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Fatima is holding a box of sanitary pads made by a foreign brand, some sanitizer, and pills. She looks up and says, “This is my monthly kit. It costs me a minimum of about 30 dinars ($9.77) every month, on good days. I need all this for my period, which has become yet another burden I have to carry as prices continue to soar, especially those of foreign products like the ones I’m using.”
“I suffer from hypersensitivity, which requires treatment and a high degree of sterilization,” Fatima continues. “So I have to avoid products with chemical additives – like the locally made ones that are of very poor quality, and scented.” She adds, “I have to wear pure cotton fabrics and underwear, and this further increases my monthly expenses related to my period.”
Fatima is a young Tunisian woman in her early thirties. She lives in a popular neighborhood in the capital and is a childcare worker at a nursery. She describes to Medfeminiswiya how ever-rising prices of sanitary pads have turned her period into a monthly nightmare, saying, “I use painkillers as well as medication to treat my allergies, and I need to buy three boxes of pads every month because I need to change them every hour. One box costs around 6 dinars ($1.95). I need three of those – and the cost has doubled over the past few months, so now it’s expensive for me to get my period.”
Draining financially, psychologically, and health-wise
Fatima is no longer able to cover these expenses on a monthly basis. Her salary is no longer sufficient to match the increase in prices of most consumer goods, forcing her to ask her family for financial support. She says it feels like she is “a burden on others. It’s the same story every month: trying to buy everything I need for my period without having to ask for an advance or financial help from my family. My period has become a burden. Can you imagine the psychological stress I’m under?” Not to mention that there are other emotional stressors added to this, such as the mood swings, anxiety, and sleep disturbances brought on by menstruation.
Ahlam, for her part, explains to us that she needs “between two and three boxes of sanitary pads a month, an ointment to treat redness and sensitivity, and painkillers to relieve menstrual cramps.” She adds, “Sometimes I need more medication and ointments than usual, depending on how severe my period is. This has all become its own budget now that the price of regular sanitary pads has jumped from 1.5 to minimum 4 dinars, while my salary has not budged.”
Menstruation has become a burden for many young Tunisian women who are not only bleeding physically but becoming financially and psychologically drained in the midst of unbridled inflation – 10.5% in January 2023 according to data from the National Institute of Statistics of Tunisia – and in a market where the prices of sanitary pads is skyrocketing with no improvement in quality.
Locally produced sanitary pads are cheaper but of lower quality. They contain plastics and are scented, but the majority of low- and middle-class women cannot afford anything else. Imported pads are expensive and exclusively reserved for the upper-middle and relatively well-to-do classes, as confirmed by various testimonies.
The fact that even the price of locally produced sanitary pads is skyrocketing has pushed young Tunisian women to denounce the situation on social media platforms. One woman described this new reality on Twitter saying that “Sanitary pads have become a luxury product, and many stores now even sell them by the piece.”
New social stigma: treating single women for period complications
For many Tunisian women, menstruation is no longer just a routine occurrence but has become a trigger of accumulating psychological, financial, and economic strain, as is the case with Mariam, who is 17 years old, a high school student. She tells us that she buys pads by the piece in stores she finds around her school. “The one box my family provides me is not enough – my period lasts for more than a week,” she explains, “so I try to make do by buying a few other single pads, the locally made ones. Each one costs me a few cents, which I struggle to collect.”
Further describing the suffering she has to go through, Mariam says, “I went to the public health center in my area and requested a medical examination to find out why my period is so long and painful. I was surprised to see the nurses looking at me with contempt. It made me more afraid of being stigmatized, especially in the rural area where I live, as word could reach my family and that would rouse suspicion.”
Patriarchal cultural backgrounds within rural communities make it more difficult for women to access healthcare when it comes to sexual or reproductive health. This has been confirmed by analysis conducted by feminist activists and the data presented in this investigation.
