Advancing Menstrual Equity at the Intersection of Self-Care and Universal Health Coverage

Haley Millet, Advocacy and Program Manager, Days for Girls International

This year on Universal Health Coverage (UHC) Day, achieving the Sustainable Development Goal (SDG) of good health and wellbeing for all by 2030 may feel formidable — especially in light of the impacts of the COVID-19 pandemic. As the UN highlights, the pandemic has “exposed long-ignored risks, including inadequate health systems, gaps in social protection and structural inequalities.” On this day, we implore SDG stakeholders to focus on equity, to “leave no one behind: invest in health systems for all”.

For women, girls, and people who menstruate*, inequity in access to supportive health environments may seem rather self-evident: an estimated 500 million people worldwide do not have what they need to manage their periods. This impacts their ability to attend school, excel in the workplace, engage in family and community activities, and pursue their own goals. 

As a nongovernmental organization that seeks to eliminate the limitations associated with menstruation, Days for Girls International  (DfG) has witnessed firsthand how inequities exacerbated by COVID-19 impact women’s sexual and reproductive health and rights (SRHR) and safety. Working across 22 countries, DfG staff, social entrepreneurs, and community partners advocate to address barriers to menstrual equity in the midst of pandemic. Here, we share five key challenges that menstruators navigate on a monthly basis:

  1. Decreased access to healthcare providers for reproductive health services including care for menstrual discomfort and disorders.
  2. Decreased access to accurate and timely information about menstruation for students during school lockdown.
  3. Decreased access to menstrual products for students during school lockdown, especially for those accessing products through school programs.
  4. Increased risk of early marriage and early or unwanted pregnancy among women and girls due to school lockdown.
  5. Increased exposure to gender based violence (GBV) for women and girls quarantined in abusive households, where menstrual stigma may be cited by abusers as justification for GBV.

As the pandemic shed light on structural inequities in our healthcare systems and barriers to menstrual equity in particular, we also learned how self-care can play a major role in bridging that gap. In fact, women and girls enact an ongoing process of self-care throughout their menstrual cycle. However, the extent to which they are supported to practice self-care varies greatly.

When countries enact UHC policies and regulations to the health system that support people fully utilizing self-care, it puts care in the hands of people and helps reach vulnerable and marginalized groups who have historically been left out. This is especially true for women and girls, who regularly navigate care for the stigmatized conditions of menstruation and menstrual disorders. 

So, what do supportive self-care environments look like with regards to menstruation? Here, we identify three focus areas within UHC that government bodies and decision makers can address in order to bolster self-care for menstruators, paired with policy examples:

Focus AreaSample Policies and Regulations
Improve access to menstrual health information . When women and girls have access to accurate, timely and age appropriate information about their bodies, they are better equipped to make decisions about how to care for menstrual symptoms.
  • Institute a routine menstrual health questionnaire for providers to use during wellness visits, so that disorders may be identified early, patients are invited to ask questions, and patients are equipped with timely information about their MH experiences.
Improve access to a range of menstrual products. In order to manage menstruation with dignity, women and girls require access to a range of certified safe and effective menstrual products so that they can choose the product(s) that are right for them.
  • Implement product standards for all menstrual products on the market as essential products, similar to essential drugs. 
  • Disseminate information and train manufacturers in how to meet these standards. 
  • Develop public health campaigns to educate menstruators about menstrual product options
  • Subsidize provision of menstrual products in public healthcare facilities, secondary schools, universities, and government workplace washrooms.
Improve access to support for physical wellbeing. Women and girls may pursue both at-home remedies for menstrual symptoms including over-the-counter pain relievers, hot compresses, herbal remedies, nutrient-rich foods, and more; however, they may also pursue a healthcare professional which should be available to them.
  • Expand access to telehealth as a component of UHC, especially in rural areas, so that women and girls can discuss their symptoms with a healthcare professional and create a care plan before arriving at a facility.

When decision makers champion policies and regulations like the examples above as an integral part of UHC, women and girls are supported to practice self-care throughout the menstrual cycle. Supportive self-care environments make healthcare for women and girls more accessible, equitable, and user-friendly. Menstruators are equipped to make decisions about how to manage their menstruation, and empowered to act on those decisions, whether or not they involve seeking a healthcare provider.

Achieving health and wellbeing for all by 2030 will be strongly impacted by the extent to which women and girls are empowered to practice self-care. This is a call to decision makers towards supportive self-care policy environments, placing health care in the hands of people, so that no one is left behind.

Days for Girls International (DfG) is an international nongovernmental organization that works to advance menstrual equity by developing global partnerships, cultivating social enterprises, mobilizing volunteers, and innovating sustainable solutions that shatter stigma and limitations for women and girls. We envision a world where periods are never a problem, where women and girls can pursue their goals free from menstrual barriers and stigma.

*These terms are used in reference to people who menstruate, inclusive of all gender identities.

Banner Photo credit: Days for Girls International
Photo description: Students in Mombasa, Kenya hold washable menstrual pad kits produced by Days for Girls social enterprises.