AUTHOR: SOPHIE BUCKLAND
Intro
Menstruation is not a topic we normally talk about. It is often considered to be uncomfortable, something to be hidden and dealt with quietly. For some people, it’s not much of an issue and they can get on with their daily lives. But for many people, menstruation is a cause of anxiety, fear, helplessness and pain. Lack of access to adequate facilities and menstrual products, little or no information about menstruation and consequences forced onto people can be severely damaging. Displaced people especially struggle to deal with their periods and the generalisations, stigma and gendered language prevalent in our society does not help.
Causes
There are many factors that contribute to poor menstrual health and hygiene for people who menstruate. Cultural, religious and traditional beliefs restrict people during their menstrual cycle and even in a place like Australia it can still be a source of embarrassment.[1] Talking about menstruation and menstrual products is often considered to be an uncomfortable topic. This is why problems can go unaddressed and are often forgotten.
Most health education programs don’t adequately address menstruation, if they even do so at all.[2] When menstruation is talked about, information is directed at women and girls, but it needs to be aimed at everyone for interventions to be truly gender transformative.[3] The result is that most information is gained from peers or family members, but there are many problems associated with this. Even when there aren’t taboos surrounding menstruation, products can be hard to access, expensive and uncomfortable to use – one size does not fit all.
Menstruation is still shrouded in silence and stigma and is thus a neglected issue worldwide.[4] In the USA, 350 of 50 states have a ‘tampon tax’ where menstrual products are not considered essential items and are subsequently taxed, forcing people to spend thousands more than they should be.[5] When disasters displace groups of people, response systems often forget to account for the fact that about half their population menstruate, not addressing menstruation when it is hardest for people to deal with it.[6]
These people often lack access to soap, safe water and functional and secure toilets/latrines with mechanisms for the private disposal of used menstrual products.[7] Even when products are provided, such as at homeless and domestic violence shelters, they may not meet people’s needs and preferences.[8] Lack of access to useful products in general can be caused by issues ranging from poverty and gendered power imbalances in control over household resources, to distribution.[9]
Compounding this issue is the fact that dealing with menstruation is not a straightforward issue. Everyone has different cycle lengths, flow levels and different products are better suited to different people, due to their varying needs. Some products require hygienic facilities where they can be washed and sterilised, some require more washing than others and yet other products need a proper disposal system to get rid of them in a sanitary way. When people are affected by natural disasters and lose their homes, it often becomes a struggle to find disposal facilities or soap and safe water.[10] Basic needs go unaddressed and the result is a population unable to properly deal with their menstrual needs.
Effects
These issues all have profound consequences for those they affect. People who menstruate experience both long- and short-term impacts both psychologically and physically in relation to their confidence, self-efficacy (being able to complete tasks to a satisfactory degree), ability to participate in daily activities such as education and employment, and their health and wellbeing.[11]
Reaching menstruation can cause many problems for those who do not know what it is when they get their first period. Fear and anxiety is often perpetuated in some communities, especially when the only source of information for girls is from their female peers, whose advice is often not timely nor adequate.[12] These people, who pass on information about menstruation, may have knowledge gaps and misconceptions which are often inadvertently passed on.[13]
The costs of having inadequate facilities in (mainly) developing countries is that this severely restricts girl’s engagement and is the primary reason they are taken out of school early.[14] This costs countries millions of dollars by having uneducated women who cannot work in high level jobs and leaves them vulnerable to many different forms of abuse such as child marriage, sexual violence or coercion and early pregnancy.[15] Issues of gender-based violence, health outcomes and human rights among vulnerable populations are greatly impacted when people cannot properly deal with their period.[16] This is the reason why many NGOs focus on providing girls with facilities or resources that allow them to get an education, also helping communities and countries out of poverty.
