‘We like things tangible:’ A critical analysis of menstrual hygiene and health policy-making in India, Kenya, Senegal and the United States

ABSTRACT

Over the last decade, many countries have adopted policies addressing menstrual needs. Our research explores the opportunities and challenges that have shaped these initiatives and critically examines their scope and substantive focus. Our study analyses developments in four countries: India, Kenya, Senegal, and the United States. It is based on an analysis of 34 policy documents and interviews with 85 participants active in policy-making or advocacy. Across countries, we found a predominant policy focus on tangible and material outcomes, such as menstrual products and facilities, that is informed by a narrow perception of menstrual needs as the management of bleeding. A number of drivers influenced policy-makers to keep this focus, especially the key narrative around menstrual pads as a perceived solution to school absenteeism combined with sensationalisation in the media and the quest for quantifiable results. Menstrual stigma is so ingrained that it continues to constrain policy-makers and advocates themselves by perceiving and presenting menstruation as a problem to be fixed, managed, and hidden. When considering new policy directions, we need to create capacity for a holistic menstrual policy landscape that overcomes systemic barriers to addressing the needs of menstruators that are largely rooted in menstrual stigma.

KEYWORDS:

• Menstrual health
• menstrual hygiene
• WASH
• menstrual stigma
• policy-making
• menstruation

Acknowledgements

We thank the project’s Advisory Group which supported us throughout the research process in four countries and provided feedback on preliminary results. Neville Okwaro, Caroline Kabiru, Alex Manyasi, Arundati Muralidharan, Vinod Mishra, Santosh Mehrotra and Mbarou Gassama Mbaye were instrumental in connecting us with interviewees. Rockaya Aidara (formerly with the Water Supply and Sanitation Collaborative Council) set the spark for this project and provided guidance throughout the process. We are also grateful to the Working Group on Menstrual Health & Gender Justice at the Center for the Study of Social Difference at Columbia University, in particular Chris Bobel, Marni Sommer, Adrienne Pichon, Nancy Reame, as well as Virginia Roaf and Margaret Johnson for their thoughtful comments on earlier drafts, to Mary M. Olson and Elina Govil for their research assistance, and to Perri Schenker for her excellent editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the UN Water Supply and Sanitation Collaborative Council under Grant number GSA/ Q4 WSSCC/WP01/2019/66 as well as the Laidlaw Foundation.