The Problem with Women’s Health: Menstrual Inequity

By: Nardeen Oweis

Right now, around 800 million women and girls around the globe are menstruating but few have continual access to menstrual hygiene products. The problem is that in many countries, menstrual health is not only rarely discussed, but it is also stigmatised and even considered a taboo subject (1). Even though menstruation affects half of the world's population, there was no universal definition of menstrual health until this year. This is due to the evolving research and science on menstruation, as well as a lack of global consensus (2). Now, menstrual health, as defined by the Terminology Action Group, refers to a woman's physical, emotional, and social well-being during menstruation. (2). To be clear, the issue extends beyond a lack of access to period hygiene products to a variety of other menstrual health-related difficulties. Essentially, this is part of a bigger conversation about gender and socioeconomic disparities in healthcare systems around the world.

The first step of the journey to bridging the gap between menstrual disparities is recognizing that this is a global crisis. Often, the Western world is removed from conversations about menstrual inequities. It is mainly seen as an issue for girls and women in developing countries and regions with outdated ideologies about the menstrual cycle. Research conducted in the major city of St. Louis, Missouri in the United States reveals the unfortunate reality of menstrual inequities in one of the wealthiest countries in the world (3). In this study, 183 women completed a survey with general questions regarding menstruation (3). This survey revealed that around 64% of the women in this study did not have access to menstrual hygiene products in the past year and that approximately 21% experienced this monthly (3). Approximately, two-thirds of participants revealed to rely on community donations of menstrual hygiene products and a few even claimed to go to the emergency room at the hospital as a last-effort source (3). Sadly, five of the women in the research admitted to reverting to thievery to obtain pads or tampons (3). This study also disclosed that menstrual hygiene products were not only unaffordable by most, but also inaccessible. Many participants explained how transportation to big-box stores to purchase affordable menstrual products was costly and time-consuming (3).

To further elaborate, 64% of participants claimed to use an alternative, homemade products to pads or tampons, such as rags, pieces of cloth, or toilet paper (3). The study made no mention of the hygienic risks of the alternative products the participants used. Although using these alternatives can be cost-efficient, clean, and environmentally friendly, problems may emerge if they are not used properly and changed frequently. Many women prefer to use reusable products during menstruation for their personal reasons. However, many have no choice as they lack the financial resources to purchase their preferred product. An example of an increasingly used reusable menstrual hygiene product is a menstrual cup (4). In addition, some brands of menstrual cups can last up to 10 years (4). However, these types of products are not circulating as they should for many reasons including that many women are unaware or unfamiliar with their use. Moreover, many menstrual educational resources do not offer a comprehensive list of the variety of menstrual hygiene products that exist beyond disposable pads and tampons (4). Popularizing and educating people on these products can significantly resolve the accessibility and affordability issues that many women face worldwide when it comes to menstrual hygiene products.

Additionally, compared to the developed world, other countries have accompanying issues that exacerbate the issue of menstrual inequity. Besides not having access to or being able to afford menstrual hygiene products, many women and girls around the world also do not have access to clean and running water (1). As mentioned before, many women who lack access to menstrual hygiene products rely on homemade alternatives, such as pieces of cloth. Not being able to sanitize menstrual cloths with clean water can increase the risk of infection, infertility, and can invite a surge of other health issues (1). Thus, along with cleansing themselves, women must also practice routine cleansing of their products to avoid complications, which is not possible without access to clean water. Along with clean water, menstrual hygiene management requires private sanitation stations where women can change and dispose of products. Recently, there has been a global, growing initiative known as WASH (water, sanitation, and hygiene) (1). This sector of developmental practice makes it a mission to provide children with the basic human need of water and hygiene. Across the globe, menstrual hygiene management has been largely disregarded of importance in these WASH initiatives (1). The implications of this have large consequences as it adds to the false view that menstrual health is not as important as other hygienic practices.

Menstrual inequity has physical, social, and mental implications that highlight the severity of this problem. First and foremost, menstrual health is a strong indicator of reproductive health. Poor menstrual health has been linked with but not limited to pain and discomfort, abnormal uterine bleeding, toxic shock syndrome, reproductive tract infections, and other vaginal diseases (2). These symptoms when manifesting in teenage girls have an impact on their education (1). A study in South India revealed that many girls had to withdraw from school once they got their first period (1). One of the main reasons being that they reached maturation and are now ready for marriage (1). The girls who remain enrolled in school are absent more often than their male peers due to discomfort and pain directly related to their periods (1). In Nepal, absentee rates are also high because the schools lack the necessary privacy and compounds for washing, pressuring many menstruating girls to stay home and avoid embarrassment (1). Furthermore, it is evident that not being able to control menstruation and maintain menstrual health can cause a great deal of stress for women and girls. (1). Also, menstruation itself can be a very sensitive time for women and girls due to the changes in hormones (5). A study revealed that 68.1% of women who experience menstrual inequity every month also experienced moderate or severe depressive symptoms, compared to 43.4% of women who have never experienced any type of menstrual inequity (5). In this study, these percentages correspond to 431 women in college in the United States (5).

