It is 9:30 a.m. in Accra, Ghana, on a Friday, and the city is already alive. At Makola Market in the Central Business District, trotros, Ghana’s colourful shared minibuses, weave through taxis while street vendors call out to commuters, urging them to buy fresh fruits and fried dough balls known locally as “bofrot”.

The temperature is 30 degrees Celsius. The sun bears down heavily on anyone outside an air-conditioned vehicle, and beads of sweat form quickly, rolling freely down faces and soaking through shirts.

Amid the rush, Dokua, a bright and ambitious National Service personnel at Adowa Bank, laces up her sneakers in preparation for a long day. Her assignment is straightforward but ambitious.

She must sign up thirty new customers before close of business. That means walking the pavements of Makola Market, speaking to traders, artisans, and anyone willing to listen. The sun is relentless. Public washrooms, when available, are barely usable. There is no comfortable place to rest.

Today, Dokua faces an added burden. She is on her period with severe cramps. She considered calling in sick. Yesterday’s monthly performance review reminded the team that they were behind on targets and excuses would not be tolerated.

Bank policy also requires a doctor’s note from Dokua. She just needs painkillers and rest to manage the situation and not necessarily to see a doctor.

All that mattered were results. Despite nausea, pain, and hot flashes, Dokua rises and reports for duty.

As she navigates the narrow aisles of the market, traders tug at her arms and clothing to draw attention to their goods. No one notices that she is wearing her Adowa Bank Lacoste shirt, identifying her as a National Service personnel and, therefore, deserving of basic courtesy.

She dares not complain. In Ghana, menstruation still carries a quiet stigma. When she asks if she may shorten her rounds, her supervisor’s expression alone is telling. She is reminded that more than a thousand National Service applicants competed for the role and that she could easily be replaced if not ready to work.

Her colleagues dismiss her discomfort as women’s “wahala” and tell her not to behave as though she is the only woman who menstruates. They overlook the fact that menstrual pain varies in severity. The condition, medically known as dysmenorrhoea, could be debilitating. Some women experience mild discomfort.

Others endure pain so intense that it interferes with concentration, mobility and productivity. Dokua, who belongs to the latter category, forces a smile and later clutches a hot water bottle in the bank’s cramped break room, hoping it will bring her some relief.

Picture a young woman in a similar situation, working an eight-hour shift at a fast-food restaurant. She stands behind the counter as the queue stretches toward the door. Orders are called out rapidly. The air is thick with heat from the fryers. The floor is slick with oil.

There is no opportunity to sit or stretch. Each time she asks to visit the washroom to change her pad, her supervisor gestures toward impatient customers and tells her to manage until the rush is over. By the time she finally gets a brief break, her uniform is stained, her back aches, and the cramps take her breath away. Yet her performance will still be measured only by how many meals she sold.

Dokua’s experience, as well as that of the young woman at the fast-food restaurant, may be described as “presenteeism”, a term defined as being at work when one ought to be at home, either due to illness or as a result of working excessively long hours to the point of reduced effectiveness. It essentially refers to a situation where an individual is physically present at work but functionally unproductive.

POLICY V LEGISLATION OR HYBRID MODEL

Dokua’s ordeal and that of the fast-food worker are not isolated but emblematic of a systemic gap in many Ghanaian workplaces, where menstrual health remains largely unaddressed despite its profound impact on productivity and well-being. To bridge this divide, Ghana must weigh policy incentives against binding legislation, or pursue a hybrid approach that mandates minimum protections while allowing tailored implementation.

Workplace policies have certain advantages. They allow customisation to suit organisational needs and could be introduced incrementally. However, policies alone have limitations. Without legal backing, implementation could be inconsistent across workplaces, resulting in inequality. Women may also face informal barriers, such as reluctance to request leave or managerial bias, which could reduce the policy’s effectiveness.

A hybrid model offers the most balanced solution. By combining legislation that establishes a minimum standard of menstrual leave with organisational policies that enhance accessibility, promote awareness, and integrate leave into broader wellness programmes, women are provided with both legal protection and practical support.

