *
“The menstrual discharge,” wrote the male anthropologist M. F. Ashley-Montagu in 1940, “is most generally conceived to be a particularly noxious effluvium which automatically renders everything unclean with which it comes into contact. That being so, the female during her catamenial flow is considered to be herself unclean and as noxious as the effluvium itself.”13 Anyone writing about menstruation or, as I may call it from now on, the noxious catamenial flow, starts with Pliny. Gaius Plinius Secundus was known as Pliny the Elder and for his multivolume Natural History. There are many wonders in the thirty-seven volumes, but even Pliny admitted that it is difficult to think of “anything which is more productive of more marvelous effects than the menstrual discharge.”14 Human females, he wrote, are the only “animated beings” to have a monthly discharge. He was wrong about that. He was wrong in abundance.
On the approach of a menstruating woman, he wrote, nature would cringe and submit. “Seeds which are touched by her become sterile, grafts wither away, garden plants are parched up, and the fruit will fall from the tree beneath which she sits.” Her look, also, is formidable, because it will “dim the brightness of mirrors, blunt the edge of steel and take away the polish from ivory.” She can kill a swarm of bees, turn iron and brass rusty. She can scare away hailstorms and lightning, as long as she is both bleeding and naked. At sea, she doesn’t even need to bleed: a storm will flee before the sight of her unclothed body. What a useful creature. Farmers must employ their menstruating wives with great joy, because “if a woman strips herself naked while she is menstruating, and walks round a field of wheat, the caterpillars, worms, beetles and other vermin will fall from off the ears of corn.”15
I wish some of these were true: it would save time weeding. The editor of one edition of the Natural History adds a footnote to say that Pliny’s accounts are “entirely without foundation.” But they were built upon centuries of belief about the power of the menstrual woman and others built upon them in turn. It’s telling how many of the Pliny powers were judged to be witchcraft. Menstruation must have been unsettling. How could women bleed and not die, when men bled and did? Before agriculture and settlement, as Janice Delaney, Mary Jane Lupton, and Emily Toth write in their book The Curse, women’s blood was judged to be good. It was like other cyclical processes that seemed magical—the sun, the moon, the tides—and deserved appropriate awe. “Worship and appeasement of the Great Mother and her bleeding fertility would ensure [early man’s] temporal safety.”16 The blood turned bad when man became a farmer, life became more stable, and he had less need of magical protection. Then, the menstruating woman became taboo, set apart and separated from things she may damage, like crops and harvests.
By the time of the Old Testament, the evil of menstruation was firm enough to be used as an analogy: the book of Isaiah urged the observant to cast away their sinful silver and gold idols as they would a menstruous cloth. Whoever wrote Leviticus was more straightforward. After pronouncing purity rules around leprosy, he moved on to sperm and menstrual blood. “When a woman has a discharge, if her discharge in her body is blood, she shall continue in her menstrual impurity for seven days; and whoever touches her shall be unclean until evening.”17 At least he was fair: men who emit sperm outside intercourse are equally unclean. Both men and women should offer two turtle doves or pigeons to the Temple at their end of their cleansing. (Knowing something of young men, I’d guess their turtle dove expenditure was higher than women’s.) Leviticus’s egalitarian pollution was not shared by Aristotle, who knew sperm was a much higher class of discharge.
In the thirteenth century, Nahmanides (Rabbi Moses ben Nahman or Rambam) judged the menstrual woman and found her wanting. “The dust on which she walks is impure like the dust defiled by the bones of the dead.”18 Most religions agree that a menstruating woman should stay away from God or holy books and places, and they are emphatic about cleansing. Buddhists are the most relaxed, but Japanese Buddhism requires women to cleanse for eleven days after a period. Women who have given birth have to cleanse for only ten.
The most creative response to the fearsome catamenial flow comes from the islanders of Wogeo in Papua New Guinea. This place was described by the anthropologist Ian Hogbin in a 1970 book as “the island of menstruating men.” Women’s menstrual blood is both dangerous—she can kill a man by touch when she is bleeding—and cleansing, enough that men simulate it with a creative technique involving crabs and penises. First, writes Hogbin, the man catches a crab and steals a claw. He spends a peaceful day of nil by mouth, then late in the afternoon:
He goes to a lonely beach, covers his head with a palm spathe, removes his clothing, and wades out until the water is up to his knees. He stands there with his legs apart and induces an erection either by thinking about desirable women or by masturbation.
Then, he takes his stolen claw and hacks at his penis until blood flows. He must wait until “the sea is no longer pink” (this makes me wonder how much blood Wogeo men contained), then returns ashore. At that point, both menstruating women and fake menstruating men observe the same rituals, though the woman has to stay at home and is not allowed to use doors. When answering a call of nature, she “has to leave and enter through a hole in the floor or the wall.”19
It is unclear whether the island of menstruating men developed its rituals because men were envious of periods or frightened by them. But anthropologists cite other tribes where the bleeding woman is treated with kindness and respect. Among the Yurok Indians of northern California, menstruating women are spared all chores and duties for ten days because they are on their “moontime.”20 The Kalasha women of the Hindu Kush retire to a prestigious structure called the bashali, where women hang out, have fun, and sleep entwined. In this reading of menstrual seclusion, the woman is prized for her blood, because it means fertility and power.21 She enjoys the time off (who wouldn’t?). In Nepal, I was told that some girls like to spend time in the chaupadi huts with their friends: they play online games on their phones (because poor people have phones, too) and have slumber parties, even if the slumbering is cold and likely to be disturbed by men and beasts.
