Menstrual Hygiene Management: A taboo that must be broken!

By Gender Team on Thu, 06 June 2013

Mother and child from Cambodia. Photo by the author.
Mother and child from Cambodia. Photo by the author.

Written by Anupma Jain, Senior Social Sector Specialist 

Unforgettable—that’s how I would describe the moment I raised the issue of menstrual hygiene management with project teams and government officials in Southeast Asia. Shocked and stunned—they looked down at their shoes closely inspecting remnants of their breakfast from earlier in the day. Their eyes shifted to look beyond me to avoid immediate eye contact. I too hesitated, as I carefully maneuvered the conversation to avoid any insensitive reactions. I was treading new ground and I knew it.

Menstrual hygiene management (MHM) is an important gender issue. It affects about one-quarter of the global population, or about 1.8 billion women and girls of reproductive age (15-49 years). Close to 60% of them or 1.1 billion live in Asia and the Pacific. Most of these women and girls will menstruate every month for two to seven days, and thus would require information and facilities for proper disposal of hygiene products. 

The topic of menstruation nevertheless remains a taboo in many societies. Cultural practices, religious beliefs and social myths make it difficult for both men and women to talk about menstruation. Lack of information, separate latrine facilities, menstrual hygiene products, poor management and disposal of these products further exasperates the situation for women and girls. According to WaterAid, women and girls in some South Asian communities, for instance, are not allowed to use water sources during menstruation and nearly 20% of those interviewed refrained from using latrines during their periods despite having access to them. WASH United recently shared an interesting fact during May Menstravaganza: “taboo” comes from the Polynesian word “tapua" meaning both “sacred” and “menstruation.” 

“Girls” bathroom at a vocational school in Indonesia. Photo by the author.

Lack of appropriate MHM practices also adversely affects the sustainability of public assets like public latrines. How many public latrines in schools, market places, community centers, and health centers are appropriate or conducive to supporting good MHM practices? Without proper information and facilities for disposal of menstrual hygiene products, public (and household) latrines will become clogged and assets will begin to deteriorate at a rapid rate.  

Urban development projects, including those in water, sanitation and hygiene (WASH), provide opportunities to bring this silent but important gender issue into the spotlight by incorporating MHM requirements into the design and management of public latrines and solid waste management initiatives.  The cost of incorporating improved MHM practices for women and girls in such projects would be incremental— improved design of latrine facilities for women to give them more space, construction of separate latrines facilities with water supply, placement of trash bins, hygiene awareness and sensitivity training in secondary schools. I suspect some enhancement features would not cost much more within the overall project budget, but would be a cost effective investment and could help to maintain public latrines in working order.

The opportunity cost of not making this additional investment, however, could be substantial—lower retention rates of adolescent girls, increased  risk of eve-teasing and gender-based violence, loss of dignity and self-esteem amongst adolescent girls, higher risk of developing infections associated with poor reproductive health and practices (e.g., scabies in the vaginal area or urinal infections), and missed opportunity to help mothers educate and empower their daughters about their personal hygiene practices. Unhygienic menstrual management would have dire impacts on their lives. 

Open and uncontrolled dumpsite in Southeast Asia. Photo by the author.

The cycle of improved MHM, however, cannot stop with improved water supply and sanitation facilities or greater education and awareness of hygiene practices. Women’s improved economic status in the region will enable them to access and afford more modern forms of menstrual hygiene protection. Hence, MHM needs to be linked to proper collection, transportation and disposal of menstrual hygiene products. This makes it an important urban environmental issue—one that needs to be addressed, as the share of the urban population in Asia and the Pacific to the world urban population is expected to grow, the region’s risk to climate change increases, and cities become more prone to inland and coastal flooding. 

Night market in Lao PDR. Photo by the author.

Admittedly, there will be limitations in how far urban development and WASH projects can incorporate MHM practices. The first step, however, is to get those shifting eyes to focus. By strengthening the links with environmental sustainability and proper asset management, the ‘culture of silence’ around MHM can be broken to engage in meaningful dialogue. Only then, can projects meet the needs and improve the lives of about 1.1 billion women and girls of reproductive ages living in Asia and the Pacific.