We All Bleed Transparent

Or: unlocking human potential by changing what it means to menstruate.


The Origin Story

Everything begins with two individuals, Adam and Eve.

(Actually, it doesn’t really matter what their names are, or who they are — what really matters is their gender. But instead of calling them something boring like X and Y, let’s just stick to Adam and Eve, because that’s controversial and exciting.)

Adam is male, and Eve is female.

There are many differences between Adam and Eve, even though they’re both homo sapiens. 

It turns out that Adam has a stronger natural talent for running, and can climb trees that Eve can’t.

Eve can also do something amazing that Adam can’t: she can create and carry new life in her body.

Our problematic faves. “Adam and Eve” by Jacob Jordaens.

So, they decided that Adam should go out and gather food and materials, and Eve should work at the home base and use what Adam brings back to make clothes, build shelter, and cook food.

Adam and Eve are an amazing team. Their key differences were what made them so powerful. They rallied more like them, and built strong villages. Thousands and thousands of years later, those villages turned into massive concrete jungles, with homo sapiens conquering nearly every square meter of surface area on the planet.

Now, things are peaceful. Because there aren’t any more dangerous animals “outside”, the Adams of the world came back into the villages, towns, and cities. Because they were strong and capable and respected, they naturally became leaders of these villages.

But something strange happened. Even though the original Adam and Eve were like the left and right arm of homo sapiens, the Eves of the world slowly started to shrink as the Adams grew. The Eves who built homes, villages and communities stopped doing those things because there’s only room for one head of the village. They shrank inwards into their homes, into the living rooms, into the kitchens.

Because of this, now homo sapiens is like a giant who has one strong, muscled arm, and one atrophied, skeleton-like arm. But even with the atrophied arm, homo sapiens has done incredible things—things like building intelligence using computers and information, engineering flying vehicles to travel the continents, communicating across oceans, and building farms that span millions of square kilometres.

But homo sapiens can do so much more. Nearly all of these incredible things were done by just a fraction of the population — the fraction that lives in developed countries, the fraction that has access to the Internet, the fraction that has had at minimum a high school education, the fraction that is male. 

The giant has been building the world while crippled.

The parts of homo sapiens that don’t have all the things mentioned above, are the parts who don’t have access to equal opportunity. These parts contain incredible human potential that we’ve locked up ourselves in the most convoluted prison ever.

So… how do we unlock that human potential?

We can start by empowering girls in underdeveloped regions.


The Period Problem

Thanks for making it through the most inaccurate retelling of human history ever told — let’s talk some real numbers instead now.

Here’s the deal: Melinda Gates, co-founder of the Bill & Melinda Gates Foundation, pledged to commit $1B to promote gender equality in October.

Melinda Gates in San Francisco. May 2019

You: Wow, that’s a lot of money. Why though?

Answer: There’s a huge imbalance in gender representation on the higher echelons of society.

“Fewer Republican senators are women than men named John — despite the fact that Johns represent 3.3 percent of the male population, while women represent 50.8 percent of the total population. Fewer Democratic governors are women than men named John.”

The New York Times

But this statistical imbalance starts from the very bottom, not from the top. It starts from the dregs of a culture that used to prevent women from becoming empowered in society, from the side comments of family friends who still wonder why such a nice girl wanted to major in engineering. It’s a culture that still persists, unchanged, in underdeveloped areas.

I’m talking places like Somalia where female genital mutilation is commonplace, sub-Saharan Africa where 4 in 10 girls are married off before the age of 18, and regions like Maharashtra in rural India where 4 in 5 girls drop out of school after getting their periods.

Here, I want to discuss actionable ways we can lift up the platform so that more girls and women can have access to the resources everyone else has. That way, they can carve out a place of their own in society and unlock their true potential.

There’s over 1B girls living under the poverty line—imagine what we could do if we could, as a civilization, tap into all that human capital. We could be solving the world’s hardest problems 10x faster than ever before.

Current state of affairs is complex, but we can tackle it by methodically eradicating each individual factor that prevents girls from self-actualizing. And we can start with something every girl has to face: menstruation.


TL;DR:

  1. Women in developing regions can’t afford to purchase sanitary pads regularly, therefore suffering acute health issues
  2. When girls get their period, they can’t go to school or are even barred from doing so
  3. Not going to school = not being empowered to learn and work for themselves

Soul-crushing statistic #1: 70% of menstruating women in India (that’s 248.5M women) cannot afford purchasing sanitary pads.