Clearly women like to be clean after menstruating. They probably like time off from kitchen and marital duties. But I’m suspicious of ritual purity rules. If dirt is matter out of place, then maintaining purity is a matter of putting people in their place. Imaginary dirt is such an effective weapon of limitation. See India’s untouchables, imprisoned in filthy jobs—tanning, body removal, latrine emptying—because they are judged filthy. See the most powerful schoolyard taunts of disadvantaged children: they are dirty, they reek, they are inferior. See “you smell,” the hardest schoolyard insult to protest. Such a system is an imaginative phenomenon, wrote Virginia Smith in Clean, “that rationality finds so strange—that ritual purity and impurity laws do not refer to observable cleanliness or dirtiness, but to a classified purity status.”22 You can touch something and not be dirty, but you are unclean. You can bathe in the shit-filled Ganges and be filthy, but you are clean. Mary Douglas once wrote that to understand purity rules, you have to ask whom they exclude. “The only thing that is universalistic about purity is the temptation to use it as a weapon.”23
* * *
In 2005, the Supreme Court of Nepal made chaupadi illegal, without providing any mechanism to prosecute people who continue it.24 So it thrives regardless and in enough accessible places for Western media to have become enthralled by it in recent years. They seem less enthralled by the fact that Nepal’s menstrual taboos are so far from being eradicated, they are celebrated with a national holiday.
Kathmandu, three a.m. Anita from WaterAid has arrived to collect Poulomi and me from our hotel on a hill above the city. I am grumpy from my mutilated sleep and from the nerves that come with hunting. This morning marks the first day of Rishi Panchami, a popular annual festival that lasts for three days. It is, according to one listing of common Hindu festivals, “celebrated with great joy.”25 This is what it celebrates: Once, there was a Brahmin named Uttank. He lived with his wife Sushila and a daughter in a village. One night, the parents were horrified to see their daughter covered by ants. A local priest was consulted. The cause was obvious: she had committed sins in a previous life. Notably, she had entered a kitchen while menstruating. The answer was to cleanse away this past sin and the ants would depart. In another, even cheerier version of the tale, the daughter was reborn as a prostitute because she didn’t observe menstrual restrictions. To celebrate Rishi Panchami, the government gives all working women a day off. This is not to recognize their work but to provide them with time to perform rituals that will atone for any sins they may have committed while menstruating in the previous year. (The prepubescent and the menopausal are exempt.) Women especially enjoy it, I read on the Hindu website, and “strongly believe that this will wash away all their sins acquired by them knowingly or unknowingly.” The writer helpfully adds that “in the olden days women were not allowed either in the house or in the kitchen during their menstrual periods,” leading me to wonder whether he—a sure guess—is writing from space, or a cave, or the olden days.
We head for Pashupatinath Temple, Kathmandu’s grandest. In the morning dark its beauty is dulled but it’s not the star attraction anyway. That is the thousands of women, queueing in that intimate way that Westerners don’t: tightly, and hands on the shoulders of the person in front. It looks like a mile-long embrace. The women are waiting to pray, and they began lining up at eleven p.m. the night before, but there is no ill temper or frustration. The atmosphere is one of a concert or a festival. The chatter, the excitement, the Sunday best of red saris and gold jewelry: this feels like fun. I ask Anita to talk to the women about the legend behind Rishi Panchami, and wait for them to say they are just here for the merriment, that they know little about the truth behind this festival. This is my shameful arrogance. None of the women Anita speaks to is ignorant about the nature of the day. Their adherence is not empty but firm and fully aware. “We may have touched a man by mistake,” they say. “We have to do this because our ancestors did. It’s tradition.” Nearby I find female police officers watching over the crowds, keeping order. “Yes, we are modern women,” said one, leaning on her motorbike, gripping a mug of hot tea in the cold morning, her weapon at her hip. But Rishi Panchami must be honored. “I can’t do the rituals this year because I’m on duty, so next year I’ll do double.”
Once they have prayed, the cleansing rituals begin. The rules are strict: they must enter a river, then brush themselves with a holy twig 365 times to signify that they have purified themselves. Then they cleanse their hair with buffalo dung before washing it with cow urine and milk. This is the theory, but the riverbanks near the temple are empty. No one does the rituals there anymore, says Anita, because too many sewers drain into the river. She calls her mother for advice, and we are directed to the opposite bank and farther downstream. The water looks cleaner, though it probably isn’t. But we find five women dressed only in red petticoats squatting side by side on a log facing the river, jewels of vivid color against the dawn and dull water. They haven’t yet begun the ceremony, and they gesture to us to sit, to watch, to help them fend off the monkeys. The men doing urgent calisthenics on the far side of the river aren’t invited, but they also stay for the duration. They have a good view.
The matriarch is Gita Sharma, fifty-five in age but seventy in looks. She snaps at the youngsters, “You are not doing it properly. You must learn.” Muna Dhal is one of the learners. She is twenty-two, from eastern Nepal, and she accepts our strange questions with patience while she manages the bags, potions, and powders that make up the menstrual-sin-washing kit. “Because we maybe committed a sin during menstruation. Maybe unconsciously.” Why is it a sin? “Because it’s said so.” Ask her, Anita, if that means women are dirty. “Yes. They are cleaner now but still we do this.”
No one does the full 365 brushes of the ritual: that would take too long. Instead, they will do a symbolic number to stand in for the rest: with the appropriate twig, they brush their private parts, feet, knees, belly button, elbows, heart, underarms, hair, and teeth. Along the way, they chat and laugh and ignore the aerobic voyeurs on the far side, while preserving their modesty. It is an acrobatic and graceful endeavor and I am entranced, right up to their rubbing buffalo shit in their hair and pouring urine on their heads. Anita asks Gita whether she believes she had sinned and Gita responds with superior scorn. “Well, if I didn’t, I wouldn’t have done all this, would I?”
