Why we’ve yet to mainstream menstruation

This piece was originally published by Apolitical on April 14, 2021.

By Odette Hekster, Managing Director of Population Services International (PSI)-Europe.

Existing policies have kept menstrual health out of women’s hands. That needs to change.

I’ve always been interested in the processes through which social policies come about, and whether they really benefit the people they claim to. I have a background working in the science of public administration, which is perhaps why this has captivated me for so long.

Together with its partners, my current organization recently engaged a broad range of stakeholders to develop a guide outlining how national governments, donors and the private sector can invest in menstrual health and hygiene for women and girls around the world.

Right now, an estimated 500 million women and girls lack either the knowledge, skills, services or products needed to ensure their health and well-being during menstruation. Not all women and girls menstruate, and not all people who menstruate are women. The term ‘girls and women’ is used as a shorthand in this article, but refers to all people who menstruate including girls, women, transgender and non-binary persons.

The links between menstruation and sexual and reproductive health, education, water and sanitation, as well as socio-economic security, mean these challenges are even more dire for women in low and middle-income countries.

Menstrual health and hygiene clearly aren’t high enough on the political agenda. In fact, I would argue it is a subject policy-makers have consistently relegated.

Our report concluded that if national and donor governments took women and girls’ menstrual needs more seriously, existing policies on sexual and reproductive health would have a better chance of actually serving them. This would advance gender equality, and so go much further to achieving the Sustainable Development Goals.

Taking menstrual health more seriously in principle is all well and good. In practice however, I would suggest the following two actions.

User-centred research

A good example of an initiative that delivered tangible results from the perspective of women’s health and safety was one I worked on as a consultant for UN-Habitat 20 years ago.

My team and I conducted several women’s safety audits in areas within sub-Saharan African countries, where people generally lived on very low rates of income. We knew the concerns women had about the threat of gender-based violence and their vulnerability in their cities. Moreover, we trusted that they knew what the solution should look like.

Period poverty is inextricably linked to wider poverty.

Using a tool developed in Canada in 1989, we mapped informal settlements in several sub-Saharan African cities with the help of local women. The aim here was to identify unsafe areas for women and girls.

It turned out that unfinished buildings in these cities were ideal hiding places for sexual predators. In response, we got local authorities to urge the owners of these buildings to clean their properties and so make them less obscure. In addition, neighbourhoods were provided with lighting in places women told us they felt unsafe, and local partners were trained to patrol the neighbourhood.

Now, 20 years later, programme developers are keener than ever to apply the same principle of user-centred design to public services. When you apply that principle to people who menstruate, a range of topics come up that cut across existing policies.

What I’ve learned from this is that women and girls generally want existing policies to come with facilities that allow them to change and clean their menstrual products safely and with dignity. They want education programmes to provide timely and period-positive information. They want sexual and reproductive health programmes to include counselling around issues such as fertility, menstrual pain and menstrual disorders. And they want social policies to address period stigma and to shift discriminatory social norms.

In short, existing policies that don’t consult women generally don’t do what women need them to.

An end to debate

Providing women and girls with access to quality menstrual health and hygiene also means changing the terms on which we, as public servants, engage with this issue. Women’s health has historically been hijacked by debate at the political level. This naturally hinders the process of creating policies that work for women.

Think of the sheer number of politicians who for centuries have elected to tell women what they should do with an unintended pregnancy. Think too of the ever-growing number of women around the world who insist that this is a personal, private and medical discussion to be had solely between the individual and their physician. Menstruation is no different. Debate on these issues has arguably done women and girls more harm than good. Enough is enough.

Menstruation is a normal and natural part of the reproductive system, experienced by over half of the world’s population. It accompanies people from the beginning of puberty until they hit menopause. Menstruation is itself a significant predictor and indicator of health and well-being. Policies within education, health, water and sanitation must do better to acknowledge the fundamental role menstruation plays in women’s lives. They must also acknowledge the fundamental role women play in discussions around menstruation.

Governments throughout the rich world have started to provide free sanitary pads to girls in schools — a response to what is called ‘period poverty’. While this is certainly laudable, it unfortunately shifts attention away from the reasons mainstream social welfare policies have so far underserved women and girls. Period poverty is inextricably linked to wider poverty. It is vital therefore that socio-economic conditions do not place poorer women at higher risk of ill health with respect to their menstrual cycles.

Responding to menstrual needs by making them an integral part of mainstream policy would not only improve the health of women and girls, or their social and economic activities, but would make existing policy fit for purpose. This is what is meant by the OECD’s prescription of “sound public governance”, which aligns with the principle of “inclusiveness, participation, gender equality and diversity”.

What we need is a proper system of accountability that can tell whether or not pertinent, tangible and sustainable progress is being made on women’s menstrual health. This means asking women and girls directly what they need before we act on their behalf. And it means not subjecting their futures to even more baseless political debate. Women and girls know best how to take charge of their menstruation.

They knew best 20 years ago, and they know best now. — Odette Hekster

To learn more about why and how to invest in menstrual health for the economic, educational, and health benefits of women and girls in low and middle-income countries around the world, download your copy of Making the Case for Investing in Menstrual Health and Hygiene today.

Banner photo credit: vulvani.com

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