‘But many things are needed, of course. We need to talk about the qualifying period for sick pay in relation to absences caused by menstruation, for example. We need more research about menstruation-related conditions and more aid money could be allocated to menstruation-related efforts.’
Chris Bobel is a professor of women’s, gender, and sexuality studies at the University of Massachusetts in Boston. She is also the president of the Society for Menstrual Cycle Research (SMCR), a transnational organisation that promotes research about menstruation. When I meet her in Boston in June 2015, at the menstruation conference that SMCR organises every other year, she is on the go, with glowing cheeks, ruffled hair, and a happy smile. Almost exactly one year later, she writes in an email about the dramatic increase in media attention for the issue of menstruation in the US during the last few years. She calls the extensive feature on menstruation in the magazine Newsweek in April 2016 ‘HISTORIC!’ A vicious circle of silence may have been broken, she thinks: ‘I think the marginalization of the research is the consequence of the devious brilliance of the menstrual stigma. Ignorance breeds shame and shame breeds ignorance.’
In the book New Blood: Third-Wave Feminism and the Politics of Menstruation (2010), she examines the place of menstruation in the feminist movement in the US today. She divides the feminists interested in menstruation into two categories. Those she calls ‘feminist-spiritualists’ embrace menstruation as a source of female pride. The ‘radical feminists’ separate menstruation from the gendered body and talk about menstruators, not women. She also writes via email: ‘Feminists of the previous generation were leery of drawing attention to menstruation – for fear that it would be used against women. There were feminists who addressed menstruation, but they were largely marginal. This does seem to be shifting now.’ A little later, she continues: ‘I just hope that we don’t cede this movement to the product makers.’
Chris Bobel expresses the same concern as so many others. The menstrual revolution – as she writes – becomes meaningless if it comes to revolve around products when we need to challenge the shame first.
* * *
The activists strike from below and those who work at the level of the UN create frameworks. The implementation falls to the national governments.
Archana Patkar takes a cough drop that smells of eucalyptus. She is wearing two bracelets with 22 yellow beads and 6 red to symbolise the menstrual cycle. It is time to let go a little of the global and focus on the local, she says, and with the local she means the national.
‘Menstrual management has to be included in national strategies, and it should be explicit – no circumlocutions. Money must be set aside.’
She wants to see less talk and more action. Archana Patkar has high hopes for national menstruation policies in Senegal, Cameroon, Niger, Tanzania, Kenya, Cambodia, Nepal, Bangladesh, Sri Lanka, and Bhutan – all of the countries where her organisation WSSCC works with menstruation.
She lists the three points that they cover in their menstrual education: breaking the silence, safe menstrual management, and strategies for waste disposal. She adds that, when time and money are lacking, the first is far more important than the other two. Breaking the silence.
‘There is so much ignorance and so many misconceptions. And there lies the root of the evil, of fear and trauma.’
It is up to the state to make sure that everyone has access to information, just like it is the state’s responsibility to provide conditions for safe and comfortable menstrual protection, the possibility to change and wash both at home and in schools or at jobs. It is the state that must put mechanisms for waste disposal in place.
‘But we need to remember that human rights are not just about the relationship between the state and the individual. The state also has to make sure that other actors don’t stand in the way of the individual’s rights, like employers and advertisers.’
She also mentions prisons, which are not always run by the state. In many cases, it has turned out to be difficult for inmates to access menstrual protection. Other people in vulnerable situations are those fleeing war or affected by natural disasters. There is no guarantee that emergency kits include menstrual protection or that menstruators have access to the private spaces they need when they live in tents with makeshift toilets and showers.
National policy documents that include clauses about menstruation exist, according to Archana Patkar, only in India. In their national guidelines for sanitation and hygiene, menstruation is mentioned four times: in relation to waste disposal, knowledge, and access to water. Archana Patkar, who grew up in Mumbai, became involved as an advisor when menstruation was to be included.
Archana Patkar describes convincing the Indian decision makers as a challenge. She gets up to find a booklet – the manual that WSSCC uses for its menstrual education in India – and shows the Indian government’s logo. The four lions, originally a sculpture more than 2,000 years old, have been the official emblem of India since the 1950s. By adding the emblem, they gave menstrual education a new distinction in the Indian states. With their workshops, WSSCC built knowledge and interest at state level. In the next step, regional politicians made demands about action at the national level, which eventually led to the inclusion of menstruation among the guidelines.
