Menstruation is a physiological phenomenon that women and girls experience every month. Yet, it remains taboo in many cultures worldwide. In most countries, it is a delicate and rather uncomfortable topic, which explains the silence that surrounds it. As a result, women and men lack awareness and knowledge when it comes to menstruation, which encourages detrimental menstrual hygiene management and practices. It also explains how deep-rooted beliefs can still exist in some countries, such as that women are impure when they menstruate and should therefore be denied basic human rights, which includes a lack of access to food, water or proper sanitation facilities. In addition, women and girls suffer from serious psychological side-effects: embarrassment, shame, and loss of dignity are undeniable consequences of stigmatizations surrounding menstruation. Therefore, considering menstrual hygiene management as an urgent issue is not only a matter of gender equality but also of human rights, education, health and other impacted fields.
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1. EDUCATION:

In Africa: 1 out of 10 adolescent girls miss school during menstruation and eventually drop out.

In South Asia: 1 out of 3 schoolgirls are not aware of menstruation prior to menarche and only the 2.5% of them know that menstrual blood comes from the uterus.

Schools cannot always offer the conditions necessary for students who are girls and women who are teachers to safely and hygienically manage their menstruation. These conditions include access to gender-separated bathrooms and access to sanitary menstrual hygiene methods and disposal. This can cause embarrassment for girls and women when they begin to menstruate, especially if the lack of these conditions means that their menstruation ends up leaking and embarrassing in front of classmates or colleagues. This can mean that girls begin to stay home when they are menstruating. The result is that girls fall behind with their education during their periods, and this may lead to absenteeism and eventually dropping out, because of the little support to dignified menstruation management. Instead, schools can become places where girls’ right to education are violated.

The school absenteeism due to the challenge of menstrual management is not exclusive to developing countries, but it also happens in developed countries such as the US, where families with low-income can’t afford proper sanitary products because those are not featured by most of the governments as essential products and are highly taxed and not included in the food-stamp human services.   


Menstrual Education

In India, around 200 million women have a poor understanding of menstrual hygiene practices.

In South Asia: 1 out of 3 schoolgirls are not aware of menstruation prior to menarche and only the 2.5% of them know that menstrual blood comes from the uterus.
— WHO-UNICEF Joint Monitoring Programme, ‘Consultation on Draft Long List of Goal, Target and Indicator Options for Future Global Monitoring of Water, Sanitation and Hygiene’, 2012.

When it comes to menstruation, stigmas and taboos in some regions and a limited access to information, impede women and girls to understand what is happening to their bodies. Deep-rooted traditions might have negative effects on how they perceive menstruation by making them believe that they are impure, contaminated or dirty when they menstruate.

Menstrual education is vital for a healthy menstruation management. Globally, many girls reach menarche without having any information about menstruation.

A menstrual education for women and girls includes learning about what is menstruation but also about the different ways of managing their period, what international organizations refer to as ‘Menstrual hygiene management’ (MHM). MHM is defined by WHO-UNICEF as Women and adolescent girls using a clean material to absorb or collect menstrual blood, and this material can be changed in privacy as often as necessary for the duration of menstruation. MHM also includes using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials.

Parents and teachers play a great role in providing girls with menstrual education. See the section on parents, teachers and practitioners to find out information on how to educate girls on menstruation. 

 

2. HEALTH

Approximately 70% of all reproductive diseases in India are caused by poor menstrual hygiene.

Menstruation is a natural biological process of a woman’s life. However, not all women are able to keep up healthy menstrual hygiene management. For example, in rural India, as in many other countries, women and girls use unsanitarymaterials suchas rags, husks, dried leaves, grass, ash, sand or newspapers. The access to affordable and hygienic products is very limited. Further, inadequate menstrual hygiene management can result in serious health problems and illness such as urinary or reproductive infections. Women’s psychological well being is also at stake as taboos surrounding menstruation encourages important stress levels, fear, embarrassment, and social exclusion.

Most women are not aware of the potential risks associated with menstrual products. Recently, Congresswoman Carolyn Maloney has decided to introduce the Robin Danielson Act to ensure women and girls’ health and safety around the world. Named after one victim of Toxic Shock Syndrome (TSS), a illness caused by high-absorbency tampon use, this legislation aims to inform women on the potential dangers menstrual hygiene products can represent

To know more about the risks of infection related to menstrual cycle read here, here, here and here 

 

3. ECONOMY

Poor access to toilets and clean water, or facilities for disposing menstrual waste at the workplace encourage women to miss work. The local economy is damaged in terms of efficacy and productivity, leading to an accumulated global loss. In Bangladesh, the estimated cost due to women and girls missing school and work is $21,750,000 (Her Project, Female Factory Workers’ Health Needs Assessment: Bangladesh, 2010).
Nevertheless, the situation is slowly improving thanks to the work of some social enterprises such as Azadi (India), AfriPads (Uganda), SHEnterprises (Rwanda), Zana Africa (Kenya) and Huru (Kenya) that contribute to sell, to distribute and to local produce affordable sanitary pads in the communities

See also: Menstrual Hygiene Day partners

Did You Know?

