For women travelers, feminine hygiene products like tampons, pads and menstrual cups can be hard to obtain and complicate travel plans. Here’s what you should know about period poverty and access to menstrual products around the world.

This post originally appeared on her report.

A lack of access to feminine hygiene products is a perturbing epidemic around the world—so much so that the United Nations has recognized menstrual hygiene (or, rather, lack thereof) as a public health and human rights issue, exacerbated by “period poverty” and taboos surrounding menstruation that debase women and girls during their cycles.

Some 1.2 billion women lack access to basic sanitation and hygiene, many of whom risk their futures when they’re absent from school and work opportunities. And the intolerable state of feminine hygiene is a women’s issue that plagues not only those who live within these limitations, but also women who travel.

For women traversing the globe, the limited availability of feminine hygiene products such as tampons, pads and menstrual cups can complicate travel plans. As such, here’s what you should know about period poverty and access to menstrual products around the world.

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The State of Feminine Hygiene Around the World

Feminine Hygiene Products in North America

In most of North America, pads, tampons (both with and without applicators) and menstrual cups are readily available in supermarkets and pharmacies.

That said, these feminine care products aren’t necessarily affordable for everyone.

In the United States, most states still place a “luxury tax” on menstrual products. This contributes to the fact that nearly two-thirds of low-income women cannot afford menstrual hygiene products. More than one in five of them report that they face this issue every month, according to research published in Obstetrics & Gynecology. Meanwhile, regardless of economic status, period poverty keeps one out of five girls out of school during their monthly cycle, according to data by Always.

Likewise, one-third of women under 25 years old in Canada cannot afford menstrual products, according to a poll conducted by Plan International Canada. Consequentially, 83 percent of the women surveyed reported feeling prevented from fully participating in activities, and 70 percent reported missing school or work because of their periods.

Feminine Hygiene Products in Central & South America

Most Central and South American countries offer pads in supermarkets and pharmacies, though you may be hard pressed to find tampons or menstrual cups in many of them. If you can find tampons, it’s likely that your limited options will be without applicators.

Despite the general availability of feminine hygiene products, however, complications with the importation of these products has lead to significant shortages in South America in the past.

Argentina, for example, experienced an infamous tampon shortage in 2015. Businesses blamed the government for slow import permits following a crack down on the control of foreign currencies; meanwhile, government officials accused businesses of trying to drive up prices and, as such, attempted to curb inflation and capital flight. The result: a supply shortage of pharmaceutical products, including tampons.

In Venezuela, the cost of government-regulated tampons and other feminine hygiene products jumped 1,800 percent in 2016. This forced average Venezuelan women to spend a third of their monthly wages on feminine care products. Still, rampant hyperinflation and a lack of foreign currency exacerbates the issue.

In some other South American countries where menstruation is taboo, discriminatory practices surrounding periods are still heavily prevalent. In Bolivia, for example, some school girls carry around used menstrual pads, warned that period blood is so toxic it can cause diseases such as cancer if mixed with trash.

Feminine Hygiene Products in the Caribbean

Most Caribbean countries are replete with pads and, while many offer tampons, they’re not nearly as easy to find. Your options for tampons are few and far between, and these are often relegated to supermarkets and pharmacies in more populous, international cities.

Nonetheless, period poverty in the Caribbean keeps a wealth of women out of work and a gamut of girls out of school. And taboos surrounding menstruation still shame women during their cycles.

In Jamaica, for example, common curse words stem from a woman’s period. And all around the Caribbean, feminine hygiene products like pads are still wrapped in newsprint and separately bagged in black bags.

Feminine Hygiene Products in Africa and the Middle East

Pads and tampons are available in major cities across Africa and the Middle East but, in more rural and war-torn areas, they’re seldom available.

The scarcity of feminine hygiene products in rural parts of Africa mean that many women and girls resort to improvising with everything from cut-up rags and bits of mattress stuffing to leaves and mud to absorb their period blood. Many girls miss school as a result—in fact, some are even coerced into insolation during their cycles.

In Sub-Saharan Africa, one in 10 students miss school during their periods, according to the World Bank. Four in five girls in East Africa lack access to health education and sanitary pads, according to the ZanaAfrica Foundation. Sixty percent of girls in Kenya have dropped out of secondary school; after all, more than one million miss up to six weeks of school each year since they lack reliable access to menstrual products.

