• Opinion
  • June 2, 2019
  • 10 minutes
  • 0

The taboo on menstruation is keeping women’s health in the dark

Opinion: Menstruation is not new — we just haven't talked about it

This article was written by Danielle Keiser, Nicole Townsend and Mariana de la Roche from the Menstrual Health Hub (MH Hub), a female health social impact business. For more like this, see our public health newsfeed.

Ready to start the conversation about menstruation?

Even though menstruation is a natural and normal process in every girl or woman’s life, there are still taboos, beliefs, creeds and social norms related to monthly bleeding that negatively affect the lives of the female population.

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Education, infrastructure, sanitation and hygiene, education (at a school or community level), distribution, tolerance and understanding, employment or taxation, are all areas in which policies have been developed to address or improve menstrual health. While this is a seemingly long list, policies that address menstrual health have only been around for the last decade or so, with many just forming in the last few years.

Menstruation and the microcosm of equality

If menstruation has been around as long as humans have, why have we waited this long to address it as a policy topic? Obvious reasons have to do with the stigma and taboo surrounding menstruation as religious beliefs, bogus myths and deeply ingrained cultural practices still hold a very tight grasp on people’s ability to accept menstruation as a vital sign of female health.

And despite the rising tide of menstrual activism, there still is an overall culture of silence around the topic of menstruation, which according to the World Bank, “limits the ability of women and girls to fully and equally participate in society, undermining their overall social status and self-esteem”.

When we hold the menstrual experience up to the light, we can see a microcosm of the fight towards gender equality: we see a lack of quality, accurate education taught by informed professionals which leads to a lack of understanding and social empathy what it means to menstruate.

Furthermore, good education, knowledge and resources must be contextualised to the culture in which it is being taught. On the political level, we see a lack of clear leadership, political will and inclusion in national and international agendas, as well as a poor show of collaboration across the private and public sectors.

Where we are today

Any high-level policies related to menstruation began with the efforts of technical advisors, researchers and development practitioners working in water, sanitation and hygiene (WASH). These public servants deliver, for example,”WASH in schools” education in which schools were being used as a conduit through which they integrated WASH infrastructure and hygiene education.

This is where the technical term “Menstrual Hygiene Management” (MHM) was born. MHM is defined as “Women and adolescent girls being able to use a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required. In addition to having access to safe and convenient facilities to dispose of used menstrual management materials” (sanitary pads, tampons, among others).

MHM policies have been led by various different ministries and have taken root in largely low-middle income country (LMIC) regions such as South Asia (India, Nepal, Bangladesh), sub-Saharan Africa (Kenya, Ethiopia, Lesotho, Uganda, Zambia, Senegal, Botswana), as well as the Pacific Islands and Oceania (Solomon Islands, Fiji and Papua New Guinea).

These policies are led by different ministries in each country and have been informed by the human right to clean water and sanitation and exist to ensure that there is adequate infrastructure in place to enable a girl or woman to manage her period. A few highlights from successful MHM policies include:

  1. Kenya’s Ministry of Health-led multi-stakeholder Menstrual Hygiene Management Strategy
  2. The Philippines’ Ministry of Education-led Guidelines for the Implementation of the Water, Sanitation and Hygiene in Schools (WinS), in which effective MHM shall be ensured in all elementary and secondary schools’, and
  3. India’s Ministry of Drinking Water and Sanitation-led MHM National Guidelines.

Substandard for sub-Sahara

In addition to having period-friendly toilets, the ability to manage optimal individual menstrual hygiene reveals important role that product standards play in protecting consumers and ensuring that menstrual products are safe to use.

Earlier this year, hundreds of Kenyan women took to Twitter with #MyAlwaysExperience when they realized that the Always pads sold in Kenya were of much lower quality than those the brand sells in Western countries. Many women complained that the pads in Kenya caused rashes, burns and irritation because they were made with substandard materials.

The company has claimed no wrong-doing in this case claiming that that “all their products go through very rigorous regulatory tests and are also tested with real women to ensure that they are safe for use.”

Without access to menstrual products, many women and girls are forced to be creative and use whatever materials they can get their hands on.

There’s very little known (or available online) about national policies for menstrual product distribution.

The two most relevant ones are the schemes from Kenya and India. Approved in August 2018, Kenya passed “The Basic Education Amendment Act amends Basic Education Act”, placing the responsibility of providing “free, sufficient and quality sanitary towels to every girl child registered and enrolled in a public basic education institution and has reached puberty” on the government. 

Axing the women’s tax

Access is also a matter of affordability.

The price of menstrual products varies greatly from one country to another, with a box of tampons costing as much as $8 in the US and as little as $2.2 in Germany.

In addition to unusually high price points (compared to toilet paper and other necessities), menstrual products are also taxed, many times as a “luxury product” as high as 20%. Luckily, there have been noticeable changes in many governments’ response to the “Tampon Tax”.

Starting with Kenya back in 2004, Canada, France, Australia, Tanzania, Colombia and India have all followed suit and “axed the tax”.

In the United States, most states tax menstrual products at 7.25% – 9.75%, however in the last three years over 10 states have slashed the tax, citing that this is an issue of menstrual equity, or about the right to equal access to hygiene products since they are a necessity, not a luxury.

Slashing or eliminating the tax on these products is a good start towards the path to gender equality and inclusion, and acceptance of menstrual health as a key topic/agenda. However, as queen of menstrual equity Jennifer Weiss-Wolf notes, “a truly comprehensive menstrual equity agenda would eventually drive or help reframe policies that foster full participation and engagement in civic society— accepting and even elevating the reality of how menstruating bodies function.”

Menstrual policies set a foundation for creating a more inclusive and equitable society by aiming to improve hygienic, economic, educational, professional, and social conditions for girls and women. They also signal the important role that menstrual health/ hygiene plays across the lifecycle of women, not just as girls or young ladies. — Danielle Keiser, Nicole Townsend and Mariana de la Roche

For more, check out the array of menstrual health policies on the Menstrual Health Hub’s (MH Hub) Policy Hive. 

(Photo credit: Death to the stock photo)


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