Opinion: 4 ways to address menstrual stigmas, taboos and discrimination

Girls learn about their rights at the Adolescent Friendly Space in Dolakha, Nepal. Photo by: Plan International USA

Like many news outlets, CNN ran a report on Dec. 22 reporting on the death of a 15-year-old Nepali girl. Smoke inhalation is all too common a problem in confined spaces where indoor cooking stoves are used. Rather, it was the location — a menstrual hut — and the fact that the girl from western Nepal was taking part in chhaupadi. This is a common practice in some parts of Nepal where women, considered “unclean” during menstruation, are ritually separated from the rest of the community for the duration of their period. 

This was the second such death within a month in this far western part of Nepal. While the absolute numbers of deaths are low — notwithstanding the tragedy of each individual case — the wider issue at stake here is the systematic exclusion of girls and women from society. Exclusion from education. From health care. From access to basic services. From opportunity. All over something as biologically familiar as menstruation.

Chhaupadi is only one example of the many cultural practices that discriminate against women and girls during menstruation. In a recent listicle, Plan International USA highlighted the wide-ranging sets of beliefs surrounding menstruation across the globe. The list was a powerful reminder that stigmas and taboos combine in all societies in ways that create and reinforce harmful social norms. Tellingly, the listicle included examples of taboos from relatively prosperous countries such as South Africa and even right here in the U.S., emphasizing the point that this is not just an issue for countries undergoing rapid economic development.

Recognizing the widespread nature of this issue is only part of the battle. How do we address practices of this kind? And how should we do so without descending into a cultural relativism that crowds out legitimate critiques of harmful social norms, norms that limit the rights, choices and opportunities of half of society?

For Plan International USA, our work is coordinated through long-established local offices in 52 countries, driven by local staff drawn from the very communities in question. We seek to know and understand. We start by listening to communities and working with them. In doing so, we observe social mores and understand the reasons why stigmas develop.

Here are four ways to effectively integrated solutions to address discrimination.

1. Focus on menstrual health-related stigmas and taboos, which underlie gender inequalities, misinformation, negative cultural practices, and the culture of silence that surrounds menstruation. Experience suggests portfolio approaches work well when addressing stigmas and taboos, including using science to dissect taboos and faulty logic; applying social arts such as community theater to promote socially appropriate messaging; or more tailored training that targets specific influencers, such as parents or community elders.

2. Provide education and knowledge — not only for girls and women, but increasingly for men and boys so that menstruation, and the options for managing it, are understood broadly across society. Immediate steps here include a combination of practical tools and curricula (such as school guides, WASH plans or facilitators manuals and puberty books); better targeting of key audiences (not only girls, but boys, women, local government officials, teachers); and developing new curricula and content on the menstrual cycle, health and managing menstruation.

3. Drive improved access to menstrual health-appropriate sanitation and hygiene facilities, so that girls’ needs are met, especially when in school. This typically involves design solutions for facilities at schools and health clinics that promote access to and use of facilities that allow for menstrual hygiene management or that “nudge” behavior. Examples include facilities that have construction of separate rooms for changing, places to hang reusable menstrual pads after drying/washing, and access to water and soap for handwashing at or near a facility.

4. Work with the private sector and other providers to improve the supply chain of menstrual health products so that local markets are created and sustained as demand rises. This generally involves the private sector as actors in supply chain management and coordination and/or product line partnerships with social enterprises.

In isolation, each of these steps is by itself an important stepping stone in building a society ready to address menstrual health — a society in which a period isn’t disadvantageous or harmful to a girl’s ability to learn, lead, decide or thrive.

But the real power lies in combining these steps, a framework around which to work with communities so that the tragic case of the Nepali girl from Gajra village will swiftly become a thing of the past.

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About the authors

  • Darren%2520saywell

    Darren Saywell

    Darren Saywell heads the WASH program at Plan International USA. He has 20 years operational, research, consultancy and teaching experience and has previously held positions at the Water, Engineering and Development Center in the United Kingdom, the World Health Organization and the International Water Association. In October 2011, he was nominated as the vice-chair for Sanitation and Water for All.
  • Untitled 1

    Caitlin Gruer

    Caitlin Gruer is a senior program associate at Plan International USA, where she works as part of the water, sanitation and health practice. Her work focuses on menstrual hygiene management, sustainable WASH programming, and the intersection between WASH and nutrition. She has a master's in global health and sociomedical sciences from Columbia University's Mailman School of Public Health. She currently lives in Washington, D.C.