Human Rights Framework: A tool for achieving Menstrual Health for all

Concept paper prepared by:

Georjia Newhouse (Special Projects & Operations Officer, Masy Consultants)

Introduction

The stigma, embarrassment, myths, fears, and taboo that surround menstruation negatively impact millions of people globally every day (Wardana 2020, Wrinkler & Roaf 2015, Gottlieb 2020). This natural, fundamental, and inextricable part of life and growth is hidden in secrecy and shame. This challenges people that menstruate to know how to feel about menstruation, how to speak openly, how to manage it and how to navigate different realms of life whilst menstruating (Gottlieb 2020; Clue 2016; Wardana 2020). These complex barriers require a creative and nuanced approach in dismantling the stigmatised menstrual taboo (Hennegan et al. 2021, Connolly 2020). This paper will explore challenging taboo to achieving Menstrual Health through the rhetoric of human rights (Gottlieb 2020; HRW 2017). Firstly, an overview of human rights and Menstrual Health will be provided, before marrying their intrinsic connections. My placement experience at Masy Consultants, where I have developed a workshop dedicated to Menstrual Hygiene Management for students in the Philippines will be utilised as a reference to support how this framework can inform practice. Further discussions will outline how social workers are positioned well to utilise a human rights lens, and where this framework has informed positively on social work interventions addressing barriers to Menstrual Health. This paper will conclude on some summary thoughts on the trajectory of Menstrual Health as fundamental to human rights.

This paper adopts gender inclusive language to ensure it represents all people that menstruate, cisgender girls and women, non-binary persons, transgender persons, intersex persons.

Menstrual Health

It is alleged that ‘menstruation is as old as humanity itself’, and that we all know someone that menstruates; however, its sustained concealment and the power of stigma sees a suppression of education and open dialogue which strengthens the barriers to realising change (Bobel 2020: 1; Zivi 2020; Connolly 2020). However, with an increased consciousness of the need to address this silenced taboo, Menstrual Health has gained popularity on the global agenda (Hennegan et al. 2021). Accordingly, Hennegan et al. (2021) focused on conceptualising a unified definition to capture the evolution of Menstrual Health amidst its gained momentum (Hennegan et al. 2021; Zivi 2020). Through lengthy multi-sector stakeholder engagement and feedback from 51 experts, Hennegan et at. (2021) defined Menstrual Health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle” (Hennegan et al. 2021: 2). The definition continues to illustrate what achieving Menstrual Health looks like through the life-course, including factors such as receiving Menstrual Health education, access to effective and affordable menstrual materials and water and sanitation facilities, access to health services where appropriate, freedom from stigma and discrimination, and full participation in all spheres of life without exclusion, discrimination, violence or restriction (Babbar et al. 2022; Hennegan et al 2021: 2-4). This definition is useful as a tool that not only reflects critical elements of a human rights framework but unites the fragmented definitions of Menstrual Health to advance progress in advocacy, policy, practice, and research (Gottlieb 2020, Hennegan et al. 2021).

(Global Health, Maternal and Reproductive Health, Public Health Education 2021)

Historically menstruation has been surrounded by misconceptions, myths, and stigma; and it is these enduring taboos that have sustained dense barriers to achieving Menstrual Health, gender equality and realisation of human rights (Hennegan et al. 2020; Connolly 2020). It is acknowledged that menstrual taboos that deem periods as shameful and dirty, are deeply rooted in philosophical, cultural traditions and religious practices (MacClean et al. 2020; Zivi 2020; Sawo 2020). The impacts such taboo and stigma have for people that menstruate is monumental, maintaining hindrances to manage menstruation safely and with dignity and reinforces barriers to participate in cultural, social, economic, and public spheres of life (Zivi 2020, MacClean et al. 2020). This perpetuates the cycle of gender inequality, strengthens the patriarchal society, and undermines menstruating people's fundamental human rights (MacClean et al. 2020; Connolly 2021).

