Employers could have a big role to play in normalising women’s healthcare by lifting the silence about our bodily functions
In my school there was a code: The gym teacher would ask, “Who’s not having a shower?”– and that was the only way periods were acknowledged, ever. How British, how normal, how expected. I don’t remember ever taking a day off school with period pain, though sometimes it was so bad I was given prescription painkillers by my GP, without question. The question should have been: “If your pain is that bad, is something wrong?” It turns out it that it was, and eventually I was diagnosed with severe endometriosis at the age of 40, by which time my fertility – damaged by endometriosis, probably – was long wrecked. I wish I’d had the courage to demand better, but how could I, when I didn’t know any better?
Like millions of other women and girls, I had never encountered anything in society to teach me to treat my periods with anything but shame. It is a powerful message of stigma – so powerful that I found myself recently looking at a lipstick in my pocket and worrying that it looked like a tampon. And this was just after I’d given a speech about the terrible toll of menstrual taboos for the WaterAid charity.
Yet a new report by Public Health Englandshows what we all know: that women’s concerns about period pains and periods are their third biggest reproductive health worry (after avoiding unwanted pregnancies and their sex lives). They just don’t dare speak about it.
We have all grown up with the same surround-sound messaging about our biology: be quiet. You can see this from the earliest advertising for what is laughably called feminine hygiene (are we dirty?): ads showing women playing sports in tennis whites, and the word “fresh” being used with abandon. I’m quite fond of a Kotex ad from the 1930s that encourages women to buy its pads so they can be “tangy”. Fresh, tangy, sporty: all these are codes too, for not talking about pain and discomfort – and, above all, for not smelling. This stifling of an entirely normal biological activity causes real harm.
A paper called The Girl Who Cried Pain found extensive evidence that women’s pain is treated as less important than men’s by healthcare workers. One study found that boys with post-operative pain were given codeine while girls were given paracetamol. Men who had had a coronary artery bypass graft got narcotics; women after the same procedure were given sedatives, “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”. Why does this continue? Partly because we let it.
The last few years have seen things shift in periods at least: now Thinx and other companies do loud and bold advertising, with posters on subways showing grapefruits supposed to suggest vaginas. The first ad that dared show period blood, not blue windscreen-wiper wash, was launched by Bodyform last year. It only took nearly a century.
Perhaps legalised time off is a solution. Legislation offering menstrual leave exists already. Women in Japan, Korea and a few other countries are allowed to request days off work, something that one academic called “an unusual institutionalised practice”. It sounds like a good idea. When Italy tried to bring in similar legislation last year, it didn’t pass, and critics came up with the usual objections: Italian women are already stigmatised for their biology, with some employers forcing them to sign undated resignation letters in case they become pregnant. Other objections: menstrual leave sends the message that menstruation is a disease or an affliction. It is sexism, or stigmatisation. It may lead to the women who seek menstrual leave being paid less or be given less authority. Japanese women rarely use it because they fear exactly that, or that they might be considered weak. (This of course would not happen if men menstruated – as Gloria Steinem wrote, brilliantly, in 1978.)
That’s not the legislation’s fault. Men won’t hire women if we have menstrual leave, wrote one magazine editor, as if the problem were women, not the men who wouldn’t hire them. What is that, if not internalised stigma? An enlightened employer knows that a woman who can work without being bent double with cramps is a better employee.
I once visited garment factories in Bangladesh that had instituted the HERproject, a female health initiative organised by big business (Levi’s, Primark and Asda are some of the partners). This was no touchy-feely NGO scheme: 80% of Bangladesh’s garment workers are women. Many, too poor to afford pads, were using scraps of highly treated cloth cuttings, and getting infections and cramps bad enough to cause high rates of absenteeism. Rates dropped when women got two things: subsidised sanitary pads and the opportunity to talk openly about their health, including periods. I’d rather it was not big business and its need to make workers more efficient that prompted the change, but I’m glad it did, nonetheless.
Whether menstrual leave is the answer is unclear, but at least it puts periods and period pain on the political agenda. Gordon Brown, wrote his adviser Damian McBride, didn’t dare announce that he had reduced the tampon tax – a sure vote-winner – because he couldn’t bear to say the word “tampons” at the dispatch box. Laws are words, and words of all kinds are the solution to stigma. Public Health England’s conclusion was that women “desire that reproductive health issues are normalised and destigmatised so that they can be discussed openly”. When the silence about period pain is still so loud, talking is a decent start.
Reproduced from The Guardian.