The Indian government also distributes pads, but it is an activity marked by corruption. The distribution is sporadic; it lacks structure. Both money and pads disappear on the way to the students who are the target group. And all this focus on pads – she repeats over and over again – scares Archana Patkar.
‘People get all excited about the money they can make and it risks overshadowing everything else. I also think that it’s an insult to women and girls, as if they can’t decide what menstrual protection they want for themselves – if they just get the right information.’
Before we part company, I ask about the criticism of ‘Menstrual Hygiene Management’ – the term she took part in launching – that has been raised on several occasions, including at the conference on women’s health here in Copenhagen. The criticism arises because the word ‘hygiene’ signals dirt – and therefore also shame – which is the underlying problem.
‘I’ve thought about it. If it is a problem, like you say, then I’m completely open to dropping it. Maybe ‘menstrual health’ is better? But in that case, we first have to look at what our colleagues in Asia and Africa are saying. I know that it’s an effective term in many countries, partly because it redirects the focus away from puberty and sexuality. It’s “harmless” and therefore acceptable.’
* * *
India acted first. Kenya has been working on a menstrual policy for several years and should be hard on its heels. There are good reasons to look more closely at menstruation and human rights in Sweden too. The shortcomings are obvious: sparse information in schools; high VAT rates on menstrual products; low priority on research; ignorance about appropriate care for menstruation-related problems like menstrual pains, endometriosis, PMS, and PMDD. The persistent shame.
There are also groups that are more vulnerable than others: those without housing, water, and toilets. In an interview with the local Swedish newspaper Skånska Dagbladet, 37-year-old Ann who lives on the streets says in passing: ‘just imagine getting your period and not being able to wash yourself.’ In April 2016, a study was published about discrimination against Roma people who reside in Sweden temporarily – on the basis of the right to water and sanitation. The conclusion was that the Swedish government, by denying access to toilets and water for Roma living in informal settlements, is violating human rights.
‘There are no efforts whatsoever to give that group access to water and toilets,’ says Martha F. Davis, who wrote the study together with Natasha Ryan.
Even though the two researchers themselves only mention menstruation at one point in the study, she notes that it is a factor that increases vulnerability.
‘Those who menstruate may have greater need for a toilet
also at night and may have to walk far. And they have to throw away their menstrual protection somewhere. The likelihood that you don’t change menstrual protection often enough increases, and that leads to health hazards.’
Martha F. Davis has for several years devoted herself to the right to water and sanitation, in Sweden for the past year and before that in the US.
‘The menstrual perspective has been ignored, but that is changing. As with so many other women’s issues, I think it has been a blind spot in the research.’
Menstruation and human rights span the remits of many government ministers, but what unites most – though not all – of those who menstruate is their gender. I ask the Swedish Minister for Gender Equality, Åsa Regnér, for an interview, but she does not have time.
Do we need a menstrual policy in Sweden too? A national campaign to break the silence and stigma? I wish they would talk about it: the minister for the environment about menstrual protection; the minister for finance about VAT rates; the minister for education about menstrual information; the minister for research about endometriosis, menstrual pains, PMS, and PMDD. The minister for gender equality about stigma and shame.
* * *
The silence is a disaster for those of us who menstruate. It makes us powerless. As long as we do not talk about menstruation, the problems and failings are not seen and we cannot demand change. Mute, we continue to wonder if it has to be like this. Should it bleed this much? Should it hurt this much? Should I be this sad? Should it be so expensive? Should we tolerate being ridiculed and harassed because we bleed? That menstrual blood which is the precondition for the celebrated pregnancies and babies.
The revolution has to happen everywhere. Silence and shame are given another dimension when combined with poverty. But for us all, the silence means that we are denied our rights. Our bodies collide with a society that does not acknowledge the way they function and therefore also that they exist.
REFERENCES
Some 40 interviews carried out in the US, Uganda, Kenya, Bangladesh, India, and Sweden are important sources, as well as information from presentations during the 2015 Menstrual Health and Reproductive Justice Conference in Boston, 4–6 June 2015, and Women Deliver 4th Global Conference in Copenhagen, 16–19 May 2016. What follows below is a selection of other sources.
