Dar es Salaam. Menstruation continues to persistently limit the lives and future aspirations of girls and women, as well as the development of the society as a whole, especially in developing countries and, above all, among the most vulnerable.
Over the past decade, menstrual health has gained prominence on the global development agenda. Menstruation has received increased attention also in the UN Human Rights Council, where the human rights perspective has been increasingly underscored.
However, in the promotion of menstrual health, recently the narrowness of the responses has been acknowledged, as the product-centric approaches have often diverted attention from the root cause of the problems - menstrual shame.
While various actors have developed a multitude of solutions to promote menstrual health, the means to eradicate persistent root causes have often been inadequate. Good results have nevertheless, been achieved, for example, in Tanzania where the commitment of religious leaders towards menstrual health and new menstrual technology have challenged deep-rooted menstrual shame.
Disability and the menstrual challenge
The average woman has about 450 menstrual cycles in her lifetime, which is equivalent to about 6.25 years of life. The impact of menstruation on equality and the realization of human rights has long been underestimated.
In Tanzania, menstrual blood is considered a private matter and beliefs about impurity are often associated with menstruation. A study in five African countries showed that 66 percent of girls are unaware about menstruation before reaching menarche.
In addition, menstruation is often managed unhygienically, inadequately and even with life-threatening methods. In Tanzania, many women do not have access to commercially available menstrual pads due to limited availability and unaffordability.
Traditional cloth or other basic means are used to manage the flow. Due to the shame associated with menstruation, girls often isolate themselves at home during menstruation, even missing school.
Discrimination is often identified based one personal trait, however, in reality a person can be discriminated for several attributes such as age, gender and disability which are inseparable. This kind of intersectional discrimination related to menstruation may be more common than previously thought, as it is often not acknowledged.
The impact of menstruation on a woman’s life can be significantly influenced by geographical location and disability. 80 percent of persons with disabilities live in the developing world, where inaccessibility to health services and information is affecting girls and women with disabilities disproportionately.
As sexuality of persons with disabilities is also often a taboo, providing menstrual training for them is deemed unnecessary and their menstrual health is not invested in equally. Decisions about them are taken without them; disregarding their views.
The dependence of girls with physical disabilities on caregivers and family members, and the lack of assistance may further weaken their position.
Due to ignorance and the vicious cycle of poverty that persons with disabilities commonly face, menstruating females with disabilities may be left without menstrual pads, abandoned at home or even tied up.
“These are the taboos which affect all the women and girls but for the people with disabilities it becomes double because they already face some taboos because of disability and when they menstruate they face yet another taboo which isolates them during menstruation”, describes a Tanzanian menstrual health expert and educator.
Fear of exposing the menstruating status is likely to increase isolation, insecurity and shame associated with menstruation and disability.
At its best, however, menstruation could create a sense of unity for girls and women regardless of their disability.
Innovations alone are not enough
There are number of novel innovations related to menstrual health, one of them is the menstrual cup which is relatively new in the African context. A pilot study on the adoption of menstrual cups in Tanzania shows that women and schoolgirls favour menstrual cups because of their financial benefits, hygiene and comfort. It is also environmentally friendly, which is especially important in contexts where waste and water management is insufficient.
Large scale international research on use of the menstrual cup in developing countries supports the claims of its safety and usability. Yet religious beliefs about losing virginity coupled with lack of information, lack of water and unaffordability hinder acceptance of the cup.
While many organizations working on menstrual health are focused on changing the world one menstrual pad at a time, the underlying menstrual shame maintains its place in communities, challenging the daily lives of girls and women. Menstrual health discourse has its problems as it over-emphasizes products and the miraculous power of modern innovations to solve all menstruation related challenges.
The well-meaning menstrual health projects can further increase menstrual shame by framing traditional menstrual pads as inappropriate. It is often the element of shame that makes traditional products a health risk if, for example, they cannot be dried outdoors in the sunshine but are tucked away under a mattress. In order to break menstrual shame in a sustainable way, it is necessary to look at the structures that maintain it. The UN Human Rights Council resolution on the rights to water and sanitation in 2018 urged states to take new measures to address menstrual stigma and shame.
Towards sustainable change with religious leaders
Religious actors have significant influence on gender norms. Tanzanians listen carefully to religious leaders and religion impacts their everyday lives and decisions. At its best, innovative menstrual technology can foster a dialogue among religious leaders. This has happened with regard to the menstrual cup in Tanzania.
Fida International is among the actors that have promoted menstrual health as part of its project activities in Tanzania. Menstrual cups have opened the door for a dialogue on gender disparities, access to menstrual information and how to break silence around menstruation. Such a dialogue is important and enables joint strategies to promote menstrual health in communities and offers alternatives to comfortable and safe menstrual products.
In Eastern Africa, menstrual health ambassadors have then been trained by the churches and have the know-how to raise the issue of menstrual health and invite various stakeholders to discuss menstrual health in a culturally appropriate way.
In Tanzania, 93 percent of the population describe religion as a very important part of their lives. Religion defines attitudes and decision-making and is a key source in the pursuit of well-being. Thus, the role of religious leaders is significant and should be emphasised in breaking the silence surrounding menstruation.
Majority of religious leaders are men, which is why mainstreaming of female perspective in religious organisations is extremely important as it can also raise awareness on importance of menstrual health as a community and public health concern. It also increases acceptance of new menstrual products and confidence in their usability.
“At the beginning of the project, most church leaders considered menstrual health inappropriate for their church context. Through discussions, however, church leadership recognized the challenges of menstrual health in their communities. Now, the major youth and women’s events have cleared space for menstrual health and other sexual health topics alongside spiritual teachings, reaching audiences of thousands in Tanzania”, explained a representative for Fida International’s Tanzanian church partner, the Free Pentecostal Church of Tanzania.
Myths about virginity and menstrual cup can only be broken if religious actors are at the forefront in disseminating reliable information. They continuously reach large populations through religious activities, community programmes and educational and health institutions. Menstrual health organizations and stakeholders have a key role to play in engaging religious actors in the action.
International Menstrual Hygiene day is celebrated on the 28th of May. The date is no coincidence: number 28 refers to the average duration of the menstrual cycle and number 5 to the number of average days of menstrual flow per month. This year the day is cerebrated while the world is in the middle of the Covid-19 pandemic. Periods don’t stop for pandemics and meanwhile the gendered, financial and health effects of the crisis will further challenge the menstruation of girls and women in East Africa.
The International Menstrual Hygiene Day has gained momentum globally as a platform for normalizing the talk about menstruation and breaking the shame around it. Now more than ever, bold and innovative approaches and extensive collaboration between various stakeholders is needed to promote sustainable menstrual health.
Bertha Mhepela, MSc Integrated Sanitation Management, Alva Bruun, Senior Development Adviser (human rights), ministry for Foreign Affairs of Finland, Virpi Mesiäislehto, PhD Researcher, Eastern Africa Regional Adviser of Development Cooperation, Fida International and Magdaleena Lehmuskoski, Master of Public Health and Global Health, Registered Nurse .