Opinion: Creating a more equal post-COVID-19 world for people who menstruate

COVID-19 highlights the vulnerable amongst us across the globe: Those who are most vulnerable because of the crowded conditions they live in; those who must continue working despite the threat of infection; and those who cannot absorb the shock of the economic impact of closed economies and quarantine.

Importantly, advocates are calling attention to the many gendered aspects of the pandemic, including increased vulnerabilities to gender-based violence during lockdowns, and the risks faced by primary caretakers — particularly women in the household and health care workers, approximately 75% of which are women.

An estimated 1.8 billion girls, women, and gender non-binary persons menstruate, and this has not stopped because of the pandemic. They still require menstrual materials, safe access to toilets, soap, water, and private spaces in the face of lockdown living conditions that have eliminated privacy for many populations.

Of equal concern, progress already made or underway around important gender issues is now halted or reversing. Menstruation serves as a proxy for this observation. 2020 started out as a year of progress, with a groundswell of interest and potential for improved investment to address the menstrual health and hygiene needs of girls, women, and all people who menstruate.

Investment is urgently needed, as a recent report estimates that over 500 million women worldwide do not have what they need to manage their menstruation. The inability to manage menstruation with safety, dignity, and comfort may negatively impact the physical and mental health of those who menstruate around the world.

Attention built from a decade of research and programmatic efforts to understand and address the challenges facing those who menstruate is now understandably sidelined in the face of more critical lifesaving measures, such as assuring the provision of personal protective equipment and important public health measures to contain the spread of infection.

Yet periods do not stop during pandemics and maintaining and adapting services to support menstrual health are essential to address alongside critical COVID-19 related priorities.  

Reasons to invest in menstrual health and hygiene

1. Contributes to building inclusive and sustainable water, sanitation, and hygiene services. Menstrual health and hygiene require investment in sustainable WASH services, which are crucial for women’s health, gender equality, and for mitigating the spread of future pandemics.

During the pandemic, there may be increased vulnerabilities relating to menstruation resulting from lack of access to these most basic services, particularly in low-income countries. Less availability of water, coupled with increased household needs for hand hygiene — including hand-washing and soap — may mean less for menstrual needs; and shared or public toilets may be closed or not disinfected regularly, resulting in safety risks for those who rely on visiting these facilities. Provision and on-going maintenance of water, sanitation, and hygiene services and supplies is essential.

2. Potential impacts on sexual and reproductive health. The menstrual cycle is fundamentally linked with sexual and reproductive health. As concern grows about a shortfall in contraceptive access to adolescent girls and women, and the provision of sexual and reproductive health education to young people, menstrual knowledge is a critical thread connecting both interventions.

Schools are closed, health centers are disrupted, and community-based programming is shut down or deprioritized. These realities in turn negatively impact the provision of essential information, with potentially harmful long-term consequences for women and girls. Alternative channels need to be utilized and services reinstated as soon as possible.

3. The potential for positive societal change. Strong taboos and stigma persist around menstruation in all corners of the world, restricting the lives of girls and women from engaging in the activities of daily life, and creating feelings of shame and embarrassment.

Such realities are likely exacerbated in ever-closer living conditions resulting from the pandemic, with potential implications for girls’ and women’s levels of anxiety and stress as they attempt to adapt. Tackling menstrual stigma to change social norms around keeping periods secret and the restrictions in daily activities experienced beyond personal choice, can be addressed.

Communication messaging aimed at households and families, including men and boys, may emphasize the support needed to manage menstruation during a pandemic, potentially contributing to lasting positive societal change.

4. The ability to address essential items. The inability to access effective menstrual materials each month needed to attend school, go to work, shop, and engage in other life activities, is essential to address.

Menstrual materials may be quality cloths, reusable pads, disposal pads, menstrual cups, period panties, or whatever other product is culturally and individually preferred. As evidence has shown, many people in both low- and high-income settings faced challenges accessing menstrual materials before the pandemic.

As programs providing subsidized access to menstrual products are closed down, and food banks and service organizations become overwhelmed, the number in need is growing. There is a tremendous opportunity from this collective pandemic experience to recognize that menstrual materials should be on the list of “essential items” that all households need, with concomitant efforts made to diminish existing affordability and access challenges.

All these issues are felt more acutely by those in more vulnerable situations such as people who experience homelessness, in quarantine, displaced persons, and those with disabilities.

As the global community seeks to develop longer-term responses for societies hit by the pandemic, investments in critical health interventions, such as public health systems and vaccines, are important but not sufficient. The opportunity is ripe to invest in other critical areas which would transform our world to a “new normal,” as called for by so many political leaders.

To get back on track, addressing the fundamental gendered inequalities of the most vulnerable among us is essential. Investing in a new normal for menstrual health and hygiene, addressing menstrual stigma, the provision of water and sanitation systems, and supporting sexual and reproductive health and rights, is a good place to start.