The hard and soft of committing to menstrual health and hygiene in WASH

A young school boy stands facing the camera against a bright green background. He is holding a sign that says, “as a student boy, I help inform boys not to tease girls, but to respect them as menstruation is natural. Through menstruation, we are all born.”

Making menstruation a normal fact of life by 2030

WaterAid's Chelsea Huggett and Water for Women's Gender and Social Inclusion Specialist, Jose Mott share insights and progress on Menstrual Hygiene Day 2022.

Last year we had the call-to-action.

This is the year that we commit to action – to ending period poverty by 2030.

WASH actors have a pivotal role to play. We must commit to ensuring no one is held back because of period poverty, in all its forms.

Without accessible, safe and dignified menstrual health and hygiene (MHH) for all who need it, we cannot achieve SDG6.2 - sanitation and hygiene for all.

What’s WASH got to do with it?

The ability to access water, sanitation and hygiene facilities – ‘the hardware’ - is a critical part of our commitment as WASH actors, but currently, an estimated 3.6 billion people¹ (about half of the world’s population) don’t have access to safely managed sanitation², and 3 billion people lack access to handwashing facilities with soap.

What is period poverty?

The lack of resources for safe and dignified menstrual hygiene management is known as ‘period poverty’. Typically, those who lack access to basic sanitation facilities also lack access to sanitary products to manage their periods. This everyday challenge is compounded by debilitating stigmas and taboos associated with menstruation that exist in different cultures, which result in women, girls and gender non-binary people lacking privacy or dignity during menstruation. For those with disabilities, these issues are amplified.

Imagine what it is like, then, to manage periods for millions of women, girls and gender diverse people of reproductive age who menstruate without this basic hardware? And imagine how much harder it is again for those with disabilities?³

If this isn’t hard enough, managing periods is made even worse by debilitating stigma and taboos associated with menstruation in many, if not all, parts of the world. The belief that menstrual blood is dirty and should always be concealed leads to a greater burden for people who menstruate to do so discreetly, leading to feelings of shame, secrecy, and stress. This can mean staying home instead of participating fully in work or community life. It can also mean girls missing school while on their period. All this leads to the invisibility of menstruation as a policy and resource allocation issue. These barriers can impact access to the appropriate ‘hardware’ needed to manage menstruation effectively and privately - toilets, handwashing facilities, period products. Therefore, investing in ‘software’ solutions that shift stigma and taboos which contribute to the invisibility of menstruation is paramount.

As WASH actors, we need to build on the work being done to integrate software and hardware approaches to ensure a holistic solution to MHH, particularly when we consider the increased focus on climate-resilient WASH, and the urgent need to address systemic inequalities. A sustained focus on the ‘software’, as well as supporting women and people who experience marginalisation to be leaders in menstrual health policy and solutions, means that stigma will be less pervasive, and solutions for improved WASH access likely to be more user-oriented, and therefore, more sustainable.

Paying equal attention to both the ‘software’ and the ‘hardware’

What does paying equal attention to the ‘software’ and ‘hardware’ for good menstrual health and hygiene look like?

Inclusive WASH facilities that are accessible, safe and contextually appropriate
Availability of period products that are appropriate and affordable
Services that support targeted self-care
Education that empowers women, girls, gender diverse people and people with disabilities
An environment free of stigma and taboos associated with menstruation

The last three points relate more specifically to software outcomes. Addressing norms that contribute to menstruation-related stigma and taboos is critical to enabling the other software and hardware outcomes listed above, to ensure menstruation is widely accepted as a normal fact of life.

Do No Harm:

Any WASH or other program can potentially result in negative consequences, particularly for marginalized people, who may inadvertently be exposed to increased stigmatisation or risk of gender-based or other targeted violence. The Fund sees ‘harm’ as a continuum, understanding that discriminatory attitudes are the underlying cause of violence and other severe harm. To ‘do no harm’ requires deep understanding of the complex dynamics of people’s lives. It requires robust program monitoring systems, responsive to unintended consequences. Accepting violence as a daily reality in the lives of women and marginalized people, transformative practice recognises the importance of understanding the causes and dynamics of such violence. It requires understanding of and linking with survivor-centred and rights-based prevention and responses services for advocacy and referral.⁴

But it is no easy task - these norms are deeply entrenched in all cultures. Shifting them in ways that support people who menstruate and do no harm, requires investment in solutions that are gender equality-focused, culturally sensitive, holistic and long-term.

To achieve good menstrual health, those who menstruate – women, girls, transgender men, and non-binary people of reproductive age, including those with disabilities, must be able to:

Access information about menstruation, including self-care and hygiene practices

Care for their bodies during menstruation in ways that are hygienic, comfortable, private and safe, which includes access to effective and affordable period products, and supportive WASH facilities and services

Access appropriate health services and resources for treatment and care

Feel supported in an environment that is free from stigma and distress, and

Have a choice of whether and how they participate in all spheres of life, free from ‘menstrual-related’ exclusion, restriction, discrimination, coercion, and/or violence⁵

The above holistic definition of menstrual health from Sexual Health Matters highlights the critical contributions needed by WASH actors to make good menstrual health a reality for all.

