“As the daughters grow up, they have the same kind of childhood as their mothers, tending sheep, picking algae, and digging for licorice roots. Later, the daughters, as their mothers did, treat their periods with a rag or plant ash,” reads a passage in Mei Jie’s Outcry of the West, a literary non-fiction winner of the second Lu Xun Literary Prize in 2000.

The high cost of female sanitary products in China has recently hit domestic headlines, causing a public outcry against the “period poverty” that affect low-income women and lead to the prevalence of unregulated, poor quality menstrual products in the market. Photos of 100 unbranded and unpackaged menstrual pads, sold over the internet at just 21.99 RMB, went viral online on August 8. Posts under the hashtag “Unpackage sanitary pads” have since been viewed more than 1.37 billion times.

The photos shed light on the difficulties that low-income women worldwide face in accessing safe and inexpensive sanitary products. The World Health Organization estimates that 63 percent of gynecological diseases result from unhygienic pads. The photos have led to renewed calls in China for tax cuts on sanitary products, currently taxed at 13 percent,  and better regulation of sellers.

Under Weibo, users have complained about cost of sanitary products. Most commenters estimate spending at least 40 yuan per month on menstrual products, with some claiming to spend 100 yuan. It might be a minimal expense for a middle-income household, but could be significant for the approximately 600 million people in China who still live on less than 1,000 RMB a month.

Cheaper products are often of poor quality or knock-offs. Last month, a couple in Guangdong was arrested for selling counterfeit branded sanitary pads online. They had earned 7 million RMB over the past year. “I thought expensive brand pads must be reliable,” a college senior in Hebei province surnamed Wang, who has bought counterfeit pads, told TWOC. “How can we distinguish the real ones inside the box?”

Ignorance and misunderstandings about menstruation and women’s health products also abound. In 2018, a user on Zhihu posted the question, “My boyfriend wants to split up after finding me using a tampon. What can I do?” One response read “Those who use tampons are not good girls,” while other comments accused the woman of sexual promiscuity.

When netizens called for donations of sanitary products for female medical workers during the Covid-19 outbreak, some scoffed, “Lives are at stake, and you’re still hung up about pants?” Still, the “Relief Campaign for Sisters Fighting the Pandemic,” a movement started by netizens over Weibo, saw over 610,000 pairs of period underwear sent to the pandemic’s epicenter in Wuhan in just 35 days.

Some charities help women living in poverty to get the products they need. Love Girls, established in 2013, helps over 80,000 girls living in impoverish areas by donating sanitary products and teaching them about menstruation. However, Love Girls was criticized online recently for mismanaging donor funds by packaging their donations inside expensive-looking bags, which were found to contain only two packs of sanitary pads each.

Work units in China are now required to provide sanitary subsidies at a rate set by the provincial human resources and social security bureau. In Henan province, regulations states that female workers will get no less than 35 RMB a month as a sanitary subsidy.

Education around menstruation, along with sexual and reproductive education in general, still lags in China, particularly in the countryside. When I volunteered at a rural school in Anhui province in 2016, I carried a 12-year-girl home after she complained of an upset stomach. “Thanks for taking me home,” she later wrote to me in a letter. “Sorry, I lied. I didn’t have a stomach ache. I have a lot of blood. My grandmother told me it’s shameful to tell others. But you are my favorite teacher. I do not want to lie to you.” She wrote her grandmother was also reluctant to buy pads for her, so she had to use pads as little as possible.

I wrote back, trying to comfort her and explain that this was a normal physiological phenomenon, but she had begun to avoid me since the day I took her home, and didn’t show up to say goodbye the day I left the village.