STAINS
SCIENTIFIC ARTICLES
Getachew, G. et al. 2016. ‘Menstrual hygienic practice and associated factors among adolescent high school girls’, Journal of Bio Innovation, 5(1), pp. 1–15.
McMahon, Shannon A. et al. 2011. ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights, 11(7). Available at: https://bmcinthealthhumrights.biomedcentral.com/track/pdf/10.1186/1472-698X-11-7?site=bmcinthealthhumrights.biomedcentral.com (Accessed: 24 June 2017).
Montgomery, Paul et al. 2012. ‘Sanitary pad interventions for girls’ education in Ghana: a pilot study’, PLoS One, 7(10). Available at: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0048274&type=printable (Accessed: 24 June 2017).
Sommer, Marni. 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), pp. 521–529.
Sommer, Marni et al. 2015. ‘Comfortably, safely, and without shame: defining menstrual hygiene management as a public health issue’, American Journal of Public Health, 105(7), pp. 1302–1311.
Winkler, Inga T. and Virgina Roaf. 2014. ‘Bringing the dirty bloody linen out of the closet: menstrual hygiene as a priority for achieving gender equality’, Cardozo Journal of Law and Gender, 21(1). Available at: http://wsscc.org/wp-content/uploads/2016/06/Bringing-the-Dirty-Bloody-Linen-Out-of-the-Closet-Inga-T.-Winkler-Virginia-Roaf.pdf (Accessed: 24 June 2017).
STUDIES/REPORTS
Dasra. No date. Improving menstrual health and hygiene in India. Available at: www.dasra.org/cause/improving-menstrual-health-and-hygiene (Accessed: 24 June 2017).
Fehr, Alexandra E. 2010. Stress, menstruation and school attendance: effects of water access among adolescent girls in South Gondar, Ethiopia. Summary report for CARE Ethiopia. Emory University. Available at: http://water.care2share.wikispaces.net/file/view/CARE_A.Fehr_REPORT.pdf (Accessed: 24 June 2017).
Mutunda, Anne. 2013. Factors impacting on the menstrual hygiene among school going adolescent girls in Mongu District, Zambia. Unpublished MA thesis. University of the Western Cape. Available at: http://akros.com/downloads/papers/mutunda-study.pdf (Accessed: 24 June 2017).
Sommer, Marni et al. 2013. WASH in schools empower girls’ education: proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2012. UNICEF and Columbia University. Available at: www.unicef.org/wash/schools/files/WASH_in_Schools_Empowers_Girls_Education_Proceedings_of_Virtual_MHM_conference.pdf (Accessed: 24 June 2017).
The Netherlands Development Organization (SNV)/IRC International Water and Sanitation Centre. 2013. Study on menstrual management in Uganda. Available at: http://menstrualhygieneday.org/wp-content/uploads/2016/12/Menstrual_Management_-study-report_Uganda.pdf (Accessed: 24 June 2017).
UNICEF. 2015. Advancing WASH in schools monitoring. Available at: www.unicef.org/wash/schools/files/Advancing_WASH_in_Schools_Monitoring(1).pdf (Accessed: 24 June 2017).
World Health Organization and UNICEF. 2013. Progress on sanitation and drinking-water: 2013 update. Available at: http://apps.who.int/iris/bitstream/10665/81245/1/9789241505390_eng.pdf (Accessed: 24 June 2017).
OTHER
Malala Fund. No date. What works in girls’ education. Available at: www.malala.org/brookings-report (Accessed: 21 March 2016).
Ministry of Drinking Water and Sanitation India. 2015. Menstrual hygiene management: national guidelines. Available at: www.mdws.gov.in/sites/default/files/Menstrual%20Hygiene%20Management%20-%20Guidelines.pdf (Accessed: 24 June 2017).
UN Women. No date. Progress towards meeting the MDGs for women and girls. Available at: www.unwomen.org/en/news/in-focus/mdg-momentum (Accessed: 21 March 2016).
WaterAid. No date. Where we work: Uganda. Available at: www.wateraid.org/where-we-work/page/uganda (Accessed: 2 May 2016).
