Period Poverty: Foregrounding People Who Menstruate in the Water and Development Debate

 My last blog post outlined a handful of outcomes that emerge through the gendered role of water collection. This post will argue for the importance of including people who menstruate in the water and development discourse in Africa. A blog post coming in the next couple of weeks will expand on the importance of recognising all the identities claimed by people who menstruate, however in this post I will discuss the mainstream literature's appraisal of where menstruation needs to be considered in WASH interventions in Africa then go on to outline why a more inclusive approach must be considered.

A facilitator talking about menstrual health and hygiene using a flipbook at a workshop in Muranga, Kenya (source)

This is an important topic to touch on for a multitude of reasons, only a handful of which I'll be able to get to in this post. For one, people who menstruate are impacted (in many different ways) throughout the global North and South. Secondly, menstruation is largely ignored by or legislated (sometimes informally/socially) for by males. Thirdly, its intersection with WaSH alters the requirements of some interventions (the need for privacy during menstruation for example). Fourthly, despite Menstrual Hygiene Management (MHM) being a significant real life indicator for Sustainable Development Goals (SDG) 3, 5 and 6 (health, gender and water respectively) it is roundly left out of the UN's portfolio of used indicators for the SDGs. Fifthly, the discourse surrounding menstruation needs to reflect what we know about trans and non-binary identities and the development discourse must do its part. In recognition of this fifth point, I have substituted phrases like 'people who menstruate' for any instance of the words 'women' or 'girls' in the supporting literature that is not a direct quote.

Problems surrounding MHM can be largely split into two categories; hardware and software. The former refers to menstrual hygiene products and physical infrastructure like suitable WASH facilities. The latter refers to education and social stigma surrounding menstrual hygiene. 

Hardware

As far as WASH facilities are concerned, poor access to piped water, flush toilets and space to wash one's hands is likely to impinge more on those trying to maintain menstrual hygiene. This effect can be compounded by the gendered allocation of water within households. Public wash facilities also impinge on the lives of people who menstruate. In Durban, South Africa it was reported that pit latrines and community ablution blocks (CABs) were not maintained and didn't provide adequate privacy. Doors would not lock and cracks were vulnerable to the gaze of unwanted onlookers. In addition there were often no facilities for the discreet disposal of menstrual hygiene products.

In rural Western Kenya it was found that young people who menstruate could often not afford to purchase suitable menstrual hygiene products like pads, and would have to ration them or simply use cloths made from old clothes, blankets, pieces of mattress, socks, towel, cotton wool or tissue, some of which that could be were washed and reused. These inadequate products leave people who menstruate susceptible to multiple illnesses, including reproductive tract infections (Anjum et al, 2019). Additionally, in the case of two studies amongst Kenyan adolescents it was reported that some exchanged sex for money in order to buy sanitary pads and others were dependent on boyfriends for the purchase of them.

Software

Perhaps more problematic because it persists even where 'hardware' is sufficient, is the issue of 'software'. Globally and within parts of Africa there are a multitude of responses and taboos associated with menstruation however many young people who menstruate report facing stigma which manifests as teasing from peers in class, poor familial support and a lack of cultural acceptance of alternative menstrual products such as tampons. More pervasive still is the feeling of menses being dirty and disgusting. Ethnographic literature reports a multitude of understandings of the female body which point towards menstruation as a 'cleansing' that not only removes sexual fluids but is good for one's health (Scorgie et al, 2015). This idea extends to menstrual hygiene products being seen by other members of the community, in particular men. Many reported being told that menstrual hygiene products must be disposed of immediately because they are unattractive. The same study , conducted in South Africa, reported that participants avoided disposing of menstrual hygiene products in full latrines or in public bins where they or the product could be seen by others. One participant complained that those disposing of menstrual hygiene products in open dumps for general waste "disgrace all of us girls". 

The effects of this can be particularly pronounced for those who are still in education, a staple indicator in the development discourse. Some studies report that 50% to 70%of young people who menstruate in Sub Saharan Africa miss between 1.6 to 2.1 days of school per month on average. Many of those that continue to attend school do so with low confidence, with feelings of shame and whilst fearing bullying and teasing, which have all been shown to affect performance in school and participation in activities inside and outside school (Ssewanyana and Bitanihirwe, 2019). 

To Conclude

It seems to me that even as gender mainstreaming becomes part of the development discourse, the nuanced requirements of people who menstruate continue to be neglected in research and in the discourse itself. Nowhere is this more apparent than in the dearth of references to menstrual hygiene in the UN's SDGs, despite it being a key factor in at least three of the 17 goals. 

It is important that the issues faced by people who menstruate become part of mainstream development discourse, but, however it is also imperative that research and language reflect the spectrum of identities claimed by those people. I will expand on this in a forthcoming post.