Chapter 7 + Flowing

Migrant menstruation: a pending debt with vulnerable girls and women

Being a woman can mean being part of a vulnerable population in a difficult context, such as immigration, where sexual health and feminine hygiene tend to be the last in a list of emergency priorities.

Illustration by Gia Castello

Original flaws 

Venezuela’s minimum wage is 2,555,000 bolívares a month, the equivalent to approximately $4.16 [October 2019 data]. The cost of a package that has eight to 10 sanitary pads, can be between $1 to $2.26, depending on the brand, type of absorption and size of the towels. A box of 40 tampons costs $13 to $20 (up to twice the amount of the minimum wage), and a menstrual cup has an average cost of $ 4.5. Numbers show that a woman spends a total of a minimum monthly salary to cover her menstrual needs.

f this is a devastating outlook for Venezuelan women in terms of spending, the supply is no better.  In 2016 the Kimberly-Clark company, dedicated to the manufacture of hygiene products, left the country. In 2017, Johnson & Johnson stopped the production of sanitary pads and towels. These were replaced by substitute brands at higher prices and often of lower quality.The complex situation in Venezuela includes a shortage of food and products, causing prices to rise. Additionally, the country is facing a health crisis and access to health services has become almost impossible due to a lack of staff.According to the Venezuelan Medical Federation, health centers have an inoperability of 80%. Also, it is estimated that at least 26.000 health professionales have left the country since 2012  due to hyperinflation and insufficient wages.
Since 2016, there has been a crisis due to the shortage of medicines both in “public health centers” and the “pharmacies and drug stores of the country,” according to a report by the Venezuelan Health Observatory (OVS).

The collapse of medical services, plus the high costs of hygiene products, force a majority of the population to prioritize their most urgent needs, making them invest their money in food. As a result, it becomes very difficult for Venezuelans to access health services and menstrual hygiene, violating their right to enjoy a full and dignified menstruation.

Menstruation as a factor of inequality 

Illustration by Gia Castello

It is in this difficult context that the Fundación Proyecto Mujeres en Venezuela -or Proyecto Mujeres- [Women in Venezuela Project Foundation] works, "so that menstruation doesn’t become a factor of inequality in the lives of girls and women," explains Estefanía Reyes, general coordinator of the organization. To ensure that young Venezuelans have the essential elements to have decent menstruations, they have a project called Niñas Visibles [Visible Girls], which since January 2019 aims to “contribute with menstrual hygiene education in schools of vulnerable communities.”

During the first six months of the project, they have focused on getting girls and adolescents to adopt sustainable menstrual hygiene methods, explains Madelein Rossell, activist at Proyecto Mujeres [Project Women]. This consists of implementing methods that become "sustainable over time, such as reusable towels or menstrual cups, and have a less environmental impact," since these last five years and eight to 10 years, respectively.

The organization has already supported over 50 girls, 38 moms and four teachers from the Fe y Alegría [Faith and Joy] Educational Unit 'La Chinita' in Maracaibo. Through support systems and training focused on gender, menstruation and sexual health, they aim to use education in an attempt to remove “taboos, myths and stigma” on these issues, says Estefanía Reyes.

“Sex education is very difficult. They group sexual health into a single category and don't talk about hygiene or personal health. These issues remain unknown.”  This lack of information leads to myths, such as "menstruation is not normal," says Madelein Rossell. "There is no acceptance that this happens to all women," she says. There are also mistaken beliefs regarding birth control. Many believe, for example, "that during menstruation it is unlikely to have a pregnancy when actually a pregnancy can occur at any time in the woman's cycle, even if it is minimal," adds the Proyecto Mujeres activist.

The menstrual cup is another example of this lack of information. Madelein Rossell says that there is a concern among girls and virgin women who believe that the cup is “going to break their hymen, or that the cup is a method that can only be used by women who have had sexual intercourse, which is false,” she clarifies that menstrual cups come in different sizes because all women have different sizes of uterus and flow.

Venezuelans in Colombia: Over 550 thousand migrants and refugees who menstruate

Illustration by Gia Castello

Although initiatives such as Proyecto Mujeres help a small part of the population living in Venezuela, the shortage of food, hygiene products, and the country’s economic, political and social difficulties that have caused approximately 4.483.860 Venezuelans to migrate to other countries in Latin America and the Caribbean to try to find better living conditions, in accordance with the records of the United Nations High Commissioner for Refugees (UNHCR).

Colombia has been the largest recipient of Venezuelan migrants and refugees, because its geographical proximity makes it the most accessible for both the population in transit and for those who wish to stay in the country. According to Migración Colombia, there are over 1.4 million Venezuelans in Colombia. Around 48% are women, and more than 550 thousand of them are of menstrual age.

Most of the Venezuelan migrants and refugees who have arrived in Colombia have needs related to sexual health and hygiene. According to a study by Profamilia on the unfulfilled sexual and reproductive health (SRH) needs, the majority of women and men are of reproductive age and require gynecology, urology, contraceptive methods, family planning, safe abortions, among other services.

Venezuelan migrants and refugees come from a difficult contest in their country, where they had limited access to the products and services they required during their menstrual cycle. Now, in an immigration context, they become an even more vulnerable group, since sexual health and medical hygiene is not such an urgent and immediate priority as medical emergencies. This means women migrate and are exposed to risks in a foreign country such as gender violence, sexual exploitation, human trafficking, and medical violence due to their irregular situation and not knowing the systems and processes to access the health services they require.

Dealing with vaginal infections and menstrual pain

Illustration by Gia Castello

According to Human Rights Watch, “access to clean sanitary facilities and resources for menstrual hygiene are essential for a decent life and for the implementation of many other human rights, such as the right to education, work and health”.  This, however, it is practically impossible for the most vulnerable Venezuelan migrants and refugees.

