Period poverty, or the inability to afford menstrual products, is a serious issue especially in developing countries, an issue menstruating girls and women grapple with monthly and a spotlight topic on Menstrual Hygiene Day, observed annually on 28 May.

“I’m happy to come work here because I meet and work with other people,” said Ms. Fatty, who operates a special machine to install snaps on each pad. “This place gives me joy because I can forget about my disability while working here.”

The sturdy, long-lasting pads she produces help women like her with a mobility impairment, who have trouble going to the restroom. After working there for a year, Ms. Fatty hopes to continue. While her disabilities bring many challenges and she struggled to make ends meet for a long time, her life has become better since she joined the project.

Keeping girls in school

In The Gambia, Africa’s smallest nation, period poverty is prevalent across the country, but it hits harder in rural areas, according to the UN Population Fund (UNFPA). Some girls skip school for around five days every month due to the lack of menstrual products and sanitary facilities.

The girls are afraid of staining their clothes and become a target of bullying or abuse, the agency said. As a result, gender inequality widens; boys will have an advantage as they attend school more often than girls, who have a higher chance of dropping out of education.

To tackle this problem, UNFPA developed a project in Basse, in the country’s Upper River Region, to produce recyclable sanitary pads. These pads are distributed at schools and hospitals in local communities.

The agency takes it as an opportunity to talk about bodily autonomy and sexual and reproductive health with young girls to mitigate period shaming and stigma.

Empowering young women

The project is also a way of empowering young women in the community as it provides them with a secure job and an opportunity to learn new skills.

Since 2014, Menstrual Hygiene Day has been observed on the 28th day of the fifth month of the year as menstrual cycles average 28 days in length and people menstruate an average of five days each month.

Poor menstrual health and hygiene undercuts fundamental rights – including the right to work and go to school – for women, girls and people who menstruate, according to UNFPA.

It also worsens social and economic inequalities, the agency said. In addition, insufficient resources to manage menstruation, as well as patterns of exclusion and shame, undermine human dignity. Gender inequality, extreme poverty, humanitarian crises and harmful traditions can amplify deprivation and stigma.

With that in mind, the theme for Menstrual Hygiene Day this year is “Making menstruation a normal fact of life by 2030”, said UNFPA Executive-Director Natalia Kanem.

“A girl’s first period should be a happy fact of life, a sign of coming of age with dignity,” she said. “She should have access to everything necessary to understand and care for her body and attend school without stigma or shame.”

The Day brings together governments, non-profits, the private sector, and individuals to promote good menstrual health and hygiene for everyone in the world. The occasion also aims at breaking the silence, raise awareness around menstrual issues and engaging decision-makers to take actions for better menstrual health and hygiene.

Learn more about what UNFPA is doing to eliminate period poverty here.

This feature, which focuses on the illegal trade in substandard and fake medicines, is part of a UN News series exploring the fight against trafficking in the Sahel.

From ineffective hand sanitizer to fake antimalarial pills, an illicit trade that grew during the COVID-19 pandemic in 2020 is being meticulously dismantled by the UN and partner countries in Africa’s Sahel region.

Substandard or fake medicines, like contraband baby cough syrup, are killing almost half a million sub-Saharan Africans every year, according to a threat assessment report from the UN Office on Drugs and Crime (UNODC).

The report explains how nations in the Sahel, a 6,000-kilometre-wide swath stretching from the Red Sea to the Atlantic, which is home to 300 million people, are joining forces to stop fake medicines at their borders and hold the perpetrators accountable.

This fight is taking place as Sahelians face unprecedented strife: more than 2.9 million people have been displaced by conflict and violence, with armed groups launching attacks that have already shuttered 11,000 schools and 7,000 health centres.

Deadly supply meets desperate demand

Health care is scarce in the region, which has among the world’s highest incidence of malaria and where infectious diseases are one of the leading causes of death.

“This disparity between the supply of and demand for medical care is at least partly filled by medicines supplied from the illegal market to treat self-diagnosed diseases or symptoms,” the report says, explaining that street markets and unauthorized sellers, especially in rural or conflict-affected areas, are sometimes the only sources of medicines and pharmaceutical products.

Fake treatments with fatal results

The study shows that the cost of the illegal medicine trade is high, in terms of health care and human lives.

Fake or substandard antimalarial medicines kill as many as 267,000 sub-Saharan Africans every year. Nearly 170,000 sub-Saharan African children die every year from unauthorized antibiotics used to treat severe pneumonia.

Caring for people who have used falsified or substandard medical products for malaria treatment in sub-Saharan Africa costs up to $44.7 million every year, according to World Health Organization (WHO) estimates.

Motley trafficking

Corruption is one of the main reasons that the trade is allowed to flourish.

About 40 per cent of substandard and falsified medical products reported in Sahelian countries between 2013 and 2021 land in the regulated supply chain, the report showed. Products diverted from the legal supply chain typically come from such exporting nations as Belgium, China, France, and India. Some end up on pharmacy shelves.

The perpetrators are employees of pharmaceutical companies, public officials, law enforcement officers, health agency workers and street vendors, all motivated by potential financial gain, the report found.

Traffickers are finding ever more sophisticated routes, from working with pharmacists to taking their crimes online, according to a UNODC research brief on the issue.

While terrorist groups and non-State armed groups are commonly associated with trafficking in medical products in the Sahel, this mainly revolves around consuming medicines or levying “taxes” on shipments in areas under their control.

Snip supply, meet demand

Efforts are under way to adopt a regional approach to the problem, involving every nation in the region. For example, all Sahel countries except Mauritania have ratified a treaty to establish an African medicines agency, and the African Medicines Regulatory Harmonization initiative, launched by the African Union in 2009, aims at improving access to safe, affordable medicine.

All the Sahel countries have legal provisions in place relating to trafficking in medical products, but some laws are outdated, UNODC findings showed. The agency recommended, among other things, revised legislation alongside enhanced coordination among stakeholders.

Custom and law enforcement officers prevent huge quantities of contraband from entering the markets of destination countries.

States taking action

Law enforcement and judicial efforts that safeguard the legal supply chain should be a priority, said UNODC, pointing to the seizure of some 605 tonnes of fake medicines between 2017 to 2021 by authorities in the region.

Operation Pangea, for example, coordinated by UN partner INTERPOL in 90 countries, targeted online sales of pharmaceutical products. Results saw seizures of unauthorized antivirals rise by 18 per cent and unauthorized chloroquine, to treat malaria, by 100 per cent.

“Transnational organized crime groups take advantage of gaps in national regulation and oversight to peddle substandard and falsified medical products,” UNODC Executive Director Ghada Waly said. “We need to help countries increase cooperation to close gaps, build law enforcement and criminal justice capacity, and drive public awareness to keep people safe.”

Following the death of 70 children in The Gambia in 2022, the World Health Organization identified four contaminated paediatric medicines in the West African nation.