Sanitation Taboos: Menstrual Hygiene

 Sanitation Taboos: Menstrual Hygiene

 Sanitation is far from homogenous, as Mcfarlane et al. (2014) explores in their paper about how sanitation is produced and sustained in informal settlements. A gendered lens is therefore needed to unveil some of the disparities in “everyday sanitation” that women experience. Women disproportionately bear the difficulties of sanitation inadequacies (Bapat and Agarwal 2003) but are reluctant to discuss their experiences- partly because they deem water access and quality as more important than sanitation (ibid). Although they are intrinsically linked, Curtis et al. (2000) note that improved health outcomes are dependant more on adequate sanitation facilities (such as waste disposal) than water provision; reiterating the importance of sanitation that is often undervalued.

But the key factor that underpins why sanitation is overlooked is that is a ‘taboo’ topic across several cultures around the world, including within Africa. It is uncommon for it to be openly discussed and therefore rendered invisible. Menstrual hygiene management (MHM) especially is one dimension of sanitation that is heavily stigmatised and the shame surrounding it undermines women’s wellbeing and poses as a serious human rights concern. There is little knowledge on safe menstrual care and so women are exposed to a whole range of health risks.

There has been extensive research into menstrual absenteeism in schools and workplaces- underpinned by the poorly planned sanitation facilities that neglect women’s MHM needs, including sanitary waste disposal systems or water supplies. To understand why women need these facilities, it is important to gage a holistic understanding of which menstrual hygiene products are used- which ranges across different cultures and contexts.

Disposable sanitary products are hailed as a much hygienic alternative for many women who risk using newspapers or old rags to manage their menstruation. These products are made more affordable by some governments including Rwanda and Kenya, who have removed VAT or “pink tax” on sanitary products. But there are still some limitations associated with disposable products use. The inadequate disposal of such products can endanger existing sanitation systems, due to limited knowledge on appropriate discarding practices. Women would dispose of menstrual products in pit latrines, causing them to fill up faster and creating problems with emptying devices (Roxburgh et al, 2020). Other practices include self-incinerating, which is also dangerous.

Opting for reusable products therefore appear as an attractive solution to disposable products. However, the feasibility of this is largely contingent on water supplies. For example, in the informal settlement of KwaHlathi, South Africa, the absence of water and handwashing facilities near pit latrines (Scorgie et al. 2016) led to an almost exclusive use of disposable products, as private washing and drying facilities were not available for cleaning reusable products. Likewise, in communities where water is already limited and needs to be fetched from open sources, regularly cleaning reusables is difficult as well.

One MHM option that could curtail many of the issues of traditional menstrual hygiene products is using ‘menstrual cups’- a reusable, medical-grade silicone cup that collects menstrual blood, rather than absorbing it. Economically, menstrual cups are far most cost effective than disposable sanitary products, with their 5-10 year lifespans. Moreover, menstrual cups are hygienic and safe to use; providing up to 12 hours of protection- which can help address absenteeism discussed earlier as women can comfortably attend school and work without worrying about finding private facilities or leaking etc (main reasons for why they would not attend). Using menstrual cups can also curb the concerns with the lack of washing facilities in communal pit latrines and privacy, as women can empty cups when they shower. And of course, its reusable nature also relieves stress on communal waste systems too- hence being the most sustainable menstrual hygiene product that is available on the market.

From what has been discussed, menstrual cups seem to be a excellent and practical solution to MHM issues, and there are several schemes across Africa that are working to distribute these products. In Kenya, The Cup Foundation has distributed over 15,000 cups to girls between 11-16, and aims to eliminate menstrual hygiene waste in Kibera, Kenya- Africa’s largest slum. Indeed, cultural challenges still prevails such as widespread misconceptions of menstrual cup use with “breaking hymens” and “virginity”. Such misunderstandings can be addressed through workshops and educating women and young girls about their bodies and menstrual care- which Ruby Cup’s “buy one, donate one” model features. In regards to general acceptability, there is evidence of positive responses from women (Besinka et al. 2015), suggesting the scope for introducing menstrual cups and providing women with an improved alternative to traditional menstrual hygiene products. Effective community education that de-stigmatises MHM and by introducing women to options such as the menstrual cup- but most importantly giving them the choice to pick which product suits them- is a key strategy that can successfully tackle women’s sanitation concerns that tend to be ignored.

Empowering women through improvements in MHM not only contributes to improvements in public health, but also increases women’s overall productivity; enabling them to participate socially and economically during a time that they previously would have been restricted. Although it is not explicitly mentioned in the Sustainable Development Goals, by focussing on improving menstrual hygiene helps to address both Goal 6 (access to water and sanitation) and Goal 4 (inclusive and quality education). 

    Check out this video which explores how women and girls can be empowered by the menstrual cup: