Menstruation and its multiple social, economic, environmental, health and technological dimensions surprisingly is starting to be discussed globally, in multiple arenas and under very different and sometimes opposing frameworks. But how is this issue positioned at this early stage of an emerging research agenda? Which actions have been implemented? This blog is a reflection on the importance of thinking outside the box.
The UN and INGOs: Menstruation in the development sector
Within the UN development agenda, menstrual hygiene management (not called menstruation) has come to be seen as an important human rights issue and part of women’s rights discourse (OHCHR 2014). While mainly addressed within the Water, Sanitation and Hygiene (WASH) sector, discussions around menstruation have mainly focused on the Global South and suggest an emphasis on medicalised understandings of menstruation, stressing the importance of hygiene.
UN agencies (UNICEF 2006, UNESCO 2014), various scholars (Sommer 2010, Wilson et al. 2012), INGOs (e.g. SIMAVI and Wash United), and civil society actors and groups (such as Rubycup, LenaCup and BeGirl that promote sustainable menstrual products) contend that there is a causal relation between menstruation and girls’ school dropout rates in countries in Sub-Saharan Africa and South Asia due to the lack of menstrual products and the lack of water and sanitation facilities (e.g. separate toilets for boys and girls, toilets with doors, or sanitary bins). However, to date little empirical research concretely substantiates the proposed link between the two factors, and criticisms to this assumption have begun to emerge (e.g. Crofts and Fisher 2012, Birdthistle et al. 2011).
Following the example of INGOs and other development-related organisations, some governments have started to place attention to the subject, leading to the approval of national policies and regulations emphasising the importance of providing products to manage menstruation. A clear example is Kenya, where the government since 2017 is legally obliged to provide free menstrual products to schoolgirls.
Burgeoning menstrual activism
Menstrual activism, a growing and very heterogeneous movement whose practices and narratives either conflates or fully opposes those in the development sector, is also helping to place menstruation on the public agenda. In general terms, the movement has focused on valuing women’s bodies, as well as questioning and fighting the stigma associated with menstruation.
But at the same time this movement speaks of the importance of body literacy: knowing about the functioning of our own bodies. Multiple examples of menstrual education initiatives can be found across the globe which mobilise alternative understandings to the biomedical discourses about menstruation. These initiatives are found on online platforms, in theatre plays, comic books, fanzines, YouTube videos, and also in ‘hands-on’ workshops on sexuality.
The movement has also focused on campaigning against menstrual shaming or against the imposition of taxes on menstrual products, and on the innovation and redesign of reusable menstrual products. As an evolving movement, there are also increasing efforts to achieve more structural changes at the level of influencing policy and legal changes needed to address the multiple issues of menstruation and to move beyond the provision of products as the one and only way in which to address a very complex subject.
The need for more empirical research
Popular statements that cannot be traced to any empirical study, such as that “African girls do not attend school during their menstruation”, have become a sort of universalised truth. Over the last three years, for my PhD research I have interviewed a number of different actors based on different continents and directly involved in topics of menstruation. Interestingly, the statement resonated with many of them and was considered an urgent matter needing attention despite the lack of empirical evidence.
In Argentina for example, some menstrual activists talk about this issue and even reflect on possible strategies to provide a solution. The statement is replicated even on websites of multinational corporations (e.g. Procter & Gamble 2007). More specifically, a Google search of this term yielded 807 unique results—a number that indicates how easily this broad yet scientifically unsubstantiated claim has traveled around the world, to the point of acquiring the status of a fact.
Menstruation: An ISS research topic
The ISS has been home to several studies on the topic of menstruation. Over the past year, both Kenyan and Colombian Masters students have written thought-provoking research papers on the topic. The first paper focused on menstrual experiences of adolescent girls in Kibera, the biggest slum in Kenya, and the second on menstrual cultures in Barcelona.
As part of the 2016 ISS Development Research Seminar (DRS) series, the ISS hosted a session titled ‘Technologies for Civic Innovation’, where menstrual activists from Argentina and a representative of Dutch INGO SIMAVI were invited to engage in dialogue. Since 2015, for my PhD research I have been reflecting on the aforementioned global dynamics and their relations with menstrual activism in Argentina, where the menstrual movement has gained a lot of strength in the last decade.
Some time ago I read an article by Ole Redkal, in which he speaks about the discussion around the myth of the spinach as a good source of iron. Redkal (2014) describes ‘the decimal point mistake’ discussion and how it misled millions in and outside academia into believing that there is no high composition of iron in this edible plant. He questions how this statement was born in academia and how it became an urban legend.
What roles do scholars and development agencies play in the ‘making of realities’? The call to make menstruation a topic on the public agenda is out, which signifies an advance toward change, but also implies big challenges. The ways in which this call is put to action invites us to think out of the box, questioning our own assumptions and debating and advancing research in new directions.
 In using this statement, no reference is ever made to a specific geographical area inside the African continent, showing the lack of sensitivity to how the understanding and management of menstruation varies depending on socio-cultural context, class, age or ethnicity.
 Based on the ‘missing school’ argument, Procter & Gamble has developed the project ‘Protecting Futures’ which consists of providing access to menstrual products and building sanitation facilities.
Birdthistle, I., K. Dickson, M. Freeman and L. Javidi (2011) ‘What impact does the provision of separate toilets for girls at schools have on their primary and secondary school enrolment, attendance and completion?: A systematic review of the evidence’. London: EPPI-Centre, Social Science Research Unit, Institute of Education.
Crofts, T. and J. Fisher (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads,’ Journal of Water Sanitation and Hygiene for Development, 2(1), 50-58.
OHCHR (2014) ‘Every woman’s right to water, sanitation and hygiene.’ Retrieved from United Nations Human Rights Office of the High Comissioner: http://www.ohchr.org/EN/NewsEvents/Pages/Everywomansrighttowatersanitationandhygiene.aspx
Procter & Gamble (2007) ‘Tampax and Always Launch Protecting Futures Program Dedicated to Helping African Girls Stay in School.’ Retrieved from: http://news.pg.com/press-release/pg-corporate-announcements/tampax-and-always-launch-protecting-futures-program-dedicat
Rekdal, O. B. (2014) ‘Academic urban legends,’ Social Studies of Science, 44(4), 638-654.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania,’ Journal of Adolescence, 33(4), 521-529.
UNESCO (2014) ‘Puberty Education & Menstrual Hygiene Management. Good Policy and Practice in Health Education.’
UNICEF. (2006) ‘Progress for Children: A Report Card on Water and Sanitation.’
Wilson, E., J. Reeve, A. Pitt, B. Sully and S. Julious (2012) ‘INSPIRES: Investigating a reusable sanitary pad intervention in a rural educational setting.’ School of Health and Related Research (ScHARR). University of Sheffield.