In some Asian countries, women are allowed to stay home from work when they menstruate. What we call the “menstrual leave” was first initiated in Japan after World War II, when sanitary facilities were largely missing and women were flooding into the workplace. In South Korea, women are allowed one day of menstrual leave per month and get additional pay if they decide to stay in the office. The menstrual leave legislation has also recently spread to Taiwan, where women can enjoy three days of menstrual leave a day in addition to their sick-leave. 


4. ENVIRONMENT

Approximately 73,000,000 women in the United States use tampons made of cotton and rayon and the average woman may use as many as 16,800 tampons in her lifetime.
— Petition for the Robin Danielson Act, Society for Menstrual Cycle Research

Menstrual hygiene management has an important environmental impact all over the world. On one side, the disposable products resulting from the use of tampons and pads require hundreds of years to biodegrade (US Environmental Protection Agency, Waste, Recycling & Disposal, 2008); and also, the incorrect disposal of used sanitary products can lead to clogged toilets that could eventually become a public health problem.

On the other side, the residues from the sanitary products contain harsh chemicals including pesticides and other environmental pollutants, like dioxin(US Food & Drug Administration, Menstrual Tampons & Pads, 2005). The contaminants eventually reach the groundwater and the landfills, causing pollution and health concerns. In particular, the use of such toxic elements such as dioxin seriously endangers women’s health. 

A solution would also be to encourage the use of environmentally‐friendly alternative like reusable, washable sanitary pads and menstrual cups, organic tampons and pads, although those should only be used when access to water and soap are available.

 

5. HUMAN RIGHTS

Human rights are rights inherent to all human beings, whatever our nationality, place of residence, sex, national or ethnic origin, color, religion, language, or any other status. We are all equally entitled to our human rights without discrimination. These rights are all interrelated, interdependent and indivisible. Taboos around menstruation as well as poor menstrual hygiene management and education can put many of these human rights at risk. These include right to physical security, children’s rights, right to dignity, right to education, right to health and right to work in favorable conditions. Read more.

 

People with Disabilities

About 15 percent of the global population lives with some form of disability, making it the largest and most disadvantaged minority in the world. (UNDESA, http://www.un.org/en/development/desa/news/social/opening-the-door-for-people-of-all-abilities.html)

People with disabilities may have diverse specificspecial needs regarding menstrual management, even though their menstrual cycles are just the same as any other population group. These special needs will depend on their particular disabilities.

For instance, girls with visual impairment often find it difficult to identify when their period has first come until they get more experience. Therefore, a thorough trainingis needed about how it can be felt or sensed that one is menstruating, as well as easy and consistent access to sanitary menstrual products. It is important to encourage girls with visual impairment to have the support from someone they trust, to check for any possible stain of blood in their clothes.

Additionally, people with speech and hearing impairment may need visual aids to learn about menstrual cycle and how to manage it healthily. The most essential key is to provide girls with a comfortable environment to communicate about their concerns regardless of the disability.

Women and girls with physical disabilities can need assistance with anything from having access to handicap-accessible toilets to having the physical support from another person. Nevertheless, their needs depend on the physical disability and the extent of the disability, but it is vital to always respect the person opinion on the need of support. Consequently, the toilets and other habilitations should be done regarding to each specific case or request.

Girls with intellectual disabilities may have more extensive needs in relation to their abilities; despite to achieve the highest level of independence and self-sufficiency in their lives should be always the target of the training. Individual orientated training programs are essential; communicating with simple words, using visual aids as support, and assisting in the practical process should be part of any training aimed to girls with intellectual disabilities.

http://www.cddh.monash.org/assets/menstrual-management-guide-staff.pdf

http://www.srcp.org/pdf_versions/managing_menstruation.pdf


Menstrual Hygiene Management in Disasters

Menstruation does not stop during crises or disasters, which means the women and girls’ need for access to menstrual hygiene management does not stop either. Not only do women face health repercussions and embarrassment if they are not able to properly manage their menstruation, but they also often put themselves at risk by waiting until dark and looking for privacy to change the sanitary method which puts them at risk for violence. The humanitarian response sector is slowly coming to terms with these risks for women in disaster and crisis zones and are working to incorporate MHM into their projects. Integrating MHM into these situations means making sure that private latrines or toilets, sanitary materials, and disposal methods are available.

Check out NFCC's work on disaster management

FAQ Links

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We recommend you use The Go Ask Alice! site, supported by a team of Columbia University health promotion specialists, health care providers, and other health professionals, along with a staff of information and research specialists and writers.