Period tax: Although funding has allowed for the first round of free pad deliveries in KwaZulu-Natal, the second will depend on budget allocations. (John Wessels)

#FreeToBleed: The struggle of being too poor to afford pads

Pontsho Pilane
Choosing between eating and bleeding through your school uniform comes at a cost.

In the summer of 2009, Ntombi Dlamini got her period for the first time. Dlamini, who was 13 years old at the time, wasn't 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, who prefers not to use her real name, and her grandmother live at the Jabula shopping complex between Umlazi and Lamontville about 20km outside of Durban. It's a small retail centre with a few storeys of residential flats above it. Dlamini is a grade 12 learner at Lamontville High School, about 2km from her home. She has to walk 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 cloths," Dlamini 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 – so 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 cannot 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'd 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, that means a person could spend up to almost R40 000 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 a year. Like Dlamini, many poorer people don't even consider the possibility of buying pads. They just do without.

Filling the gap
In January, the KwaZulu-Natal education department announced that it would spend R20-million to provide free sanitary pads to learners in about 3 000 poverty-stricken schools in the current financial year.

No other province has launched free pad projects on the same scale as KwaZulu-Natal has.

"We realised that learners were losing about three days of school per month as a result of not being able to afford pads when they have their periods," says provincial education department spokesperson Muzi Mahlambi.

The department will distribute sanitary pads to learners in poorer schools, known as quintile one to four schools. Schools in quintiles one to three are the poorest of all public schools and learners don't pay school fees, government guidelines state. People in the communities where these schools are located often have low literacy levels with little or no income.

"We are targeting no-fees schools and ones that run feeding programmes because we already know that these schools are for disadvantaged learners," explains Mahlambi. "The fact that the school is nonpaying or has a feeding programmes already tells us that these learners are from poor families."

KwaZulu-Natal has 12 education districts and more than 6 000 public schools, according to the department's 2015-2016 annual report. Mahlambi says almost half of these schools will benefit from the free sanitary pads initiative.

In white plastic packaging that is branded with the department's green and gold logo, each packet contains 12 individually wrapped sanitary pads. A government circular released in January explains that learners in grades 4 to 12 who menstruate would receive one packet every month. But Mahlambi told Bhekisisa that they would not limit each learner to one packet only, as research shows menstrual flows vary – periods may occur every 21 to 35 days and last two to seven days, according to the United States-based medical research organisation Mayo Clinic.

The circular also states that a four-month supply of sanitary pads would be delivered to each school, which should last until April. The next delivery would only happen in the second quarter of this year and would depend on budget allocations.

Mahlambi said that deliveries would be made on a case-by-case basis, as some schools didn't have enough space to store the sanitary pads in bulk.

"We are piggybacking on the systems that are working for us already … The storerooms at some of these schools have to also store textbooks, tools and other things ... It's going to be creative because this is not a one-size-fits-all methodology ... We are leaving that up to schools to tell the department what their capacity is," he explains.

The department expects to have "some difficulties" in running the programme. "But these will be corrected as often as required."


Nontokozo Buthelezi uses her own money to buy pads for her learners so that they don’t have to miss school when they menstruate. (John Wessels)

Nontokozo Buthelezi is a teacher at Enhlube Combined School in Nomponjwana, a village about 50km away from Empangeni in KwaZulu-Natal. For almost 10 years, she has been buying sanitary pads for about 100 learners at her school. It is her way of ensuring they don't miss school because they are menstruating, she says.

Many of Buthelezi's learners come from single-mother households or families where grandparents take care of their grandchildren and are dependent on social grants to do so.

"Some of these learners come from very poor families where they have to worry about what they will eat that night or if their uniform will not tear from being so worn out. Pads are the last concern for them and their families," she explains.

"Many of them don't even have proper school shoes. They wear Ogog'uholile [isiZulu for ‘Gogo has been paid'] – low-cost black takkies that the learners only get when their grandmothers have saved enough money from their pension to buy them."

Buthelezi, who teaches four different grades at the school, says she has no choice but to help her learners. If she doesn't, many of them won't come to school when they menstruate.

"I usually just have two packets in my cupboard. It's all I can afford. But they run out quickly," she says. "So many of the learners need them."

Sometimes Buthelezi doesn't have extra money to spare at the end of the month. In such cases, she asks the principal for permission to let the learners leave for the day.

She explains: "It would be cruel to keep them at school when they are going through so much. They are already distracted and anxious. The simplest thing to do is to let them go home."

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 & 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 study published in the journal Contraception found that, on average, young women who used Depo-Provera for about five years had up to a 4% 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 countries including South Africa found that Depo-Provera users could be at a 20% to 60% 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.

(Not) free for all: Learners from Lamontville High School were delighted when the campaign for free sanitary pads was launched. (John Wessels)

It is a Friday morning at Lamontville High School and there's excitement in the air. The KwaZulu-Natal education MEC Mthandeni Dlungwane will be launching the free sanitary pads project at the school later in the day.

A group of schoolboys carries three large packages of sanitary pads from the department's cars to the school's assembly grounds. They meticulously stack each batch.

At 12pm, the school siren rings. More than 1 000 learners in maroon and grey uniforms rush out of their classrooms to line up for the school gathering. They erupt in joy when Dlungwane announces that from that day every learner who menstruates will receive state-sponsored free pads every month.

The department brought 396 packets of pads to Lamontville High School, but there are about 600 schoolgirls registered at the school. "We're still unsure how this process will work, but I'll leave it up to our administrative clerk to divide and hand out the pads among the learners who need them," says the school's acting principal, Bonginkosi Mngadi.

Lamontville High School is categorised as a quintile four school, according to Mngadi. Learners pay a yearly school fee of R500, which is still unaffordable for many parents.

"The education department says we are a quintile four school, but looking at the homes which most of these learners come from, I would say we are a quintile two school," he explains.

According to Dlungwane, R60-million will be allocated to free sanitary pads in the 2017-2018 financial year. The money that was allocated in the previous financial year was incidental, but as of April the project should be an item in the budget.

"We are also the products of poverty and we needed to make sure we protect the learner. It is our responsibility to ensure that no learner misses school because of not having sanitary towels," says Dlungwane.

For Dlamini, this announcement comes as a relief and a sign of hope. "Pads were a luxury for me. I only bought them if I had extra money," she says. "These free pads will make a real difference … Maybe now I can stop using contraceptives."

But 200km away from Lamontville, Buthelezi only heard about this new initiative on the radio. She says her school has not heard whether they will also be recipients of the department's free sanitary pads.

Buthelezi leans on a chair in her living room. "I also grew up without pads, you know."

She pauses.

"I just want my learners to have a better life than I did."

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