This article was originally published on April 24, 2019 on Impaktor.com as a part of a series on the Sustainable Development Goals. The original article may be found here. Co-authored by Inga Winkler & Sydney Amoakoh.
Expanding the Discourse on Menstruation in the Sustainable Development and Human Rights Agendas
If 2015 was the year the period went public, 2018 was the year menstruation won its spotlight at the United Nations. From the Commission on the Status of Women to the High Level Political Forum and the Human Rights Council, menstruation has become part and parcel of conversations between delegates, resolutions and outcome documents that address the importance of menstrual health and its impact on development and human rights.
Now we need to ask ourselves – how can we seize on this current momentum to ensure that menstrual health is comprehensively integrated into the human rights and sustainable development agendas of 2019? How can we turn the momentum into a movement? What needs to come next?
Menstrual Health’s Momentum in the Human Rights & Development Agendas
As menstruation moved from the shrouds of secrecy and taboo at the UN level, it gained recognition as a cross-cutting issue that is integral to the realization of the human rights and sustainable development agendas. Continuing to fuel such focus and discourse on periods at high-level forums is important because this type of attention can incentivize national policy-making. It encourages other States to learn from the practices, setbacks and successes of the growing group of States that have adopted national menstrual health policies and programs.
Governments are not only able to inspire their peers in regional and global forums, but are also uniquely positioned to normalize discussions on menstruation in the international community and amongst their own populations. They can inspire a new generation of innovative thought on finding solutions to long-standing gaps in menstrual health around the world. Moreover, integrating menstrual health into the SDG agenda can set incentives for monitoring and data generation, which in turn can improve programming to meet menstrual health needs.
In the last decade, the water, sanitation and hygiene (WASH) sector has served as an invaluable entry point for highlighting menstrual hygiene needs, and for opening up spaces to discuss menstrual health. Through WASH interventions, menstruators in dozens of countries have benefitted from menstrual hygiene programs.
The WASH sector has also championed the issue at the UN level – and last year was no exception. New language in the Human Rights Council resolution on the human rights to safe drinking water and sanitation expands the original concerns for products and facilities. It addresses the impacts of poor menstrual health on “women’s and girls’ enjoyment of human rights, including the rights to education, health, and safe and healthy working conditions.” It calls on States to take action to address these impacts and menstrual stigma by ensuring women and girls can access factual information, menstrual products and gender-sensitive facilities.
In the Photo: Key speakers from the 39th Human Rights Council side event, “Tackling Stigma and Discrimination: From Menstruation to WASH Access for People on the Move.” Photo Credit: (c) WSSCC/Camila Souza
The resolution, together with a report by the Special Rapporteur on the Human Rights to Water and Sanitation, as well as a side event, equipped States with the knowledge and motivation to integrate menstrual health into their SDG initiatives. These developments are also important because they show the WASH community’s proactive stance in addressing menstrual health needs beyond the provision of products and facilities.
While it is impossible to deny that people need spaces and supplies to manage their periods, there is a need for greater emphasis on menstrual health considerations beyond WASH. Menstrual health is connected to leading a healthy life (SDG 3), having the ability to seize educational and work opportunities (SDGs 4 and 8), gender equality (SDG 5), promoting sustainable patterns of consumption and production (SDG 12) and reducing inequalities (SDG 10). There is a need to consider all these areas comprehensively and fight the problems lying at the core of gaps in menstrual health, namely socio-cultural stigma.
Menstrual Health As More Than Just an SDG 6 Issue
In 2018, the international community signaled understanding that more comprehensive menstrual health globally will require their active participation in building cross-sectoral approaches.
At the Commission on the Status of Women in March 2018, the women’s rights community brought attention to menstrual health through their Agreed Conclusions on gender equality and the empowerment of rural women and girls. They called on States to combat stigma and hindrances to menstruators’ participation in public life by promoting education, cultures and health practices in which menstruation is viewed as healthy and natural.
In the Photo: Key speakers at the High Level Political Forum 2018 side event, “Putting Menstrual Health on the 2030 Agenda.” Photo Credit: UNAI/Kayla Hamidi
A few months later, menstruation gained the spotlight at the High Level Political Forum, where several side events helped to elevate menstrual health. Experts called for broader recognition of menstrual health management challenges, and for more detailed research on how it impacts the lives and human rights of women and girls. The resulting ministerial declaration held that States must ensure access to sanitation and hygiene facilities that take into account the specific needs of women and girls for menstrual hygiene management. While this language does not frame menstrual health beyond the WASH lens, it still embodies a significant step in seeing it integrated into SDG agendas. The main SDG framework does not include menstrual health, so documents like the ministerial declaration are an alternative avenue for establishing the issue as an essential component of achieving development goals.