Soul-crushing statistic #2: In Kenya, one pad can cost an entire day’s salary

But the problem goes deeper — even once these women do have the resources to buy pads regularly, the mere act of purchasing them and using them can be an unsurmountable barrier.

Why?

“If you were to buy a packet of sanitary napkins today, you have to go to a chemist shop or a medical store, which is manned by men — male shopkeepers, and there are male bystanders, there are male customers — and there’s this one woman there who’s announcing that she wants a packet of pads, implying that she has her period. So the male shopkeeper kind of doesn’t even look at her straight.” 

Suhani Jalota, co-founder of the Myna Mahila Foundation
Sanitary pad manufacturers at the Myna Mahila Foundation.

The act of menstruation is filled with cultural taboo and acute shame in many South Asian nations. For many women who live in rural areas, they cannot even hang their menstrual cloths to dry in the same place as their other clothing. The period represents impurity.

This doesn’t affect just their mental health, but also their physical health. 1 in 53 women in India are diagnosed with cervical cancer, whereas in countries like the UK, the statistic is only 1 in 135. Indian women are at a much higher risk of severe candida and bacterial vaginosis infections due to reusing dirty rags as sanitary pad substitutions.

Even more importantly, this cultural taboo and lack of appropriate menstrual care sabotages the self-actualization of women.

1/4 of Indian girls don’t attend school during their menstruation. Studies done in states like Maharashtra and Tamil Nadu show numbers are even higher – 4 out of 5 girls don’t even go back to school after getting their periods. In Africa, four days out of every four weeks of school are missed due to menstruation. During their period, girls are also asked to stay away from religious spaces, kept in isolation, and barred from going outside.

No education = no knowledge = no power.

Because of an uncontrollable biological function, these girls play the game of life with a crippling handicap—one that never needed to exist in the first place.

What can we do?

Of course, to solve this problem I could create some kind of non-profit organization to employ local women to manufacture sanitary pads, and then deploy a team to get them to where people need them most, but that wouldn’t be sustainable. India is the second most populated country in the world — there’s 250M women who don’t have access to proper menstrual hygiene materials. And beyond India, there’s probably another half a billion of similarly marginalized women. It just doesn’t make sense.

I need a solution that’s deeply impactful, and scalable. How do I fundamentally bypass that sociocultural barrier that prevents menstrual hygiene from becoming top-of-mind in the first place, while simultaneously tackling the financial barriers?

See, it’s the concept of the blood that is excreted every month that is shameful—the fact that it is so noticeable, so pungent, so red. It’s a big part of what makes it so deeply embarrassing and “dirty”. The blood is one of the most in-your-face markers of some of the less palatable sides of femininity.

The key to changing this perception is to eliminate the blood.

Before you write me off as a total nutcase, I don’t necessarily mean eliminating menstruation altogether. All I need to do is change the form of the menstrual fluid as it exits the body — at least, that’s my hypothesis.

We can create a type of undergarment (and it has to be a reusable undergarment, not a disposable product, as that will only perpetuate the financial and environmental barriers that already exist) which turns period blood transparent.

There’s two steps to doing this:

  1. Make the menstrual fluid transparent by using a crude polysulfone membrane filter to separate the red blood cells (which contain the red-pigmented hemoglobin) from the plasma (the liquid in which red blood cells are suspended). This will leave nothing behind but a clear, yellow liquid that’s much less noticeable and easier to clean.
  2. Break down the hemoglobin using a protease (a class of enzymes that catalyzes protein breakdown) such as aspartic protease, which would remove the red pigmentation from menstrual blood altogether.

She Sieves Sea-Cells By the Seashore

The first and most essential step would be separating the plasma from the blood, leaving behind a thick red blood cell concentrate (RBCC). Plasma is a translucent, pale yellow fluid (mostly made of water) that is much less offensive-looking than blood and a lot easier to clean without any major stains, so we can leave this fluid on the surface of the underwear.

It turns out this separation process is a bit more complicated than it seems: generally, the way we separate whole blood components today is by placing blood samples into a centrifuge and spinning the living daylights out of them until they come out differentiated.

A centrifuge-separated blood sample.

Obviously, we can’t put a centrifuge into your underwear.

The good news: naturally, red blood cells tend to settle to the bottom of a sample thanks to a process called erythrocyte sedimentation. The bad news: this takes very, very long to do. In healthy humans, sedimentation rate is sometimes just 30mm/hr.

