The United Nations has recognized menstrual hygiene as a global public health and human-rights issue, yet across the world, “period poverty,” as some call it, is the reality for millions of women and girls.

In India, for example, it is estimated that only 12 percent of the country’s 355 million menstruating women can afford to use sanitary protection, while around 50 percent of school-age girls in Kenya do not have access to sanitary pads. Globally, more than 1.2 billion women lack access to basic sanitation and hygiene.

Earlier this year, the extent of the problem in Britain, one of the richest countries in the world, came to light when a school in Leeds, England, contacted Freedom4Girls, a British charity that provides free sanitary products to girls in Kenya, over concern that female students in their own city were missing class because they could not afford sanitary protection during their periods.

Since then, similar stories have emerged elsewhere in Britain, although this is hardly a new problem. Given the increased global attention on the need to promote sustainable goods, however, Britain may be finally discussing period poverty more openly but is not promoting ec0-friendly products.

The situation in Britain is emblematic of the gaps facing many females every month. A recent survey by Plan International UK, a charity focused on children’s rights and equality for girls globally, found that one in 10 girls in the country had been unable to afford sanitary protection and that 12 percent have improvised sanitary wear because that is all they can afford.

The problem is acute for homeless women as the British government provides money to homeless shelters to enable them to buy condoms and razors for residents but not sanitary products, forcing women to rely on charitable donations.

Complicating the problem is that pads and tampons are classed as “nonessential luxury items” in the European Union, a similar status across the Western world, including in the United States, and subject to a tax of 5 percent in Britain. This tax, however, is to be dropped in 2018. A petition asking the British government to provide free sanitary products in schools received more than 111,000 signatures this year, and the topic has been debated in Parliament twice.

Meanwhile, charities and nongovernmental organizations have been providing free sanitary products to women and girls who need them. This is a temporary measure, but the disposability of the products means that dealing with periods remains a persistent financial struggle for some people.

Progress is being made in at least one major metropolis abroad: in New York City, free tampons are available in public schools, and in the city’s subways, period underwear products are advertised throughout the transportation system.

Despite the public debate here in Britain on period poverty, little to nothing is discussed about sustainable solutions that are available for women and girls to use every month.

These products include reusable items like the menstrual cup as well as reusable pads, period underwear and environmentally friendly, organic versions of disposable tampons. Reusable products generally last around five years, while the menstrual cup, sometimes called a Mooncup in Britain, can last a decade, making them not only more environmentally safe but also more cost-effective for women who use them.

Sustainable products can also be a healthier choice for women in lieu of conventional disposable products, which have been linked to toxic shock syndrome, infection and other health issues.

Reusable products can be left in place safely longer than disposable items, and none contain any of the harsh chemicals — such as bleach — found in throw-away tampons or pads. Yet sustainable options are still largely unknown and unused by most women. One factor seems to be lack of awareness and perceived availability.

“I am attracted to the thought of reusable menstrual products because I’m aware of the environmental damage caused by single-use menstrual products,” Miranda Butler, 28, a lawyer in London, said in an interview. “The only barrier to me doing so is the fact that I simply don’t come across them and therefore never think to use them. I haven’t spotted any in pharmacies or supermarkets and so am never prompted to do anything other than buy the same single-use products.”

While Miranda Whitmarsh, 23, a professional critic in Glasgow, said that even though she was “really seriously considering getting a Mooncup for mainly environmental reasons,” she had not invested in one “probably because they seem harder to get hold of.”

Some women who were interviewed for this article who had heard of or used a sustainable product did not have much information on the range of other choices to buy. The Mooncup is not pervasive in pharmacies in Britain and is not advertised much; women who use them tend to buy them online.

Disposable items are advertised far more in Britain than sustainable versions. A representative for the Women’s Environmental Network, a British charity working on women, health and environmental issues, pointed out in an interview that the “mainstream feminine hygiene industry spends £14 million [about $18.5 million] on advertising every year in the UK alone, so it comes as no surprise that disposables are seen as the default go-to product for women to manage their periods.”

The limited marketing of sustainable products is linked to the enduring cultural taboos surrounding menstruation. Advertising for conventional disposable products are often presented in sterilized, unrealistic images and concepts of menstruation.

