Today marks 10 years of Menstrual Hygiene Day. The day provides an opportunity to recall initiatives of speaking up and breaking the silence on menstrual hygiene.
Annually, people and organizations all over the world celebrate Menstrual Hygiene (MH) Day to raise awareness of the importance of menstrual hygiene management. However, this is more than an annual awareness event.
This is a movement that has grown in might for a #PeriodFriendlyWorld. Every month, more than two billion people around the world menstruate. Menstruation–or period–is a natural and healthy process, yet millions of these girls, women, transgender men, and non-binary persons are unable to afford menstrual products or access to safe water and sanitation to manage their menstrual health and hygiene.
Poor menstrual hygiene can lead to infections, reproductive health problems, and other complications. However, it is not just a personal health issue; it is intricately linked to well-being, gender, education, equity, empowerment, and human rights, specifically to several of the United Nations’ Sustainable Development Goals (SDGs) in the realms of health, education, gender equality, and sanitation i.e., SDG 3, 4, 5 and 6. Menstrual hygiene management (MHM) is an essential aspect of hygiene in enabling women, girls, and other menstruators between menarche and menopause towards life opportunities and reaching their full potential.
We often cite the challenges faced by menstruators as simply tangible such as the unavailability of affordable menstrual products, access to safe and convenient water, sanitation, and hygiene (WASH) facilities to change and dispose of used menstrual products when they are very much rooted in cultural taboos and discriminatory social norms. Gender inequality, extreme poverty, humanitarian crises and harmful traditions can amplify deprivation and stigma attached to menstruation leading to an overall culture of silence around the topic, resulting in limited information on menstruation and menstrual hygiene management.
According to a study by the UN Harmful Practices Working Group in Nepal, 89 % of women and girls throughout the country reported they experience some form of restriction or exclusion during menstruation (e.g., banned from visiting temples, entering kitchens, using communal water tap) with Chhaupadi being the most extreme form of menstrual restrictions, despite being outlawed by the Supreme Court of Nepal in 2005.
Menstrual hygiene management behaviors are not driven simply by providing information on menstruation. Behavior change communication (BCC) approaches are often sought to create a more supportive environment by addressing myths, misconceptions, and social stigma around menstruation. Regardless of the BCC approach used, it is important to keep in mind the role of behavioral motives and social norms in all behavior-change program designs.
The Behavior Centered Design (BCD) approach employed by WaterAid for sustained behavior change focuses on addressing three levers for change: (i) addressing key behavioral motives (disgust, comfort, nurture, affiliation, and status) and emotions identified through research and assessment in motivating behavior change, (ii) explores social norms and alter to create new social norms to encourage desired behaviors and (iii) changing behavioral settings to reinforce behaviors. For example, some of the WASH motives such as comfort and disgust can be associated with the use of menstrual products, regular change of sanitary pads, proper disposal of used menstrual products, etc. Participatory activities involving families, peers, and community members to a greater extent support the improvement of attitudes towards menstruation, attitudes towards restrictions, attitudes towards menstrual product use, and reduce restrictions within the community.
Engaging boys, men, and key influencers including religious leaders, faith healers, and traditional healers in dialogues and events has been key to creating new social norms to normalize menstruation and challenge cultural barriers in the community. While providing easy access to menstrual products and WASH facilities, visual cues, nudges, and reminders are also used to make sure the environment supports in the reinforcement of MHM behaviors.
In Nepal, 1 in 4 girls missed school due to menstruation during the last menstrual period with pain, discomfort, and fear of staining as the predominant reasons. Though knowledge is important, it is insufficient for changing behavior, especially around perceptions and practices of menstrual restrictions. Behavior change is a dynamic, iterative, and crucial process for creating a #PeriodFriendlyWorld. It requires an enabling environment for MHM behaviors and sustainability.
As we strive to change how the world perceives menstruation, a multi-sectoral, holistic approach is required where initiatives can effectively combine BCC interventions with appropriate infrastructure and menstrual products, in a conducive policy environment. Since 2014, MH Day has seen significant growth in its global movement where each day more organizations and people are contributing to an enabling environment where menstruators can manage their periods safely, hygienically, and confidently, without shame. Though we have seen progressive changes, there is still a long way to go together to achieve a #PeriodFriendlyWorld.
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