In short, the main propeller of this problem is stigma; driving women to fear speaking on the matter and education to remain inadequate. In some cultures, the taboos regarding menstruation are so obtrusive that it manifests in physical restrictions. For example, in Nepal, the majority of menstruating girls and women are restricted from attending religious functions, cooking, sleeping on the same bed as their husbands or others, and more (1). Some girls who are menstruating are not even allowed to play or attend school (1). Impurity is one of the most common taboos regarding menstruation (1). Many menstruating women in Nepal are convinced that they are impure and that they must avoid touching things to avoid contaminating or spreading their “impurity” (1). These harmful taboos and cultural ideologies concerning menstruation are hindering the menstrual equity movement. Shockingly, educational systems are also to blame for the projection and maintenance of these taboos. In South Asia, a girl or woman is typically unaware of menstruation until her first cycle (1). Teachers refuse to engage in conversations about menstrual health and when they do, they focus on the cultural and ritualistic aspects of it (1). Even in the Western world, education on menstrual hygiene management is lacking. The study in St. Louis revealed that many women and girls had concerns that their knowledge of menstruation and menstrual health was insufficient (3).

Although this problem has existed for generations and remains an issue, many strides have been made to address it. First, many countries have eliminated the sales tax on menstrual hygiene products in stores or what is known as “period tax” or “tampon tax” (3). However, many states and countries are still taxing women who buy such products (3). Since the 1990s, there has been a public outcry for public policies to address menstruation as many women suddenly died from Toxic Shock Syndrome believed to be caused by high-absorbency tampons (6). Local educational systems are also starting to join the menstrual equity movement. The Toronto District School Board recently announced that public schools in Toronto will be providing free menstrual hygiene products in all girls’ washrooms (7). Although many efforts are made to address this problem, the stigma and taboo nature of menstruation remains the leading obstacle to menstrual equity. When I was in high school, we only had one class about female menstrual cycles and reproductive health as a part of the gym curriculum. Most of the education I received was from the internet, which is known to be quite unreliable at times. Schools should make it a mission to help end period poverty by not just offering free menstruation products in washrooms, but also by modifying their curricula. Students should not only be taught the mechanics and functional aspects of the female reproductive system in biology class but also how to apply the knowledge in improving their menstrual and reproductive health. By removing the stigma and embarrassment associated with discussing menstrual health, educational systems encourage more girls and women to speak up about their own menstrual health. Essentially, success is achieved when women no longer feel embarrassed or feel the need to whisper or separate from their male counterparts to freely discuss one of the most natural processes of life.

References

(1) Mahon, T., & Fernandes, M. (2010). Menstrual hygiene in South Asia:

a neglected issue for WASH (water, sanitation and hygiene) programmes. Gender & Development, 18(1), 99-113. https://doi.org/10.1080/13552071003600083

(2) Hennegan, J., Winkler, I. T., Bobel, C., Keiser, D., Hampton, J., Larsson, G., Chandra-Mouli, V., Plesons, M., & Mahon, T. (2021). Menstrual health: a definition for policy, practice, and research. Sexual and reproductive health matters, 29(1), 1911618. https://doi.org/10.1080/26410397.2021.1911618

(3) Sebert, A.K., Peters, E.B., Danjoint, D., & Wall, L.L. (2019). Unmet Menstrual Hygiene Needs Among Low-Income Women. Obstetrics & Gynecology, 133(2),238-44.

(4) Hennean, J. (2019). Inserting informed choice into global menstrual product use and provision. The Lancet: Public Health, 4(8), 361-362. https://doi.org/10.1016/S2468-2667(19)30126-4

(5) Cardoso, L.F., Scolese, A.M., Hamidaddin, A., & Gupta, J. (2021). Period poverty and mental health implications among college-aged women in the United States. BMC Women's Health, 21(14). https://doi.org/10.1186/s12905-020-01149-5

(6) Weiss-Wolf, J. (2020). U.S. Policymaking to Address Menstruation: Advancing an Equity Agenda. The Palgrave Handbook of Critical Menstruation Studies, 539–549. https://doi.org/10.1007/978-981-15-0614-7_41

(7) Teotonio, I. (2019). Toronto school board to provide free menstrual products to students. The Star. https://www.thestar.com/news/gta/2019/08/29/toronto-school-board-to-provide-free-menstrual-products-to-students.html