Rishi Panchami enrages many educated Nepali women. It’s not so much the superstition but the legitimacy that the government gives it by providing a holiday that declares women to be dirty and polluting. Why can’t the festival simply celebrate women instead? Privately, female Nepali sanitation activists tell me that their male colleagues—even in NGOs that campaign against menstrual taboo—see no need to object to chaupadi or Rishi Panchami because it is tradition. Also, Nepal has made great headway in improving its sanitation, launching policies and promises, even while recovering from a dreadful earthquake. Rishi Panchami is a battle for another day, another year. It can wait. Until then the women will come, dressed and delighted, to atone for sins they didn’t commit, in water that won’t clean them, removing taints only the gods can see.
* * *
On our second day in Jamu, Radha leads us on a ninety-minute walk to Tatopani, a village of ninety-five households where she goes to school. Tatopani means “hot water.” Cold Water Village is down the valley. Along the way, the chaupadi sheds, initially visible in every yard, become rarer. This is because Tatopani has launched a chaupadi minimization program, and it’s working. In the village offices, a group of concerned citizens has gathered. Some sit on the village water, sanitation, and hygiene (WASH) committee. Some are health workers. Two are young men, a rare sight. These beautiful green paddy fields, dramatic forests, and rushing rivers do not pay wages; leaving home does.
The young men are the most passionate. Their families migrated here from Achham. That is where chaupadi is most rooted, but it is also where the first chaupadi-free villages emerged, and where a government minister’s wife in 1998 became the first menstruating woman in her district to spend a night in her own house. In earlier times, the villagers tell me, the menstrual restrictions probably made sense. Women could have a few days’ rest while they were weak from blood loss. The men were around to do the chores and there were family members to do the cooking. Things are different now. The men are gone, the women must work, and the deprivation and damage done by chaupadi is greater.
“They have to stay outside but still do all the difficult jobs,” says Kabi Raj Majhi, a young man who is the most vocal of all the villagers and the chair of the committee. When WaterAid’s local NGO partner NEWAH arrived in the village to build a water point, its staff saw an opportunity to change things. “They said women should be allowed to use the main water point,” says Kabi, “even when they were menstruating.” Menstruating women are supposed to bathe away from others: in Jamu, we found one girl on her period trying to wash in a puddle. “A traditional healer objected and NEWAH said, fine, you use another water point then.” The healer soon capitulated.
An old man in the corner begins to speak: “Before, they were kept outside for seven days. Now it’s five and I think that’s fine, but it should stay at five.” He knows that chaupadi is necessary because of what happened during Nepal’s civil war, when thirteen thousand people were killed and thirteen hundred went missing.26 These western regions were full of Maoist rebels. “When the Maoists were here,” the old man said firmly, “they didn’t observe chaupadi. They let women in the house. And then the Maoists died in the war.”
The others shout him down. But the problem isn’t men like him or traditional healers. “We can change them,” said Madan Kumar Majhi, Kabi’s cousin and a member of the chaupadi minimization committee. “But it’s the women who are the barrier.” The mothers and mothers-in-law are the worst. A female health worker tells the room how she pretends to be menstruating just so her mother-in-law starts shaking and trembling and pretending to be sickened. “She acts as if she is ill, as if a ghost has come in. But when I am actually menstruating, I touch her and nothing happens.” She laughs, but she has to observe the taboos.
Change comes slowly and it is limited. “Sometimes,” says Kabi, “we have only got the women to be allowed to sleep inside the compound. We are trying to persuade people to set aside a separate room inside the house for chaupadi. We know it’s not perfect, but we are trying. There’s no electricity in the chaupadi sheds so it’s damaging girls’ education.” Even the ones who are allowed to attend school can’t study when they get home without light and in the cold. Before, it was worse: menstruating girls were never allowed books because the books were considered symbols of the goddess of knowledge, and they could not be dirtied.
A short walk away, I sit down with a group of girls at Radha’s school. They have come in especially to talk to me, even though there is a government strike that day and school is closed. Nepal’s government is fragile and any political party can call a national strike, which happens frequently. These girls are not fragile. They are feisty and smart. They say that chaupadi is embarrassing. “We know that you don’t do it,” said Pabitra, seventeen. “They don’t do it in developed countries.” But only four out of a dozen have been freed from sleeping outside in chaupadi sheds. “It makes no sense,” says Anjana, whose mother is a health worker. Her mother came home two years earlier and said they weren’t going to do chaupadi anymore. “Women bleed even more during childbirth but they can stay in the home. Goddesses are women, aren’t they? They bleed but they’re allowed to stay in the temple. Why can’t we?” She knows the answer. “It’s a lack of education. People think that because it’s an old practice, it’s authentic and powerful.” She says they talk about menstruation in their health lessons at school. “The teacher tells us it’s not a good thing.”
Chaupadi is powerful. It is also extreme. But in many countries, you don’t need a shed to build a menstrual taboo.
* * *
Khushi knew it was cancer. Ankita thought she was injured. Everyone believed they had a sickness. None knew why she was suddenly bleeding, why her stomach was “paining,” as Indian English has it, what on earth was causing this sudden earth-shattering blood. They cried and were terrified and then they did their best to find out: they asked their mothers. And their mothers would not answer. So they asked their sisters and aunties. And eventually they were told, you are menstruating. You are a woman now.
