Globally, Menstrual Hygiene Management (MHM) is one of the most common terms used to describe issues associated with menstruation in policies and programmes. However, advocates of menstruation are calling for wider uptake of a more holistic definition for menstrual health in the hope that this will improve coordination, plug gaps and ultimately increase the impact of interventions and funding. Much of the current global emphasis of menstruation-related programming implemented by WASH sector actors focuses on hygiene and the practicalities of absorbing menstrual blood and cleaning menstruating bodies, without sufficient attention on the associated stigma and policy gaps that hamper menstruators’ adequate inclusion in society. Indeed, couching menstruation purely in terms of hygiene risks reinforcing beliefs that menstruation is ‘dirty’ or even shameful – something to be concealed, covered up and cleaned.
This blog is a reminder that menstrual health is a human right – rather than just a hygiene concern, and thus, explores what this means within Bangladesh, home to 54 million women and girls who menstruate.
Reframing dignity, stigma, and representation
Global studies assert how advocates of menstruation consider the successful ‘concealment’ of menstruation a means to protect women’s ‘dignity’. In Bangladesh too, although aid workers tend to provide knowledge about menstrual hygiene to adolescent girls, in some cases they reportedly teach them to conceal their reusable pads and clothes from men to protect their dignity. There are yet to be open discussions in most countries to overcome the notion that even if period blood is accidentally visible, menstruators must not be shamed but rather be supported to protect their wellbeing.
As well as being encouraged to conceal menstrual blood, menstruators are also often pressured to conceal themselves while menstruating. Taboos concerning menstruation severely restrict women’s and girls’ ability to lead their lives, particularly in the marginalised communities of Bangladesh. For instance, girls are often advised by their parents to stay home during menstruation as they may get possessed by demons if they do not clean themselves. This impacts school dropout rates, along with factors such as the encouragement of marriage soon after puberty hits. Women also visit kabiraj (men who practice Ayurveda) who ‘help’ women to ward off evil spirits through herbal medicines, when they suffer problems with menstruation. Other men and women also often discriminate against menstruating women, believing that being around them will cause them problems.
Furthermore, the representation of menstruation often does not acknowledge the wider complexities surrounding menstrual health. Just as a focus on hygiene can reduce menstruation to concealment and cleanliness issues, the media often depicts menstrual products as universal solutions. Advertisements tend to show happy images of girls and women after accessing sanitary pads. For instance, a recent Bangladeshi advertisement portrayed how women can undertake trekking while menstruating, after obtaining sanitary pads. As well as ignoring the societal restrictions associated with menstruation, such advertisements risk imposing additional expectations on women to take on challenging tasks regardless of how they maybe actually feeling while menstruating. Access to sanitary pads does nothing to address the range of effects of menstruation on everyday life.
The stern reality of many menstruators is that they suffer from menstrual pain and stigma. Consequently, social issues such as menstrual leave and physical ailments such as endometriosis, Polycystic Ovary Syndrome (PCOS) and others are obscured, which may in turn act as psychological stressors for the menstruators. Although there has been some progress in advertisements showing men buying sanitary pads for women, these ads still have not overcome the ideology that sanitary pads can resolve all menstrual health problems.
Globally, advertisements also tend to ignore the large proportion of women in low, middle and high-income countries from poor socioeconomic backgrounds, who use old cloths and rags, leaves and mud to manage their menstruation as many cannot afford to buy sanitary pads.
Tampon tax and affordability issues
In Bangladesh, pads are heavily taxed and menstrual products were also not included in the essential items dispersed by the government during the COVID-19 pandemic. This has led marginalised men and women to prioritise buying food and paying rent over buying sanitary pads. Although, value-added tax (VAT) was temporarily removed for two years (2019- 2021) on imported raw materials used to produce sanitary pads, the retail prices of sanitary pads have barely reduced, and menstruators still cannot afford them.
One consequence of this is that menstruators resort to using potentially unhygienic materials to absorb menstrual blood, often with harmful consequences. For example, 60% of female ready-made garments (RMG) workers in Bangladesh use fabric rags collected from factory floors to manage their menstruation, leading to infections and leaving nearly 73% of those women unable to work for almost a week per month. This also leads to a knock-on financial impact for both the workers and the companies due to lost incomes and output.
Moreover, in Bangladesh, most interventions that involve providing sanitary items focus mainly on disposable sanitary pads and reusable pads. Information on the availability of other products, such as reusable menstrual cups, which have some cost-effective and environmental benefits, is lacking.
Reforming policies and interventions
Although some policies in Bangladesh address menstruation in their agenda, they require revision as they do not holistically address all associated concerns. For instance, the National Strategy for Water Supply and Sanitation 2014 and the Eighth Five Year Plan (July 2020-June 2025) have explicitly mentioned menstruation in their clauses, such as providing sanitary pads and establishing better toilet facilities for women. However, the structural barriers concerning menstruation that restrict women’s mobility, safety, and opportunities have not been properly addressed in these policies.
Besides, the comprehensive sexuality education (CSE) curriculum, a significant part of Sexual and Reproductive Health and Rights (SRHR) education in Bangladesh, includes information which promotes gender stereotypes, such as the notions that girls should not go out alone or that illness among girls causes unhappiness in the family and renders them incapable of doing household chores. Teachers also do not properly teach students about menstruation. There is also a related need for policies to combat the notion that women are the bearers of hygiene responsibilities concerning water and sanitation while men can continue to be the prime decision-makers, encouraging patriarchal structures.
Furthermore, there is limited global research and knowledge on the fact that not all women menstruate and all those who menstruate (such as transgender and non-binary people) are not women. Thus, concrete statistics are yet to be available on the total number of menstruators in the country including all genders. Most studies on menstruation in Bangladesh are geared towards adolescent girls with some focus on marginalised women residing in the urban slums or villages. Although this is a commendable approach, excluding menstruators from different gender dynamics hampers effective policy implementation, as a ‘one-size-fits-all’ approach cannot work properly. Moreover, disabled women are also excluded from the current policies both in Bangladesh and many other countries. According to UNICEF, globally, ‘it is often assumed that girls with disabilities do not menstruate’.
A way forward
Despite the challenges, some remarkable interventions exist in Bangladesh through the ‘MHM Platform’, that brings together different actors such as, NGOs, WASH and SRHR alliances, UN agencies, research institutions and the private sector. The Government of Bangladesh, along with this platform, intends to form a National Menstrual Health Strategy.
Other interventions include baseline studies and some NGOs and INGOs producing environment-friendly sanitary pads often engaging women, building female-friendly toilets by obtaining women’s and girls’ opinions in the Rohingya camps and urban slums, designing education materials and, providing girls and women with dignity kits.
Thus, based on the aforementioned findings, listed below are some recommendations to adequately address menstrual health in Bangladesh.
- Reform existing policies and create new policies that address menstrual health holistically.
- Explore the gender dynamics of menstruation.
- Empower people who menstruate to make decisions about their own bodies, to understand periods as normal and healthy, to choose between products and to speak out when their menstrual needs are not met.
- Sensitise men and boys about menstruation as a normal bodily function and make them an integral part of the interventions.
- Impart positive messages through different media channels.
- Remove tampon tax on all menstrual products.
- Provide free menstrual products.