Every month, Alice Shikuku has to choose between buying enough food for her family and buying sanitary pads for her daughter.
Her family moved to Korogocho, one of the poorest slums in Nairobi, Kenya, four years ago, when the father of her children died. Not long after, she was forced to sell her sewing machine, her only source of income, so she could get treatment for an infection in her leg.
"Life became extremely difficult," Shikuku tells CNN while sitting outside her sheet-metal home alongside her children. "Today, I have nothing. There is a material I was given to sew, but I don't have a machine to do so."
On a good day, Shikuku can make around $1 (150 Kenyan shillings) washing clothes and cleaning houses, but the cheapest pads available in Korogocho cost 33 cents (50 Kenyan shillings).
That means her 14-year-old daughter, Mercy, often must go without. Last month, Mercy was sent home from school after her period caught her by surprise. And she regularly stays home if she doesn't have pads, to avoid embarrassment.
"She has heavy menses. During her periods, it stains her clothes," Shikuku explains.
This is what period poverty looks like, and it's a shared experience for millions across Kenya.
An estimated 65% of women and girls in the country can't afford basic necessities to manage their periods, according to a report from the US Agency for International Development. The half-dozen women and girls whom CNN spoke to in Nairobi say they regularly miss school because of this, a problem widely reported across Kenya.
New research suggests that poor air quality could make matters worse.
Studies have linked air pollution to an increased risk of endometriosis, a condition that causes tissue like what lines the womb to grow outside of the uterus. Endometriosis can cause severe pain and heavy bleeding during menstruation, among myriad other reproductive health problems.
In the United States, researchers found that girls who had higher exposure to fine particulate matter, a primary source of air pollution, in childhood and during their mothers' pregnancies had earlier timing of menarche, their first period.
Audrey Gaskins, the senior researcher of the study, tells CNN that although it's difficult to compare country-to-country, one of the primary concerns is what the effects would be in places that have much worse air pollution.
"One thing that we're seeing in the studies that we've been doing in the United States is that there's really no safe level of air pollution," says Gaskins, an associate professor at the Rollins School of Public Health at Emory University. "We want to keep it as absolutely low as possible."
Gaskins says the fact that research is still showing an impact on girls as early as in utero (before a baby is born) despite the lower levels of pollution in the US compared to some other countries "is terrifying".
Around the world in Taiwan, a study carried out by China Medical University in Taichung found that women exposed to the highest levels of air pollution were 33 times more likely to develop dysmenorrhea, or painful periods.
Taiwan has a well-established health system, says Oscar Lee, the vice superintendent of China Medical University. Compared with Kenya, women can more easily access anti-inflammatory drugs and birth control commonly used to manage painful periods. That discrepancy should be worrying, Lee tells CNN.
"We still have women [in Taiwan] in their reproductive ages suffering from this painful period caused by poor air quality, then think about those who live in developing countries," Lee says. "I think this is a major global health concern."
Source: CNN
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