When menstruating, people can experience a variety of symptoms such as pain, headaches and fatigue, or more serious issues.[17] Inaccessibility of hygienic ways to deal with menstruation affects all people who experience it. They are far more likely to get vaginal infections due to being unable to completely dry reusable pads, clean and sterilise cups or the use of unhygienic materials such as leaves, newspaper or rags.[18]
Most people worldwide do not get prompt or effective clinical care when they experience menstrual health problems, such as premenstrual syndrome, painful menstrual periods, excessive bleeding and delayed or early periods.[19] This reduces the functioning and sense of well-being of those who experience it, but can also result in potentially serious medical conditions in the long term when issues that manifest in menstrual symptoms are not diagnosed or treated.[20]
In addition to the above, more than 12 billion disposable products are used each year, worldwide.[21] These products create approximately 6.3% of sewage-related debris on rivers and beaches.[22] Methods used to dispose of them such as pit latrines, toilets, garbage, incineration/open burning, burying and open dumping into ponds and fields are damaging, rudimentary and unregulated, but may be the only option available.[23]
Solutions
So what can be done about this? How do we help the people experiencing period poverty? Well, there are a few solutions that need to be addressed. I’ve identified three main areas that are important in addressing this problem.
First, access to adequate disposal and bathroom facilities with clean water that people can use. In disaster response scenarios it is particularly important to include these people who projects are meant to benefit in the design process, so that the facilities provided actually work for them (since people may have different needs to what response teams consider important).[24]
Secondly, it is important to provide more sustainable methods to deal with menstruation, and ensure people have the ability to effectively use these. A large problem with shelters providing disposable menstrual products (such as pads and tampons) is that they need a continuous supply that suits the people who need them. However, very rarely are enough products donated and when they do they may not actually be of much use (eg. light pads are less effective in dealing with heavier periods).
Finally, there needs to be a better system to help homeless people in developed countries as well as others to deal with their periods through reducing stigma, using reusable solutions and the understanding that it’s not only women who menstruate, and not all women do menstruate.[25]
The first solution is pretty straightforward. Talk to the people you are meant to be helping when designing interventions and trying to help displaced people, since they are the ones who best know what they need. This was proven in refugee camps in Cox’s bazar, where women were central in the design of menstruation-supportive water, sanitation and hygiene facilities.[26] The input of these people who the new facilities were aimed at led to a number of changes from the initial design, since the people had many needs that weren’t addressed. Examples include making the roof from a different material so no one could see in and adding a pole to help pregnant and elderly women.[27] Creating hygiene facilities with input from the women they’re aimed at is very effective at creating something they’ll actually use. Simply just providing products is not helpful if they cannot be used, so all areas of menstrual health and hygiene need to be addressed.
But disposable products are unsustainable and damage the environment. Reusable products such as menstrual cups, absorbent underwear and reusable pads (to name the most commonly known) are effective if used properly, but proper facilities to use them are essential. While it may be easy for privileged people with a steady financial income to purchase and use products, they may not be so viable for those living day-to-day, or on the street. The solution to this is to provide access to facilities that allow people to use reusable products, as well as provide these products and information on how to use them.
Reusable products are more economical and environmentally friendly and a better alternative to conventional products.[28] Using reusable pads and absorbent underwear seems simpler than menstrual cups, since they don’t need to be inserted. While there may also be cultural taboos about vaginal insertion,[29] menstrual cups don’t require the user to be wearing underwear to use them. The choice depends on the preference of the user, so it is important a variety of products and proper education about all of them is provided.[30]
There are many misconceptions when it comes to using cups; that they are uncomfortable and leak.[31] However, a study on the adaptability and efficacy of menstrual cup in managing menstrual health and hygiene showed that all problems with the menstrual cup could be fixed with guidance.[32] While some issues were found initially, all problems could be solved with guidance and participants reported feeling more comfortable using the cup after the second or third cycle with it.[33] In addition to this, a study found that over one year reusable menstrual cups had less than 1.5% the environmental impact of disposable products and approximately 10% of the cost,[34] making them by far the better option. So reusable menstrual products are way better than disposable ones. Why don’t you give them a try?