In the same vein, Asrar Ben Jouira, a feminist human rights activist and President of the Intersection Association for Rights and Freedoms (IARF) in Tunisia, states in an exclusive interview with Medfeminiswiya that “Women are always the victims in any crisis, and the current economic crisis in Tunisia is no different, bearing in mind that the government considers sanitary pads a luxury, a luxury product.”
An abundant source of tax money for the state and major capitalist enterprises
“After the government decided to reduce the import of luxury products such as cosmetics and raise taxes on them to mobilize resources, the price of pads increased,” explains Asrar. “This is a burden carried by women alone, and it reflects the patriarchal nature of policies that view essential products as abundant sources of tax money.”
“Even discussing this issue is taboo because of its connection to the sexual and reproductive field,” Asrar continues. Indeed, these topics are usually classified as secondary issues not worthy of discussion in patriarchal societies, as confirmed by most of the testimonies we have received and the facts we are documenting.
The Tunisian government approved, in the Finance Law of the year 2022, the raise of customs duties on a number of consumer products. These include cosmetics but also some plastic products that are one of the raw materials required by the local sanitary pad industry – which could explain the rise in prices, in conjunction with the soaring inflation. General inflation caused an increase in the price of pads, but in addition to that, the government is choosing not to subsidize these products, as confirmed to us by a number of manufacturers with whom we managed to discuss this issue.
Increasing price tags on sanitary pads is a growing concern for many Tunisian women who are already suffering from a decline in health coverage and the regression of state policy in this field, not to mention the successive crises ravaging the country and primarily impacting women’s access to healthcare.
IARF President Asrar Ben Jouira responds to this stating that “Women should be able to access sanitary pads free of charge given that menstruation is a natural phenomenon, not a choice. There is no reasoning by which pads could be considered luxury products. The state has a duty to protect women and is responsible for allocating a budget to support women’s health, and this extends to sanitary pads.”
We have not seen any gender-sensitive financial legislation, and the state has not allocated any funds for the law to be applied over all these years. Just look at pads, which the state now considers to be a luxury and which capitalist companies are selling at exorbitant prices, exploiting need to make profits
“The health policy set by the state is patriarchal, overlooking the specific needs of women,” says Asrar. “Despite the adoption in 2017 of Law No. 2017-58 on the elimination of all forms of violence against women, and despite the state’s commitment to protecting women victims of violence, we have not seen any gender-sensitive financial legislation, and the state has not allocated any funds for the law to be applied over all these years. Just look at pads, which the state now considers to be a luxury and which capitalist companies are selling at exorbitant prices, exploiting need to make profits.”
In this context, Tunisian women’s rights activists believe that the government is violating its obligations under the United Nations International Covenant on Economic, Social and Cultural Rights, which stipulates the need to provide an adequate supply of quality reproductive health facilities, goods, and services and to provide means of access to them on the basis of equality and at reasonable prices. The reality is, however, that health rights have been hit by this economic and political crisis.
From another health and human rights feminist angle, Khouloud Faizi, a midwife, feminist activist, and President of the Ambassadors for Equality movement, tells Medfeminiswiya in an exclusive interview that “Considering sanitary pads as luxury products and increasing taxes on them is a practice that contributes to the impoverishment of women, and this places a greater burden on women who are not financially independent. These women are now resorting to tissue paper or other materials that may be harmful to their health.”
As the economic crisis persists, a number of women are calling for a return to the use of environmentally friendly household fabrics and towels, but doctors do not recommend this as the use of fabrics could lead to other complications. Work conditions also prevent these matters from being taken care of and force women to adopt hasty solutions.