A critical contribution is our investment in approaches that improve software outcomes for people who menstruate. Efforts such as anti-stigma awareness raising, accessible information provision, hygiene behaviour change campaigns that explicitly promote menstrual hygiene, and integrated solutions with education and health actors.

You can read about some of the solutions Water for Women partners are implementing through our MH Day postcards.

And of course, our essential contribution is to improve the hardware outcomes – our bread and butter - such as menstrual hygiene friendly WASH infrastructure in households, schools, institutions, healthcare facilities and other public places, and strengthening supply chains for affordable period products.

Menstrual health and hygiene in practice across Asia and the Pacific

Menstrual health and hygiene solutions are being rolled out through 18 Water for Women WASH projects across the region. Addressing stigma and tackling taboos has become core to these initiatives by:

engaging men and boys in appropriate ways to support menstrual hygiene initiatives
supporting menstrual health and hygiene in WASH systems and policies
making toilets menstrual hygiene friendly and protecting environments by promoting safe disposal
supporting the menstrual health of people with disabilities
improving access to period products
supporting women’s livelihood initiatives such as reusable pad production

Through these software and hardware approaches, Water for Women partners are committed to making menstruation a normal fact of life. We are transforming WASH systems to strengthen diverse voices of women, girls and gender diverse people, including those with disabilities; shifting stigma and harmful norms, and improving access to menstrual hygiene friendly toilets and period products.

You can learn about these solutions in more detail in our Learning Brief: Pivotal not peripheral: Ending period poverty by prioritising menstrual health and hygiene in WASH, launched last year on Menstrual Health and Hygiene Day.

Open external page https://player.vimeo.com/video/713919936?wmode=transparent

It’s time to commit to change

As water scarcity and climate hazards become an increasing reality, our commitment to ensuring no one is left behind or held back because of period poverty has never been more pressing.

Through the learnings and work of Water for Women partners, we have some tips to share in making menstrual health and hygiene a reality for all:

Respond to the context: Ensure MHH initiatives are grounded locally, considering and address cultural sensitivities, power dynamics, environmental health, availability and affordability of period products, access to water, and sanitation levels, to name a few.

Tackle taboos: Seek to understand the underlying gender and social norms that drive WASH behaviours, and address with sensitivity, being guided by strong Do No Harm approaches (see below)

Be guided by people with lived experience: Ensure women, girls and gender diverse people, including those with disabilities, are at the centre of decision-making when it comes to designing and implementing MHH initiatives.

Engage with men and boys: Seek ways to support men and boys – in the right places and spaces - to be allies for changing mindsets on menstruation and advocates for supportive systems and structures to drive menstrual health change in communities, schools and institutions.

Collaborate with a range of stakeholders: Work with rights holder organisations (women’s organisations, organisations of people with disabilities and organisations representing sexual and gender minority groups) and support their engagement with government policy-makers in the WASH, health, education and GEDSI (gender equality, disability and social inclusion) sectors to develop menstrual hygiene-friendly WASH policy and budgets.

Share practice and learning: Find opportunities to share practice - successes and challenges - across the sector and beyond, to not only strengthen the quality of our collective work, but also our accountability.

Five Common Do No Harm strategies across the Fund:

Ensure the projects is informed by a gender and social power analysis undertaken at project inception;

Consult with and amplify the voices of people with lived experience;

Engage with Rights Holder Organisations for GEDSI capacity building of staff, partners and stakeholders and for advancing their rights agendas;

Engage with men and boys to support empowerment initiatives of women, girls and the marginalised;

Engage with WASH duty bearers on GEDSI issues in WASH, and support their direct engagement with RHOs on GEDSI and WASH issues.

Photo by Live & Learn Environmental Education Papua New Guinea

“As a student boy, I help inform boys not to tease girls, but to respect them as menstruation is natural. Through menstruation, we are all born.” A male student expresses is solidarity and support for girls, his fellow students at a school in New Ireland Province, Papua New Guinea

Plan International and Live and Learn Environmental Education are tackling taboos in PNG by training teachers to deliver menstrual health and hygiene education and awareness in schools.

Joint Monitoring Program, Sanitation Statistics - UNICEF DATA
Safely managed sanitation facilities Sanitation - Our World in Data: “Safely managed sanitation” is defined as the use of an improved sanitation facility which is not shared with other households and where: excreta is safely disposed in situ or excreta is transported and treated off-site.
Guidance on Menstrual Health and Hygiene | UNICEF
Do No Harm definition from the Water for Women Towards Transformation strategy
Hennegan, J et al; April 2021 Menstrual health: a definition for policy, practice, and research - PMC (nih.gov)

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