From animal skins and old rags to cow patties and silicon cups, women around the world use all sorts of materials to manage their periods each month.

Basic necessities for dealing properly with menstruation, such as access to clean water or a decent toilet, are simply unavailable to millions of women and girls.

Without these services, menstruation can negatively affect women’s health as well as their involvement in social and economic activities, says Louisa Gosling of WaterAid, which has published a photo gallery detailing the various ways women around the world manage their periods.

Clockwise from top left: some women cut cow dung to size for use during menstruation; others use powdered dung placed in a pouch; ; a tampon; a homemade sanitary pad.

“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,” says Gosling, who serves as quality programmes manager for the water, sanitation and hygiene charity.

Globally, one in three people lacks access to a decent toilet of their own, while one in nine is unable to obtain clean water near their home, according to WaterAid. A Unesco report found that one in 10 girls in sub-Saharan Africa misses school during their monthly periods, while some simply drop out of school altogether.

Clockwise from top left: Nyanda, a small piece of cloth used as a sanitary pad in Malawi; cotton pads used in Ouagadougou, Burkina Faso; an IUD; a reusable pad.

Whether it’s by taxing sanitary products, failing to build segregated toilets, or refusing to teach girls about their reproductive health and rights, governments not only fail to provide the infrastructure necessary for women and girls to manage their periods, they also ignore the associated links to women’s health and economic and social wellbeing, says Gosling, who insists far more needs to be done.

“WaterAid is calling on governments worldwide to prioritise appropriate sanitation, clean water, and good hygiene in schools, homes, and workplaces, and access to sanitary products to all, to ensure that women are not excluded from society once a month as a result of a natural process.”

Munyes, 44, digs a hole in the ground in Uganda’s Karamoja region. During her period she sits on top of the hole to collect the blood.

Although both India and Tanzania recently repealed the “tampon tax”, which in some cases subjected hygiene products to a 12-14% levy, campaigners have long warned that the majority of women and girls do not use these products due to lack of access, information and affordability.

“While the decision of our government to abolish taxes on sanitary products was a bold step in the right direction, much more needs to be done,” says Ibrahim Kabole, WaterAid’s country director for Tanzania.

“Half the population lives without a clean water supply close to home and more than 75% do not have a decent toilet, which is crucial for women to manage their periods.”

In many countries, women most frequently use cloth during menstruation, according to the charity. Cloth is reusable and, for many women, is seen as a cheaper and more sustainable methodology than sanitary pads. In India alone, roughly 121 million women are of reproductive age, according to WaterAid: if all of them used just eight sanitary pads a month, that would amount to 12bn pads a year.

Sangita, 32, from Nepal, makes her own sanitary pads instead.

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

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

In Uganda, Lepera Joyce, 23, uses goatskin to trap the blood, which she then washes away privately with cow ghee because “no one is supposed to look at your blood”.

“I started menstruating when I was about 14 years old. Since that time my favourite material for managing my periods has always been a goatskin,” she says.

“Once, I bought a pack of sanitary pads from the shop, but I did not like them because if a woman has heavy blood flow she can use more than three pads in a day, and they are expensive. Also, they are small and do not absorb all the blood, yet the goatskin skirt works for the whole day.”

Limpo, 22, from Zambia, uses cow dung, which she collects from the plains. She dries out the patties and shapes them into small pieces. She cannot afford to use sanitary pads, she says.

“I do not put the cow patties directly on my skin, I wrap it in a cloth and place it nicely to capture the flow without staining other clothes,” she explains.

“I like this method because cow patties soak up a lot of blood before they are completely soaked. I go about doing all sorts of things without any trouble. Once soaked, I carefully dispose of it privately. I usually dig a small hole in the ground and bury it. In our culture, it is not allowed that men see such things.”

Claire, 40, from Manchester, uses pads, tampons and a Mooncup when she menstruates.

“The tampons and pads are made of 100% cotton and are perfume and chlorine free, as well as being biodegradable. The Mooncup is made out of silicon and is plastic-free. You insert the moon cup into your vagina and then the little head sticks out, so that you can pull it out again,” she says.

“My main consideration is that these products are better for the environment. I made a lifestyle choice to reduce waste. Before becoming more environmentally conscious, I used regular supermarket brands. With the Mooncup, a side benefit is that it saves me having to buy much of the normal products, as the cup is reusable. I like using it because I can leave it in longer than a tampon, it’s safer for the body.”