On International Women’s Day 2019, a group of UN Special Procedures issued a statement recognizing that, “[t]he stigma and shame generated by stereotypes around menstruation have severe impacts on all aspects of women’s and girls’ human rights, including their human rights to equality, health, housing, water, sanitation, education, freedom of religion or belief, safe and healthy working conditions, and to take part in cultural life and public life without discrimination.”
They specifically drew attention to the impact of menstrual stigma on the rights to health and education, stating that:
“Many health care providers are dismissive of serious health issues and women’s symptoms related to menstruation and it can take several years to be diagnosed with endometriosis. […] Moreover, due to stigma and limited knowledge of menstruation (in the context of widespread inaccessibility of comprehensive sexuality education), many girls have negative and ambivalent feelings about menstruation and experience psycho-social stress, which impacts their ability to learn.”
In their conclusion, they remind us that in moving forward, “[m]yths and misinformation need to be combated through comprehensive, non-judgmental, accurate and accessible information to improve menstrual literacy.”
These developments show that the international community is already conceptualizing menstruation beyond SDG 6. These developments are a starting point to discuss and take action on menstrual health in the humanitarian, development, health, housing and women’s rights communities, among others. Broader thinking and language can see menstrual health added to the major human rights and development frameworks that once closed their eyes to the issue.
Moving forward, we need to build on the connections made between menstrual health and displacement, health, housing, development and women’s rights, education, employment and other facets of participation in public life. Knowledge generated by these efforts should be used to see menstrual health included in more global, regional and national frameworks and agendas.
Looking to the Future: Leave no Menstruator Behind
As with any fast-moving new agenda, the speed and reach of the current momentum around menstruation not only bring significant opportunities, but also pose risks – risks of rushing toward poorly-conceived policies and entrenching existing patterns of exclusion and marginalization. At this crucial moment in the emergence of menstrual health as a matter of public health and human rights, we need to ask: Whose voices are being heard and whose are muted?
For instance, by framing menstrual health as a women’s or adolescent girls’ issue, do we ignore other health issues women experience across the lifespan? Do we acknowledge women who do not menstruate? Conversely, do we address the needs and experiences of menstruators who do not identify as female? By focusing interventions on girls in schools, do we further entrench the marginalization of girls who are out of school? By failing to ask these questions in our efforts to move menstruation from the margins to the center of global discussions, we risk closing our eyes to the needs and experiences of many individuals.
It is vital to position the voices of menstruators themselves as the guiding force behind research and initiatives. We need to focus on menstruators who belong to marginalized groups, and ensure interventions acknowledge their lived experiences and address the unique barriers they face to menstrual health. True solutions do not leave anyone behind.
These voices are not hard to find. Menstruators from all walks of life have already begun to speak up about gaps in menstrual health and the elements needed for more inclusive approaches.
Blogger-activist, Crippledscholar writes about the lack of guidance and support for menstruators of differing physical and cognitive abilities. She shares that a lot of information is “about control and often menstrual cessation in order to make the menstruating person more convenient for a care giver. This sometimes goes so far as sterilization of the disabled person.”
Activists from LGBTQ+ communities have been voicing the difficulties that many sexual and gender minorities face while menstruating. Cass Bliss, creator of the photo campaign #bleedingwhiletrans, has “noticed a concerning lack of space and recognition for people who menstruate and don’t identify as women, whether that’s because they’re trans, non-binary, and/or intersex.” Hong Kong competitive bodybuilder and gender studies scholar, Law Siu-fung adds that trans men, “may experience pain or discomfort (with their periods), but [feel] like they cannot speak to doctors about it, in fear of being exposed as transgender.”
In the Photo: Creator of the photo campaign #bleedingwhiletrans Cass Bliss. Photo Credit: Cass Bliss/@tonithetampon Instagram feed.
Women have also been shedding light on the challenges posed by menstruating while experiencing homelessness. They often find menstrual health services (financially) inaccessible. Pads and tampons are not usually included in donations, leaving many women like Taylor D. to wonder, “[d]o I want to eat and be full, or how can I ration my menstrual products so they can last for the duration of my period?” There are often also restrictions on the opening hours of public bathrooms and showering facilities, meaning that menstruators without stable housing may have to go hours or days without safe spaces for changing or cleaning themselves. Having blood stains on what may be your only set of clothes can bring feelings of shame or draw ridicule from others. It can also prevent you from going to a job interview, which perpetuates cycles of poverty.
