Menstrual health programmes that provide girls in developing countries with pads and cups aren't good enough

Menstrual health programmes that provide girls in developing countries with pads and cups aren't good enough

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In some parts of the work, such as Nepal, women are cast out of their households during their menstrual days to live in sheds or shacks outside the main house. Often, those shelters are badly made, and exposed to the elements and danger from animals.

Providing girls with menstrual supplies and a private place to use them has emerged as a popular way for international groups to tackle global poverty, Chris Bobel says, but she argues that these efforts should be viewed through a critical lens - and largely that is not happening.

In her new book, The Managed Body: Developing Girls and Menstrual Health in the Global South, she contends that programmes to provide pads and cups to girls in developing countries - also known collectively as the Global South - miss the mark, well-intentioned though they may be. They overlook higher priorities, such as clean water and comprehensive education efforts, she says, and actually work against eradicating taboos surrounding menstruation.

Bobel, an associate professor of women’s, gender, and sexuality studies at the University of Massachusetts Boston, has been researching and writing about menstruation and society’s attitudes toward it for more than 15 years. She has strong feelings about how menstruation has been stigmatised, which, she argues, affects everything from girls’ esteem and sense of self to long-term potential.

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She became interested in menstrual health in developing countries after reading a 2009 blog post questioning whether providing girls with pads would keep them in school. She suspected they wouldn’t, and a study cited in the piece basically said as much. As Bobel looked into the question, she noticed that non-governmental organisations, governments and well-meaning individuals all seemed to seize on pads as the answer.

Researchers, advocates, activists, entrepreneurs and even government officials, Bobel says, have issued calls to “make menstruation matter.” The World Bank and Unicef have promoted menstrual health education, including hygiene, to keep girls in school because girls who remain in school tend to have fewer children and are less likely to marry early and live in poverty.

Some organisations say menstruation is one of the main reasons that girls drop out: stories abound about girls who miss school for days at a time each month or must leave altogether once they begin menstruating.

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A report published by the United Nations Educational, Scientific and Cultural Organisation (Unesco) in 2014 says, “Menstruation is a particularly salient issue because it has a more pronounced effect on the quality and enjoyment of education than do other aspects of puberty.”

The report cited issues related to latrines, safe water, good sanitation and hygiene practices, as well as access to menstrual products. Without these, the report warned, school would be “unhealthy, gender discriminatory and inadequate.” The UN. Commission on the Status of Women recommends creating health and educational opportunities that promote menstruation as normal and natural.

Bobel is pleased with these ideas. But she says that while organisations do promote menstrual health education, those efforts seem to be secondary to promoting menstrual products.

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“In February 2018, Twitter lit up with selfies of stars of the Bollywood screen posing with an object typically kept hidden,” she writes. They were promoting the work of an Indian entrepreneur named Arunachalam Muruganantham, known as “Padman,” who invented a way to make sanitary towels cheaply.

A South African Amnesty International chapter, which advocates for free pads, began a #WorthBleedingFor campaign. “Project Dignity,” a South African charity that provides education, reusable pads, and panties, says it aims to “reduce absenteeism and dropout rates in schools, and increase opportunities for girls to complete their education with dignity.” The solution: menstrual materials.

But for Bobel, the solution needs to be far more nuanced. Pads and cups, Bobel writes, clean up and hide menstruation, “an accommodation of, rather than resistance to, stigma.”

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Pain, caused by cramping, or other physical symptoms needs addressing, she says. So do other issues: Violence against girls and women and attitudes about them and their place in society. A lack of comprehensive reproductive health education. Teachers, parents, community leaders and other adults who need to learn how to be supportive.

Educating the entire community, not just girls, will help bring about a necessary cultural shift, she says. Bobel writes that the menstrual pad, whether single-use or reusable, is often held up as a kind of silver bullet - the thing that will keep girls in school, allowing them to lift themselves, and by extension, their entire communities out of poverty.

Many NGOs tout sobering evidence to underscore the need for materials, Bobel found. But “my own investigation shows that journalists, activists and MHM (menstrual hygiene management) advocates alike are grabbing enticing ‘evidence’ from one another without going to the original source to verify the information’s validity,” she says.

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While deeply caring people see menstruation as an opportunity to improve lives, she said in a recent phone interview, education and fighting stigma should be the main priorities.

Bobel says that development programs require a wide lens - one that carefully examines the West’s colonial past and a predilection for imposing its values and products on others.

For large corporations, she says, the developing world is a potentially lucrative market for disposable Western-style products, which are enticing because they’re “easy” and “modern,” but they can pose an environmental threat to areas already struggling with inadequate sanitation. Plus, the products do not alleviate the notion that a girl’s menstruating body is a problem to be solved.

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Negative attitudes about menstruation and how they shape society’s views of women aren’t found just in developing countries, either. Studies in the West have shown a correlation between negative attitudes about menstruation and poor self-image. Yet, Bobel notes, these campaigns imply that the West has the answers to the problems faced in other parts of the world.

If modern products were transformative, she says, wouldn’t women here have fewer negative attitudes toward menstruation? “We’re operating on this assumption that if girls in, let’s say, Nairobi, had the same access to menstrual materials as they do in the West, then everything would be OK,” she said. “But the wealthy girls here still ... see their bodies as problems, they still feel the burden to keep their menstruation a secret.”

Bobel would like to see menstruation regarded as a healthy part of life everywhere. “Menstruation is actually a vital sign. It’s an indicator of health. It’s linked to bone health and organ health and mood,” she says. “But we weaponise menstruation. We use it to joke, to diminish, to shame. And so, a menstruator’s job is to quickly tidy it up and pretend it’s not happening.”

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