Of the top ten health crises facing women in Zimbabwe (or elsewhere in Africa), I would not put lack of access to manufactured sanitary pads anywhere on the list. I suppose urban middle-class African women might use the product, but no woman I have ever interviewed in East Africa about intimate issues of reproductive health (numbering in the hundreds if not the thousands) has any familiarity with the product.

Rather, women do as women in the US used to do - they make their own pads out of old fabric bits that they launder themselves. Have you ever wondered where the expression "on the rag" came from? Go back a few generations in the US or Europe and you'll find that rags were quite literally a monthly part of women's lives. The same is true today throughout Africa.

Is this ideal? Probably not. Pads, manufactured in sanitary facilities and packaged in sterile plastic wrappers until use, will most certainly reduce the risk of any potential infections. However, you've got to ask yourself why - in a continent that, for example, has soda and beer bottling facilities in most major towns, manufactures dozens of brands of soap and laundry detergent, and has a textile industry that mass-produces some of the world's nicest fabrics - is there no major indigenous production of sanitary pads? An economist and an anthropologist would give you the same answer - there is not now, nor has there been historically, a local demand that would inspire investment in such a facility.

Yes, it is easy to lambaste the Zimbabwean government for insensitivity to women's health. Goodness, the Zimbabwean government is insensitive to the health of just about everyone who isn't named Robert Mugabe. That does not mean, however, that a lack of sanitary pads for sale in the stores is either a result of government neglect or a harbinger of a major women's health crisis. As long as they have access to laundry soap, women will make do. They do so all over Africa. And they always have.

This being St. Patrick's Day, a story about an Irish friend is in order. She had lived in Tanzania for over a year, spoke Swahili fairly well, and knew a lot about how to interact culturally. One day she ran out of her supply of pads from home, so she went looking for some in the main town of the region we were living in. After some searching, she found a store that had a few boxes of Always tucked away high on a back shelf. She asked the (male) clerk to get her the box. He pretended not to hear her. Eventually she insisted, loudly, that he sell her the product. He very reluctantly maneuvered the box into a bag. He refused to look at her when he took her money, and just left the bag sitting on the counter for her to take, without saying another word to her. This was the only supply of pads available for hundreds of miles. Had there been a trail of women beating a path to the store's door, they would have figured out a way to sell the product without harming their clerk's sensibilities - but it was clear from his discomfort and from the dust on the box that the product had very few customers.

Since then, I've taken special note to see whether menstrual supplies are offered for sale in the stores I've visited in Africa. The answer, almost invariably, is that they are not. The market simply does not exist. Make of that what you wish, but if you really want to address the health issues that are at the top of the minds of women throughout Africa, make much more of lack of access to medicines, iron deficiency during pregnancy and lactation, lack of basic medical and maternity services, and our collective failure to adequately address most of the major diseases that affect women and their families throughout the continent.

Women have been having periods for thousands of years, millennia before the invention of commercial sanitary pads.

And I imagine in Zimbabwe it's only been a couple of generations since traditional ways of coping with menstruation have been displaced by pads -- undoubtedly within the memory of the female elders.

Why they heck are they dependent on Western commercial "sanitary" products? Is it really unthinkable that they use what their foremothers used?

I feel for women who suffer, but is this really among the most important public health issues in Africa?

I'm not trying to minimize the suffering, but what did Zimbabwean women do before modern menstrual pads existed? (And I'm also not sure how using tree bark externally to absorb blood would cause a vaginal infection.)

I'm asking the question because I wondered what mothers did before disposable diapers existed, or what they did in places where there's not enough fresh water available to rinse out cloth diapers (a very water-intensive process).

The answer led me to elimination communication (as it is known in modern times), aka the ancient practice of communicating with and pottying infants and not leaving them to pee/poop in their garments. I've successfully done it with my son, to our mutual benefit, and he has been out of diapers since 16 months.

Sort of unrelated, but the same kind of questioning applies. What did these women use before, and why are they now dependent on modern disposable pads, thereby causing large amounts of non-recyclable trash to enter their communities?

Wow, The Pen Ultimate, has your work given you a lack of optimism? No, a lack of pads is not the greatest health crisis in Zimbabwe. But it is immediate, it sucks and is something we can easily solve without overhauling the public health system in Zimbabwe or dealing with pharmeceutical companies and their patents. We can send some freaking pads. It's people like you who make my fellow students feel like there's nothing significant they can do to help others and then they get apathetic and don't bother.