I meet Ankita and Khushi in a schoolyard in Uttar Pradesh. I am traveling across India with a sanitation carnival called the Great WASH Yatra. Great, because its ambitions were big: five states, 1,243 miles. WASH, because that was what its ambitions consist of: to spread knowledge about water, sanitation, and hygiene (these are usually given the acronym WASH). And yatra, a Hindi word for a procession, pilgrimage, journey.
In each state, the Yatra sets up shop: a central stage, and dozens of stalls housing games and entertainment, all promoting better hygiene, hand washing, the use of toilets. One morning, I wake early and emerge from the dorm room to see half a dozen policemen earnestly playing a game of poop chess (where a blindfolded player has to navigate between turds and find the soap). Every day, the stalls all have long queues of boys and men. But in one corner is something different: a tent of golden yellow and red, which bears the sign FOR LADIES ONLY. This is the MHM Lab. A menstruation tent. (MHM is Menstrual Hygiene Management and the standard NGO acronym for anything to do with periods.) In 2012, when the Yatra and I trundled across India, this lab was revolutionary. I was used to shit being an unspeakable topic of development (things are better now). But menstrual hygiene? The scant level of attention given to periods made fecal sludge management look popular.
That’s why the organizers of the lab didn’t expect anyone to turn up. But every day, even on religious holidays, there are long queues of women and girls outside the golden tent. Cynics may think they had come for the freebies. There are reusable cloth sanitary pads on offer as well as instructions on how to make more. These are a draw and a good compromise: most women in India use bunched-up cloth (old saris are popular) because they can’t afford commercially produced pads. Visitors could also make a bracelet from red and yellow beads, to illustrate the menstrual cycle (twenty-two yellow, six red). Mine is made by a man who clearly should have stepped inside to learn more, because he gives me twenty-two days of blood and six days of relief. But he isn’t allowed inside. There, behind the curtain and the man-proof sign, the team is dispensing something that is extremely precious and only for women: information. There, the women and girls can come to find out about their periods, their bodies, themselves. It is this that draws the crowds, not the beads.
Over 70 percent of the 747 women and girls surveyed during the Yatra’s travels had known nothing about periods before they began them because their mothers and grandmothers had told them nothing.27 During one of the Yatra stops, I meet Neelam, a fourteen-year-old girl whose mother had died of breast cancer. (She calls it “something rotten in the breast.”) When she started menstruating, she thought it was cancer, because who was there to tell her differently? Nearly a quarter of the MHM tent visitors also said that menstrual blood was dirty. This belief is not unusual. A survey by WaterAid in Iran found that nearly half of Iranian girls and women think that menstruation is a disease.28 In some cultures—Afghanistan, some Jewish traditions—the acceptable reaction to a girl’s first period is to slap her across the face, either as a punishment, because the blood is interpreted as a sign that the girl has had sex, or as a discouragement, so that a slapped girl will not immediately go and have sex with a boy, propelled by her powerful puberty like a jet stream toward sin.29
In the Yatra survey, 99 percent of respondents said they faced some kind of restriction when they were menstruating. In the schoolyard in Uttar Pradesh where Khushi and Ankita tell me about periods, they also say this: when we are bleeding, we are not allowed to touch pickles, because we will rot them. This is such a powerful belief in India it inspired Whisper, a commercial sanitary pad company owned by Procter & Gamble, to launch a Touch the Pickle campaign, encouraging girls to break boundaries, smash taboos, and buy Whisper sanitary pads. I am trying to understand how menstruation could damage something suspended in acid when Khushi launches a follow-up. “I don’t paint my nails during my period because the varnish will go rotten.”
Don’t think her dumb or ignorant. She later marched me around her school complaining that her teachers weren’t good enough and that she wanted to learn. On the street, walking among fearful dust clouds, she gestured to the air and said, “Ma’am, this is Uttar Pradesh, you can find any pollution you like: noise pollution, water pollution.” And women pollution: this charming, memorable young woman thought she was as polluted as anything else in Uttar Pradesh, because she had also been taught that.
Research in the developing world, writes Dr. Catherine Dolan, “paints a picture of menarche as a fraught process, characterized by uncertainty, fear and distress.”30 But the importance of secrecy and hiding is not embedded in growing girls only in developing countries. Shame and embarrassment have nothing to do with poverty or education. Recently I met someone whose mother hadn’t told her about periods because she was convinced that if the girl knew, she would start her period sooner. But this girl’s mother was a middle-class academic with a PhD.
Stigma and silence spread a long way and in all directions. In the early 1960s, NASA was wondering whether women would make good astronauts, being smaller and lighter, both qualities ideal for cramped space vehicles. A 1964 report, though, found two problems: wombs and hormones. It would be unfeasible to match “a temperamental psychophysiologic human and the complicated machine.”31 By 1983, NASA’s understanding about women’s biology had advanced far less than space flight. When Sally Ride, the first female astronaut, was preparing for a seven-day space mission, she was asked how many tampons she would need. By scientists. Was one hundred the right number? She said no, that was not the right number.32 Today, NASA employs Dr. Varsha Jain, a woman with the best business card in science, as it reads SPACE GYNECOLOGIST.33 Hopefully the agency now knows how many tampons women need, on earth and above it. (Anyway, female astronauts usually opt to suppress their periods in space. You would, wouldn’t you?)
* * *
“Menstrual taboo” sounds so NGO, doesn’t it? Along with “stigma” and “menstrual hygiene” and “menstruation” itself. We, the privileged women who have toilets and privacy and a massive feminine hygiene industry: we are protected from taboos and stigma by our culture, our education, our progress. We say “periods” or “the curse.” We send our boyfriends to buy sanitary products. We are advanced and immune.