Unfortunately, there’s a catch; once you establish these products are better, as mentioned before, they’re still not a viable solution for many people. A large problem with the uptake of reusable products is that they need to be cleaned and sterilised and some people simply do not have the means to do this. Therefore, public facilities to clean, sterilise and dry these products are needed. Many people are uncomfortable about menstruation and would be reluctant to go somewhere in public if it was clear it was related to menstruation. So we need to add facilities to public bathrooms where people normally go anyway that allow for reusable menstrual products. They need to be unisex facilties so anyone can access these facilities and there needs to be enough of them to meet demands. Clean water and a private space to clean products, dedicated sterilizing units and a heat source that can dry products would be ideal. Even if the heat source could only partially dry, those with the ability to do so could finish drying later, and those who couldn’t could use products such as cups that don’t need to be dried as much as cloth.
The best way to address problems such as stigma and misconceptions, in all areas, is through education. A study was also done on how to improve knowledge and perceptions about menstruation. They found that people (not just women) wanted to learn more about menstruation and when they were presented with a well thought out menstrual education program it led to high satisfaction.[35] The survey conducted afterwards found that the extent of menstrual education received correlated with their perception of menstrual products, meaning programs could change perceptions (when done systematically) and could alleviate menstruation challenges attributed to poverty.[36]
It is important to include and inform men and those who don’t menstruate, so that they can help and understand those that do. One problem with having predominantly male decision-making groups (such as parliament) is that issues and problems people in power don’t experience get ignored, since they don’t realise it is something that needs to be considered. That’s why education and including diverse people is an important part of the solution.
Talking about menstruation is incredibly important, but when people are left out of the conversation it can be incredibly damaging. It’s important to know that not all cis gender women (people assigned female at birth) have periods, due to a variety of medical conditions or the fact that they are trans or intersex.[37] And not all people who menstruate are cis gender women. Trans men, intersex, genderqueer and nonbinary people may also have periods.[38]
Menstruation is a biological process, not a ‘woman’s thing’. Different people will have different experiences, so it’s important to use inclusive language to reduce bias.[39] Using non-gendered language makes information more accurate and accessible, meaning anyone can access vital health information, regardless of their identity.[40] If people don’t fit the common definition of ‘woman’, they can easily become isolated, marginalised, stigmatised and discriminated against. When diseases and health care issues are gendered, it becomes harder for trans and gender nonconforming people to access healthcare.[41]
Conclusion
To truly transform the way we deal with menstruation, the topic needs to become an open conversation. Creating education programs to normalise and teach people about menstruation can open up barriers, while using non-gendered language means everyone is included. Talking to the people products are designed for make them more effective, as knowledge and understanding of this important topic is spread. Reusable menstrual products are better for the environment and are cheaper on a long-term basis, but access to proper hygiene facilities where people can use these products is essential to help them. Now you know, you can do something about it.
Reference List
Bell, J. (2017, April 7). Talking about periods beyond gender. Clue. https://helloclue.com/articles/cycle-a-z/talking-about-periods-beyond-gender
Hait, A., Powers, S. (2019). The value of reusable feminine hygiene products evaluated by comparative environmental life cycle assessment. Resources, Conservation & Recycling, 150, 1-1. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=16&searchType=AdvancedSearchForm¤tPosition=6&docId=GALE%7CA599047828&docType=Report%2C+Brief+article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA599047828&searchId=R15&userGroupName=61cggs&inPS=true
Kakani, C.R., Bhatt J. (2017). Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(7), 1-8. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=4&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA534838627&docType=Report&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA534838627&searchId=R1&userGroupName=61cggs&inPS=true
Moon, G., Kim, I., Kim, H., Choe, S., Jeon, S., Cho, J. (2020). How can we improve knowledge and perceptions of menstruation? A mixed-methods research study. BMC Women’s Health, 20(1), 1-9. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=66&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA637891182&docType=Article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA637891182&searchId=R10&userGroupName=61cggs&inPS=true
Plesons, M., Patkar, A., Babb, J., Balapitiya, A., Carson, F., Caruso, B. (2021). The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. Reproductive Health, 18(1), 1-11. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=21&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA653575649&docType=Report&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA653575649&searchId=R2&userGroupName=61cggs&inPS=true
Rodriguez, L. (2021, June 29). The Tampon Tax: Everything You Need to Know. Global Citizen. https://www.globalcitizen.org/en/content/tampon-tax-explained-definition-facts-statistics/
Schmitt, M., Wood, O., Clatworthy, D., Rashid, S., Sommer, M. (2021). Innovative strategies for providing menstruation-support water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox’s bazar, Bangladesh. Conflict and Health, 15(1), 1-10. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=31100&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA653672675&docType=Article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA653672675&searchId=R11&userGroupName=61cggs&inPS=true
UNFPA. (2021, June). Menstruation and human rights – Frequently asked questions. United Nations Population Fund. https://www.unfpa.org/menstruationfaq#Menstruation%20cannot%20be%20managed%20properly
VanLeeuwen, C., Torondel, B. (2018). Improving menstrual hygiene management in emergency contexts: literature review of current perspectives. International Journal of Women’s Health, 10, 169-183. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=7&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA576052346&docType=Report&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA576052346&searchId=R12&userGroupName=61cggs&inPS=true
[1] C.R. Kakani & J. Bhatt. (2017). Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=4&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA534838627&docType=Report&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA534838627&searchId=R1&userGroupName=61cggs&inPS=true
[2] M. Plesons. et. al. (2021). The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=21&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA653575649&docType=Report&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA653575649&searchId=R2&userGroupName=61cggs&inPS=true
[3] Ibid.