“Considering sanitary pads as luxury products and increasing taxes on them is a practice that contributes to the impoverishment of women”
“I have noticed a significant decline in the quality of sanitary products,” Khouloud elaborates. “The idea of using homemade sanitary pads goes back to our grandmothers, who used rolls of cotton cloth during menstruation. It is true that this may provide many women an alternative to paying high prices for disposable products – while also providing an environmentally friendly option – but if they are not properly sterilized, they may cause infections in the lower reproductive tract, which in turn may be transmitted to the upper genital tract, i.e. to the uterus and fallopian tubes, which may lead to a number of complications and more serious problems for women’s health.”
The midwife and feminist activist echoes what most of the feminists we spoke with also said, stating that “The Tunisian state’s public health policies are neither gender-sensitive nor supportive of gender equality. First because sanitary pads are not subsidized, and second because they are considered luxury products with added taxes.”
“Failing to include sex education in the educational curricula to help girls learn the hygienic practices they must follow during their period reflects the state’s lack of interest in health policies specific to women’s needs,” Khouloud points out. “Add to this the fact that menstruation is not recognized as a legitimate or acceptable excuse for absence from school or work, and it becomes clear that our legislation is patriarchal in nature, flattening and underestimating women’s suffering.”
Also, due to the nature of her profession, Khouloud deals and communicates with women on a daily basis. On public policies in the field of women’s health, she notes that “In recent years, I’ve noticed a lack, even an almost complete absence of sexual and reproductive health tours in secondary schools and institutes. You could even say this topic is being marginalized.” It should be noted here that the Ministry of Health has previously organized tours within educational institutions for health professionals to educate and raise awareness, but these have ceased completely.
Data listed in a study entitled “Reproductive Health Policy in Tunisia: Women’s Right to Reproductive Health and Gender Empowerment,” which was published on the website of the Health and Human Rights Journal and addresses Tunisia’s reproductive health policy between 1994 and 2014, reveals that “progress has been slow in terms of incorporating reproductive rights into the national reproductive health policy. Furthermore, the implementation of this policy has fallen short, as demonstrated by regional inequities in the accessibility and availability of reproductive health services, the low quality of maternal health care services, and discriminatory practices. Finally, the government’s lack of meaningful engagement in advancing gender empowerment stands in the way as the main challenge to gender equality in Tunisia.”
Between 2006 and 2013, the number of female students graduating from college was almost twice that of male students, but despite this, Tunisia is still far from achieving gender equality, according to the same study mentioned above. The table below, cited from this study, reveals the slow improvement of reproductive health between 1994 and 2008 by calculating the evolution of Tunisia’s maternal mortality ratio (per 100,000 live births), which had decreased in 2008 to 44.8 from its previous ratio of about 68.9 in 1994. This also confirms the failure to meet the desired expectations and results that would indicate an effective health policy and health empowerment, especially in the northwestern and central interior regions.
The study concludes that discriminatory practices constitute one of the main factors that prevent women from having equal access to reproductive health services in Tunisia. These practices discriminate between married and unmarried women, as evidenced by the Family Health Survey conducted by the National Board for Family and Population in 2002.
Economic dependence and political exclusion
A report prepared by the Tunisian Association of Democratic Women (ATFD) revealed to the CEDAW Committee, which is in charge of following up on the implementation of the CEDAW Convention, that women in Tunisia are subjected to several violations of their sexual and reproductive rights. This includes discrimination against unmarried women, and even virginity testing which is undertaken in a number of cases.
The report indicates that women’s sexual and reproductive rights have been among the most controversial issues in the country since 2011, coinciding with the political momentum that accompanied the January revolution. Drawing from the above, the report concludes that access to reproductive health requires women to be empowered, which is difficult to attain when they are economically dependent and politically excluded.
This slow progress can be attributed, in part, to women’s low participation in the economic sphere and political life, as this limits their ability to defend their rights, including those related to their reproductive health.
All of the above leads us to a simple conclusion: women are still the ones paying the cost of crises, and states are still profiting off women’s losses. Women are the ones who have to bear the brunt of the deeply rooted patriarchal barriers both politically and culturally, further widening the economic and health gap and disrupting health empowerment… until further notice