Olivia Cotes-James wants us to talk about menstrual health. Properly. No more euphemisms , no more opaque marketing, no more superstition, and no glossing over cramps, bleeding, or pain. Reframing current attitudes is vital for female empowerment and health, as well as the environment, says the 29-year-old founder of Luüna Naturals, which bills itself Asia’s first period care company with an all-female leadership team. Last year the United Nations warned that taboos around menstrual health were “disempowering” women worldwide, and called for action to end it. “Period stigma is the biggest barrier to the global advancement of women,” says Cotes-James. “Periods can still cause us to feel dirty, ashamed and frustrated. If menstrual taboos persist and society continues to devalue our fundamental female biology, what hope do we have of ever being seen as equal?” On average, women will spend up to eight years of their lives on their period, according to Unicef. They are vital to the continuity of the human race, but myths and misconceptions still dominate worldwide. The arrival of menstrual cups, period underwear, which can remove the need for products entirely, and apps that track your cycle have led to a new culture of openness in a generation keen to verbalise the realities of the female experience – from #MeToo and #ShoutYourAbortion, to miscarriage awareness campaign #Iamthe1in4 and #Trustaftertrauma, where women share stories of obstetric violence. Bloggers and vloggers lay bare the realities of how period products work on social media. There is even a period emoji in the pipeline. Our bodies are still subject to decision making by predominantly male-led governments. We deserve the final say over our bodies Olivia Cotes-James Normalising menstrual health can only be good for women’s overall health, says Cotes-James, whose firm sells organic cotton pads, liners and tampons, and silicone menstrual cups. It also works to help low income communities across Asia who don’t have access to safe, hygienic products. She explains: “Instead of seeing menstruation as a powerful indicator of well-being we are taught to shun it. In doing so, we ignore vital signs of underlying health issues. For example, around 1 in 10 women have endometriosis, yet it still takes almost a decade on average to diagnose. “A huge part of this is the fact that we don’t pay attention to telltale signs like how much blood we lose every month, or dismiss painful menstrual symptoms as normal because society has led us to believe that they are.” Using a cup could help women gauge if the amount of blood they lose falls within the normal range, she says. In parts of Asia, deeply ingrained cultural and religious beliefs often add another layer of restrictions. In rural Nepal, women are still exiled to outhouses during their period, despite the practice being illegal, resulting in deaths from exposure as well as sexual and animal attacks. In parts of South Asia, menstruating women are seen as unclean, spreading disease, and are forbidden from touching communal food, while across the region having a period renders people too impure to visit temples. Even among tech-savvy professionals in city centres, myths persist – some fear using tampons is akin to a sex act, others believe virgins cannot use menstrual cups, or that they cannot swim or exercise during their period. With offices in Shanghai, Hong Kong and Singapore, as well as London, Luüna hosts workshops, myth-busting meet-ups and frank discussions about period products, fertility, and menstrual health – for women and men. The Luüna Period Collective collaborates with local initiatives. For every cup sold, it donates one, but it also provides education in disadvantaged communities where poor sanitation, a lack of clean water and restrictive cultural norms add to the stigma. “Encouraging the use of plastic pads in low-income communities does not solve period poverty, and it exacerbates another urgent issue – plastic waste,” Cotes-James says. In the developed world, the average woman uses 11,000 disposable menstrual products over 30 years, according to the Women’s Environment Network. Switching to a cup, which could last up to 10 years, would potentially save billions from landfill where they can take centuries to decompose. Born in New Zealand but raised in the UK, Cotes-James splits her time between Hong Kong and Shanghai. She’s clear that while there are pronounced issues in Asia, universally women have been let down by inequality and archaic approaches to female reproductive health. There is five times more research into erectile dysfunction than premenstrual syndrome, for example, according to science forum ResearchGate, despite the latter affecting far more people. A 2005 study by the University of Pennsylvania found female pain is more likely to be underestimated. Cotes-James says it took her years to realise the painful symptoms she was experiencing during her period were actually an allergic reaction to the viscose and polyester found in some sanitary pads and tampons. For decades, men decided everything about periods – from running companies that make menstrual products and overseeing advertising, to setting legislation that taxes them as a luxury item and failing to require firms to declare what period care items are made of, she says. Growing public anger is driving change – India, Canada, and 13 US states have abolished the so-called tampon tax, while legislators in Scotland are backing a bill that will make period products free. But Cotes-James says: “Our bodies are still subject to decision making by predominantly male-led governments. We deserve the final say over our bodies – that includes everything from feminine care companies being required by law to disclose ingredients on packaging, to overcoming restrictive reproductive rights. “That is one of the biggest challenges we face in the fight for gender equality and we are still a long way from that being the reality.” Myths and menstrual taboos Menstrual cups may be taking Western countries by storm, but conservative attitudes and virginity myths are holding back a breakthrough for the reusable devices in Indonesia and across Asia. “We still have the culture where you stay a virgin until marriage, so women who haven’t had sex don’t want to put anything in their vagina,” says Jakarta-based gynaecologist Christo Ekapatria. Running menstrual cup education campaigns in school is untenable because it would be seen as promoting sexual intercourse, he adds. Even finding menstrual cups or tampons in Indonesia’s sprawling capital is no easy task. Most supermarkets and convenience stores sell pads only, those that do sell other items charge high prices. In one upmarket shopping centre, a 10-pack of pads costs just 7,500 rupiah (US$0.55) but the same number of tampons sells for more than eight times that, while an imported menstrual cup costs US$30. Still, a tiny minority of women are using cups in Indonesia, including Virra Alaydroes who says they give her more freedom to do activities like yoga and save her money in the long run. “Menstrual cups basically help to reduce going back and forth to the toilet (to change pads),” the 30-year-old Bali resident says. Instead of seeing menstruation as a powerful indicator of well-being we are taught to shun it. In doing so, we ignore vital signs of underlying health issues Olivia Cotes-James, founder of Luüna Naturals Some groups in Indonesia are touting reusable pads and period underwear as an environmentally conscious middle ground. The Perfect Fit project, run by charity Kopernik, is teaching Indonesian women in rural areas how to make and sell reusable pads, with an eye to eventually convincing them to use cups. Canada’s Diva, one of the biggest players in the market, says it plans educational campaigns in Indonesia to change the narrative. “The myth that an internal menstrual product has an impact on virginity can limit women in the choices they make to manage their periods. And it also encourages them to put their own comfort and autonomy second.”