Periods: your body's monthly visitor. But no matter how many times that visitor stops by, menstruation remains a taboo topic around the world.

People who menstruate have long been taught to be ashamed of or to keep silent about their periods for many reasons. At a pool party, someone might avoid swimming because they “feel sick,” or they need to go to the bathroom to “reapply their makeup.” These reasons pop up to avoid saying the truth: “I’m on my period.”

These are the beliefs or traditions that perpetuate stigma around periods and can even hold people who menstruate back from education, access to jobs, and more.

China

When Chinese swimmer Fu Yuanhui announced that she was on her period when she swam during the 2016 Olympics in Rio, she broke down a major misconception about menstruation. After she said she had her period, the Guardian reported that many in China took to social media to say they didn’t know someone was able to swim while menstruating without leaving blood in the pool. That’s because tampons are reportedly rare in China.

According to the Guardian, only 2% of people who menstruate in China use tampons. This is reportedly because of health concerns surrounding tampons and the belief that using a tampon could mean someone is no longer a virgin if using one tears the hymen. Of course, someone’s hymen being intact is not linked to whether or not they’ve had sex, and having sex isn’t shameful. The Los Angeles Times reports that a lack of sex education contributes to why some don’t use tampons. This taboo runs so deep that in 2015, there were no tampons manufactured in China, but there were 85 billion pads produced in the country.

England

According to the Independent, more than 137,700 of girls in the UK missed school in 2017 because they couldn't afford menstrual products. Researchers for Always, a menstrual product company, found that of 500 girls aged 10 to 18 polled, 7% had skipped school because of their period and lack of access to products. Shame and stigma surrounding that, according to the Independent, resulted in a loss of education for these girls. And beyond missing school, girls in the UK are also reportedly putting their health at risk, using menstrual products for longer than they are supposed to.

India

Many women who are on their periods are not allowed to be in the kitchen or attend ritual practices, according to a 2016 Hindustan Times report on period taboo in India. According to The Wire, many don’t believe periods are natural, while others consider them “dirty.” And 28% of girls said they do not go to school during their period because they don’t have sanitary or affordable menstrual products. This means that period stigma and a lack of access to menstrual products is leading girls to miss out on their education.

According to CNN, a 12% tax on pads was imposed in 2017 in India, highlighting how they remain inaccessible for many women. CNN reports that women resort to using potentially harmful things to catch menstrual blood, including scraps of cloth, newspaper, ash, wood shavings, and more.

Now, a film called Pad Man is addressing menstrual stigma and lack of access to products head-on. The film follows Lakshmikant Chauhan — whose character is based on Arunachalam Muruganantham, the man who invented a machine that dispenses menstrual products at a low cost, increasing access for women in India. Since 2006, he has given more than 4,000 machines to women in India and has shipped more than 200 machines to 27 developing countries globally, according to NPR.

Nepal

In Nepal, a historic practice called Chhaupadi has recently been banned. The practice entails banishing a person who’s menstruating to a shed outside their home because of the belief that women become “impure” during the time of their period, according to TIME. The practice reportedly leaves women susceptible to diseases, rape, and in some cases, even death. In 2016, a teen girl died in the hut she was banished to while menstruating. The country outlawed Chhaupadi in 2017, and the law takes effect in August 2018.

Kenya

In Kenya, more than one million girls miss up to six weeks of schools each year because they don’t have reliable access to menstrual products, according to the ZanaAfrica Foundation. Coupled with a lack of sex education that can lead to unintended pregnancy or STIs that might cause girls to miss school, ZanaAfrica points out that young women are at an educational disadvantage because of a bodily function. Luckily, ZanaAfrica is doing something to change that, and it’s working. According to NPR, the Kenyan government has been allocating about $3 million per year since 2011 toward distributing free menstrual pads to schools in low-income communities. ZanaAfrica reportedly helps distribute the pads and provide health education so girls have a better chance of staying in school. While taboo reportedly still persists on the topic and there is still a lack of access to sex education, NPR notes the political efforts in Kenya to increase access to menstrual products are working, while countries like the United States continue to tax menstrual products and make them less accessible.

The United States

In the U.S., period stigma is evident in many places, from the convenience store to the White House. In 2015, then presidential candidate Donald Trump said in an interview about Megyn Kelly that “you could see there was blood coming out of her eyes. Blood coming out of her wherever.” As of 2018, most states still place a “luxury tax” on menstrual products. This tax means items that aren’t a necessity, and are instead a luxury, will be subject to taxing while items that are necessities are exempt, such as food and some medicines. However, menstrual products are taxed as “luxury items” even though they are an essential part of a many people’s lives. In fact, the price of menstrual products keeps many people from being able to access them, which can have big consequences. For some, periods can perpetuate homelessness by forcing individuals to decide between buying a meal or buying menstrual products. The shame surrounding periods can also prevent people from asking for help buying menstrual products or result in missing school, job interviews, and more.