Glacier National Park, Montana. Sharp mountains, blue-green water, dark conifer forests and woods, majesty and splendor: this place has the kind of scenery that inner-city children don’t know how to dream of. It was high summer, 1967, and there were campers all over the park. Glacier contains backcountry, and backcountry is bear country, so there are rules and suggestions to follow for humans who want to share the landscape with Ursus arctos horribilis. Keep an immaculate camp. Cover and seal all food and raise it off the ground. Leave nothing of interest. Sleep inside your tent. If you see a bear, climb a tree. Try not to menstruate.
One night that August, twenty miles apart, grizzly bears attacked and killed two young women. These were the first two recorded grizzly attacks since the park had opened in 1910. They were horrific. Michele Koons and Julie Helgeson, in black-and-white photographs, are fresh-faced. They have big hair and excellent American teeth. They look similar, though they weren’t related and probably didn’t know each other. But they have been paired in history not only because of how they were killed but because of a wrong and poisonous belief as to why.
Koons was camping near Trout Lake with four other young people; Helgeson had headed to the Granite Park Chalet area with Roy Ducat. They knew about grizzlies, because that was what many people came to Glacier Park to see. In Jack Olsen’s book Night of the Grizzlies, an account of the attacks, a park employee admitted that there was tacit encouragement of grizzly tourism and that garbage dumps were more accessible to bears than they should be.34 So bears associated garbage with food and with people. Either humans had food or they could become food.
When Michele’s companions heard a bear, four managed to escape their sleeping bags and climb to a safe height in time. Michele couldn’t unzip hers and died because of it. Over near Granite Park Chalet, the bear was too quick and aggressive. Roy Ducat was badly mauled but escaped. The bear caught Julie and dragged her downhill, where she lay in the open for nearly two hours before an armed ranger and a search party could reach her. Although there were three doctors staying at the cabin, she died of her injuries, which were grotesque and severe. Her legs had been partly eaten.
Michele and Julie are famous not because of their awful deaths but because they both became associated with a belief that endures: that bears and other wild creatures are attracted to menstrual odor, and that having a period in backcountry may be fatal. In its initial report, the National Park Service commented that “the Trout Lake girl was in her monthly menstrual period while the Granite Park Chalet victim evidently expected her period to begin at any time.”35 (Presumably they bothered to name the two young women properly elsewhere.) Michele Koons was wearing a sanitary pad when she died. The other young woman in her party had her period but “was using the internal tampon-type device which supposedly leaves no odor because the menstrual fluid is not exposed to the air.” Because the bear came to this girl but then left her alone, and because the Parks Service had received “a number of letters” from women who had been attacked by wild beasts while having a period, the conclusion seemed obvious. Menstruation, and particularly wearing a sanitary pad, “was a plausible reason for the attack.”36 As for Julie Helgeson, two tampons were found in her backpack, so she was obviously expecting her period and must have smelled that way to the bear. The presence of rubbish and food waste from humans attracted the bears, not an externally worn sanitary pad. The bear that killed Michele had hassled several other hikers over the summer. The 1981 pamphlet “Grizzly Grizzly Grizzly Grizzly,” published by the US Forest Service and the National Parks Service, advised visitors to abstain from “human sexual activity,” to be clean and tidy, not to wear perfume, and that “women should stay out of bear country during their menstrual period.”37
Scholars took this notion seriously enough to study it seriously. In 1977, Bruce Cushing of the University of Montana’s Wildlife Biology Program exposed four polar bears to menstrual odors, using the Churchill Bear Laboratory in Manitoba and a fan.38 He also had menstruating and non-menstruating women sit “passively” in front of caged bears. Outdoor bears were exposed to used tampons filled with menstrual and venous blood left on stakes, along with seal odor, horse manure, seafood, and chicken. Bears, Cushing found, love seal odor, scorn regular human blood, but are intrigued by the menstrual kind. They chewed the tampons. Cushing ended with prudence. “This study supports the theory that menstrual odors act as an attractant to bears, at least polar bears. However, this should not be taken to extremes as that is not the same thing as saying menstrual odors lead to attacks.”
Were the polar bears attracted to the odor? Pheromones? Some peculiar chemical? A later study was more conclusive, and its authors deserve applause for the most entertaining scientific method I’ve read about in a while. To establish whether black bears were attracted to period blood, they hooked used tampons onto fishing lines and cast them past ursine noses, then dragged them back again. The working hypothesis was that bears would be as interested by the tampons as by garbage and other control substances. So would I be, if a fishing line holding a used tampon had come sailing past my nose while I was minding my own business. They also exposed human-socialized bears to menstruating women by having them hang out together. After six experiments in various conditions over several years with different tampons, different women, and different bears, the scientists came to a conclusion. “No bear showed appreciable interest in menstrual odors regardless of the bear’s age, sex, reproductive status or time of year.”
In 1988, Caroline Byrd, a forestry specialist, was prevented from working in the backcountry because a bear had ransacked a hunter’s camp, and the US Forest Service decided it was the fault of menstruating women. “A few days later,” wrote Byrd in her master’s thesis “Of Bears and Women,” her fury barely contained by the calm Courier typeface of her manuscript, “my crew (three women and one man) was informed that due to the recent bear trouble, women would no longer be allowed to work in the backcountry during their menstrual periods.” The policy was eventually rescinded, but not the conviction that period blood was dangerous, which swirls and percolates far and wide, relentless.
