Photo: Hands holding via Unplash
Imagine a whisper, a raised brow, an inconspicuous cough and then a murmured admission as someone reveals, ‘it’s that time of the month’. Perhaps replace that with ‘shark week’, ‘Aunt Flo’, ‘Having the painters in’ or ‘the Crimson Tide’ to discover that we have developed more than one way to creatively beat around the bush when it comes to talking about menstruation or periods. Euphemisms like these create a vivid image of avoidance and have become place holders for menstruation, a naturally occurring biological process which globally, on any given day, more than 300 million people are experiencing.
For all our linguistic innovation, it’s important to realise that the language we choose to use has power. Discourse is not only a method for communication but it also constructs our social realities: it builds identities and creates power relations. In other words, the way we talk about menstruation will impact and form the reality of menstruation.These social realities in turn, feed back into our discourse and narrative, which can make it difficult to change narratives and perceptions. For instance, as long as menstruation is perceived to be a taboo, people might struggle with openly accessing menstrual products, meanwhile the lack of accessible menstrual products will enhance the perception that menstruation is something to be not-discussed and hidden.
The power of discourse is especially visible when it comes to advocating for period poverty – the experience of not having access to the necessary materials to absorb blood, places for disposal or spaces for changing and washing during menstruation. It has been estimated that 500 million people worldwide lack the necessary access to menstrual products and spaces for menstrual hygiene management. In this sense, period poverty creates practical needs but also hints at broader issues of limited sexual reproductive knowledge and a widespread culture of shame and silence.
What is menstrual hygiene management?
According to the WHO and UNICEF, menstrual hygiene management consists of women and adolescent girls being able to use “a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.”
The impact of period poverty on menstruating people is context-specific and varies drastically depending on income, setting and levels of access. This is especially the case in emergency and humanitarian settings. A testimony from Manisha in Nepal reveals that “women while menstruating are restricted from entering the kitchen, worshipping god and celebrating festivals, but still in some villages they are forced to reside in a small hut which is illegal since 2005”. In a story from Indonesia, rags are used instead of expensive period products while in Zimbabwe, we learn that the issue of household prioritisation becomes key to shaping experiences of period poverty where “you are approaching your period days and there is not enough money for food alone, some would even resort to asking their circle of friends and roommates for pads pretending as if they forgot to buy but in actual fact they would not be able to afford it”. These personal stories are but a small glimpse into the diverse ways people manage their periods.
These often complex overlapping needs make period poverty a multi-sectoral issue and complicate its management for policymakers and practitioners. It is relevant to human rights, health, education and gender equality, making it a multi-dimensional challenge with a diverse range of interventions. One of these dimensions is in the realm of water, sanitation, hygiene (WASH) and health where a lack of access to affordable menstrual products can leave menstruators searching for alternatives like toilet paper, magazines, leaves, goat skin and cow dung which are unhygienic and dangerous.This more WASH-oriented view has been critiqued, however, as having the unintended side effect of classifying menstruation as something dirty in need of ‘managing’ by policymakers and practitioners. Chris Bobel, a Professor of Women’s, Gender, and Sexuality Studies suggests that this framing presents menstruation as a “bloody mess waiting to happen to the girl who is not ‘protected“. For actors engaging in this space, this can situate menstruation in larger notions of female empowerment and dignity and by extension, shape the kind of interventions and approaches they adopt to address it. Oftentimes, period poverty is tackled through the provision of menstrual products and sexual reproductive health education sessions. Unfortunately, this can risk failing to address a key underlying factor; menstruation is steeped in context-specific cultural nuances, religious significance and social taboo.
In many cultures periods are viewed as something shameful or embarrassing that must be kept secret. In some cultures, menstruators skip school and have their movements or habits restricted or altered because they are considered ‘impure’ or ‘dirty’ during menstruation. These kinds of perceptions can be linked to discriminatory social norms and make period poverty an especially delicate matter to address considering its private nature and multiple dimensions. Thus, even if practical resources, like menstrual products are provided, as long as the social norms are not addressed the interventions will lack effectiveness.
Whether we’re talking about menstruation as ‘that time of the month’ or not talking about it at all, it’s important that we begin to acknowledge that however we, policymakers and practitioners classify and talk about it, has the power to challenge what Chris Bobel so aptly calls the menstrual mandate of shame, silence, and secrecy.
Eye on Global Health 