Growing up, Bushra Mahnoor dreaded getting her period. It meant shame, stigma and, often, missing school.
As an adolescent in Pakistan with four sisters, she says there were never enough period supplies in her home. They'd ration pads — regularly using ones designed for eight hours for well over 24 hours — and sometimes they had to use a rag or a spare cloth that could easily leak. Others face a similar situation. According to a report from UNICEF, published in 2025, only about one in 10 girls and women in Pakistan use commercially manufactured products.
"When I knew I might not have a pad and I had to rely on a cloth, those were the times I could not even imagine going to the school," Mahnoor recalls, who is now 25.
Her school uniform was pure white and she remembers a teacher ordering a classmate to stand by the back wall of the classroom so others wouldn't see a period stain on her uniform.
"It was a big taboo mentioning that you were on your period. But mentioning that you were on your period without access to a pad was just even more humiliating," she says.
So Mahnoor became a pro at coming up with excuses to stay home: A vague illness. A stomach ache.
"I grew up with a lot of shame," she says.
Now Mahnoor is trying to change the reality for girls in Pakistan. She's the executive director at Mahwari Justice, a nonprofit in Pakistan that advocates for menstrual health. In September 2025, she filed a lawsuit aimed at reclassifying menstrual products from luxury products to essential goods. The goal is to eliminate the taxes placed on the products — which she hopes will lower prices to make sanitary items more affordable.
None of Mahnoor's experience comes as a surprise to Marni Sommer, a professor of sociomedical sciences at Columbia University's Mailman School of Public Health who has been studying menstrual health for more than 20 years.
"Accessing [menstrual] products is an issue pretty much everywhere," she says.
Historically, she says this issue has slipped between the cracks of global health and development efforts because it does not fall neatly into one of the focus areas like education, water sanitation, gender and health and because it's a topic that's often stigmatized. "It's everybody's and nobody's at the same time," Sommer says. "That has made it quite difficult to get funding and resources, because it's like: Where does it belong? And who should fund it?"
However, in the past five years, Emily Cruz — who works on menstrual health for the nonprofit Splash — says there's been more attention on the issue and change in individual countries, "particularly in the last five years, to remove those different types of taxes and import duties." For example, in Malawi, feminine sanctuary products have been reclassified as essential goods rather than luxury goods. And Ethiopia has seen the surtax and import duties on products removed.
In Pakistan, the UNICEF report says there is no national policy, plan or strategy for menstrual health and hygiene. NPR spoke with Mahnoor to learn more about her work in the country, her personal experience and the experiences of other Pakistani women.
The interview has been edited for clarity and length. NPR reached out to Pakistani officials at the Ministry of National Health Services, Regulation and Coordination and the Ministry of Law and Justice for comment but did not receive a reply.
How did you come to care about this issue?
When I had my initial period — I was just 10 years of age at that time — and I was given a pad to use, and I did not know how to use it. I stuck it upside down, so the sticky surface was touching my body, and it was itching me the whole day. I kept using pads that way. I did not know, and of course, couldn't ask anybody.
I've seen a lot of mothers that, even after their daughters get their period, they ask them to act like they haven't — [in Islam] it's forbidden to pray five times a day when you're on your period but they ask their daughters to pretend to pray so that the men in the family, especially the husband or the brothers of that child, won't know that she is of fertile age now. Because as soon as they know that the girl has started menstruating, they're going to pull her out of the school, if she goes there, and they're going to marry her off to a man double or thrice her age. And that is something we have seen so often. It just breaks my heart. Mothers are usually very helpless in these situations. The link to child marriage contributes to the secrecy around periods and makes it an extremely isolating experience.
Nobody was forcing my mother to do [child marriage] but, there was still this secrecy. I remember I was told to even hide it from my siblings, my sisters, and anybody else in the house.
What made you become vocal about menstrual health?
In 2022, when I was in college, we had massive floods that drowned a third of our country. Something that [some friends and I] saw was that period needs are being neglected, left and right. [The neglect is not new but] the relief efforts ignored period needs. And we started campaigning through social media.
We realized that there was a lot of backlash to talking about periods openly, and that shifted our focus and made us realize that we have the power to mobilize funds and actively do something on our own, on the ground.
I went to Balochistan with the medical team — I just hitched a ride with them — and I was giving out pads. I met people who were living in a relief camp, and they had one rag and the sisters would use that rag interchangeably. They'd wash it in the flood water and give it to the other sister to use. That shook me to the core.
What do women do when they don't have access to pads?
The most common method — that I have also used a lot — is to use a cotton pad. So you just take a piece of cloth and [make it into a pouch, then] you stuff cotton inside it. The main problem with that is that when you wash it you cannot dry it out in the sunlight [which is a natural disinfectant], because then everybody would know that you were menstruating and there is a huge stigma. So what people do is that they dry it inside the rooms [and] that can lead to a lot of bacterial growth inside of it because it cannot be fully dried. This can cause [vaginal problems, including irritation and reproductive tract infections].
A lot of people cannot even afford that cotton to put inside the cloth, so they just wrap the cloth multiple times or sometimes people stuff the cloth with mud or sand to make it absorbent. That is something they do in a lot of tribal areas.
Other people have said to us: We don't even wear panties, can you give us waist bands? It's like an elastic band that can be tied around their waist so they can take a piece of cloth and use that for their period.
Tell us about the lawsuit you're championing.
Like many countries in the world, Pakistan imposes a luxury tax on period products. They're not taxed as normal sales items and they're not given the exemption of essential items.
We have a section in our Constitution — it's called Article Six — that gives an exemption to a lot of products that are considered essential items, like medical supplies and, for the cattle industry, cattle semen is considered essential — and period products are not. Instead, there's almost 40% of tax on pads.
So what the lawsuit does is really simple: The lawsuit is challenging the fact that period products are taxed as luxury items. It's saying this tax is discriminatory because mostly the men are not using them, so it puts an unfair burden on women and the people who cannot afford it. We want to see the taxes removed and the products classified as essential items.
It was filed in September. But because of the unstable political and judicial nature of our country, we are waiting to receive a hearing date to proceed. But at the same time, we are bracing ourselves for a very long battle. In Nepal, they just got rid of this tax but it took them four years.
If the lawsuit succeeds, what would happen? Are you optimistic?
We're being realistic also because it doesn't automatically make period products cheaper. So when India got rid of this tax in 2019, there are studies that indicate that period products didn't end up becoming cheaper. So we are not thinking of an immediate huge reduction in the price, but it will create some degree of impact we hope, and it will also have symbolic value.
It [would be] a big step but, I would say at the same time, it's a very, very long journey.
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