In some African countries, handling the waste of feminine hygiene products is a whole other issue. For example, 11.5 million women in Ghana lack sanitation management facilities that adequately separate waste from human contact, according the World Bank. And, according to a UNICEF case study on Burkina Faso, schools seldom offer safe or private places for girls to change their menstrual materials, so an estimated one in 10 skip school altogether.

In Malawi, many parents refuse to talk to their daughters about menstruation because the taboo against it is so strong, according to UNICEF. In parts of Nigeria, women and girls are expected to isolate themselves during their cycles, as they’re deemed “unclean.” And, in Somalia, they’re not allowed to pray, fast, go to the mosque or partake in any religious customs as observant Muslims until they’re “pure” again.

Meanwhile, period poverty and taboos surrounding menstruation wreak havoc on the Middle East. According to a UNICEF study on Kabul and the Parwan Province in Afghanistan, 29 percent of girls miss school because of their periods, over 70 percent don’t shower during their periods and half were unaware of what their periods are before they started menstruating.

And in war-torn countries like Syria, women and girls under siege are largely left without clean water and proper hygiene products, which has lead to serious gynecological complications.

Feminine Hygiene Products in Asia and the Oceania

Feminine hygiene products such as pads and tampons are widely available across major Asian cities and the Oceania, but you’ll have a harder time finding these care products in more rural areas across the region. Still, depending on the location, tampon brands and types will likely be limited.

In Australia and New Zealand, pads and tampons are widely available, but you won’t typically find tampons with applicators.

In some countries like Thailand, for example, pads are readily available and tampons with applicators may be available in bigger grocery stores, like Boots. Likewise, in Japan, you’ll easily find both Western and local Japanese brands of feminine hygiene products in most stores.

However, in some countries like Vietnam and China, while pads are easy to find, tampons (especially tampons with applicators) are a more difficult item to locate. In China, only two percent of women who menstruate use tampons, largely because of health concerns and the notion that tampon use suggests virginity loss because tampons can tear the hymen.

Meanwhile, in India, only an estimated 12 percent of the country’s 355 million menstruating women can afford to use the sanitary products that are available, according to Mumbai’s Center for Enquiry into Health and Allied Themes. As such, many women resort to using newspaper and even wood shavings. Because of the inaccessibility and taboo that periods are “unnatural,” 28 percent of girls miss school and 23 percent of girls have listed menstruation as the main reason for dropping out of school, according to a National Family Health Survey.

In Nepal, a historic practice known as Chhaupadi, which banishes girls and women to a shed outside their homes during menstruation, was only banned as of 2018. And in many primarily Muslim areas of Asia, such as Indonesia, certain feminine hygiene products like tampons are deemed shameful. There, a quarter of girls don’t talk to anyone about menstruation before their first cycle, according to UNICEF.

Feminine Hygiene Products in the UK and Europe

Feminine hygiene products like tampons, pads and menstrual cups are, generally, widely available throughout all of the UK and Western and Eastern Europe. It is important to note, however, that most tampons available in European countries come without applicators.

Scotland recently became the first country to provide free sanitary products to students at schools, colleges and universities. Meanwhile, women in many European countries are battling high taxes. It wasn’t until 2016 that the European Union allowed member states to scrap tampon taxes.

Despite how readily available they are in some countries, many low-income women throughout UK and Europe cannot afford the cost of these feminine hygiene products.

In the United Kingdom, for example, seven percent of girls from low-income families miss school as a result of their periods, according to a OnePoll survey. Another Plan International UK survey found that one in 10 girls are unable to afford sanitary products and 12 percent are thus forced to improvise sanitary wear.

How You Can Prepare for Your Period While Traveling

Traveling during your period isn’t necessarily ideal. But it doesn’t have to prevent you from partaking in activities or enjoying yourself if you do indeed have access to affordable feminine hygiene products and helpful tools before you go.

Here are three ways to prepare for your period before traveling.

1. Pack Feminine Hygiene Products with You

Of course, if you’re not sure if a destination to which you’re traveling will have the feminine hygiene products you need, it’s wise to pack them with you. While other toiletries like shampoos, conditioners and cleansing washes can easily be purchased overseas (to save space and weight in your luggage), you probably want to pack at least some tampons and pads or a menstrual cup with you.

