When 26-year-old Kiran Gandhi ran the London Marathon in April, she crossed the line. Not just the finish line but a fine line hovering between socially unacceptable and uncomfortably courageous. She ran with her period, allowing her menses to stain in between her spandex leggings. The overtly displayed stain demanded attention.

“Firstly, I thought, Oh god, I really don’t want to run a marathon with a tampon in, as it’s something I’ve never done before,” Gandhi told BuzzFeed News, adding that she knew what other people would think when they saw her leaking on the course. “You shouldn’t have to worry about how you look for others on a marathon course. To me, that shed light on the fact there is no global conversation about periods.”

Gandhi said she decided to “run free” by not wearing a tampon because women around the world are often shamed for having their period. As a direct result of not using the sanitary product, she kickstarted a global conversation about period shaming, which asked: Why do we feel embarrassed to buy tampons but not toilet paper?

The Female Athlete’s Cyclical Struggle

After months of preparation for a race, the last thing a woman wants is her period. Leg cramps, fever-like exhaustion, migraines, and sensitivity to light and sound make running a marathon far more difficult than getting the timing right for changing a tampon while running the course.

Menstruation, with all of its fluctuating hormone levels, can have a considerable effect on how the female body responds to the demands of exercise and competition. In a series of experiments conducted at the University of Denmark, scientists discovered that during physical training, women’s tendons and ligaments didn’t grow as thick or powerful as men’s.

Despite physiological setbacks, an Australian study published in 2011 shined some light on how estrogen affects a female’s athletic ability. Researchers measured the amount of calories female rowers burned, and their oxygen consumption, respiratory exchange, and blood levels, and found that although all athletes were at various stages in their menstrual cycle, there was no significant difference in performance. Despite the pain and possible distraction from the menstruation, they rowed on without letting it hinder their performance.

Every month, women (runners, especially) push themselves through the lowest points of their cycles, when the pain is unrelenting. Women also have an inherent pain threshold that helps get them through the pain of pregnancy and childbirth. Runner’s World Coach Jenny Hadfield says this helps to develop key mental skills that come in handy for race day. However, some periods affect a woman’s athletic performance so much that it’s hard to deny the effect they have on the race clock.

"I ran 3,000 meters at the national championships in nine minutes 15 seconds and felt really tired," 20-year-old mid-distance competitive runner Jessica Jude told BBC News. "One week later, at the Birmingham Grand Prix, I ran the same distance in nine minutes flat with no extra training. It's scary that it can affect you so much because it is the difference between first and last."

Fifteen seconds may seem like nothing, a flash in a moment. But to a long-distance runner in a high-stakes race, it can mean the difference between breaking a record and coming in fourth place. It is more challenging to run at certain points of a woman’s cycle, and being a runner through middle school and college, I personally knew about these struggles all too well.

Aside from twisting an ankle or tearing a muscle, getting my period on race day is my greatest fear. I’ll be running my first marathon in a few months and, like Gandhi, do not want to run with a tampon. Normally I would apologize for the directness and honesty of this conversation, but that’s Gandhi’s point — women should not feel sorry for speaking about their periods.

While there’s a lot of truth to the statement Gandhi made, what she did was not only unhygienic but also demonstrably offensive if misunderstood. Yes, most media coverage acknowledged she was trying to raise awareness of “period shaming.” But her actions were also portrayed as an outlandish outburst from a feminist extremist, and amid the praise she received on social media, many people also called it “ disgusting as f---” while others accused her of attention-seeking.

That said, her point on the taboo subject had gone viral, and everyone was talking about it. Speaking to Fusion , she said: “Women’s bodies are expected to look a certain way, and to behave a certain way — a pleasing way. Society is more than happy speaking about our breasts, our face, our butt, because these can be sexually enjoyed. But our culture is not happy to acknowledge or speak about the parts that are not meant for the sexual enjoyment of others. We are full bodies, and all parts of us must be OK to speak about.”

That Time of the Month Around the World

While Gandhi was able to spur a national conversation about periods, hundreds of thousands of young girls and women around the world aren’t able to openly speak about them. For them, it’s a monthly struggle to find a way to privately and safely manage their menstruation, according to A World at School , a global campaign initiative designed to improve childhood education around the world.

By running without a tampon, Gandhi wanted to help people realize how uncomfortable and unhygienic it is to free-bleed. In doing so, she hopes to spread awareness about the lack of access to sanitary pads and tampons that many women face today.

Beyond not having these basic sanitary needs, a larger challenge exists in many countries. In Iran, for example, 48 percent of girls believe menstruation is a disease. In India, 10 percent of girls believe this same falsehood, along with seven percent of Afghan girls. In Uganda, it’s common for a girl to miss school because of the pain and physical discomfort caused by menstrual cramps. And an overwhelming majority of girls don’t have access to Aleve or Midol for pain management, which is why they wind up bedbound, avoiding any kind of physical activity. Many of these girls grow up to be women who aren’t empowered to talk or freely act on their own bodies. The stigma forces them to suffer in silence.

Human rights efforts are deeply rooted in the fundamental right to human dignity, and women in these countries are often robbed of this dignity from an early age. By understanding the reasons women like Gandhi speak up about periods, we can help push this conversation forward in hopes that girls will one day speak freely about their periods and have access to basic needs, without shame.

"You see, culture is happy to speak about and objectify the parts of the body that can be sexually consumed by others," Gandhi told PEOPLE. "But the moment we talk about something that is not for the enjoyment of others, like a period, everyone becomes deeply uncomfortable. If we don't own the narrative of our own bodies, somebody else will use it against us."