Béla Schick was a Hungarian pediatrician who in 1910–11 devised the Schick test, still used to detect immunity to diphtheria. For that, we are grateful. He was also convinced that menstruating women made flowers wilt. This revelation came to him when he asked his maid to put some red roses in water and was shocked that by the next morning they had withered. She told him she was menstruating. Schick experimented further, giving flowers to menstruating women. The flowers died, quickly. He expanded into dough, getting several women to prepare some and noting that the dough prepared by the sole menstruating woman in the group rose 22 percent less than the others.39 Obviously, he concluded, a woman on her period was expelling not just blood and tissue but some potent chemical that had an abominable effect on botany and bacteria. It was, he declared, “menotoxin.” This also conveniently aligned with old-fashioned superstition and taboos. Pliny was right along with every other vividly absurd and usually male commentator on the corrupting superpowers of the bleeding woman. Women really could slay rodents with what a recent TV writer called our “menses badness.”40
Menotoxin was an attractive idea and an instance of ingenious branding, and it bore much academic fruit. In 1940, the anthropologist M. F. Ashley-Montagu wrote “Physiology and the Origins of Menstrual Prohibitions,” which explored recent research on menotoxin. His list of references was unsettlingly long and predominantly German. Male scientists were clearly spending much time, effort, and money on the pernicious question of why dough didn’t rise properly when handled by a woman on her period. Some diversified from bakery, injecting menstrual serum, whatever that was, into guinea pigs. Their theories were diverse. Women were emitting choline, or choline transformed into trimethylamine. Or oxycholesterol or mitogenic rays. Menotoxin was being debated in the letters pages of the Lancet in 1974.41 Modernity has not prevented menstrual nonsense: recently, a renowned Japanese sushi chef declared that obviously women were discouraged from becoming sushi chefs because periods spoil fish.42
In 2002, psychologists in Colorado enrolled sixty-five students (thirty-two female, thirty-three male) in a study. First they were taken to a room with a woman they are told is a fellow student, asked to fill in a questionnaire, and then left alone. The woman then apparently accidentally dropped either a tampon or a hair clip. She did this “with a blank expression on her face.” The goal was to measure disgust. In disgust theory, both the hair clip and the tampon should provoke equal distaste. Cut hair is disgusting because it can carry disease, and so are hair accessories by association. A tampon, as the eminent disgustologist Paul Rozin found, sets off all the disgust alarms: when his research team asked men and women to put the tip of an unused tampon—unwrapped in front of them—into their mouths, 69 percent refused. Three percent wouldn’t even touch it.43
The Colorado study was striking. Students who had watched the woman drop a tampon then judged her to be “less competent, less likeable,” and they avoided her “psychologically and physically.” The effect was stronger than when the women dropped “a less ‘offensive’ but highly feminine item—a hair clip.” This aversion was the same in both men and women. When Tampax surveyed one thousand Americans in 1981, half the respondents agreed that a woman shouldn’t have sex while she was menstruating.44 A 2017 survey by ActionAid, an NGO that works with women and girls in poverty, found that half of British women don’t feel comfortable discussing their period with men (including their dads).45 Another by WaterAid found that 42 percent hid sanitary products from their work colleagues on their way to the bathroom, and 56 percent would not go swimming during their period. Nearly 80 percent amended their lifestyle in some way while menstruating, and the amendments were usually the limiting, hiding, avoiding kind.46
Surveys are not robust science. But they have to stand in for it because of an absence of data on women’s health and menstruation. Here are some things that science could stand to look at more closely: Premenstrual syndrome. Premenstrual disorder. Pain. Hormones. (I wrote this book while fighting menopausal depression, brain fog—a polite expression for temporary dementia—and other symptoms caused by hormonal fluctuations. When I asked the Society of Endocrinologists for an expert to discuss the effects of estrogen on the brain, it said the society didn’t have one.)
I did a short and definitely unscientific test by using two search terms on PubMed, a database containing 27 million citations from journals and books. “Premenstrual” had 5,496 citations. “Erectile dysfunction” had 21,672. Erectile dysfunction must be distressing. But does it debilitate 90 percent of men for at least two days a month? Does it damage their ability to work, think, live? Premenstrual syndrome is so poorly understood, its existence continues to be questioned, though not by me. When the psychologist Kathleen Lustyk made applications for grants to study PMS, they were refused “on the grounds that PMS does not actually exist.” The magazine writer Frank Bures wrote a book recently, claiming that PMS was a “culture-bound syndrome” created by the level of stigma around menstruation. He aligned it with other culture-bound syndromes such as one where men imagine their genitals have been sucked up into their bodies by voodoo; or the Indian affliction gilhari, “in which patients arrive at the hospital with swelling on the back of their necks, complaining that a gilhari (a kind of lizard) crawled under their skin.”47 His reasoning for this is that PMS is most likely to be reported by women in western Europe, Australia, and North America, and that “the more time that women of ethnic minorities spend living in the United States, the more likely they are to report PMDD.” Premenstrual dysmorphic disorder is a more severe version of PMS. The Diagnostic and Statistical Manual of Mental Disorders, the psychiatrists’ bible, now lists four main criteria for PMDD. First, you must have symptoms including marked depression, anxiety, persistent or marked anger, and marked affective lability (e.g., feeling suddenly sad or tearful or experiencing increased sensitivity to rejection). These must be bad enough to interfere with daily life, they must be related to the menstrual cycle (and be an exacerbation of symptoms relating to some other disorder), and occur during at least two consecutive menstrual cycles.48
I’d gladly switch places with Frank Bures on the several days a month when I have to avoid a nearby road bridge because I don’t have the defenses to stop myself from jumping off it, or when picking up a phone and speaking to a human seems the hardest thing in the world to do, and when I must breathe under the weight of invisible kettlebells sitting on my chest. Similar claims are routinely made about the menopause, such as that hot flashes are all in the mind. This is true, as that is where temperature is regulated, though the drivers are not thoughts but hormone fluctuations. Bures should know about this: men’s testosterone levels rise and fall on a monthly cycle. That’s probably well researched.