The Women’s Environmental Network is concerned by the marketing of products that are ecologically damaging and that “teenage girls in particular are targeted by heavy marketing that mentions nothing of the environmental effects of their manufacture and disposal.”

According to various data, every woman in Britain in her lifetime uses more than 11,000 pads or tampons, creating more than 200,000 tons of of landfill waste a year, which takes 500 years to biodegrade.

The problem is compounded by how society is conditioned to view menstruation. As Shailini Vora, the director and programs coordinator at NoMoreTaboo, an enterprise in Britain raising awareness of and providing sustainable menstrual products, said that “the reason menstrual cups and washable pads/tampons have been rejected by the public is that they involve increased contact with menstrual blood, which has been framed as polluting and disgusting.”

She added, “A big thing we’ve found in our research is that service users don’t have the confidence to communicate that they’re in need of menstrual products, and staff don’t feel comfortable talking about it nor communicate the availability of these products very well.”

Mandu Reid founded The Cup Effect, a nonprofit group in Britain to promote public knowledge of menstrual cups. Reid elaborated on the problems of promoting sustainable, lesser-known menstrual products. “We are a small organization that does not have the resources to roll out campaigns that come anywhere close to rivalling the big players,” she said.

“Where we’ve engaged with the advertising industry, there hasn’t been resistance, but I often get the impression that the taboo takes them so far out of their comfort zone, that their ‘creative juices’ and problem-solving abilities shut down.”

The topic turned into a pass-the-buck response when certain national offices were asked about how the government provides funding or investment for sustainable solutions to period poverty. The Government Equality Office said it was a matter for the Department for the Environment.

A spokesperson for that department said: “We welcome industry initiatives to promote the use of sustainable or reusable sanitary products and would encourage environmentally sustainable alternatives. Industry are best placed to support greater sustainability in these products to prevent and reduce the amount of these materials that go to landfill.”

Justine Greening, the British education minister, passed off responsibility on period poverty to schools, saying in a parliamentary debate: “Schools already have discretion over how they can use their funding. If they want to make sanitary products available to disadvantaged students, they are free to do so . . . the issue goes far wider than the role of schools: it is also about making sure that parents understand the need to play their role in educating their children.”

The Department for International Development did not offer a comment on whether it donates money or sustainable menstrual products as part of its foreign aid or other global endeavours.

Sustainable products are not always the right answer, however, to period poverty in Britain and elsewhere. Gabby Edlin, the founder of Bloodygoodperiod, which provides sanitary protection products to women in Britain, said: “While everyone wants to be eco-friendly, there is a need to look at what people require first of all, and a lot of the women [our organization] supports do not have any washing facilities to wash the menstrual cup or places to dry the reusable sanitary products.”

Successful programs have been achieved even where water or cleaning facilities are scarce. As Reid of The Cup Effect, told PassBlue: “We have done a small pilot project at a refugee camp in Malawi. And another of our projects in a drought stricken area of Kenya showed that cups were a better option than cloth or washable pads due to the much smaller amount of water required to keep them clean and use them safely. . . . If there is enough water to sustain life, there is enough water to use a menstrual cup safely.”

Three British political parties have pledged to provide free sanitary products to schools and homeless shelters in England and Wales, while the Scottish government has started a pilot scheme in Aberdeen to distribute these products at no cost in schools — making them the first national government to do so. But these donations do not include sustainable menstrual products.

So why aren’t such choices being promoted by governments?

“The people who make decisions often have zero knowledge of [cups], and even if they do know about them . . .  they have preconceived ideas about why they aren’t suitable in certain places and for certain women,” Reid said. “The paternalism of these attitudes is a source of great frustration.”

Rhona Scullion

Rhona Scullion is a Scottish writer and reporter who works as a prison law advocate in Nottingham, England. She writes on a variety of human rights and British political topics, often on women’s issues. Having previously worked in Hong Kong and Peru, she has written for the Women News Network and UNA-UK, among others. Scullion has a joint honors bachelor’s degree in English literature and modern history from the University of St. Andrews and a postgraduate law degree from Nottingham Law School. She passed the English bar exam in 2017.