(Gunther 2021)

Human Rights

Following the Second World War in 1948, The United Nations General Assembly adopted The Universal Declaration of Human Rights (UNDR) ‘as a common standard of achievements for all peoples and all nations’ (UN 2022). The UNDR was created by representatives from diverse political, religious, and cultural backgrounds from around the world to outline the fundamental principles that all human beings are entitled to, specific to civil, economic, social, and cultural realms of life (UN 2022). Human rights are grounded in a framework that is bound by international law, in which the governments, known as the duty-bearers of rights, have obligations to the people living within the states; known as the rights-holders (HRW 2017). Therefore, individuals, groups, and organisations implement human rights as a declamatory tool to highlight injustices and where fundamental dignity and freedoms have been restricted, prohibited, and silenced (Zivi 2020, HRW 2017).

Central to human rights is the person's inherent dignity and exercising of agency, regardless of gender, disability, race, or religion (Wrinkler & Roaf 2015) The stigma that surrounds menstruation is argued to violate a host of human rights, inclusive people who menstruate right to inherent dignity (Wrinkler & Roaf 2015). Looking at Menstrual Health through the lens of human rights will highlight the systemic injustices that sustain the barriers for menstruating persons to realise their dignity and human rights in their day-to-day lives (Wrinkler & Roaf 2015; HRW 2017). In practice, a human rights framework provides an objective standard for practitioners, advocates, and individuals to hold the duty-bearers accountable (HRW 2017).

Human Rights and Menstrual Health

Menstrual Health isn’t explicitly mentioned in the International Bill of Human Rights or in any specific documents that outline women’s human rights; however, it has gained global dynamism as a human rights issue (Zivi 2020). In 2014, the United Nations Human Rights Council specifically discussed the absence of menstrual hygiene management and associated negative impacts on gender equality (Zivi 2020; Wardana 2020). This positioned Menstrual Health as a human rights issue and outlined how the stigma that surrounds menstruation negatively impacts on human rights of people that menstruate (Zivi 2020), HRW 2017). This part of the paper will focus on the intersection of human rights and Menstrual Health, and the importance of promoting and respecting the creation of an enabling environment for Menstrual Health (HRW 2017; Hennegan 2017).

The human right to water and sanitation

The human right to water and sanitation sees individuals with the ability to access sufficient, safe, affordable, and accessible water, and access to sanitation that is safe, socially, and culturally appropriate, hygienic and ensures privacy and dignity (HRW 2017). To attain Menstrual Health, one must be able to access such water and sanitation facilities to change menstrual materials, to wash menstrual materials and maintain good hygiene practices (Wrinkler & Roaf 2015; HRW 2017). Water and sanitation disproportionately impact people that menstruate, and therefore it is essential to place emphasis on the importance of realising that this human right is met.

Access to water and sanitation creates an enabling environment for Menstrual Health to be managed. For example, on placement, Masy Consultants addresses inadequate water and sanitation in the Philippines and understands the need to specifically address Menstrual Health to achieve gender equality. Masy Consultants aims to build hand washing stations and gender-segregated toilet blocks in schools to ensure the right to accessible and safe water and sanitation and provision of safety to protect students’ privacy and dignity whilst managing menstruation at school.

The human right to health Critical to Menstrual Health is the human right to health, which includes not only access to healthcare and medicine, but access to health-related education and information inclusive of reproductive and sexual health (HRW 2017; Connolly 2020; Wardana 2020). Under international human rights law, governments have an obligation that all persons can exercise their human right to health, which includes Menstrual Health (HRW 2017).

Underpinning the right to health is receiving information and education regarding the biological process, how to manage it and the potential symptoms such as tiredness or cramping (Wardana 2020, HRW 2017). However, many people don’t have sufficient information, and the stigma surrounding Menstrual Health impedes on the ability to seek help, resulting in common fears and susceptibility to negative health impacts (HRW 2017). This issue is prevalent at Masy Consultants where students that menstruate in elementary schools in the Philippines have a lack of information and misconceptions regarding Menstrual Health. A common taught cultural practice is to restrict consumption of sour foods during menstruation, which are typically a key part of the students' diets (Haver et al 2013). This results in calorie deficit, and the girls expressed feeling weak, fatigued and dizziness during this time, yet didn’t receive any knowledge on how to manage these symptoms (Haver et al 2013). The combination of cultural practices and absence of health-related information negatively impacts on the girls right to health and education.

