Sanitary pads are being bought in bulk in major cities in Pakistan as women rush to contribute to the flood relief effort–the only problem is, no one asked the women if they needed them.

To take an impoverished view, these well-intentioned but perhaps misplaced contributions could be seen as an imposition. A slightly less charitable view would be that urban-dwelling women who have had no regular, prolonged interaction with women who live in the countryside are making assumptions about their needs. It might be a time to listen before we act. The second best option is to speak to people who have worked extensively in rural communities during the floods of 2010.

“They (women in rural areas) use cloth and they have been doing it hygienically for many years,” said Neha Mankani, a development professional with experience of working during last year’s Balochistan earthquake as well as with midwives across Pakistan for the Indus Health Network. She added that they didn’t have access to sanitary napkins in the past and are unlikely to have it in the future once the disaster relief ends. So sending sanitary napkins could be counterproductive.

Hygiene is a need but a better way to help women would be to send cotton rolls or cotton cloth that they could use. She hastened to add, however, that while cotton cloths can be washed, drying them has been a challenge due to the moisture in the air and the lack of sunlight.

Mankani, who runs Mama Baby Fund and has worked internationally in places such as Uganda during a refugee crisis, told Aaj News that ‘cultural sensitivity’ is a recurring theme when it comes to menstrual hygiene products. Most people think in the ‘one size fits all’ paradigm, she said. “You hand over something which no one has used in the past. You are imposing your own solution on others instead of listening to what they need.”

She had reiterated the same on Instagram in a widely circulated message saying that underwear and sanitary napkins (unless specifically requested by women) are not used and will end up adding more trash to an area.

Emergent solutions

Anum Khalid, a 23-year-old final-year student at the Bahauddin Zakariya University in Multan and 22-year-old Bushra Mahnoor from Lahore’s Punjab University have been running a campaign for the last two months to raise funds for hygiene products for flood survivors.

Mahwari Justice might only exist on social media but it has already sent around 8,000 hygiene kits (containing underwear and sanitary pads) to people in Balochistan and southern Punjab. Anum pointed out that during the 2010 floods, a lot of women suffered from her area suffered vaginal infections, which is why she thought about raising funds for menstrual hygiene products.

She said that women-led organisations, including those from Qilla Saifullah and Lasbela in Balochistan, had reached out to them after finding out about their campaign. She understands that some women might not be used to sanitary napkins but pointed out that emergent solutions were the need of the hour. “We wanted to send re-usable cotton pads but the issue or drying after re-wash is a major challenge and one cannot be sure if the germs are cleaned.”

Khalid added that there was also the concern that one-time use sanitary napkins would add to the litter, which is why they are exploring alternative solutions.

She said that the initial opprobrium that the movement generated, particularly on social media regarding the need for sanitary products, had taken a back seat with more people coming forward to contribute as well as those working in flood-affected areas asking for supplies. “Yes, people need immediate assistance and they should get those. But why should they compromise on their hygiene?”

Beyond sanitary napkins

Attiya Dawood is a celebrated poet, activist and feminist who hails from Sindh and has experience working in disaster relief efforts, including the floods of 2010. “Menstrual hygiene is very important and women need sanitary napkins but right now is not the best time for it,” she told Aaj Digital.

Dawood speaks to multiple women on a daily basis. “Today, I spoke to several women from Lasbela who showed me sanitary napkins and said that they didn’t know what to do with them.”

Dawood pointed out was that women in Sindh do not have a culture of wearing underwear. “This means they can’t use sanitary napkins as they wouldn’t have the padding to keep it in place.”

She added that using cloth wasn’t the right solution, particularly considering that they are kept to dry in “concealed places away from the prying eyes of men” and that might leave residual germs. However, she added that bedsheets and old pieces of clothing remain the preferred solution for these women.

Moneeza Ahmed, another activist who has extensive experience of working with rural communities and marginalized groups, agrees with Dawood’s assessment. She said her collective of feminist organisations don’t believe sanitary products to be the right product for women in rural areas. Women in rural Sindh do not use plastic-based sanitary napkins, she said.

“In such situations, consultation with women are reduced. Instead of sending them what we think they need, we need to ask these women about their needs.”

Moneeza said that activists in urban settings often have limited knowledge of the situation and the cultural context. “Information we are getting from women on the ground: nutrition is a huge issue for pregnant women, child formula and food,” said Moneeza.

She added that there were other concerns that need greater focus. “As we saw during 2010 floods and the 2005 earthquake, women in tents are vulnerable to violence and harassment. They often can’t go to the bathroom at night,” she said, adding that while this wasn’t part of the immediate relief but something that the government could consider for long-term assistance.

A woman who has worked for years in Khairo Dero, Sindh told Aaj Digital that women in her area don’t use sanitary napkins. Instead, she recommended this list of urgent requirements:

• Rice flour
• Rice
• Masoor daal
• Channa daal
• Tea
• Sugar
• Cooking oil
• Washing powder
• Detergent soap
• Bath soap
• Women and men’s shalvar kameezes
• Blankets
• Children’s clothes
• Charpoys

The activists who Aaj News spoke to said that one should not get drawn into arguments based on false equivalence comparing menstrual hygiene supplies to shaving kits or have them branded as ‘luxury items’ as some people have done on social media.

Attiya Dawood said that it was an issue of awareness and timing, while saying that a more comprehensive plan was required to introduce menstrual hygiene concepts. She emphasized that immediate assistance was the priority, with food, shelter and health primary concerns.

She added that urban helpers need to keep in mind that the dietary habits of people in rural areas, particularly Sindh, are vastly different from those in urban centres. “Most people in rural areas are unable to digest food like biryani, qorma and nihari,” she said, saying it was the reason for the widespread diarrhea at relief camps.

Instead, people prefer boiled rice which they would even eat with sugar, she said. “Instead of sending a degh of biryani, they should send zarda (sweetened rice).”

She said that this would serve as a full meal for people in Sindh. “Particularly children will eat it happily. These people prefer eating bread dipped in milk.”