Bushra Mahnoor, photographed at residence in Attock, Pakistan, advocates for the menstrual well being of women in Pakistan. “It was an enormous taboo mentioning that you simply have been in your interval. However mentioning that you simply have been in your interval with out entry to a pad was simply much more humiliating,” she says. Her non-profit Mahwari Justice final 12 months filed a lawsuit to reclassify menstrual merchandise as important items. At present, menstrual pads are taxed as luxurious merchandise.

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Ben de la Cruz/NPR

Rising up, Bushra Mahnoor dreaded getting her interval. It meant disgrace, stigma and, typically, lacking faculty.

As an adolescent in Pakistan with 4 sisters, she says there have been by no means sufficient interval provides in her residence. They’d ration pads — frequently utilizing ones designed for eight hours for properly over 24 hours — and generally that they had to make use of a rag or a spare material that would simply leak. Others face an analogous state of affairs. In line with a report from UNICEF, revealed in 2025, solely about one in 10 women and girls in Pakistan use commercially manufactured merchandise.

“Once I knew I may not have a pad and I needed to depend on a material, these have been the occasions I couldn’t even think about going to the varsity,” Mahnoor remembers, who’s now 25.

Her faculty uniform was pure white and she or he remembers a instructor ordering a classmate to face by the again wall of the classroom so others would not see a interval stain on her uniform.

“It was an enormous taboo mentioning that you simply have been in your interval. However mentioning that you simply have been in your interval with out entry to a pad was simply much more humiliating,” she says.

So Mahnoor grew to become a professional at arising with excuses to remain residence: A obscure sickness. A abdomen ache.

“I grew up with quite a lot of disgrace,” she says.

Now Mahnoor is attempting to alter the fact for women in Pakistan. She’s the manager director at Mahwari Justice, a nonprofit in Pakistan that advocates for menstrual well being. In September 2025, she filed a lawsuit geared toward reclassifying menstrual merchandise from luxurious merchandise to important items. The aim is to get rid of the taxes positioned on the merchandise — which she hopes will decrease costs to make sanitary gadgets extra inexpensive.

None of Mahnoor’s expertise comes as a shock to Marni Sommer, a professor of sociomedical sciences at Columbia College’s Mailman College of Public Well being who has been learning menstrual well being for greater than 20 years.

“Accessing [menstrual] merchandise is a matter just about in every single place,” she says.

Traditionally, she says this problem has slipped between the cracks of world well being and improvement efforts as a result of it doesn’t fall neatly into one of many focus areas like training, water sanitation, gender and well being and since it is a subject that is typically stigmatized. “It is everyone’s and no person’s on the identical time,” Sommer says. “That has made it fairly troublesome to get funding and sources, as a result of it is like: The place does it belong? And who ought to fund it?”

Nevertheless, up to now 5 years, Emily Cruz — who works on menstrual well being for the nonprofit Splash — says there’s been extra consideration on the difficulty and alter in particular person international locations, “notably within the final 5 years, to take away these several types of taxes and import duties.” For instance, in Malawi, female sanctuary merchandise have been reclassified as important items slightly than luxurious items. And Ethiopia has seen the surtax and import duties on merchandise eliminated.

In Pakistan, the UNICEF report says there isn’t a nationwide coverage, plan or technique for menstrual well being and hygiene. NPR spoke with Mahnoor to study extra about her work within the nation, her private expertise and the experiences of different Pakistani girls.

The interview has been edited for readability and size. NPR reached out to Pakistani officers on the Ministry of Nationwide Well being Providers, Regulation and Coordination and the Ministry of Legislation and Justice for remark however didn’t obtain a reply.

How did you come to care about this problem?

Once I had my preliminary interval — I used to be simply 10 years of age at the moment — and I used to be given a pad to make use of, and I didn’t know how you can use it. I caught it the wrong way up, so the sticky floor was touching my physique, and it was itching me the entire day. I saved utilizing pads that method. I didn’t know, and naturally, could not ask anyone.