One method that’s been developed to accelerate this sedimentation process is a membrane-based, sedimentation-assisted plasma separator that can sieve the red blood cells out of plasma within a couple of minutes, developed in 2013 by researchers from the University of Pennsylvania. It’s the size of a thumb, and combines a variety of methods to work without a pump.

The key element is the asymmetric porous polysulfone membrane, also known as a Vivid Plasma Separator membrane. This membrane traps the bigger materials, like cells, at the top and inside the membrane, and lets the smaller materials, like water molecules, sift down beyond the membrane.

The advantage of this kind of depth filtering method is that you can process larger samples of blood relatively quickly, which is perfect for the application we’re intending to use it for.

Don’t (Pro)tease Me

TL;DR:

  • By destroying the protein chain and the associated heme rings in hemoglobin, we can effectively remove red pigmentation from the red blood cell concentrate (RBCC)
  • We can destroy these bonds by using protease enzymes, like aspartic protease or aspergilloglutamic peptidase

Now that we’ve separated the icky red blood cell concentrate from the plasma, we need a way to get rid of the red pigmentation in the RBCC, too.

But first, a quick biology lesson:

Proteins, put as simply as possible, are made up of long chains of amino acids folded into impossibly complex structures. Hemoglobin is actually a grouping of four protein subunits, and each unit is made up of a protein chain that’s tightly bound to a heme ring.

Heme is the substance in hemoglobin that allows your lungs to carry oxygen to the rest of your body, and carbon dioxide back out. It’s a ring of atoms that comes from a molecular family called porphyrin, generally known to be a deeply pigmented family.

A heme ring with an iron ion in the middle.

Inside this ring is trapped an iron ion, which is the ion to which the oxygen molecule will attach itself to.

Most people assume that the red colour of our blood comes from this iron ion, but in fact that isn’t true—it’s the heme ring itself. This makes our job a lot harder, because instead of replacing the iron with another atom, now we actually have to destroy the heme ring.

Luckily for us, there’s a bunch of machines in nature that can already do this, and they’re called protease enzymes.

These little enzymes are specialized in breaking down the peptide bonds—the giant amino acid chains—that exist in proteins. A lot of unicellular organisms in particular use these to break down proteins into energy, and there’s plenty of industrial applications for proteases in things like detergents.

One option is aspartic protease, which can be key to breaking down heme groups in order to remove the iron ion from the center. Aspartic protease is used in a lot of (brace yourself) hookworm species, where they need the iron in heme to generate energy. The enzyme cleaves the peptide chain in several locations, beginning the catabolic process (a process where bonds are broken down) of hemoglobin.

Another is aspergilloglutamic peptidase, which is great at attacking histidine residues (a type of amino acid residue) that are attached to the heme ring and therefore excellent tools for targeted discolouration of the hemoglobin in the RBCC. This methodology is used during the processing of red blood cell proteins in the food manufacturing industry.

Porous Membranes and Enzymes… in Underwear?

So now you’re probably thinking… how on earth is all of this technology going to fit into a single pair of underwear?

Great question.

The answer is… I don’t really know—yet.

I have design prototypes in mind—one of them being a multilayered textile “cake” in which one layer will contain the polysulfone membrane and another the protease enzymes to decolourize the red blood cell concentrate. Or even a tampon that has the polysulfone depth filter built in, and the enzyme solution on the corridors of the membrane’s container.

But I don’t really know how any of these will perform until I make a working prototype and test it on willing subjects.

For example, a tampon won’t be the best way to deliver this solution, since women in many cultures are reticent to insert anything into their vaginas. Plus, as mentioned previously, we don’t want this to be a disposable solution, because that would make it difficult for women to afford purchasing them.

With the underwear prototype, we’d have to incorporate multiple different textiles, both hydrophobic ones and permeable ones. There also lies the difficulty in the unpredictability of each woman’s period flow.

However, every problem has a technical solution, and given more time and resources to research and test these hypotheses, I can no doubt make this product a reality for women all across the world who are shamed into hiding for their periods.


Rewriting The Story

I’m obsessed with unlocking human potential. I’ve wanted to become a part of the United Nations to solve social problems and lift the platform for marginalized populations since I was in the 4th grade. But I soon realized that the larger the institution, the slower the decision-making.

The key to making great impact when you’re just one or two people is leveraging technology. By combining the sciences with powerful business strategies and the right people, we can elevate the quality of life of billions of people with comparatively very little investment.

Unlocking the potential of girls in developing nations is the first, and also the most difficult, step to take. And we can start by tackling one of the most basic problems of all – the shame associated with their very own femininity, and the dearth of resources to preserve their menstrual hygiene.

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