World Bank. 2016. Poverty overview. Available at: www.worldbank.org/en/topic/poverty/overview (Accessed: 14 March 2016).
——. No date. Girls’ education. Available at: www.worldbank.org/en/topic/girlseducation (Accessed: 14 March 2016).
World Health Organization. 2014. Adolescent pregnancy. Available at: www.who.int/mediacentre/factsheets/fs364/en/ (Accessed: 21 March 2016).
OUR SHAME
SCIENTIFIC ARTICLES
Bhartiya, Aru. 2013. ‘Menstruation, religion and society’, International Journal of Social Science and Humanity, 3(6), pp. 523–527.
Mason, Linda et al. 2013. ‘“We keep it a secret so no one should know”: a qualitative study to explore young schoolgirls’ attitudes and experiences with menstruation in rural western Kenya’, PLoS One, 8(11). Available at: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0079132&type=printable (Accessed: 24 June 2017).
Uskul, Ayese K. 2004. ‘Women’s menarche stories from a multicultural sample’, Social Science and Medicine, 59(4), pp. 667–679.
BOOKS
Bobel, Chris. 2010. New blood: third-wave feminism and the politics of menstruation. New Brunswick, NJ: Rutgers University Press.
de Beauvoir, Simone. 2011 [1949]. The second sex. Translated by Constance Borde and Sheila Malovany-Chevallier. London: Vintage.
de Walle, Etienne and Elisha P. Renne, eds. 2001. Regulating menstruation: beliefs, practices, interpretations. Chicago, IL: The University of Chicago Press.
Delaney, Janice, Mary Jane Lupton and Emily Toth. 1988. The curse: a cultural history of menstruation. Champaign, IL: University of Illinois Press.
Johannisson, Karin. 2013. Den mörka kontinenten: kvinnan, medicinen och
fin-de siècle (‘The dark continent: women, medicine and fin-de-siècle’). Stockholm, Sweden: Norstedts.
Knight, Chris. 1991. Blood relations: menstruation and the origins of culture. New Haven, CT: Yale University Press.
Laws, Sophie. 1990. Issues of blood: the politics of menstruation. London: Macmillan.
Malmberg, Denise. 1991. Skammens röda blomma: Menstruationen och den menstruerande kvinnan i svensk tradition (‘The red flower of shame: menstruation and the menstruating woman in Swedish tradition’). Uppsala, Sweden: Uppsala University.
Olausson, Sara, ed. 2014. Kvinnor ritar bara serier om mens (‘Women only draw comics about menstruation’). Stockholm, Sweden: Kartago Förlag.
Pliny the Elder. 1942. Book 7, ch. 15, Naturalis Historia, vol. II. Translated by H. Rackham. Loeb classical library series. Cambridge, MA: Harvard University Press.
STUDIES/REPORTS
WSSCC and UN Women. 2014. Menstrual hygiene management: behaviour and practices in the Louga region, Senegal. Available at: http://wsscc.org/wp-content/uploads/2016/04/Study-–-Menstrual-Hygiene-Management-Behaviour-and-Practices-in-the-Louga-Region-Senegal-WSSCC-UN-Women.pdf (Accessed: 24 June 2017).
AUDIOVISUAL
Khan, Zayera. 2014a. Menstruation with/out gender. Available at: www.youtube.com/watch?v=eZCb79S7Z-I (Accessed: 24 June 2017).
——. 2014b. We who bleed. Available at: www.youtube.com/watch?v=Xms1pZdXShc&t=16s (Accessed: 24 June 2017).
WaterAid. 2015. If men had periods. Available at: www.youtube.com/watch?v=zOMPS2zkE1M&list=PLc-oawSTlDS2Czt08quehOIO-DGJ5IKoh (Accessed: 13 April 2016).
OTHER
Akello, Charlotte. 2015. Let’s join the talk. Available at: https://letstalkmenstruation.wordpress.com (Accessed: 25 September 2016).
Always. No date. Always.com. Available at: https://always.com (Accessed: 6 April 2016).
——. No date. Always’ Facebook page. Available at: www.facebook.com/always (Accessed: 6 April 2016).
Leviticus 15:19–25, Holy Bible: New International Version.
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