At any given time, around 1.8 billion people are menstruating. That includes girls, women, trans men and non-binary persons. Recent global reports and research findings show that millions of these menstruators are unable to manage their menstruation efficiently and with dignity. Lack of WASH (water, sanitation and hygiene) facilities, lack of accurate information, limited access to hygienic products, menstrual stigma and social inequalities are the key facts that continue to affect menstrual health. Globally, homes, communities, public places, schools and workplaces are not adequately equipped to address these shortages and social facts. Such circumstances increase girls’, women’s and other menstruators’ vulnerability to unsafe menstruation. It also doesn’t help that menstruation is a neglected public health issue around the world.

WASH and menstrual health

Water, sanitation and hygiene are fundamental to achieving menstrual health. Limited or no access to WASH leads to inadequate washing and unhygienic practices during menstruation, which further pose risks to reproductive and urinary tract infections. Safe and clean water is mostly concentrated in urban spaces across countries. Rural and low resource settings only manage to get access to water through community water supply, borewells, mountain meltwater, handpump, and rivers that may not guarantee safe and clean water. Similarly, these settings have limited access to sanitation facilities. Homes and schools do not have basic sanitation facilities raising health and hygiene concerns. Girls and women are left with the option of using open defecation where they face harassment and personal safety issues.

Menstrual stigma and lack of awareness

Lack of accurate information about menstruation makes adolescent girls unprepared for managing their menstruation safely and efficiently. Girls remain fearful and shameful of menarche and menstruation. To avoid talking about menstruation openly, women use euphemisms which further prevent people from knowing about menstruation. Menstrual talk remains secretive among girls and women. Euphemisms such as ‘impure,’ ‘dirty,’ ‘on the rag,’ ‘aunt flow, ‘or ‘bad luck’ connote negative construction of menstruation and women’s bodies that puts women in an inferior position and creates a stigma around menstruation. They lack awareness about the physiological functioning of the menstrual cycle and menstrual health management. As a result, they do not make informed decisions about their cycle and health concerns in time.

Lack of menstrual waste disposal system

In many lower income countries, communities and schools do not have proper waste management systems. 

Used sanitary pads are often disposed of in rivers, wells and drains. This blocks water flow in rivers, and clogs drains and sewages. Sometimes, the used products are burnt or buried in the soil. Such improper menstrual-product disposal contaminates water and soil, increasing health risks and affecting the environment. Most girls and women are not aware of these harmful effects on the environment and continue to dispose of menstrual products in water bodies.

Gendered menstruation experiences

Girls and women in many cultures around the world face restrictions during menstruation. In schools, they get teased for having leaking and weaker bodies. Menstruating girls and women are not allowed to enter worship places or touch men and their belongings. Cultural beliefs construct menstruation as impure and untouchable. These beliefs shape girls’ and women’s behavior and actions around men and sacred places. There are reports of multiple menstrual practices that keep menstruating girls and women isolated from their households. Although menstruation equates good health and fertility, it is kept hidden among girls. Boys and men are excluded from menstruation conversations.

Sustainable framework for a dignified menstrual health management (MHM)

Many countries have witnessed a shift from menstrual hygiene to a more holistic physical, mental and social well-being to promote dignified MHM. A setting with stringent cultural beliefs and stigma, strict practice of norms, no menstrual preparedness, limited access to clean water, no waste disposal system and limited access to health centers, needs to have a framework that is culture appropriate. The categories of gender, rurality, culture, and access to WASH intersect to shape menstrual health. Other contexts of study may include categories such as caste, class, ethnicity, religion, region, conflict ridden and disaster-prone identities for implementation.

Interventions need to be implemented by government, local health professionals, local NGOs, academicians, and media together at different levels. While setting up WASH facilities is crucial, stigmatization of menstruation is equally important to tackle menstrual stigma and taboo. 

There should be a proper waste collection system in the community and schools for collection, segregation and management of used menstrual products. By adopting a culturally appropriate framework, menstruation issues can be reduced to a great extent.