By Pamella Liz Nunes Pereira
Postdoctoral fellow at PPGBIOS/Fiocruz and Epidemic Ethics.
Researcher at Anis – Institute of Bioethics.
 
As a result of the COVID-19 pandemic, Brazil has been facing deepening historical inequalities related to housing, education, health, and food. During the health crisis, 117 million people - 55% of the country's population - experienced some type of food insecurity and 19 million experienced hunger. Even in the face of this appalling reality, the Brazilian Government abolished the largest income transfer program in the country and replaced it with a program that fails to provide a stable and continuous basic income for those in extreme poverty.
 
Since 2014, the United Nations (UN) has considered access to menstrual hygiene a right that needs to be treated both as a public health and human rights issue. Data from before the COVID-19 pandemic shows that among the 1.9 billion people worldwide who menstruate, approximately 500 million do not have the necessary conditions to manage their menstrual cycle with health and dignity. Ensuring menstrual health entails providing all people who menstruate with the minimum sanitary conditions provided for in the Sustainable Development Goals (SDGs), specifically the goals related to health and wellbeing, access to safe water and sanitation, and achieving gender equality and the empowerment of women and girls. According to the United Nations Population Fund (UNFPA), “Gender inequality, extreme poverty, humanitarian crises and harmful traditions can all turn menstruation into a time of deprivation and stigma, which can undermine their enjoyment of fundamental human rights. This is true for women and girls, as well as transgender men and non-binary persons who menstruate.
 
To ensure menstrual health, countries such as India and Kenya have put into place initiatives to ensure that all people who menstruate can manage their cycle with dignity and can continue to attend school and other social activities during their menstrual period without embarrassment or limitations.
 
In contrast, in Brazil, the President recently vetoed a Bill for the Menstrual Promotion Program. The Bill was approved by the Chamber of Deputies and the Federal Senate and unilaterally vetoed by the President. The National Congress is currently seeking to overturn the veto.
 
The Brazilian Menstrual Promotion Program proposes to provide for the free distribution of sanitary napkins to women, girls, transgender men, and non-binary people, who are students in public schools, or living on the streets, in prison, or in situations of extreme vulnerability. The main objectives of the program include: combating menstrual precariousness, identified as the lack of access to, or lack of resources for, the purchase of hygiene products and other resources necessary during the menstrual period, and reducing school absences during the menstrual period so as to minimize harms to learning and school performance. In Brazil, more than 4 million people who menstruate do not have basic hygiene items in schools when they are menstruating, and 713,000 live without access to a bathroom or shower at home.
 
In denying the rights of menstruating women, girls, and people of different genders, the Brazilian Government claims that there are not sufficient resources and logistical capacity to facilitate the distribution of menstrual products as well as guarantee essential items for food rationing, vaccines, and medicines. The Minister of Women, Family and Human Rights stated:
 
“Today we have to decide is the priority vaccines or pads? Poor women always menstruate in Brazil and no government worried about this before. And now Bolsonaro is the "executioner” because he is not going to distribute pads this year? We have our own government program and we will offer pads in the proper time. Now, all the budget of the health ministry is for medicine and vaccines, a matter of priority, we will not take rice out of the basic food parcel to replace this with sanitary pads.”
 
Presenting only two solutions to an issue, when in reality there are or may exist several others, creates a false dichotomy, as in the case of the supposed choices that the Brazilian Government would need to make between guaranteeing either basic health rights, or hygiene rights, or food security. With such claims, the Government ignores the essential fact that menstrual health, food security, and access to health are all rights that must be guaranteed in conjunction with each other. The Government has also once more reaffirmed its position against gender equity and against fundamental rights.
 
Rather than a discussion about the pressing needs of people in precarious situations, who face menstrual poverty in a context of structural vulnerability, the veto has instead sparked discussions - not based on reliable evidence - about the total cost of and funding sources for the distribution of menstrual products. Proponents of the Bill state that the funding would come from the amounts that the Government already allocates to the Unified Health System (SUS) and the National Penitentiary Fund. However, the President and the Minister of Women, Family and Human Rights insisted on the veto, with arguments that can be considered neither ethical nor based on evidence. Among the Minister's arguments is that they cannot replace food for rationing with sanitary napkins, and that the entire budget of the Ministry of Health is committed to vaccines and medicines for the treatment of COVID-19. However, there is no choice that actually needs to be made between these human rights: ensuring rights to food security and vaccination does not impede the distribution of menstrual products to those who need them and are unable to purchase them.
 
The COVID-19 pandemic has deepened existing inequalities in LMIC countries, where significant portions of the populations face food insecurity, difficulties in accessing health services, and other failures in terms of basic human rights. In a public health emergency, ensuring access to health is central, and government efforts are largely directed towards the full functioning of health systems and the acquisition of medicines and other essential supplies to control the spread of infectious diseases. However, the vaccine needs to be accompanied by other protections that are equally necessary for the population's dignified survival. We must never lose sight of the fact that ensuring human rights must be at the heart of responses to health emergencies. I urge the Brazilian Government to not hierarchize the basic needs of girls, women, non-binary people and transmen in situations of vulnerability. In a scenario of limited resources, many choices need to be made, and the criteria cannot be just economic or based on false dichotomies - they must be based on principles of social justice, equity, solidarity and the guarantee of bodily integrity and human dignity. We cannot continue with exclusionary arguments, as our reality is already too full of inequalities and exclusion. We need menstrual products, and vaccines, and food, and basic sanitation, and so much more.
 
Since the publication of this blog, Brazil's National Congress overturned President Jair Bolsonaro's veto of the project to combat menstrual poverty (PL no. 4,968/19) which guarantees the free distribution of sanitary pads for women, girls, transgender, and non-binary individuals in vulnerable situations.
 
Pamella Liz Nunes Pereira is a Postdoctoral fellow at Epidemic Ethics and at FIOCRUZ/RJ (Oswaldo Cruz Foundation), with PhD and Masters degree in Collective Health from the same institute. She's a social scientist from UERJ (Rio de Janeiro State University), and Researcher at Anis - Institute of Bioethics, Human Rights and Gender. 
http://lattes.cnpq.br/9901709302467476
https://orcid.org/0000-0002-7276-9922
 

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