In the summer of 2009, Ntombi Dlamini got her period for the first time.
Dlamini, who was 13 years old at the time, was not excited about this new phase in her life. Menstruating added yet another burden to her already troubled existence.
“I don’t have parents,” she explains. “I live with my grandmother and we survive only on her pension money.”
Dlamini walks about two kilometres to school.
“When I asked my grandmother for money for pads, she shouted at me. She told me that there was no money and that I should just use a piece of cloth,” she remembers.
She gathered old T-shirts from her closet and tore them up into smaller rags that she could stuff into her panties.
“This would prevent me from bleeding through my school uniform,” she argued.
But it didn’t always work. Dlamini says her maroon school skirt helped her to hide the blood stains—that way she didn’t have to go home early.
She then went to the local supermarket and bought seven square washcloths that would become her monthly makeshift sanitary pads.
“I only bought dark colours-mostly brown and blue-—that the blood doesn’t show on the cloth,” she explains.
During her period, Dlamini would wash the cloths when she returned from school so she could reuse them the next day. The stained blue and brown pieces of cotton towelling would flutter in the wind for everyone to see. That’s how her grandmother—and the rest of the community—knew about her period.
“Using cloths for your period is embarrassing,” Dlamini says. “It shows everyone that you are so poor that you can’t even buy proper pads.”
Changing the cloths during school time was nerve-racking. Dlamini would wrap the soiled napkins in a plastic bag and then hide them in her shirt as she walked back from the bathroom to class. Dlamini was always terrified that she would drop the bag in front of her classmates.
She explains: “I ended up throwing many of my cloths away because I was scared of being caught even though I knew I was wasting money.”
The cost of bleeding
The average person who menstruates will use up to 17 000 sanitary pads or tampons in their lifetime according to a 2014 study published in the British Journal of Medicine & Medical Research. If one typical store—brand sanitary pad costs about R2.33 (around K135), that means a person could spend up to almost R40 000 (approximately K2.3 million) in their lifetime.
The study also states that at least 20 billion used pads and tampons end up in the world’s landfills every year.
But for many people who menstruate, survival means having to choose between food and sanitary pads.
According to South Africa’s 2011 census, a typical black household earns about R60 000 (around K3.5 million) a year. Like Dlamini, many poorer people don’t even consider the possibility of buying pads. They just do without.
Between a rock and a hard place
After a year of using cloths, Dlamini grew weary. She then heard that some types of birth control can stop menstruation.
With a group of friends, Dlamini went to her local public clinic where the nurses started her on an injectable contraceptive called Depo-Provera, a three-monthly, long-acting injectable medicine that contains the hormone depot medroxyprogesterone acetate.
“I was tired of washing and hiding the cloths,” she says. “I wanted my period to stop.” After a few months, Dlamini’s period finally did disappear.
“I was so happy. I didn’t have to worry about what I will do when my period comes,” she says.
Even though this brought relief to Dlamini, there are known risks associated with the contraceptive.
Doctor and vice-chairperson of the Civil Society Sexual and Reproductive Justice Coalition, Tlaleng Mofokeng, warns that although Depo-Provera may stop monthly periods, it comes at a cost.
She says: “One of its biggest problems is the loss of bone mineral density. Once you have used Depo-Provera for one or two years already, the side effects of the bone loss are quite significant.”
Studies have shown that the use of this hormonal contraceptive can reduce bone density.
A 2010 Recovery of Bone Mineral Density in Adolescents Following the Use of Depot Medroxyprogesterone Acetate Contraceptive Injections study published in the journal Contraception found that, on average, young women who used Depo-Provera for about five years had up to a four percent decline in bone density in areas such as their spines, hips and necks. But they were able to recover this loss of bone within five years after stopping the injectable contraceptive.
There are also serious questions about whether this popular form of birth control, often referred to as “the shot”, could make it easier for people who menstruate to contract HIV. A 2016 review of research from a number of countries including South Africa found that Depo-Provera users could be at a 20-60 percent increased risk of HIV infection.
The World Health Organisation argues there is insufficient evidence to conclude that the shot can fuel HIV risk, but is currently reviewing its position. na