The Role of Menstrual Hygiene in Development

Introducing the Menstrual Cup

Introducing the Menstrual Cup to womens groups in Meru (Kenya) – photo: The Sustainable Sanitation Alliance (SuSanA) – license CC

The United Nations’ 2030 Agenda for for Sustainable Development is an action plan comprised of 17 Sustainable Development Goals (SDGs) that seeks to eradicate poverty by 2030.  Each July, The United Nations holds a High Level Political Forum (HLPF) on Sustainable Development, which acts a mechanism for monitoring the implementation of the 2030 Agenda and provides a platform for collaboration, discussion, and partnership.

The theme of 2018 HLPF was “Transformation Towards Sustainable and Resilient Societies,” focusing primarily on Sustainable Development Goal 6 (clean water and sanitation), Goal 7 (affordable and clean energy), Goal 11 (sustainable cities and communities),  Goal 12 (responsible consumption and production), and Goal 17 (partnerships for the goals).  Although the 2018 HLPF centered around issues related to energy, consumption/production, and WASH (water, sanitation, hygiene), it is imperative to recognize that the SDGs cannot be understood or addressed in isolation.  The goals are interrelated and interconnected, spanning across social, economic, and environmental domains.

The issue of menstrual hygiene management (MHM) illuminates the interlinkages within and across the SDGs.  Safe, effective, and dignified MHM is critical in order to create sustainable and resilient societies; however, the issue is rarely discussed at the local, national, and international levels.  In an effort to foster awareness and shed light upon the current status of MHM, the International Women’s Health Coalition (IWHC) and WaterAid (in cooperation with the Delegation of the European Union to the UN and the Permanent Mission of Nepal) hosted a side event entitled, “A Rights-based Approach to Menstrual Hygiene Management,” at the 2018 HLPF. The following are key statistics, themes, and recommendations that were discussed at the side-event:

What is Menstrual Hygiene Management (MHM)?

MHM can be defined as women and girls “using a clean menstrual management material to absorb or collect blood that can be changed in privacy, as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials” (UNICEF and WHO, 2014).  Although MHM primarily refers to the logistical components of managing menstruation, the issue poses numerous medical, educational, economical, and cultural implications.

Barriers related to menstrual hygiene management?

On any given day, over 800 million girls and women are menstruating (WASH United Girls, 2018).  Menstruation is a normal, healthy and inevitable part of life for the majority of girls and women, yet it is an issue that is neglected and stigmatized in even the wealthiest parts of the world.  Moreover, when looking through a lens of poverty and extreme cultural norms/traditions, MHM becomes exponentially more complicated.

  • Lack of access to water and basic sanitation facilities: 1 in 3 people worldwide do not have access to toilets (WHO & UNICEF, 2015), and 1 in 9 people lack access to safe water (, 2018). Lack of access to water and/or sanitation facilities not only leads women and girls to avoid engaging in healthy menstrual hygiene management practices, but causes them to walk miles to find a private (often unclean) area to change menstrual hygiene products, putting them at an increased risk for violence and disease, hindering their confidence and sense of belonging in the public sphere, and interfering with their activities of daily life.
  • Lack of access to safe, clean, menstrual hygiene products and methods of rinsing or disposing of products: The majority of girls and women living in poverty (including girls and women in the United States) do not have access to affordable menstrual hygiene products such as disposable pads/tampons, menstrual cups, and/or reusable pads. Often, their only option is to overuse a single disposable product, reuse pieces of cloth, and/or create products out of harmful materials such as leaves, grass, dung, and discarded fabrics.  For example, in Bangladesh factories, 60% of women use cloth from the factory floor as a menstrual hygiene product, leading to infection and disease; these women, on average, miss 6-8 days of work per month and are unpaid during this time (IWHC, 2018).
  • School-based barriers: Less than ⅓ of schools world-wide have toilets (WaterAid, 2018) causing girls to miss 20% of school (during menstruation) or drop out of school completely (UNICEF, 2018). In numerous countries around the world (including but not limited to Least Developed Countries or LDCs), menstruation is the catalyst for school dropout and subsequently, adulthood, which includes childhood marriage and early pregnancy. When a girl drops out school and is forced to start a family of her own, she is unable to receive the education or training necessary for a job in the public sphere; her options become limited and her dreams become void.   If all girls went to school and stayed in school, their lives would follow a dramatically different trajectory, and it is estimated that 30 trillion (1012) dollars would be added onto the Gross World Product (World Bank, 2018).
  • Extreme cultural beliefs: Discrimination, and harmful cultural norms further complicate menstruation, stripping women and girls of dignity and confidence.  In many countries, menstruation and reproductive health are taboo; these issues are seldom discussed about at school or at home, and menstruating individuals may be rendered dirty, impure, or vulnerable.  Girls often have no idea what is happening to them when they begin menstruating, causing them to see the biological process as something they should be ashamed about or forced to hide.  For instance, in rural areas of Colombia, a girl is secluded in a hut during her first year of menstruation because culture dictates that she is vulnerable to spirits during this time in her life.  Only mothers and grandmothers are allowed in the hut to teach the girl about “becoming a woman” and running a household. It is expected that when she leaves the hut, she will be married off (WaterAid Colombia, 2018).   Extreme traditional practices such as the aforementioned example are diminishing as modernity increases, but these norms and belief systems continue to impact the lives of thousands of girls on a daily basis, and influence the rate of change in the future.

Recommendations for Improving Menstrual Hygiene Management

  1. Engage men and boys: Educate men and boys on the biological aspects of menstruation, and help them understand how their ignorance and stereotypical assumptions directly harm not only women and girls, but their communities as a whole
  2. Increase access to safe and private wash facilities
  3. Educate students about menstrual hygiene management, the biological process of menstruation, and reproductive health at school
  4. Strengthen local capacities:  Increase access to and awareness of community resources, which can provide information and counseling to those in the community
  5. Make cultural change from the bottom-up:  Progress must begin at the local level, ensuring that conversations and changes are made in an empowering, culturally sensitive way and a manner that is practical for the population at hand
  6. Create conversation:  Create conversation at the local, national, and international level surrounding harmful cultural norms, stigma, and taboo surrounding menstruation
  7. Classify menstrual hygiene products as “essential items”: Allow food stamps and other government funded programs to cover the cost of menstrual hygiene products
  8. Collect disaggregated data

Menstrual hygiene management is a human rights issue, which has a direct and indirect influence upon individual’s self-concept, mental health, physical health, and economic well-being.  Success cannot be defined as the percent increase in women/girls access to sanitation facilities or menstrual hygiene products.  Success must also be defined as a community or country’s ability to openly discuss menstruation and include women and girls at discussions on the local, national, and international level in order to make lasting, practical, inclusive, and culturally sensitive change. Success must include dignity, respect, and less violence for women and girls.