The human right to education The human right to education is embedded in several human rights frameworks stating not only is it free and compulsory in primary and accessible secondary, that measures are to be taken to address discrimination against women so that have equal rights as men in the opportunity’s education provides (MacClean et al 2020; Wardana 2020). However, this human right to education is a gendered issue, as globally many girls, young women and people that menstruate are absent from school or dropping out as they don’t have the adequate facilities or privacy, lack menstrual products and information, and experience shame to manage menstruation safely at school (MacClean et al 2020; Wrinkler & Roaf 2015). This sees duty-bearers not meeting their obligations, under the Convention on the Rights of the Child, to ensure that the right to education is realised by taking measures to reduce school dropouts (HRW 2017; Wrinkler & Roaf 2015). Education isn’t only a human right; it is a foundational principle of empowerment that can determine life chances and economic opportunities for girls and people menstruating (Wardana 2020; MacClean et al. 2020).

Looking at this in practice, placement at Masy Consultants sees girls and young women disproportionately absent from school and dropping out of school (Haver et al. 2013). The students have expressed inability and fear of managing menstruation at school, so when they notice they are menstruating they will not attend school or go home to manage in secrecy (Haver at al 2013). When we think about this in its entirety, if a girl is unable to attend school when she is menstruating, she is missing a significant portion of education, which thus impacts her achievements and learning at school, resulting in less opportunities upon graduation, thus in entering the workforce at a disadvantage. In interpreting the human right to education it’s understood that schools are to be an enabling environment in which the ability to manage Menstrual Health isn’t compromising any further opportunities for the menstruating person (HRW 2017; Wardana 2020; Hennegan 2017).

The human right to work

A component of the human right to work is that the conditions of where work takes place are safe and healthy, whether work is in the formal or informal sector (HRW 2017). The Committee on Economics, Social and Cultural Rights specifically highlights that a workplace is an enabling environment that meets specific hygiene needs for women (Wardana 2020).

When considering Menstrual Health through the human rights lens, this sees a requirement of the workplace and the state to meet the obligation in provision of adequate private, safe, and hygienic facilities to that Menstrual Health isn’t a barrier in realising the human right to work (Wardana 2020; Wrinkler & Roaf 2015). Where these working conditions are not available, there is potential health and other vulnerabilities at risk whilst the menstruating person is at work, or alternatively that person may be absent from work during menstruating time (HRW 2017). This highlights the systemic gender inequalities and harmful discrimination those that menstruate are subjected to in the workplace (Wardana 2020, HRW 2017).

The human right to non-discrimination and gender equality Foundational to all human rights law is the principles of non-discrimination and equality, including gender equality (HRW 2017; Wrinkler & Roaf 2015). This necessitates appropriate measures to be taken to address structural inequalities that disproportionately impact women and girls (Wrinkler & Roaf 2015). Equality doesn’t equate to ‘same’, therefore enabling such equality recognises that those menstruating will require differences in treatment to meet the differences in biological needs, and therefore a clear transformation in the stigma surrounding menstruation (Mahon et al. 2017; Wrinkler & Roaf 2015). There needs to be a response to the shame, taboo, and silence of Menstrual Health as something that is perceived to resemble inferiority, as it only entrenches existing gender inequalities and discriminatory practices and reinforces the patriarchal norms (Wrinkler & Roaf 2015; HRW 2017; MacClean et al 2020).