I’ve seen quite a lot of moms that, even after their daughters get their interval, they ask them to behave like they have not — [in Islam] it is forbidden to wish 5 occasions a day once you’re in your interval however they ask their daughters to fake to wish in order that the boys within the household, particularly the husband or the brothers of that baby, will not know that she is of fertile age now. As a result of as quickly as they know that the lady has began menstruating, they’ll pull her out of the varsity, if she goes there, and they’ll marry her off to a person double or thrice her age. And that’s one thing now we have seen so typically. It simply breaks my coronary heart. Moms are often very helpless in these conditions. The hyperlink to baby marriage contributes to the secrecy round durations and makes it a particularly isolating expertise.

No person was forcing my mom to do [child marriage] however, there was nonetheless this secrecy. I keep in mind I used to be informed to even cover it from my siblings, my sisters, and anyone else in the home.

What made you develop into vocal about menstrual well being?

In 2022, once I was in school, we had large floods that drowned a 3rd of our nation. One thing that [some friends and I] noticed was that interval wants are being uncared for, left and proper. [The neglect is not new but] the aid efforts ignored interval wants. And we began campaigning by social media.

We realized that there was quite a lot of backlash to speaking about durations brazenly, and that shifted our focus and made us notice that now we have the ability to mobilize funds and actively do one thing on our personal, on the bottom.

I went to Balochistan with the medical workforce — I simply hitched a journey with them — and I used to be giving out pads. I met individuals who have been residing in a aid camp, they usually had one rag and the sisters would use that rag interchangeably. They’d wash it within the flood water and provides it to the opposite sister to make use of. That shook me to the core.

What do girls do after they haven’t got entry to pads?

The commonest technique — that I’ve additionally used so much — is to make use of a cotton pad. So that you simply take a bit of fabric and [make it into a pouch, then] you stuff cotton inside it. The principle drawback with that’s that once you wash it you can not dry it out within the daylight [which is a natural disinfectant], as a result of then everyone would know that you simply have been menstruating and there’s a enormous stigma. So what individuals do is that they dry it contained in the rooms [and] that may result in quite a lot of bacterial development within it as a result of it can’t be absolutely dried. This will trigger [vaginal problems, including irritation and reproductive tract infections].

Lots of people can’t even afford that cotton to place inside the material, so they simply wrap the material a number of occasions or generally individuals stuff the material with mud or sand to make it absorbent. That’s one thing they do in quite a lot of tribal areas.

Different individuals have stated to us: We do not even put on panties, are you able to give us waist bands? It is like an elastic band that may be tied round their waist to allow them to take a bit of fabric and use that for his or her interval.

Inform us in regards to the lawsuit you are championing.

Like many international locations on the planet, Pakistan imposes a luxurious tax on interval merchandise. They don’t seem to be taxed as regular gross sales gadgets they usually’re not given the exemption of important gadgets.

Now we have a piece in our Structure — it is known as Article Six — that provides an exemption to quite a lot of merchandise which might be thought of important gadgets, like medical provides and, for the cattle business, cattle semen is taken into account important — and interval merchandise will not be. As a substitute, there’s virtually 40% of tax on pads.

So what the lawsuit does is basically easy: The lawsuit is difficult the truth that interval merchandise are taxed as luxurious gadgets. It is saying this tax is discriminatory as a result of principally the boys will not be utilizing them, so it places an unfair burden on girls and the individuals who can’t afford it. We need to see the taxes eliminated and the merchandise categorized as important gadgets.

It was filed in September. However due to the unstable political and judicial nature of our nation, we’re ready to obtain a listening to date to proceed. However on the identical time, we’re bracing ourselves for a really lengthy battle. In Nepal, they simply removed this tax nevertheless it took them 4 years.

If the lawsuit succeeds, what would occur? Are you optimistic?

We’re being life like additionally as a result of it would not mechanically make interval merchandise cheaper. So when India removed this tax in 2019, there are research that point out that interval merchandise did not find yourself changing into cheaper. So we’re not considering of a direct enormous discount within the worth, however it would create some extent of affect we hope, and it’ll even have symbolic worth.

It [would be] an enormous step however, I might say on the identical time, it is a very, very lengthy journey.