Risking Health, Women Forgo Periods to Cut Costs

ZVISHAVANE, ZIMBABWE — Monica Ndlovu pops a white pill into her mouth and chases it with water. She eyes her packet, still full of round brown pills – the ones that would allow her menstrual cycle to start.

She can’t afford to get her period.

Ndlovu used to sell cooking oil, rice and soap in this southern Zimbabwe mining town, but business collapsed in March when the coronavirus led officials to largely shut down the border. She can pull together enough money to buy sanitary pads for her 19-year-old daughter but not for herself. So Ndlovu skips the line of brown pills, which would induce her period.

She’s one of numerous women in Zvishavane and beyond whose income cratered during the pandemic and turned sanitary products into a luxury. Many use birth control pills to halt their menstrual flow and save money, despite unclear health risks and potentially deadly side effects.

“I have heard that it’s not safe to do this, but do I have a choice?” says Ndlovu, a mild-mannered woman whose hands are cracked from the laundry she now does to earn income. “Alternative methods like rags and cloth give me blisters.”

Doctors warn abuse of some contraceptives – particularly estrogen-only birth control – could heighten the risk of endometrial, or womb, cancer, which begins in the uterus and can prove deadly if left untreated.

Suppressing periods through pills alters hormone doses, so the womb does not shed its inner lining, says Dr. Francis Chiwora, a longtime obstetrician and gynecologist from Bulawayo, Zimbabwe’s second-largest city.

“Any prolonged skipping of the brown [pills] can be dangerous,” he says, leading to excessive bleeding and the likelihood of lingering consequences.

Vimbai Chinembiri, GPJ Zimbabwe

Monica Ndlovu swallows a pill that will help her avoid menstruating. She needs to stop her period, she says, because she lost her job and can no longer pay for sanitary products.

While many Zimbabwean women take pills that are not estrogen-only, few studies have examined the broader, long-term risks of misusing birth control. Health care workers in Zimbabwe don’t know the full extent of the threat, says Dr. Maxwell Mhlanga, a researcher at the University of Zimbabwe’s Faculty of Medicine and Health Sciences.

“Without funding and human resource personnel to study in depth,” he says, “the scope of the population which has had cancer as a result of this misuse of family planning pills, or those at risk, may never be known.”

Zvishavane, located nearly 400 kilometers (249 miles) south of Harare, is a town built on hope. The mining hub fills with migrants who seek opportunity digging for gold and other minerals. But some women now take another gamble: that forgoing periods to feed their families won’t endanger them further.

Ndlovu tried instructing her daughter to limit her sanitary pad usage to one packet a month. “Sometimes it’s not practical because she seems to have a heavy flow,” says Ndlovu, who shares a one-room house with her child and husband.

The coronavirus crisis only adds to Zimbabwe’s flailing economy. The country is battling two decades of economic upheaval and political instability, including a 2017 coup that overthrew Robert Mugabe, Zimbabwe’s leader for nearly four decades. Inflation continues to skyrocket.

A packet of the thinnest, most affordable sanitary pads costs around 85 Zimbabwean dollars (ZWL) (about $1). Ndlovu and her daughter need two packets every month, but the cost is beyond her reach in a country where the average household income in November 2019 was 581 ZWL (about $36 at the time), according to the Zimbabwe National Statistics Agency. Year-on-year inflation hit 761% this August.

The cost of sanitary pads, which are largely imported from neighboring South Africa, has shot up from 50 ZWL (approximately 61 cents) to around 130 ZWL (about $2) in the past six months, due to the nearly closed border. Tampons are available in Zimbabwe’s supermarkets, but they cost three times more than pads and are not widely used.

A month’s supply of birth control pills, on the other hand, is free at local government clinics and hospitals, and sells for 50 ZWL (about 61 cents) in private pharmacies.

“Condoms are distributed for free; sanitary wear should be as well,” says Priscilla Misihairabwi-Mushonga, a member of Parliament who advocates for free sanitary products. “Sex is a choice. Menstruation is not.”

The government temporarily lifted duties and value-added tax on imported sanitary wear in December 2018. Officials extended the suspension until this November, following campaigns by reproductive health activists. But the country’s staggering inflation means the items remain pricey.

The pandemic has augmented challenges to women’s health and highlighted the tension many already face.

Illustration by Matt Haney for GPJ

Patricia Shumba, a community health worker in Zvishavane who has spent more than a decade devoted to reproductive health, regularly encounters sex workers who block their periods. But she has noticed this practice increase more widely as the coronavirus crushes incomes.

“You can’t force someone to choose between a pad and food,” Shumba says.

Officials recognize the economic challenges but stress that women need to accept responsibility for their decisions.

“People should just follow instructions on the pack,” says Karen Dzuke, the provincial manager for Midlands at the Zimbabwe National Family Planning Council, an organization that operates under the Ministry of Health and Child Care.

She argues birth control pills taken correctly reduce the rate of womb cancer, especially since many Zimbabwean women don’t use estrogen-only pills. But she still discourages skipping the brown pills since they help regulate cycles.

Some women are willing to accept the risk. Susan Mtakunye receives free pills from a local clinic and avoids the ones that would induce her period.

Mtakunye, a chatty 34-year-old with a contagious smile, sells carbonated beverages for a living. She cares for five children. The money spent on pads can be used to feed them, she says.

She rubs her protruding belly with both hands. Nurses tell her it’s a side effect of not menstruating. They also tell her to follow the instructions on the birth control packet or risk developing cancer, she says. “But we have no choice.”