Living with limited access to basic menstrual hygiene products is the reality faced by Milagros Paez and Norlym Yanez, two Venezuelans living in Bucaramanga. They arrived in Colombia in June 20, 2019, after a three-day trip and 1,888 kilometers traveled on several buses from Ciudad Bolívar, in the state of Bolívar, passing through Valencia, Maracaibo, and then crossing the border through Maicao until they reached their destination. They know very little did they know about this city, only that it was not as big as Bogotá, the capital.

To stay in Venezuela became increasingly difficult. "Food was more expensive every day, the little money I had was not enough," says Norlym. In addition to food shortage, finding work became very difficult,  which made it all the more complicated to live a decent life.

They didn’t know anyone in Bucaramanga and had to start again from scratch. Thanks to the advice from other Venezuelans they found out about the Adventist Agency for Development and Assistance Resources (ADRA), an organization that provides humanitarian assistance to migrants.

Milagros and Norlyn sought help in ADRA, where they got a check-up and they handed them hygiene kits that contained toilet paper, a package of sanitary napkins, toothpaste, a bar of soap and deodorant. While these articles helped them meet a portion of their basic needs, their immigration status also requires that they pay attention to their sexual and reproductive health.

“Of course a pack of sanitary pads is welcome when the period arrives, but there are also signs of malnutrition in a poor diet, the lack of access to feminine hygiene products often causes the appearance of vaginal infections, ”explains Alba Pereira, director of Fundación Entre Dos Tierras [Between Two Lands Foundation] an organization that provides assistance to Venezuelan migrants and refugees in Bucaramanga. “Women often cannot go to clean bathrooms or have toilet paper to clean themselves. These conditions are much worse when women are menstruating and making it easy for them to get infections in their intimate parts and carry them for a long time because they have no money for medicine,” adds Alba Pereira.

Norlym tries to wash regularly, the products and services provided by ADRA have been very helpful. However, over the course of the past days, she has felt itchy, forcing her to find new solutions. She was uncomfortable and didn’t feel well so with the little money that she had she bought a small bottle of vinegar.

For her, the decision to buy and use vinegar is tied to the extra costs involved in treating her vaginal infection. While a 500 ml bottle of vinegar costs you little more than a dollar, and can last several days, buying a box of three 200 mg clotrimazole ovules, for a daily ovum treatment to end the infection, costs about $9, which is the same amount of money you invest for breakfast or four-day lunches. In addition, Norlym is unemployed and believes that a single box of medication will not be enough to treat her infection.

Although vinegar tends to be used to treat itching and infections, the reality is that “it is not always effective. An infection either by fungi or bacteria requires antibiotics and/or antifungal. Vinegar only works to keep the pH of the vagina acidic once the infection has been treated, ” says Silvia Plata, a gynecology and obstetrics specialist.

Fortunately, Milagros has not had any infections. She had her period during the first days of August, and she still had the sanitary towels that she had received with the ADRA hygiene kit and was able to use them during these days. However, aside from heavy bleeding, she felt severe menstrual pains in the lower abdomen, so, after taking her children to school at 6:15 am, she had to go back to bed until 11:00 am , when she got up to pick up her daughter from preschool.

In addition, Milagros must take special care with the cleaning of her genital organs, because after the pregnancy of Christian, her second child, “the toilet paper gives me allergies and itching so I must wash and clean myself with water and soap."

Exclusion and discrimination due to lack of a gender approach

“People have been leaving Venezuela to try to survive the difficulties of accessing services and health services. However, when we reach Colombia patterns of exclusion and discrimination continue since sexual health and gender based approaches are not a priority”, according to Selene Soto, Women’s Link Worldwide lawyer.

Venezuelan women and girls have left their country, among many reasons because of the harsh life conditions they experience. “We understand that one of the reasons they decide to migrate is access to sexual and reproductive health services in their country”, Selene emphasizes. 

According to the Mujeres Al Límite 2019 Report [Women at the Limit 2019], alongside “the health crisis in the country is one of the reasons women cannot access the health services they need for their wellbeing is due to economic limitations. The health system’s conditions also infringe on the access to other services to ensure wellness”. 

According to the report, 56.04% of migrant women interviewed indicate their last obgyn check-up took place a year or more before they left Venezuela. 

Venezuelan women, in their country have their right to sexual health violated due to the high costs. They prioritize other necessities and the State has not been able to ensure that they have access to the care they deserve.

According to Selene, iIt is a discrimination line that carries on. People are leaving Venezuela to try to survive, facing challenges, depending on the ways in which they leave, especially if they are walking. However, when they reach Colombia, they remain excluded due to their limited economic capacities, some women cannot have access to services or supplies that provide sexual and reproductive dignity”. 

In spite of the fact that menstruation is a natural corporal function is still a matter dealt with stigma it is a public health topic, “that ought not alienate women, but also include men, for even though it does not happen to them they should know about it, a little like brushing their teeth”, says Madelein Rossell from Proyecto Mujeres.

In a humanitarian crisis context, “menstruation is a pending topic, a debt international agencies have, a power States could guarantee in extreme vulnerability context; so that women and girls can experience they biological and social processes with as much dignity as possible and with as much information as possible to be able to make good decisions”, related Estefanía Reyes from Proyecto Mujeres. In this way, migrant and refugee women can have access to the services and medical attention, sanitary and menstrual hygiene, reduce health risks, and break the exclusion cycles in which they live while they migrate. 

Lucía Jeaneth Gualdrón is a journalist and social communication officer. She has worked for El Tiempo newspaper in Colombia, as a member of the Multimedia Journalism School and the UNHCR. She is self-taught, and enjoys ballet, reading, and learning new languages.