Settled Issues in MHM

(…more accurately, mostly settled-“ish” matters about MHM, at least at first glance.)

Written by: Deborah Jordan Brooks, Ph.D.

QUESTION:  Is it important to address issues pertaining to menstrual hygiene for low-income menstruators?

ANSWER:  Among those who work on these issues, the consensus is a clear (and fairly obvious) “yes.”  To be fair, there is some debate within the field about whether the bigger problem is the need for more menstrual education, diminishing menstrual stigma, or increasing access to commercial menstrual products.  However, there is little question among those working most closely on the issue that MHM needs to be addressed.

This influential report written by Siri Tellier and Maria Hyttel for the UNFPA ESARO Conference in Johannesburg in May 2018 provides an assessment on the state of menstrual hygiene needs, progress, and research in Africa, and in much of the rest of the world.  The importance of the issue has also been reinforced in the popular media, as well (see, for example, this article in The Nation, this one in Newsweek, this summary and report by WaterAid, and this post in Buzzfeed by Elisabeth Epstein called “28 Reasons Why Menstrual Hygiene Matters.)

Some point to still-inclusive findings regarding the relationship between access to menstrual products and school absences as showing this is not a problem (see my response here).  More commonly, however, people agree that more attention to the issue would be useful.  The real question tends to be about where MHM ranks on the international aid and donor agenda, as compared to other pressing issues related to poverty,  gender, the environment, human rights abuses, humanitarian aid, and so on. When the question is where money and infrastructure should go to most improve people’s well-being (however defined), there are legitimate debates to be had.

No matter what, it is clear that menstrual hygiene issues are picking up steam on the global stage.  There has been an influx of newer menstrual hygiene entrepreneurs and not-for-profit groups rising to address the issue in just the last few years, along with an increased stream of traditional and social media attention. Moreover, major conferences held for the first time in 2018 (i.e., the UNFPA-ESARO conference in Johannesburg in May 2018, and the African Coalition for Menstrual Hygiene Management – ACMHM conference held in Johannesburg in December 2018) have been bringing those working on MHM in Africa and around the globe together in one place to work together collaboratively on increasing the global profile and progress of MHM.  More generally, the #MeToo movement, women’s marches around the world, and other activism around female empowerment have been riveting global attention to issues of concern to women that have long been ignored by mostly-male power structures.

But in a world where many pressing issues call for attention and ever-more donor financing, keeping global focus on MHM issues will require continued diligence, creativity, public relations efforts, and hard work by those who want to see continued gains in this area.

QUESTION:  Are there roles for boys and men in menstrual education?

ANSWER:  Yes, absolutely.  When this issue gets mentioned in any menstrual hygiene conference, enthusiastic rounds of applause and ample nodding ensue.  Those in the field recognize that involving boys in menstrual education from young ages can help to reduce stigma that girls can feel about periods in multiple domains (at school, at home, in sexual relationships, etc.)  There is also widespread recognition that involving men and fathers in educational programs can also potentially have other positive effects for girls at home (i.e., more willingness to spend limited family disposable money on effective menstrual supplies and pain management, greater ability for girls to dry washable pads outside in bacteria-killing sunlight, etc.)

Any disagreement tends to revolve around to how to allocate resources.  When resources are limited — and resources in this domain are nearly always limited — organizations do not always “walk the talk” regarding including boys and men because it can be costly.  In practice, at least some portion of educational programming needs to be implemented separately so that girls and boys can feel free to openly ask questions about puberty.  Moreover, many learning materials currently in circulation would need to be written differently for a mixed-gender readership. It is not usually costless to expand the reach beyond girls.

Should an organization include boys and/or parents, but be able to reach fewer young girls as a result?  That seems to be the primary challenge faced by those who have to make tough resource allocation decisions in the field, and there is not a consensus approach to such trade-offs at this point in time.  As a result, many organizations that fundamentally agree that boys need to be part of the dialogue still have educational programs focused solely on girls.

QUESTION:  Are all menstruators women?

ANSWER:  No.  The fact that people who do not identify as women menstruate is a fact, rather than a debatable point, at least among those who acknowledge trans and non-binary gender identities.

Partly in response to powerful visual storytelling by Cass Clemmer and many others — in addition to some innovative and powerful menstrual product marketing to the trans male community by Thinx — there seems to be increasing awareness that some non-binary individuals and trans men menstruate, and that there can be negative outcomes associated with lack of inclusivity.

More inclusive terms like “menstruators” in place of terms like “women who menstruate” are starting to take hold among those who work in the field. 

However, it is still also the case that relatively few organizations use gender-neutral terms exclusively when they discuss menstruation.  Beyond habit, not all in the field would necessarily agree that the language around menstruation should always be gender neutral. 

For one thing, a good deal of fundraising on this topic focuses on menstruation as an issue of female empowerment. Losing that as a framing device and the ability to read out to female donors to support this as a “women’s issue” could potentially present funding challenges to organizations working in that domain.

Additionally, some feel that a primary reason that menstruation involves stigma and taboos is precisely because it is mostly women who menstruate (i.e., the famous Gloria Steinem quote from 1978 Ms. Magazine article, “If Men Could Menstruate“…then “menstruation would become an enviable, boast-worthy, masculine event.”)  From that perspective, menstrual stigma may be worthy of activism as a “women’s issue” — and menstruation as an opportunity for celebrating and increasing “girl power” — even though factually, everyone should be able to agree at this point that menstruation is not exclusively a woman’s issue.

But some would respond that those goals are not worth verbally excluding those who tend to already be marginalized across so many other domains.

Will it be possible to be linguistically inclusive towards every person who menstruates, while continuing to frame menstruation as women’s rights issue? As both LGBTQIA and women’s rights and activism continue to progress globally, continued debate can be expected on this topic.

QUESTION:  Is it a mistake to only focus on menstruation in young girls, rather than on bleeding throughout the lifespan?

ANSWER:  Perhaps…but there also might be some practical challenges associated with placing more emphasis elsewhere.

Menstruation is not the only process by which women experience vaginal bleeding that requires absorbent solutions and education (i.e., post-partum bleeding, menopause, some types of illness, etc.), and that often comes as a surprise to even women who were educated about menstruation.

Professor Marni Sommer from Columbia University has been a leader on emphasizing bleeding throughout the lifespan. She recently delivered a powerful presentation about it at the May 2018 Johannesburg conference (for a related paper on the issue by her and many other top scholars in the field, go here), garnering a positive response from the audience of global MHM experts gathered there.

One challenge of framing menstruation in terms of bleeding beyond menstruation may involve fundraising.  Menstruation seems like it may be an easier “sell” as a focus of work to donors, especially when combined with the yet-to-be-definitely-proven claim that donated menstrual supplies keep girls in school. Among other differences, menstruation is directly relatable to nearly half of the adult population, while other types of bleeding tend to be less frequent and/or may be experienced later in life.

While there is clearly a need for more education around these issues, product development can also help to move progress forward. The introduction of more heavy-duty pads can provide important options to women, especially when programs to improve economic access to pads focus on adult women, rather than just school girls.

At the same time, entrepreneurs are also examining opportunities to profit by expanding beyond menstrual pads into those designed for incontinence management, another issue for which some women – and some low-income women, in particular – could also benefit from product innovation and accessibility.  Pads do tend to require design modification to be used for incontinence (i.e., greater absorbancy, “splash guards” around the edges, etc.) However, some sanitary pad makers have found that it can be a logical extension of their work and missions to help increase personal care options for women, while also increasing their own profitability.