In displacement settings, menstruators face similar issues with resource scarcity. Impakter has touched on this issue, using the Ugandan refugee context to detail difficulties that menstruators in displacement settings face in finding adequate, safe spaces, information, support and products for their periods. Beyond that, disregard for people’s backgrounds in emergency relief efforts may perpetuate and amplify pre-existing forms of discrimination against marginalized groups. A report by the International Dalit Solidarity Network revealed that after an earthquake hit Nepal in April 2015, Dalit communities found they were being excluded from relief efforts. There was a “total neglect in taking care of the sanitation and hygiene needs (of Dalits),” including Dalit women’s needs for menstrual kits.
Women in detention face unique challenges as well. Prison reform activist, Chandra Bozelko shared her experiences in York prison. Menstrual product rations left inmates who had an average five-day cycle with roughly only one change per day. About 80 percent of inmates were unable to afford the $2.63 for a 24-pack of pads, as other needs like toothpaste could eat up about two days’ pay. Bozelko points out that this scarcity is not purely the result of financial restrictions, as “prisons control their wards by keeping sanitation out of reach… Asking for something you need crystallizes the power differential between inmates and guards.”
Bliss, Bozelko and other menstruators show that disregard for menstruators’ diverse identities in policies and initiatives can expose their wellbeing and rights to potential abuses. Their experiences show that menstrual stigma and illiteracy are not particular to a few select regions of the world, but are present globally at all levels of society. The geographic, thematic and human scope of gaps in menstrual health is what makes comprehensive integration of the issue into the human rights and sustainable development agendas so important.
According to activists like Bliss, progress on addressing these gaps begins when “people start thinking about menstruation as more of a multidimensional issue, and consider the different ways other marginalized identities intersect with the experience of getting your period.” Progress requires us to shape language, advertisement, information and design of menstrual products, services and facilities to be inclusive and to respect human rights. It demands that we think of menstruators’ experiences outside of WASH to consider how having a period affects their experiences in various public and private circles.
UN experts have at least begun to acknowledge these diverse experiences. The UN Special Rapporteur on the right to housing drew insight from menstruating women living in informal settlements to shed light on the need for living spaces that accommodate practical and cultural menstrual needs. In a report on deprivation of liberty, the UN Special Rapporteur on the right to health drew attention to the broader neglect of “women-specific health-care needs, such as those related to menstruation.”
In the Photo: Key speakers at the 63rd Commission on the Status of Women side event, “Empowering Women and Girls through Access to Public Services Including Water, Sanitation and Hygiene.” Photo Credit: (c) WSSCC/Joel Sheakoski
This year’s Commission on the Status of Women acknowledged that menstrual health demands attention beyond private spaces. Side events gave attendees insights on the lessons learned from global champions for improved access to public WASH and menstrual hygiene, and highlighted the growth and potential of cross-sectoral collaboration in advancing comprehensive menstrual health advocacy. The Executive Director of UNICEF also identified menstrual hygiene as one of five priority areas and urged governments to scale up efforts in addressing the issue.
The Agreed Conclusions reflect these pushes for change, recognizing the disproportionately negative effect that poor access to safe and affordable WASH in public spaces has on women and girls, especially those who menstruate. The Conclusions acknowledge the impact that poor or entirely absent menstrual hygiene facilities have on the ability of women and girls to learn. In line with leaving no menstruator behind, they also call on States to ensure access to menstrual hygiene management “in homes, schools, temporary shelters for refugees, migrants or people affected by natural disasters, humanitarian emergencies and armed conflicts and post-conflict situations and all other public and private spaces.”
Developments surrounding menstrual health at the UN last year provided invaluable headway in expanding thinking on the issue — and left us with unprecedented opportunities to mutually strengthen the menstrual health, human rights and sustainable development agendas. Now we should seize on those opportunities and ensure they are realized to the benefit of all people who menstruate.
In the Photo: UNFPA Regional Director Dr. Julitta Onabanjo pictured with little Lynnette Mtomba at the First East and Southern African Regional Symposium: Improving Menstrual Health Management for Adolescent Girls and Women on 29 May in Johannesburg. Photo Credit: Gulshan Khan