(UN Women 2019)

The need to address Menstrual Health to ensure the right to equality is attained is evidenced in the workshop developed with Masy Consultants on placement. A common cultural practice in the Philippines sees the menstruating person prohibited from bathing for the first three days of their menstruation (Haver et al. 2013). Whilst this practice is deeply rooted in cultural and societal beliefs in the Philippines, it places a restriction on girls and women from accessing their right to water and sanitation and right to health (Haver et al. 2013). This restriction reinforces the inequalities that those menstruating experiencing, and additionally subjects them to further discrimination when they are experiencing odour and hygiene challenges as a result (Haver et al. 2013). This has contributed to the girls not wanting to attend school currently, with the fear of the odour, compromising their right to education, consequently impacting opportunities for their future (Haver et al. 2013). A complex area, in which cultural practices are to be respected, yet balanced with equal opportunity for the menstruating person.

Implications for Social Work Practice

The Global Social Work statement of ethical principles sees the profession as one committed to promoting human rights and social justice, recognising the dignity of all human beings, challenging systematic discrimination and injustice policies, and advocating for equitable distribution of resources (IFSW 2018). Accordingly, social workers are well placed to implement and practise through said human rights framework to achieve universal Menstrual Health. The following discussion will outline some of the interventions and programs around the world that have employed the rhetoric of human rights to attain Menstrual Health.

Policy

Dismantling the menstrual taboo requires action at a policy level to addresses systemic barriers that inhibit the menstruating person's ability to participate in all spheres of life (Wardana 2020, Gottlieb 2020). Notable changes in the policy domain to date include policies guiding reduction or elimination of the financial costs of menstrual products (Connolly 2020). Countries around the world have demonstrated commitment to eliminating this barrier by de-taxing menstrual products, such as Kenya in 2004, Canada in 2015, India, Malaysia, and Australia in 2015 (Bobel 2020, p. 2). Scotland leads this policy change, by firstly making period products free to schools, universities, and colleges in 2018, only to follow shortly after in 2020 making period products free to all (Connolly 2020). This policy change ensures that people menstruating have their dignity protected by guaranteeing readily available products are not one of the barriers to Menstrual Health. Social work ethical principles see a respect and defence of human rights and are encouraged to challenge unjust policies, utilising their knowledge, skills, and ability to influence the political landscape (IFSW 2018).

(Escobar 2020)

Gender Equality

Involving boys and men in the education and information regarding the normal biological menstruation process is critical in dismantling the existing gender inequalities. A project was conducted in India with close to a 1000 boys and men from 66 villages, who were educated to enact the role of guardians in supporting female members in their family, as teachers in schools to disseminate sanitation and hygiene information and materials, and as community members to challenge menstrual taboo and stigma (Mahon et al 2015). The project purpose saw an initial reluctance from boys and men to engage in these roles, however through recurring meetings and communication, the attitudes significantly changed (Mahon et al 2015). The impacts of this project shifted boys and men's perception of menstruation, invoking a sense of confidence and restored dignity for the previously shamed experience of the menstruating person (Mahon et al 2015). Additionally, challenging the menstrual taboo and stigma, facilitated a reduction in gender inequalities and public exclusion (Mahon et al 2015). Social work principles recognise that collective responsibility must sit alongside human rights, meaning that a reciprocal relationship within the existing community must be established to realise human rights (IFSW 2018). Therefore, prioritising this inclusive approach to Menstrual Health, where all genders are engaged as participants, is essential to ensuring that discrimination and gender equality isn't a barrier in achieving Menstrual Health.

(Corcione 2018)