Tampax makes travel-sized tampons, for example. Or you might consider traveling with a DivaCup reusable menstrual cup.

2. Track Your Periods and PMS Symptoms (and Plan Around Them)

Know when your period is coming by tracking your menstrual cycle and planning your daily itineraries around them. Again, your period shouldn’t prevent you from enjoying your travels, but you can plan certain daily activities (like beach trips) for lighter period days, for example.

There are plenty of apps to help you anticipate your period, better understand your ovulation cycle and become more aware of your own body. Some popular apps include Period TrackerPeriod CalendarEve Period TrackerClue Period Health TrackerFlo Period and Ovulation Tracker and Cycles Period and PMS Tracker. You can also do this with pen and paper in journals such as this period symptom journal.

3. Start Cycle Syncing Before You Go

If you’re anticipating your period during your travels, you can mitigate your period pain and symptoms before they even hit you. You can do this by “cycle syncing,” or adapting your diet, exercise routine and social engagements before and during your period.

The Happy Balance is a resourceful book that explains cycle syncing, so you can learn more about how what you eat, how you exercise and how you engage can help neutralize your fluctuating hormones.

How You Can Help Deliver Feminine Hygiene Products to Women and Girls in Need

There are a number of social impact groups that are working to end period poverty around the world and ensure that women and girls have reliable access to safe and affordable feminine hygiene products.

As a responsible and mindful traveler, here are 10 organizations you can read more about (and volunteer with or send donations to help!).

1. AFRIpads

AFRIpads has provided over 2.3 million women and girls across 30 countries with reusable sanitary pads. It partnered with Lunapads to create the One4Her program, which provides washable pads and supports dedicated impact projects related to menstrual and reproductive health. And it also partnered with Moxie on its Pads for Pads initiative through which it donates pads for women and girls in Uganda with every purchase of Moxie Slenders Liners, Slenders Pads or Sleepovers Pads. Plus, AFRIpads empowers and employs more than 150 women in Uganda in the process.

2. Freedom4Girls

Freedom4Girls is a UK-registered charity fighting period poverty by sending feminine hygiene products such as re-usable menstrual cups to women in need in the UK and underdeveloped countries.

3. NatraCare

NatraCare produces organic and natural feminine hygiene products, such as chlorine-free, biodegradable tampons, pads and panty-liners made of soft and certified organic cotton. The entire range is vegan certified and compostable, which not not only helps the environment but also offers struggling countries waste management solutions.

4. Sustainable Health Enterprises

Sustainable Health Enterprises facilitates women-owned businesses in Rwanda by helping local women jumpstart franchises to manufacture affordable, eco-friendly menstrual pads made of banana fiber.

5. Days for Girls

Days for Girls is an international nonprofit that promises to provide women across the world access to quality sustainable hygiene and health education. The organization is working to address gender inequality and sanitation issues around the world by “developing global partnerships, cultivating social enterprises, mobilizing volunteers and innovating sustainable solutions that shatter stigmas and limitations for women and girls.”

6. Cora

With a portion of its monthly revenue, Cora, an organic tampon company, provides sustainable period management to women and girls in India. The company supports the economic infrastructures of the place in India to which it donates, empowering women and girls in these areas through employment and education opportunities.

7. Bloody Good Period

Bloody Good Period is a UK-based organization working to end period poverty on the ground by providing period products to women and girls who can’t afford them and offering long-term menstrual education to women and girls less likely to access it.

8. Support the Girls

The nonprofit Support the Girls believes that women and girls shouldn’t have to choose between feeding themselves and maintaining their personal health. As such, Support the Girls provides menstrual products and bras to homeless women and girls across North America.

9. A Woman’s Worth Inc.

A Woman’s Worth Inc. is a nonprofit that provides entrepreneurial women with training in business skills and helps them access the networks of information and opportunities available to them. It also offers menstruation hygiene management solutions via a number of projects, such as the Prison Project, which provides fundamental necessities for people with periods behind bars.

10. #HappyPeriod

#HappyPeriod is a campaign that provides feminine hygiene products to low-income and homeless people with periods. Its mission is to end the stigma and break the taboo surround menstruation.