With such measures in place, Dokua and the fast-food worker could recover with dignity and return to work stronger and more productive. In the absence of these protections, women are often compelled to work through pain at the expense of their health and efficiency during such periods. This remains the lived reality of many Ghanaian women across corporate Ghana.

In sub-Saharan Africa, recent findings show that dysmenorrhea is a serious but often overlooked public health issue. Studies in Ghana report prevalence rates between 70% and 85% among adolescent girls, which are higher than many global estimates.

The consequences of dysmenorrhea extend beyond physical discomfort, affecting academic performance, psychosocial well-being, and participation in daily activities. Adolescents who experience dysmenorrhoea commonly face school absenteeism, reduced concentration, lower classroom participation, and overall diminished educational outcomes.

These early-life impacts are not merely confined to educational settings; they also provide a predictive lens for understanding potential outcomes in the workplace. By parity of reasoning, when these young girls enter the workforce without adequate medical or structural support, similar patterns of absenteeism and reduced productivity could reasonably be anticipated.

If the impact is recognised in educational settings, it is both logical and prudent to acknowledge it within the workplace. The question, therefore, is not whether the condition affects performance, but whether the law should formally accommodate a predictable and recurring biological reality. In this respect, policy may influence behaviour, but law ensures accountability.

Despite advocacy for laws and policies on women’s economic rights, experts continue to highlight weak implementation frameworks. According to the World Bank Women, Business and the Law Report 2026, several sub-Saharan African countries score below 50 on enforcement perceptions (Map 3.1, panel c), reflecting limited institutional confidence in the effective protection of women’s rights within the sub-region.

CRITICISMS OF PAID MENSTRUAL LEAVE

Critics argue that institutions already provide sick leave which some contend is sufficient to cover women’s menstrual health needs. However, sickness is generally unpredictable, whereas dysmenorrhoea is cyclical and predictable in timing, though not in severity.

Using ordinary sick leave to manage a recurring biological process depletes leave that is intended for unforeseen illnesses such as malaria or other acute conditions. This leaves women vulnerable when genuine medical emergencies arise.

Another concern relates to potential financial and operational burdens on employers. It is argued that instituting paid menstrual leave could increase labour costs or incentivise discriminatory hiring practices, with employers potentially favouring men to avoid the perceived additional expense.

While these concerns are understandable from a managerial perspective, they must be weighed against the broader benefits of supporting women’s health and productivity at the workplace, as well as the requirements of the Affirmative Action (Gender Equity) Act, 2024 (Act 1121), which provides for progressive gender representation targets, rising from 30% (2024–2026) to 50% by 2034.

Some argue that providing paid menstrual leave could inadvertently reinforce gender stereotypes. There is a risk that such policies may be interpreted as an acknowledgment that women are weaker or less capable than men, thus perpetuating outdated notions of fragility and emotionality. This perception could undermine women’s professional credibility, limiting career progression and reinforcing societal biases about gendered capabilities.

This concern has also been reflected in judicial reasoning elsewhere. For instance, the Supreme Court of India recently rejected a petition seeking mandatory paid menstrual leave for working women and female students nationwide.

The Court expressed concern that such a policy could reinforce stereotypes, discourage employers from hiring women, and negatively affect their employment prospects. The petition, filed by lawyer Shailendra Mani Tripathi, proposed two to three days of leave per month to address menstrual health challenges.

However, the Court declined the request, emphasising the need to avoid measures that could be perceived as granting “special treatment” to women. The Court further noted that the government could, nonetheless, consider developing a menstrual leave policy in consultation with all relevant stakeholders.

Concerns have been raised that the introduction of paid menstrual leave could establish a “separate but unequal” status for women within the workforce. Since men do not receive equivalent leave, women might be viewed as receiving preferential treatment, potentially generating workplace tension or resentment. Such dynamics could inadvertently affect workplace equality rather than enhance it, highlighting the need for careful policy framing and communication.

