Breaking the silence on menstrual health
Two decades ago, in my home state of Maharashtra, I was bold enough to ask in a state government meeting why we were not talking about monthly periods as a cause of absenteeism in schools, given the huge dropout rate of girls moving from primary to secondary schooling. A shocked silence, nervous glances and a quick change of subject moved us smoothly to the next topic for discussion.
Today, across Africa, Asia and globally, I cite India and its normative progress on all matters menstruation to inspire policymakers to break the silence on this closelyheld taboo. The Union ministry of water and sanitation deserves huge credit for breaking the silence on December 10, 2013, with the clear articulation of menstrual hygiene management (MHM) in its national policy. This was a watershed moment. Two years later and, despite a new government, MHM has held firm in the Swachh Bharat Mission (SBM) and is clearly outlined in the policy, with matching guidelines.
The Sanitation Action Summit in Mumbai opened the stage for adolescent boys and girls to talk about menstruation; for transgender persons to share their hopes and fears; for elderly men and women, who explained that they cannot squat or carry water to wash their hands; and for sanitation workers who requested that women wrap menstrual waste well before disposal. Local and state government officers and practitioners resolved to work together to take practical steps to leave no one behind.
The SBM gender guidelines, launched on May 3, recognise the entirety of gender discrimination, including the temptation to perpetuate historical stereotypes of women’s submissive place in Indian society, the exclusion of transgender men and women from public toilets and the particular stressors that women face every day, but especially when they are menstruating.
These issues and taboos are universal. What could be more concrete, universal and practical than taking the lid off a biological phenomenon that affects half the world’s population, young and not so young, every month? Women and girls, men and boys everywhere heave a sigh of relief when they can utter the M word without squirming or giggling. Their official representatives are several steps ahead. In February, Nepal’s ministry of water and sanitation, breaking the silence on MHM, committed to a clear policy, to be published in late 2017. In Kenya, the final touches are being put on the world’s first national MHM policy; in Senegal, the sanitation and hygiene policy, with MHM and persons with disabilities clearly integrated, awaits official signature.
As Tanzania and Nigeria, among several other countries, prepare to embark on this journey, we are already recalibrating for the long road ahead. For national policies and guidelines to affect people’s lives in a meaningful way, we will need to rein in the flood of silicone cups, banana, papyrus, and water hyacinth pads, and instead revert to the simple mantra of the United Nations’ Sustainable Development Goals Agenda 2030: Participation, People and the Planet. The first step is for government leaders to listen to the voices of women and girls that we do not hear or see, as well as their representatives too far down the chain of command, to decide whether women want polluting disposables and, if they do, how they want to ensure sustainable disposal.
Our operating principle is simple: Work on national policy and local action at the same time, led by the voices and demands of women and girls least represented. In Senegal, the Water Supply and Sanitation Collaborative Council (WSSCC) has worked with the ministry of water and sanitation to develop inclusive MHM-friendly sanitation block design and specifications in consultation with women and girls who will use them. Government funding is piloting these in 40 public sanitation blocks but the ministry has already raised the bar by requiring all bidders for sanitation infrastructure contracts to include MHM in their skills and expertise.
Public spaces, unlike households, can raise standards and set the bar higher on what women and girls will demand. In Kenya, early advocacy and capacity building on MHM was firmly anchored at the county level, ensuring that governors and their first ladies integrate MHM into devolved budgets for WASH and health as well as the emerging local development plans.
A key objective of all these efforts is to merge the conversation on open-defecation-free communities, total sanitation and MHM into one on sanitation and hygiene with dignity and safety for all men and women, inside and outside the home. Another has been to recognise that menstrual health, dignity and safety is everyone’s business. Formal inter-ministerial working groups on MHM across Senegal, Cameroon and Niger ensure that the relevant ministry regulates the awareness, management or disposal aspects of MHM, with one lead ministry coordinating these efforts. But India is a continent in itself. The urgent work on hand is to break the silence one ward and gram panchayat at a time, so that women and girls can demand the information and materials they need, whatever their financial capacity.
Menstruation is after all just one blind spot among many development unmentionables. Saying the M word can train the spotlight on many others, including postpartum bleeding, fibroids, fistula, menopause and incontinence. Let’s not forget that blind and deaf girls and women menstruate too! Simple audio, sign language and Braille interventions can replace silence and fear with confidence and mobility.
A key objective is to merge the conversation on menstrual hygiene management and ending open defecation into one on sanitation and hygiene with dignity for all