Education

Comprehensive education on how to manage menstruation is critical in enabling the capacity to manage menstruation safely and a tool to challenge the stigma that frequents menstruation. Education complements the provision of products to support Menstrual Health, and the access to sanitation as it provides the knowledge to be able to utilise such hardware (Wrinkler & Roaf 2015). An educational intervention in Ghana in 2012 demonstrated the positive impact of combining menstrual products with menstrual education on school attendance and the mindset towards menstruation (Montgomery et al. 2012). The study sampled 120 girls from four villages in Ghana to engage in a trial assessing the correlations between products and education, concluding in increased school attendance after provision of sanitary items combined with education, and even upon when education was provided in silo (Montgomery et al. 2012). Education is identified as a force to challenge stigma, shame and the perceptions of menstruation and has deeper impacts on the sustainable outcomes to achieve Menstrual Health (Wrinkler & Roaf 2015). Ethical principles of social work see practitioners in support of people accessing this right to education and recognise the role duty-bearers must fulfil that Menstrual Health education is integrated in a comprehensive manner (IFSW 2018). Social workers are to embody the role as mediators within the integrative process, negotiating a balance of cultural sensitivity and the inherent right to quality and holistic Menstrual Health education (Connolly 2020, IFSW 2018).

(Khan 2022)

Limitations

Reiterating that it was only in 2014 Menstrual Health was framed as a human rights issue by the United Nations, highlighting its emergence as an identified barrier to realising human rights (Zivi 2020, Wardana 2020). This framework is identified as being under-researched and one that warrants an evidence-based approach to best understand and address systemic barriers and evaluate appropriate interventions (Hennegan 2017). The case for increased evidence-based approaches will better position policy makers, governments, and organisations to match investments in Menstrual Health when framed fundamental to human rights (Hennegan 2017).

It is estimated that 1.9 billion people menstruate globally, and currently 500 million are unable to achieve menstrual health (Babbar et al. 2022). I am left with the recurring thought that with so many people impacted and if the rhetoric of human rights provides individuals and organisations with a clear invocation of such injustices, could it be time that Menstrual Health is recognised as an explicit human right?

(Menstrual Hygiene Day 2022)

Conclusion

The sustained silence of menstruation in the public and private sphere has significant impacts on people that menstruate to achieve not only Menstrual Health but their human rights (Wardana 2020, Wrinkler & Roaf 2015). Framing Menstrual Health through the lens of human rights increases its public visibility and positions it as a priority that requires strategy, solution, and response (Wrinkler and Roaf 2015). Social work principles see practitioners as Menstrual Health allies and advocates in dismantling shame and secrecy that frequents the menstruation taboo, so people that menstruate are confident that they will have dignified Menstrual Health and attain their human rights. As Menstrual Health continues to receive attention across the globe, so too should its inextricable link to human rights, it plays an all too important role in the lives of billions of people, menstruation has, does, and will always matter.

(The Homeless Period 2022)

---

References

Babbar, K., Martin, J., Ruize, J., Parray, A.A. and Sommer, M. (2022) ‘Menstrual health is a public health and human rights issue’, The Lancet. Public Health 7(1): 10-11.

Bobel, C. (2020) ‘Introduction: Menstruation as Lens - Menstruation as Opportunity’, in C Bobel, I T Winkler, B Fahs, K A Hasson, E A Kissling & TA Roberts (eds) The Palgrave Handbook of Critical Menstruation Studies, Singapore: Palgrave Macmillan, 1-8.

Clue (2016) Top euphemisms for ‘period’ by language, available at https://helloclue.com/articles/culture/top-euphemisms-for-period-by-language, [accessed on 24 September 2022].

Connolly, H. (2020) ‘Menstruation Matters: The impact of menstruation on wellbeing, participation and school attendance’, Project Report no. 21, Commissioner for Children and Young People, South Australia.

Corcione, A. (2018) How to Use Gender-Neutral Words, available at http://teenvogue.com/story/how-to-use-gender-netural-words, [accessed on 27 October 2022].

Escobar, A. (2020) De-stigmatizing Periods and Ending Period Poverty, available at http://www.thequakercampus.org/opinions/period-poverty/, [accessed on 27 October 2022].

Global Health, Maternal Health and Reproductive Health, Public Health Education (2021) Columbia Mailman Launches Free Course on the Global Menstrual Movement, available at http://publichealth.columbia.edu/public-health-now/news/columbia-mailman-launches-free-course-global-menstrual-movement, [accessed on 27 October 2022].