Moreover, several practical and organisational barriers may impede the effective implementation of such leave. Issues relating to privacy, reluctance to request time off, and the potential for biased evaluations of employees who utilise menstrual paid leave present significant challenges.

Without clear guidelines, supportive management, and a culture of understanding, these barriers could undermine the intended benefits of such a policy and discourage women from taking leave when needed.

A COMPELLING CASE FOR PAID MENSTRUAL LEAVE

The economic case for paid menstrual leave is persuasive. Labour protection gaps limit women’s participation, productivity, and financial security, while equality laws boost employment and reshape cultural norms.

Providing paid menstrual leave would advance Aspiration 6 of the African Union’s Agenda 2063 (people-driven development anchored in harnessing the potential of African women and youth) as well as Sustainable Development Goal 5 (gender equality) and 8 (decent work), closing Ghana’s critical gap in women’s economic inclusion.

Ancestral wisdom suggests that menstrual rest is not new. In traditional Ghanaian communities, women were often given periods of rest from domestic duties during heavy menstruation, reflecting an intuitive recognition that menstrual pain requires recovery, not endurance. These practices were not indulgences but early acknowledgements that rest enhances productivity, enabling women to return to work restored and more effective.

The Ghana Women-Friendly Workplaces Report, based on responses from 2,084 women across various sectors, reveals significant gaps in workplace support for menstrual health. Dysmenorrhoea, is one of the leading reproductive health challenges faced by women at work, with approximately 18 per cent of respondents reporting it as a concern.

Despite its prevalence, 80 per cent of women indicated that their workplaces offer no support during menstruation. Where support exists, it is generally limited to flexible working hours, occasional leave, or access to sanitary products, rather than any structured menstrual leave policy.

This shows that menstrual health remains largely unaddressed in Ghanaian workplaces. It highlights the need for Ghana to take a bold step towards introducing paid menstrual leave for women and young girls, particularly at a time when His Excellency John Dramani Mahama, President of the Republic of Ghana, serves as the African Union Champion for Gender and Development Issues.

Dysmenorrhea is one of the most common gynaecological conditions affecting young women, causing an estimated 140 million missed work or school days annually worldwide. It affects 15.8–89.5% of menstruating women globally, with 2–29% experiencing severe pain.

Prevalence varies significantly by country: Japan (15.8%), India (79.7%), United States of America (85.0%), Australia (88.0%), Nigeria (83.1%), Ethiopia (85.1%). By enacting menstrual paid leave, Ghana would strengthen compliance with its obligations under the Convention on the Elimination of All Forms of Discrimination Against Women by recognising that reproductive health extends beyond maternity. Articles 11 and 12 of the Convention, which address equality in employment and healthcare, are discussed in further paragraphs of this article.

Paid menstrual leave is not about privilege; it is about recognising biological realities and designing equitable workplace systems. It affirms that women should not have to choose between their health and their livelihood.

Such a policy or law would also help normalise open conversation about menstruation in professional spaces, replacing stigma and silence with understanding and support. As Ghana strives towards inclusive growth and gender equality, that aspiration must be anchored in law and policy. Paid menstrual leave should therefore be understood not merely as a workplace benefit, but as an issue of workplace justice.

CONVENTION ON THE ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST WOMEN (CEDAW)

 CEDAW, adopted in 1979 by the United Nations General Assembly, is the first international treaty to comprehensively address discrimination against women in all areas of life. Ghana ratified the Convention in 1986.

Its preamble recognises that discrimination against women violates the principles of equality and human dignity and hinders their full participation in political, economic, and social life.

By ratifying the treaty, Ghana has committed to removing barriers to equality, addressing harmful stereotypes, and ensuring that women are able to fully and effectively contribute to national development.

 Under CEDAW, Articles 11 and 12 require states to eliminate discrimination against women in employment and healthcare, respectively. They ensure that women enjoy same rights as men in the workplace, including equal access to employment, fair remuneration, promotion opportunities, social security, paid leave, and safe working conditions that protect their reproductive health.

