Questionable Research: Are Menstrual Cups A Hard Sell?

In May of 2016, the English Guardian gushed:

"'Girls are literally selling their bodies to get sanitary pads,' says Dr Penelope Phillips-Howard. 'When we did our study in Kenya, one in ten of the 15 year old girls told us that they had engaged in sex in order to get money to buy pads.'"

The 2015 study that they carried out is more careful in some ways. "Caution is suggested in interpreting the data provided, and particularly for analyses on low prevalence behaviors such as sex for money for sanitary products." The study also reveals that the number of 15 year olds who claimed to have had sex to get money, specifically to get sanitary pads, was fewer than 20.

Another Guardian article appeared in the last few days on the same subject. The articles are both promoting a menstrual cup as an alternative to expensive, disposable sanitary pads, or similar ware.

Access to sanitary ware is vital for the health and welfare of girls and women, and making devices like the menstrual cup available is an excellent alternative to the ridiculously expensive disposable sanitary ware available in most places.

But if it's a right, and vital for health, why dress this up as an attempt to 'rescue' 15 year olds who are said to be resorting to ‘transactional sex’ just to purchase sanitary pads? One of the researchers also claims the girls are often coerced into having sex.

Back in sensationalist mode, the recent Guardian article cites the same author and study:

"The situation is so dire that in a 2015 study of 3000 Kenyan women, Dr Penelope Phillips-Howard found 1 in 10 15-year-old girls were having sex to get money to pay for sanitary ware."

Note, 3000 women, but fewer than 200 15 year olds. Both Guardian articles are about having sex for money to buy pads, rather than having sex in return for pads. But the abstract of the 2015 article seems to blur this distinction, which I would argue is an important one if we are to judge whether this research is useful, however abused, or highly questionable.

There is also an article from a 2013 study, for which Phillips-Howard is a contributor, which clearly talks about both, having sex for money to buy sanitary ware and having sex for sanitary ware.

However, the 2013 article is quite different because it states that "Girls reported [my emphasis] 'other girls' but not themselves participated in transactional sex to buy pads, and received pads from boyfriends." Claiming that other people do this may indicate that the respondent has simply heard such things, perhaps from peers, teachers, various sources of information about sanitary matters, or even presentations about HIV.

Going back to the two possible phenomena, sex to get pads (from sexual partners) and sex to get money to buy pads, do either of these stand up to scrutiny? The first seems unlikely on the basis of other claims and findings made in the literature cited, such as that few people want to talk about menstruation; males don't at all, even many females generally don't.

Do men buy sanitary pads as gifts for their sexual partners? I imagine this is rare. I have bought sanitary pads in East African shops and people don’t hide their reactions. Perhaps it happens.

Claims about girls engaging in 'transactional' sex can be found throughout the HIV, health, development and anthropological literature, all over the place. Sex in Africa is a common obsession among academics, journalists, policy makers, civil servants, Guardian readers, etc. There are claims that some girls have sex for status, food, mobile phones, phone credit, just about anything that a girl may want (or that they may be said to want).

Is it credible that lots of girls have 'transactional' sex for money, which they then use to buy sanitary pads? Well, again the articles state several reasons to think that they don't, or don't do so very much. After all, they have families with small incomes, they need to buy food, to pay bills, including school fees. Would they prioritize sanitary pads, having gone as far as to engage in 'transactional' sex?

The literature goes from claiming that girls say other girls have sex for sanitary pads or sex for money to buy sanitary pads, to claiming that 10% of 15 year old girls claim that they have had sex for money to buy sanitary pads.

By my reading, the causal link between engaging in 'transactional' sex and purchasing sanitary pads is lost if the girls don't have sex in return for the pads. But if the claim is that they have sex for the pads then the literature itself undermines the claim that some men are happy to purchase them as gifts in return for sex.

We can’t rule out the possibility that someone has engaged in ‘transactional’ sex for money to buy sanitary pads, nor the possibility that someone has done so in return for sanitary pads. But Phillips-Howard's claim that girls are literally selling their bodies to get sanitary pads looks more like a desperate attempt to shore up poor quality research than a genuine argument for the benefits of providing girls in developing countries with the most appropriate means to ensure menstrual hygiene.