Isn’t this just the latest round of the wandering womb? Ancient gynecologists decided that hysteria was caused by a uterus moving around a woman’s body.49 How preposterous and old-fashioned. Except it is not. Katharine Switzer, the first woman to run the Boston Marathon, wrote in her memoir that her high school coach—a woman—told her that if women played basketball, an “excessive number of jump balls could displace the uterus.” In 2010, Gian-Franco Kasper, president of the International Ski Federation, said on television (publicly!) that a ski jump could cause a woman’s uterus to burst.50 Women were allowed a competitive ski-jumping event only in 2014. A post on the Public Library of Science (PLoS) blog was headlined, OLYMPIC SKI JUMPING COMPETITION COMPLETED WITHOUT A SINGLE UTERUS EXPLOSION. Unlike men, wrote Dr. Travis Saunders, women’s gynecology is safely contained inside the body.51
Perhaps claiming that any kind of premenstrual symptoms are akin to imaginary lizards or disappearing penises would be more difficult if research were better or better funded. Although talking of “symptoms” will get me accused of pathologizing a natural process. It didn’t feel natural when I was writhing on the floor in pain or when, once a month for several days, no thought was not a black or dangerous one. Last year, endocrinologists discovered that women who suffer from PMDD, which they described as “clinically distressing changes in mood and behavior,” may have genes that make them respond differently, and painfully, to hormonal changes or fluctuations.52
It wasn’t until 2013 that a comprehensive review was undertaken, by a team at the London School of Hygiene and Tropical Medicine, into the state of existing research about menstrual hygiene management.53 This is astonishing, when it has been understood for a while now that a worrying number of girls drop out of school when they get their period. Often it’s when their school lacks a toilet. Ankita and Khushi, the schoolgirls in Uttar Pradesh, used to go in an alleyway behind the school, or behind plants in the dusty yard. Now imagine doing that when you have your period. I’d drop out too.
It’s well known that educated girls are better for just about everything: they have fewer, healthier, and better-educated children. The World Bank estimates that getting a higher education is equivalent to a 25 percent increase in wages in later life (compared to a rise of 7 percent for secondary).54 A UNESCO global report into education in 2014 found that Pakistani women with high literacy skills earned 95 percent more than women with weak or no literacy skills.55 Among men, the differential was only 33 percent. Overall, if female education rates rise by 1 percent, GDP increases by 0.3 percent. Educated girls are like yeast in the dough of sustainable, successful development (even dough kneaded by a menstruating woman). If girls can be persuaded to return to school because they have a toilet and good menstrual hygiene, then scholars of all ilks should be flocking to demonstrate this. The London School study found only sixty-five articles to review, a paltry number. It concluded that “menstruation is poorly understood and poorly researched” and that “there is a strong possibility that the best knowledge lies in the hands of those implementing programs.”
I wonder. If menstruation were better researched, would my endometriosis have been diagnosed sooner? The average time it takes to diagnose endometriosis is ten years. For twenty years, and by several doctors, I was given prescription-strength painkillers without question. The question should have been: Is there something wrong? Period pain, caused by prostaglandins making contractions in the uterus, is common. But extreme period pain is not. In a paper titled “The Girl Who Cried Pain,” the authors Diana Hoffmann and Anita Tarzian explored bias in how pain in men and women is acknowledged and treated.56 They had plenty of material. Children in postoperative pain: the boys were given codeine, while girls got paracetamol. One study found that male patients who had had a coronary artery bypass graft were given narcotics more often than female patients. The women were more often given sedative agents, “suggesting that female patients were more often perceived as anxious rather than in pain.” When researchers reviewed evidence from the American Medical Association’s Task Force on Gender Disparities in Clinical Decision Making, “physicians were found to consistently view women’s (but not men’s) symptom reports as caused by emotional factors, even in the presence of positive clinical tests.” Female chronic pain patients, in another study, were “more likely to be diagnosed with histrionic disorder (excessive emotionality and attention-seeking behavior) compared to male chronic pain patients.”
The hysterical woman and her wandering womb, her fragile mind. Same as it ever was.
* * *
Bihar is the poorest state in India, and despite a decent state government that has improved roads, it is the only place where our Yatra stalls and stage are erected by men who bring their equipment by buffalo. Today’s venue is a school that has one computer and only a generator for electricity. The Yatra’s MHM team has come to do outreach with teachers. Most are male. Education is the route out of menstrual stigma, but boys and men must also be taught. The state government has insisted that the menstrual hygiene program be carried out even during the festival of Diwali. “I know,” says one of the program organizers. “I wouldn’t like me for that, either.” Perhaps that’s why an angry man comes up to me and yells that we are late and how dare we? I am there only as an observer and direct him to the program organizers, because he has confused my skin color for authority. I dislike him for that, and also that during the session he was asked about the menstrual cycle and said, “After twenty-one days, when the egg ruptures, there’s a lot of bacteria and it can make them ill and if they make food they can make everyone ill.”
In the classroom, men dominate in number and in their bullying. They shout down the women. Vaishalli, who leads the session, hands out a paper that holds three questions.
What are the problems faced by girls when they get periods during school hours?