Gottlieb, A. (2020) ‘Menstrual Taboos: Moving Beyond the Curse’, in C Bobel, I T Winkler, B Fahs, K A Hasson, E A Kissling & TA Roberts (eds), The Palgrave Handbook of Critical Menstruation Studies, Singapore: Palgrave Macmillan, 143-61.

Gunther, E. (2021) How did menstruation become taboo?, available at http://www.helloclue.com/articles/culture/how-did-menstruation-become-taboo.

Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes K.L, Freeman, C.F (2013) ‘WASH in Schools Empowers Girls: Education in Masbate Province and Metro Manila, Philippines: An assessment of menstrual hygiene management in schools’, UNICEF, New York.

Hennegan, J., Winkler, I.T., Bobel, C., Keiser, D., Hampton, J., Larsson, G., Chandra-Mouli, V., Plesons, M. and Mahon, T (2021) ‘Menstrual Health: a definition for policy, practice and research’, Sexual and Reproductive Health Matters, 29: 31-38.

Hennegan, J. (2017) ‘Menstrual Hygiene Management and Human Rights: The Case for an Evidence-Based Approach’, Women’s Reproductive Health, 4(3) 212-231.

Human Rights Watch and WASH united (HRW) (2017) ‘Understanding Menstrual Hygiene Management and Human Rights’, United States: Human Rights Watch.

International Federation of Social Workers (IFSW) (2018) Global Social Work Statement of Ethical Principles, available at https://www.ifsw.org/global-social-work-statement-of-ethical-principles/, [accessed on 25 September 2022].

Maclean, K., Hearle, C. and Ruwanpura, K.N. (2020) ‘Stigma of staining? Negotiating menstrual taboos amongst young women in Kenya’, Women’s Studies International Forum 78(4) 1-10.

Mahon, T., Tripathy, A. and Singh, N. (2015) ‘Putting the men in menstruation: the role of men and boys in community menstrual hygiene management’, Waterlines 34 (1) 7-14.

Menstrual Hygiene Day (2022) About: Menstrual Hygiene Day: Making Menstruation a normal fact of life by 2030, available at http://www.menstrualhygieneday.org, [accessed on 27 October 2022].

Sawo, M.B. (2020) ‘Personal Narrative: Let Girls be Girls - My Journey into Forced Womanhood’, in C Bobel, I T Winkler, B Fahs, K A Hasson, E A Kissling & TA Roberts (eds), The Palgrave Handbook of Critical Menstruation Studies, Singapore: Palgrave Macmillan 93-98.

Wardana, K.A. (2020) ‘Human Rights Framework on Menstrual Health and Hygiene’, Advances in Economics, Business and Management Research, 140: 140-146.

Khan, M.M (2022) Menstrual Health and Hygiene: What role can schools play?, available at http://www.blogs.worldbank.org/education/menstrual-health-and-hygiene-what-role-can-schools-play, [accessed on 27 October 2022].

Wrinkler, I.T. and Roaf, V. (2015) ‘Taking the Bloody Linen out of the Closet- Menstrual Hygiene as a Priority for Achieving Gender Equality’, Cardozo Journal of Law and Gender, 21: 1-37.

The Homeless Period (2022) ‘Free Period Products in in NI Schools’, available at https://my.uplift.ie/petitions/free-period-products-in-ni-schools-menstruationmatters, [accessed 27 October 2022].

United Nations (UN) (2022) Universal Declaration of Human Rights, available at https://www.un.org/en/about-us/universal-declaration-of-human-rights, [accessed on 24 September 2022].

United Nations (UN) (2022) Do you know all 17 SDGs?, available at http://www.sdgs.un.org/goals, [accessed 27 October 2022].

United Nations Women (2019) Infographic: End the stigma. Period., available at http://www.unwomen.org/en/digital-library/multimedia/2019/10/infographic-periods, [accessed on 27 October 2022].

Zivi, K. (2020) ‘Hiding in Public or Going with the Flow: Human Rights, Human Dignity, and the Movement for Menstrual Equality’, Human Rights Quarterly, 42(1) 119-144.