Tampons are nearly ubiquitous in the West and rarely seen elsewhere. I realized this vividly when I traveled to Niger several years ago. I broke the cardinal rule of women of childbearing age and forgot to take tampons, or anything, really, to deal with my time of the month. It was an off week and I was confident enough in my body to know my period wouldn’t come early.

I was wrong.

I realized this on day 7 or so of my 10-day trip. I scrambled to find something, only to be told by a humanitarian worker traveling with me that even if I were to find a drugstore somewhere—quite rare in that country—I wouldn’t find a tampon. They just didn’t exist there.

I called on our universal bond as women to solve my immediate problem, but I remain fascinated by the idea that there are places where tampons just don’t exist. After visiting Niger and other countries in sub-Saharan Africa, and researching water and sanitation problems and practices for World Vision, I now understand why. I also understand better that those cigar-shaped rolls of absorbent material that we Western women try so hard to hide are symbols of freedom and privilege. Invisible or not, tampons point to a way of viewing our bodies and ourselves that is shaped by our social context and technology.

In Uganda, Zambia, Niger, and other developing countries, very few women, if any, use tampons. There are multiple reasons for this. One is functional: In countries where running water is only found in homes of the super wealthy and hand washing is often impossible, tampons are not only a luxury but a health hazard. This is especially true when those same women are drawing and carrying water, cooking, and cleaning for the household.

Along with sanitation problems, the social discomfort of a period gets a whole lot more dramatic when there's no place to dispose of your pads (public restrooms aren't a thing in many less-developed rural areas), no way to wash your hands before and after using tampons, and little disposable income to buy them in the first place.

There are some promising solutions that work in specific places—for instance, reusable silicone cups (like the one I rushed to buy after my Niger trip) are gaining popularity in places like Kenya because they reduce the recurring costs associated with a period. In Guatemala and other developing countries, a US-based company called SHEVA provides sanitary pads to women with some of the funds from your own hygiene purchases. In Uganda, a local NGO teaches girls to make reusable pads.

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However, not everyone is so lucky. According to a recent sanitation report from the United Nations, WaterAid, Unilever, and Domestos, more than 800 million women between the ages of 15 and 49 are menstruating on any given day. And for many of these women, the lack of tampons and other disposable menstrual products—and the lack of clean, private space in which to use them—is still a source of ongoing difficulty.

According to studies conducted in Kenya and Ghana, as girls reach puberty, they miss more school because they can't manage their periods in the public space of the classroom. A study in Ethiopia and one conducted for World Vision Zambia reported the same thing. In addition, poor hygiene practices and reused menstrual cloths mean that women are more likely to get reproductive and urinary tract infections. According to the multi-group sanitation report, women in a Bangladeshi factory tended to use rags from the factory floor to soak up menstrual blood, leading to infections that kept them away from work several days each month.

In response to these common problems, dozens of projects are underway to help women in developing countries better manage their monthly cycles. Some large humanitarian organizations like CARE International work in the area of menstrual health, often in the context of reproductive health programs, said Holly Frew, emergency communications officer for CARE USA. However, the problem does not receive enough systematic focus, according to the report written for World Vision Zambia’s Water, Sanitation, and Hygiene program. One reason: Menstrual cycles are heavily stigmatized in some cultures (including, to some extent, American culture). Another reason: Task forces dedicated to allocating funds often don’t include people “moved to focus in this area of health need,” according to the report. (In other words, giving money for tampons isn’t as exciting as giving money for orphans and other causes.)

Access, however, is not the only problem. The technology we use both shapes and is shaped by our culture, and tampons are no exception.

Not surprisingly, the $2.58 billion tampon industry is primarily fueled by tampon use in Western, developed countries—the United States, Canada, and Western Europe—according to Global Industry Analysts. About 70 percent of US women use tampons, according to Jezebel. And yet only 100 million—less than 1 percent—of the 1.7 billion menstruating women in the world use them, according to journalist Karen Houppert in The Curse: Confront the Last Unmentionable Taboo, Menstruation. In Asia and Latin America, only 3 percent of all women use tampons, partly because of this “cultural bias” against tampon use, Houppert writes.

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In much of Uganda, for instance, women do not use tampons. That’s partly because they’re difficult to find and expensive to buy, but also because of a cultural interpretation of tampons as unnecessary and intrusive, as my friend and colleague Carol Bogezi—a Ugandan PhD student at the University of Washington—told me. In Uganda, menstrual cycles are annoying and something women complain about regularly, but something they wouldn’t think of “turning off,” even if technology like cycle-stretching birth control pills were widely available, she said. In the United States, by contrast, menstrual suppression is becoming more and more common, as NPR reports.

“It’s like a check-in—‘I’m still a woman,’” she said. “People complain but don’t think of the option of halting their periods. Here, you think, well, if it’s that bad, do something to stop it.”

The way in which technology impacts our view of biological functions and social interactions is something scholars study with great interest. They call that relationship “mutual shaping theory.” The idea is that technology—including tampons—shapes the way we view ourselves and construct our culture, just as our culture and experiences shape the way we invent and consume technologies.

If your first reaction is to say “but tampons aren’t technology,” you wouldn’t be alone. A typical definition of technology revolves around industrial machines and military weapons, thus “cast in terms of male activities,” writes Judy Wajcman in her Cambridge Journal of Economics article “Feminist Theories of Technology.” Broaden the definition a bit, though—to the more expansive view of “problem-solving systems” suggested by some social construction scholars—and you encounter heated debates over creation and control of tampons, menstrual pads, birth control, and other reproductive technology that date back decades.

Using a tampon takes on new meaning when you realize the quest to develop the perfect “invisible” tampon (with a range of options) is a sign of both status and cultural heritage. Access, or lack thereof, to tampons and other hygiene products changes the experience of being a woman.

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It also suggests a new way of thinking of tampons: Not just as tools, but also as symbols. They represent a long history of cultural development that has prioritized independence while attempting to make women’s biology invisible. Their absence may represent a lack of access to things Western women consider basic necessities, but it also represents cultural differences that extend far beyond the presence or absence of a row of apologetic boxes in the feminine hygiene aisle at a grocery store. We in the West are just as shaped, and as shaped by, our technology as anyone else. We should consider our presumptions that technology equals social good, and just how many resources we expend on “necessities.”

In this context, identifying the “just action” is complicated. Yes, there are women in developing countries who need better access to clean water and sanitary resources in order to improve their quality of life. However, what may be a first response—make sure every woman has tampons! —is not necessarily practical and, more than that, not preferred by many women around the world. For many reasons, there are many social contexts where the Western solution to menstruation is not best.

For me, this tampon discussion is an object lesson in what we as Christians should be seeking to do in every aspect of our life: Pursuing empathic justice. In Micah 6:8, Christians are called to act justly and love mercy. We are further called to “walk humbly,” which in this case means having the humility to recognize that a universal challenge may not have a universal answer and that solutions useful in our particular social context may not apply to our neighbors in Malawi or Uganda. Such is our calling as followers of Christ: To recognize the injustices that afflict our neighbors and then walk alongside them to better understand how we can pursue justice with and for them.

Ruth Moon Mari is a PhD student at the University of Washington, where she studies journalism in developing countries. She is also a freelance reporter for Christianity Today.