What problems do female teachers face when they get periods in school?
What problems do male teachers face when they realize female students have periods?
There is confusion. The girls can take two days off school. No, not the girls, the teachers. No, the teachers can’t. No, the girls can’t. There is no facility in the school to change pads, a man says, so if they need to do that, they definitely need to leave. A male teacher said, “They get very irritable.” A female teacher, allowed to speak for once, says, “We help them by giving them permission to leave the school. That’s all we can do.” Missing education is sad, but period leave sounds better than what happened at my school, when the only concession to periods and pain was a code whereby the games mistress asked, “Who isn’t showering?” and I wondered how often you could say “me” and whether Miss Applewhite kept records.
A report by Plan India dating from 2010 claimed that 23 percent of Indian schoolgirls miss school or drop out altogether because they are menstruating.57 This statistic is cited by almost anyone writing about menstrual hygiene management, even though the report can’t be found anywhere. Here is another widely repeated fact: that one in ten schoolgirls in Africa do not attend school during menstruation. This is so striking and large—how do they know?—that I investigate it, finding the original quotation in a UNESCO document quoting the source as a UNICEF study that doesn’t actually contain the figure or anything like it. It is one of those shimmering figures that dot authoritative reports (a “zombie statistic,” in the words of a WaterAid analyst58) that are built only on expectation and belief that it makes sense. I find another zombie figure repeated: that a 2013 study by the University of Nottingham found that 61 percent of girls worldwide had missed some school each month because of periods.59 The study found no such thing. Believable figures are not global and more guarded: that Nepali schoolgirls missed only 0.8 percent of school days in a year, but half of them missed school at some point while menstruating. In Ghana, 95 percent of schoolgirls reported missing school, and 53 percent in Nairobi, Kenya.60A UNICEF survey found that 35 percent of girls in Niger and 21 percent in Burkina Faso “sometimes” missed school because they were menstruating.61
I’ve visited dozens of schools in the developing world, and even when they had toilets, they were filthy and ramshackle and I wouldn’t have used them. In Liberia, I once met a young woman who wore two pairs of underwear, a pair of trousers, and two skirts. All at once. She was terrified of staining her clothing, and although her school had just been decently renovated by a Liberian NGO, it had somehow forgotten to build a toilet block. Grace had to go to the bush to change her sanitary cloths, and so she either stayed home or wore her uniform of period-protective clothing.
SHARE, a research initiative at the London School of Hygiene, thinks a link between school absenteeism and periods is plausible but unproven. In sober development language: “Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in [menstrual] management methods reduce school absenteeism.”62 I’m not sure what’s more infuriating: that Grace and other girls are missing or leaving school because they are bleeding or that the reason we can’t be sure that’s connected to poor menstrual hygiene is because there isn’t enough research or science, because there never is, when it comes to women’s health.
I read an angry piece objecting to the phrase “menstrual hygiene management,” because it perpetuates the belief that period blood is dirty and smelly. But sometimes what pushes girls out of the classroom is because they are terrified that they are dirty and smelly. They don’t stand up to answer the teacher for fear their clothes are stained, and many live in hot countries where school uniforms are light-colored. Good for sunshine, bad for period confidence. In Malawi, girls interviewed by WaterAid, who almost all wore sanitary cloths, reported boys taunting them when the cloths fell out of underwear, saying, for example, that they “looked like they had killed a chicken.” (This is surely the politer version of what they said.) The cloths they used were so uncomfortable they would make the sanitary pads that my school secretary dispensed—so bulky, we called them bricks—seem like gossamer. The cloths were easily soaked and became visible through uniforms. School toilets had no doors and no water, so they may as well not have been toilets. “We go to the toilet,” one girl said, “then we eat with shit or blood on our hands.”63
Period pain was another reason for absenteeism and dropping out: girls can’t afford painkillers and will rarely dare to tell the teacher they are in pain from menstruating. Also, when girls start menstruating, it means that they are sexual beings and can be married. Studies have shown success, though limited, with the provision of sanitary pads and menstrual cups (plastic devices that gather blood and are thought sustainable, including by everyone who writes to me after I publish anything on periods and urges me to try one). When schoolgirls in Uganda were given a combination of puberty education alone, puberty education and sanitary pads, or sanitary pads alone, it was puberty education that kept them in school.64
In the Bihar classroom, a male teacher stands up at the end of the session. He is pouring water on the day, in a way, because he said, “It’s very easy to talk about menstruation but the social conditions are this: if a male teacher starts to do this, he is going to go through hell. Social conditions don’t allow us to talk to girls, and they have problems already talking to female teachers, so forget about us.” A female teacher agrees. “If a male teacher tries to talk to girls about periods, he will get beaten up.”
Teachers matter when it comes to dissolving stigma. But the girls matter most, the ones like Ankita and Neelam and Radha and her schoolmates, who have the confidence to protest injustice to me, and one day may have more, and spread it further.
I think about Radha sometimes, after I leave Nepal. She wasn’t particularly chatty or communicative, not even when we walked together for four hours back to the river where the road arrived, while she carried some of our luggage because she wanted the portering fee. I don’t know if she was smart or had hopes. But I knew that her opportunities, as a young woman in rural Nepal, were constricted. Child marriage rates in Nepal are disturbingly high, and with absent parents there was a good chance that her family would think the safest state for Radha to be in was a married one. In 2017, our photographer Poulomi returned to Jamu on assignment and found her. She e-mailed me a picture. Look, she wrote. Here is Radha, nineteen now, and married. She has to endure only three days of chaupadi now, not five. That is her pickle, her progress.