States must also prevent discrimination based on pregnancy or marital status, provide paid maternity leave, and support services such as childcare to enable women balance work and family responsibilities. In addition, states must ensure that women have equal access to healthcare services, including those related to family planning, pregnancy, childbirth, and post-natal care.

In this context, the absence of institutionalised paid menstrual leave may perpetuate workplace inequality by failing to recognise a biological condition unique to women. Where leave for severe menstrual pain is granted without pay, it may effectively penalise women for a natural biological process beyond their control, thereby reinforcing structural disadvantage in the workplace.

Countries such as Japan, Taiwan, South Korea, Zambia and Nairobi (Kenya) have menstrual leave policies. Kenya’s menstrual leave policy for instance allows female employees to take up to two “Menstrual Health Days” each month, on a no-questions-asked basis.

The policy is designed to help women manage severe pain and discomfort, while supporting their well-being and maintaining productivity without any loss of income. Some companies have also implemented menstrual leave policies, including Standard Chartered Bank (Ghana), Incas Diagnostics (Ghana), Coexist (UK) and the Victorian Women’s Trust (Australia).

Standard Chartered Bank (Ghana), for example, offers flexible work arrangements to support women experiencing severe menstrual symptoms, recognising the link between well-being and productivity. The Bank also promotes an inclusive workplace through policies and open discussions on women’s health to help women thrive in their careers.

 Italy’s Chamber of Deputies considered Bill No 3781, introduced on 27 April 2016 to institute menstrual leave for women in Italy suffering from dysmenorrhoea which alarmingly is 60-90%. The proposal marked Italy as the first European country to address menstrual leave within its legislative body, sparking intense debate. Unfortunately, the bill was not passed.

It drew on global precedents, including Japan’s seirikyuuka and practices in countries such as Indonesia, South Korea, and Taiwan, as well as the UK firm Coexist’s initiative. The aim was to enhance productivity and protect women’s health without classifying the leave as sick leave.

The single-article bill grants eligible working women up to three paid days’ leave per month (100% daily wage plus full contributions), applicable to subordinate or para-subordinate, full- or part-time, permanent or fixed-term contracts. It explicitly distinguishes menstrual leave from sick leave.

In Zambia, the Employment Code Act, 2019 provides for “Mother’s Day leave” at section 47. Under this provision, a female employee is entitled to one day’s absence from work each month without the need to produce a medical certificate or provide a reason to her employer.

Zambia’s approach ensures uniform compliance across workplaces. Recent Ghana–Zambia cooperation in trade and cultural exchange, premised on the Fugu conversations, demonstrates that the two countries can learn from each other’s innovations.

Extending dialogue to labour and social protection reforms would be a natural progression. Ghana could craft a model tailored to its context, potentially allowing up to two days of menstrual leave per month, supported by clear guidelines to prevent abuse while preserving dignity.

Dokua’s story, alongside the silent suffering of many women in restaurants, offices, and other workplaces, highlights a difficult reality that many workplaces in Ghana often expect productivity from women while overlooking their biological experiences.

With nearly 80 per cent of women lacking menstrual support and dysmenorrhoea accounting for about 140 million missed work or school days globally each year, the economic and social implications are significant. Laws and policies in certain countries, and support by a few institutions, show that meaningful reform is possible.

Although some critics fear stigma or additional costs for employers, evidence suggests that paid menstrual leave could reduce presenteeism, improve employee wellbeing and retention, while also supporting states’ obligations under Articles 11 and 12 of CEDAW to protect women’s health and equality in employment.

Such reform would further align with the gender equality commitments under the African Union Agenda 2063 and Sustainable Development Goals. Paid menstrual leave is therefore not a privilege but a matter of fairness and workplace justice, ensuring that women do not have to choose between their health and their livelihood as Ghana continues to pursue inclusive growth and gender equality.

(The author is a lawyer and development enthusiast)

Correspondence: [email protected]