Aunt Flo, the crimson tide, code red. There are dozens of euphemisms people use around the world to avoid directly talking about periods and “that time of the month.” And it’s clear that the way we talk — or don't talk — about menstruation can perpetuate period stigma.
But Chris Bobel, a women's, gender, and sexuality studies professor at the University of Massachusetts Boston, says that’s not the only way we reinforce that stigma. Many NGOs and aid agencies working to end period poverty and improve access to menstrual health do so primarily by providing period products, which she argues, on its own, can strengthen menstruation taboo, too.
Giving people who menstruate products to manage their periods without educating communities about menstrual health teaches people to think, “My body is a problem … My solution is to clean it up and I need a pad or a cup or a tampon to clean it up,” Bobel told Global Citizen.
“The problem isn't the girl's body. The problem isn't menstruation. The problem is the cultural attitude about it,” she said.
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“When we focus on product provision, what we're doing is super subtle — maybe this is overly academic and I own that — but it's a subtle message that re-emphasizes this notion that ‘the body is broken and it needs to be fixed,’” she explained.
Instead, the key to improving menstrual health is likely to be education, suggested Bobel, author of The Managed Body: Developing Girls and Menstrual Health in the Global South, which examines approaches to water, sanitation, and hygiene development work, particularly in developing countries.
Yet, when it comes to addressing period poverty, the prevailing approach of most aid agencies, NGOs, and private companies is only to provide access to menstruation products like pads and tampons.
In recent years, some more innovative programs have included menstrual health education for both boys and girls to help destigmatize periods and a few governments have made plans to incorporate menstrual health into sex education.
But Bobel said that an approach to menstrual health intervention that centers on providing girls with pads and tampons to “manage” their periods, without a substantial educational component for the girl, her family, and community, can actually reinforce shame and may not have a lasting impact.
The reasons many nonprofits and development agencies focus their efforts on providing pads and tampons to girls, often through schools, are understandable, Bobel said.
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Nonprofits rely on funders and grants, and in order to be awarded such grants and continue to receive funding, they are asked to demonstrate their impact. And the most tangible way to do that is by distributing period products, which they can easily quantify. A program that can report delivering many products to a large population of people who menstruate can concretely show funders where their money went and whom it impacted.
However, there has not been strong data that proves product-driven approaches improve menstrual health or make a significant difference to school attendance rates among female students. Though this is, in part, due to a lack of research, Bobel said.
“Overall, I think we need to put more resources into menstrual health education,” Bobel said.
By this she means well-thought-out, purposefully developed programming. She emphasizes the need for trained educators who are prepared to talk about pregnancy, sex, and even intimate partner violence — issues she says are intimately linked to menstruation and the female body. And these education programs need to be available to boys, girls, their families, and their communities to help de-stigmatize menstruation.
“Boys and other girls will tease each other because they're uncomfortable, because menstruation's not been normalized — it’s been exceptionalized,” she said.
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After introducing a menstrual health education program targeted at boys and girls in Indonesia, which included a comic book about periods, UNICEF saw boys’ perceptions of menstruation as normal jump from 61% to 89% in 2017.
While she emphasized a need for more inclusive educational efforts like these, she said period products can be both necessary and helpful, but cautioned that communities should be consulted on what their most urgent needs are before well-intentioned people begin handing out pads and tampons.
“We need a ‘both/and approach,’” Bobel said.
“We may ultimately need resources like pads and toilets and locks on doors, but we also need really good evidence-based menstrual health education, and that's what's not being funded to the same degree as these pad provision schemes.”
Overall, Bobel would like to see more research and data around menstrual health interventions. She wants to challenge us to think differently about how we approach programs that seek to improve menstrual hygiene — and in doing so, we can help end period poverty and improve menstrual health in appropriate and sustainable ways.