[4] Plesons. op. cit. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research.
[5] L. Rodriguez. (2021). The Tampon Tax: Everything You Need to Know. https://www.globalcitizen.org/en/content/tampon-tax-explained-definition-facts-statistics/
[6] C. VanLeeuwem. et. al. (2018). Improving menstrual hygiene management in emergency contexts: literature review of current perspectives. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=7&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA576052346&docType=Report&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA576052346&searchId=R12&userGroupName=61cggs&inPS=true
[7] Plesons. op. cit. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research.
[8] Ibid.
[9] Ibid.
[10] C. VanLeeuwem. et. al. op. cit. Improving menstrual hygiene management in emergency contexts: literature review of current perspectives.
[11] C. VanLeeuwem. et. al. op. cit. Improving menstrual hygiene management in emergency contexts: literature review of current perspectives.
[12] Ibid.
[13] Ibid.
[14] UNFPA. (2021). Menstruation and human rights – Frequently asked questions. https://www.unfpa.org/menstruationfaq#Menstruation%20cannot%20be%20managed%20properly
[15] Ibid.
[16] C. VanLeeuwem. et. al. op. cit. Improving menstrual hygiene management in emergency contexts: literature review of current perspectives.
[17] Plesons. op. cit. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research.
[18] UNFPA. op. cit. Menstruation and human rights – Frequently asked questions.
[19] Plesons. op. cit. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research.
[20] Ibid.
[21] Ibid.
[22] Ibid.
[23] Ibid.
[24] M. Schmitt. et al. (2021). Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox’s bazar, Bangladesh. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=31100&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA653672675&docType=Article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA653672675&searchId=R11&userGroupName=61cggs&inPS=true
[25] J. Bell. (2017). Talking about periods beyond gender. https://helloclue.com/articles/cycle-a-z/talking-about-periods-beyond-gender
[26] M. Schmitt. et al. op. cit. Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox’s bazar, Bangladesh.
[27] Ibid.
[28] C.R. Kakani & J. Bhatt. op. cit. Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene.
[29] Ibid.
[30] Plesons. op. cit. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research.
[31] C.R. Kakani & J. Bhatt. op. cit. Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene.
[32] Ibid.
[33] Ibid.
[34] A. Hait & S. Powers. (2019). The value of reusable feminine hygiene products evaluated by comparative environmental life cycle assessment. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=16&searchType=AdvancedSearchForm¤tPosition=6&docId=GALE%7CA599047828&docType=Report%2C+Brief+article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA599047828&searchId=R15&userGroupName=61cggs&inPS=true
[35] G. Moon. et al. (2020). How can we improve knowledge and perceptions of menstruation? A mixed-methods research study. https://go.gale.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=66&searchType=BasicSearchForm¤tPosition=1&docId=GALE%7CA637891182&docType=Article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA637891182&searchId=R10&userGroupName=61cggs&inPS=true
[36] Ibid.
[37] J. Bell. op. cit. Talking about periods beyond gender.
[38] Ibid.
[39] Ibid.
[40] Ibid.
[41] Ibid.