Despite calls for its inclusion, the 17 Sustainable Development Goals (SDGs) do not contain specific mention of menstruation, attitudes towards it, or the need for safe and affordable access to sanitary products across the world. Menstrual Hygiene Day is on May 28th, and a pertinent opportunity to remember that women and girls, particularly in low- and middle-income countries, are still widely affected by silence and stigma around the topic of menstruation. With this omission in the SDGs, the silence is only continuing. It signals that menstrual hygiene is not considered a development or policy issue; a dangerous and damaging assumption.
Interviews, group discussions and participant diaries from Oyugis, Kenya (research undertaken by the University of Edinburgh) can help us better understand the implications for the young women managing menstruation without access to sanitary pads in a hostile environment– and what policymakers can do to address this.
Local, national and international effects
The stigma around menstruation impacts women at local, national and international levels, with developmental repercussions to education, health and the economy. While menstrual hygiene is a global concern, Kenya is representative of those countries which combine a lack of affordable resources (two-thirds of Kenyan women and girls cannot afford sanitary pads) with a pervasive doctrine of shame around menstruation. This has a negative impact not just on a young woman’s understanding of her own body, but on her spatial freedom. At its most extreme, this can mean monthly exile – which, in late 2016, led to the deaths of two young girls in Nepal.
Tribal beliefs about menstruation differ across the 42 tribes in Kenya, and the five tribes in Oyugis. What all tribes have in common is the construction of menstruation as contaminating and unclean, with the consequent imposition of restrictions to women’s behaviour and spatial agency. Often, they are forbidden from attending church or working in the fields, the latter of which proscriptions has a direct impact not only on gendered inequalities but on a community’s productivity and economic output.
Other locations are not explicitly forbidden but may be indirectly restricted through embarrassment or anxiety: all participants spoke of missing school at some point due to menstruation. Use of dirty cloths, leaves or old clothing lead to a fear of leaking which manifests itself in not being able to concentrate in class, and there is agreement among the students that absenteeism and lack of concentration detracts from their academic performance. Poverty in Oyugis often means that adolescent girls cannot catch up with schoolwork at home, where many do not have electricity, pens, paper or desks. It is no coincidence that the young women we spoke with had failed end-of-year exams and needed to repeat years of schooling.
Education is a major factor in determining the life chances for women and their families, and thus, vitally, the economic development and potential of the country more broadly. The needs of pre- and post-pubescent young women must be heard. SDG4 strongly promotes equitable access to quality education, but simplistic solutions to encourage more girls to attend school will fail, or prove insufficient, if their specific needs and wants are not provided for. On an international scale, the stigma translates directly into a development shortfall. As long as the impact on national economies continues, nations cannot hope to reach many of the sustainable development goals..
What are the next steps for policymakers?
While it may be too late to include a specific target or indicator on menstrual hygiene in the SDGs, progress can instead focus on national and local levels. Frequently, stigmatisation and a lack of resources are perpetuated by a patriarchal community, and are often accepted unquestioningly by women. As one student said: “It is our culture. Everyone just knows that”. While harmful social and cultural norms are notoriously hard to disrupt, and predominantly sit outside state control, there is much that governmental policy can achieve.
In contrast, the government can influence the education around menstruation in schools. It is important that formal education (alongside informal education) is directed at adolescent boys as well as girls, otherwise the sense of ostracism and "unspeakability" of menstruation will only be heightened. At present, young men are partly responsible for the distressing and damaging experiences that adolescent girls face in school and elsewhere: sexual harassment heightens when girls first menstruate, as there is a perceived link to sexual readiness. Gender-based oppression at school instils a culture of violence against women and girls as an acceptable mindset. Young women are even dangerously vulnerable to transactional sex with men: as one student’s diary reveals, “[w]hen you ask your boyfriend, he will buy [sanitary products] for you but he will have to sleep with you”. Educating boys will help enable them to become more understanding, tolerant and respectful of their female peers.
Alongside policy directed at attitudinal changes, governments can take a number of practical measures. Primarily, sanitary products must be made more affordable. Poverty is a driving force behind a lack of sanitary products, despite governmental initiatives to remove taxes and customs fees: as one student noted, “many of us cannot afford them so we come up with other things”.
The first step in recognising menstruation as a development issue is to start talking about it. If silence continues, the stigma will only worsen: this Menstrual Hygiene Day, let’s start the conversation.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
