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According to Endosurvivors, just over a third of women in Nigeria - 37 million - can “barely afford” menstrual products but while this claim has been made since at least 2021, there is little data to back it up.
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Period poverty – or lack of access to menstrual products – is a real problem, and experts point out it is directly tied to the country’s economic woes, with period products becoming more expensive as people become poorer.
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It is estimated that endometriosis is the cause of 35 to 40% of infertility in women worldwide. One may reasonably assume that the prevalence in Nigeria is similar, experts say, but there is also little reliable evidence to support this claim by Endosurvivors.
While using artificial intelligence tools to monitor public debate in April 2024, Africa Check came across an article in a Nigerian national newspaper that made two notable claims.
More than 37 million women and girls in the country could barely afford their monthly sanitary products, the Guardian said, and “about 35 to 40% of infertility cases” in Nigeria may be due to endometriosis.
To test these claims, we spoke to experts and looked at the data.
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Nigeria’s population was estimated at 216.8 million in 2022, half of whom were female.
The claim was made at an awareness event by the Endosurvivors International Foundation (ESIF), the Guardian reporter told Africa Check. ESIF is a non-profit group established in 2018.
“Although the foundation didn't really say much on period poverty that day. I researched and saw it [the claim] on other media house pages too,” the reporter said.
Sanitary products “are a broad term related to menstrual hygiene” including sanitary pads, panty liners, tampons and menstrual cups, Dr Rotimi Adesanya, a fellow at the Academy of Public Health in Nigeria’s capital, Abuja, told Africa Check.
Period poverty is a lack of access to sanitary products, menstrual hygiene education, toilets or waste disposal, according to the United Nations Population Fund, which aims to improve reproductive and maternal health around the world.
Claim has been circulating online since 2021
Africa Check found that the claim that more than 37 million women and girls can barely afford their monthly sanitary products has been circulating online since 2021.
We asked the National Bureau of Statistics (NBS) if they had any data on this. In 2021 the data agency was part of a number of organisations, including United Nations (UN) agencies, that conducted the multi-indicator cluster survey.
The results, published in 2022, showed that 97% of Nigerian women reported using appropriate materials during their last menstruation.
Some 38,806 women aged 15 to 49 were surveyed in 41,532 households across the country.
But NBS statisticians told Africa Check that this indicator differed from the claim, which focused on the number of Nigerian women and girls who couldn't afford sanitary products.
Their survey didn't ask about how much poverty people experienced. We can “propose a question on period poverty” in the next survey, Abiola Arosanyin, a senior statistician at NBS, told Africa Check.
The latest edition of the Nigeria demographic health survey also doesn’t have data on period poverty.
No nationally applicable data
We asked Victor Atuchukwu, a child protection specialist at Unicef, the UN’s children's agency, if the claim was accurate.
“It is correct that there is no nationally applicable data on barriers to women accessing menstrual health and hygiene products,” he said.
“The most common surveys often carried out are around missed activities during the survey and types of products used by women in urban and rural areas.” Atuchukwu shared data on this, but warned that it was not nationally or even regionally representative.
The claim as made is therefore unproven.
Period poverty is real
But many students and their families in Nigeria are struggling to cope, Funke Treasure Durodola, convener of the Sanitary Pad Media Campaign, told Africa Check.
Durodola is a media personality and social entrepreneur and her campaign promotes menstrual “dignity” for school girls and women in low-income areas. She also has a radio drama series called My Period, My Pride.
She agreed that the country lacked data on affordability, but said the claim should not be discounted, if drawing on her organisation's experience.
“When we started our pad scholarship for secondary school girls, we gave them questionnaires to fill as a form of data pre-intervention,” she said. From the responses, she learned that some girls were using cloth, or fabric, during their period.
“Sanitary pad budget for families with more girls or females has increased exponentially. When the sanitary pad media campaign started in 2020, a pack of sanitary pads sold for N400 [US$0.28], four years later, it's selling for N1,000[$0.68]. It's higher in the hinterland [rural areas],” she said.
Poverty affects purchasing power
There is a huge correlation between household poverty and the affordability of sanitary products for women and girls, Dr David Ede-Edokpolor, a consultant obstetrician and gynaecologist, told Africa Check.
“I would say that the affordability of sanitary products and its significant impact on the welfare of girls and women in the country has become more pronounced in recent years,” he said.
Ede-Edokpolor said the loss of household purchasing power due to the economic impact of Covid and other crises had made this clearer.
“Sanitary products are now [priced] on the high side, it would be impossible for a family that is barely managing to feed itself to afford sanitary products.”
Removing taxes from sanitary products or making them affordable was a step in the right direction, but a major step would be to improve living standards, said Dr Jumoke Ogunro, a consultant obstetrician and gynaecologist at the Alpha Assisted Reproductive Klinic in Lagos.
“Once poverty is alleviated, things will be better and we won't need to push for free sanitary products.”
In its latest national multidimensional poverty index report published in 2022, the NBS said 63% of Nigerians were multidimensionally poor due to a lack of access to health, education, employment and security, among other factors.
“Poverty affects purchasing power. Things like sanitary towels automatically become a luxury. In some households, clothes and towels are used as a substitute for sanitary products. Using clothing and towels to absorb blood can be a source of microbial growth that can lead to infection and infertility,” said Ogunro.
This claim was attributed directly to the Endosurvivors International Foundation (ESIF).
Infertility is the inability to conceive or become pregnant after 12 months or more of regular, unprotected sexual intercourse.
Endometriosis is a disease in which the tissue that lines the uterus starts to grow outside the uterus.
It can cause severe pelvic pain and make it difficult to get pregnant. Its cause and how to prevent or treat it are unknown, but the symptoms of endometriosis can be treated with medication and surgery.
It affects about 10% of women and girls of reproductive age worldwide.
However, ESIF didn't provide a source for its claim and has yet to respond to our request for more information.
For data on the disease, the World Health Organization media team referred us to its website, but we couldn't find any relating to infertility in Nigeria.
Dr Abayomi Ajayi, a fertility expert and consultant obstetrician and gynaecologist, told Africa Check that he had seen the reference, but would only say that it was “more of a very sensible guesstimate”.
“You know that data is very difficult in this clime and it’s very tricky to quote institutional figures when talking about the prevalence of a disease but this rate is quite reasonable globally and since the prevalence of endometriosis seems to be almost the same globally, I think it might not be a far shot.”
We also spoke with Deborah Bush, the founding principal of World Endometriosis Organisations, a network of charities focusing on the condition.
She said the 35 to 40% statistic is a globally accepted one.
“I do not have the accurate percentage for Nigeria. To the best of my knowledge, the data we have is not catalogued into countries or regions, though there may be local Nigerian research that gives you a clearer picture, that I am not aware of.”
Bush added that the percentage of infertility related to endometriosis was high because endometriosis was a very common, under-recognised and often poorly understood and treated condition.
“We may presume that the incidence of infertility amongst those with endometriosis is potentially higher,” she said.
However, we found no evidence of the specific percentage of infertility problems in Nigerian women associated with endometriosis.
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