In the Western world, the ease with which women can manage their periods can often be taken for granted.

From organic cotton tampons to THINX underwear, we have a plethora of options to choose from when it comes to our monthly flows. But, in countries around the world, from India to Uganda, sanitary products can prove too expensive or unattainable, while periods are often taboo.

According to a global survey, 73 per cent of women “sometimes or always” hide their periods from others, while 68 percent of women are afraid to talk about their periods with their romantic partners. Lack of clean water, sanitary products, or even access to restrooms can make periods difficult for women to navigate or even speak about. One in nine people do not have clean water close to home, while one in three lack access to a decent toilet, reports the non-profit WaterAid.

In Australia, period poverty is a real issue. The Quicky spoke with Rochelle Courtenay from Share The Dignity on why Aussie girls are missing school because of their period. 

Without these services, menstruation can affect women’s health and involvement in social and economic life, such as young girls dropping out of school.

“When I am on my period, I stop playing soccer or any other sporting activities,” says 19-year-old Doris of Zambia.

“I can’t run or play games with my friends.” Doris uses lint cotton for her periods, which can prove itchy and scarce in the rainy seasons.

Despite millions of women menstruating each month, too often governments ignore how lack of clean water and sanitary products can negatively impact women’s health, economic and social wellbeing. Battling the stigma that continues to surround periods, women around the world look for their own solutions around disposal, pricing, health, and comfort. In a new photo gallery from WaterAid, poignant photographs highlight the varied ways in which women around the world manage their periods.

WaterAid is an organization that works to equip people with clean water and decent toilets. Founded in 1981, WaterAid approaches the clean water crisis by establishing locally-based field offices around-the-world that work to bring clean water to communities while also petitioning key decision makers in government to support this vital cause. Since its founding, the non-profit has empowered more than 25 million people with clean water as it continues to push for an end to the world’s water crisis.

Ever wondered what happens when a woman living in a third-world country gets her period? Find out in the video below, post continues after video.

In Uganda, Lepera Joyce uses a homemade goat skin skirt as a solution to her monthly period.

“Once I bought a pack of sanitary pads from the shop but I did not like them because if one has a heavy blood flow, she can use more than three pads in a day, which proves expensive,” explains the 23-year-old.

“[Sanitary pads] are small, they do not absorb all the blood, yet the goat skin skirt works for the whole day.”

Lepera lives in a pastoral community where herds of goats and sheep roam freely. After the animals are slaughtered, her community use the skins for bedding, clothing, and women’s periods. The goat skin skirt offers an affordable, re-usable solution for Lepera and her monthly period.

Within the communities that WaterAid works in, women spoke candidly about how they manage their monthly flows. The result is a revealing snapshot of traditions passed on from mother to daughter, as well as a look at women’s own, often innovative, solutions to their periods.

In Nepal, Sangita makes her own sanitary pads.

“Ready-made pads are costly and if you do not dispose of them properly it will pollute the environment,” explains Sangita.

“In a municipality like ours, where there is no plan for managing solid waste, these sorts of pads can contaminate our water source if not disposed of properly. So looking at the wider impact, homemade pads are safer.”

Sangita learned how to make pads three years ago, which gave her a crucial knowledge of menstrual hygiene.

In many countries, a cloth is the go-to material for women, which helps to tackle disposal issues in places where facilities are lacking.

In Malawi, sanitary clothes are called ‘nyanda,’ as explained by a local 54-year-old named Elizabeth.

“During our menstruation period, we use nyanda-a rag or a piece of cloth cut off from an old chitenge wrap [traditional African fabric],” explains Elizabeth.

“We place it in the underwear. However, some among us cannot afford underwear, so in that case, we secure the nyanda in place by tearing a long and thin piece of the rag and tying it around the waist to hold the fabric tight in place.”

WaterAid works in some of the hardest to reach places in the world to provide appropriate sanitation facilities and menstrual hygiene skills in an effort to education women and girls on how best to manage their periods.

Despite their efforts, affordability and access remain obstacles for women who are forced to use homemade period items that can pose a health risk.

In Zambia, 22-year-old Limpo uses cow patties-or cow dung-to stem her monthly flow.

“I cannot say that I am completely comfortable and happy using these materials to manage my periods,” says Limpo.

“If I had an alternative, I would use other stuff. It is just that I don’t have an option, so I keep using this anyway. I have never seen or experienced any complications with cow patties.”

Limpo collects the cow patties from nearby fields and stores them until they are completely dry. When she is on her period, Limpo will cut the cow patties into sizeable portions and then wrap it in a cloth, using it as a makeshift pad to absorb blood.

Too often a woman’s period is dismissed by society. Jokes are made about ‘PMS,’ mentions of menstruation are still considered taboo, and periods are largely seen as a ‘women’s problem’ that men need not concern themselves with.

Countries like Zambia show us that lack of access to clean water and sanitary products can block women from taking part in society fully, which is an issue that impacts everyone.

“It is the right of every woman and girl to be able to manage their period with dignity,” says Ibrahim Kabole, WaterAid Country Director in Tanzania.

“Half the world’s population menstruates for a significant portion of their life, and it is not acceptable that for so long, this has not been openly discussed or made a priority,” adds Louisa Gosling, WaterAid’s Quality Programs Manager.

“Women shouldn’t have to worry about where they might go, how they might manage their periods, or whether the appropriate facilities including running water and adequate disposal will be available.”

This article originally appeared on UnearthWomen.com and Medium, and was republished here with full permission.

Unearth Women is the first feminist travel magazine in the international market. Combining utility travel content, profiles of inspiring women, and reporting into women’s issues; Unearth Women is created by women and for women.