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Abstract
Women's use of water differs from men in essentially one aspect: in cleansing the body of menstrual blood. The pledge of the water, sanitation and hygiene (WASH) sector to place ‘women at the centre’ of development has in recent years, therefore, come to focus on menstruation. International development agencies have begun to push the agenda of menstrual hygiene management (MHM), but their use of a medical approach requires critical rethinking. This article argues that through MHM lessons, menstruation is medicalised to construct new and repressive expectations of normality for the female body. A medical construction also poorly accommodates the natural biological process of menstruation within the gamut of existing sociocultural practices. Consequently, menstruation becomes associated with the perceived need for not only sanitisation of the female body of the rural poor, but also to turn it into a working body that is able to ceaselessly and ‘normally’ perform its productive and reproductive chores. I note that the success of medicalisation relies upon the separation of the body from its purported waste, the menstrual blood. Once menstruation is confined to a pathological condition, treatable only by public agents such as doctors and commercially produced goods such as sanitary napkins, a defining essence of womanhood is thereby dissociated from the female body.
Medicalizar la menstruación: una crítica feminista de la economía política de la gestión de la higiene menstrual en Asia del Sur
El uso del agua de las mujeres difiere del de los hombres esencialmente en un aspecto: en la limpieza del cuerpo de la sangre menstrual. El compromiso del sector del agua, sanidad e higiene (ASH) por poner a la “mujeres en el centro” del desarrollo se ha centrado, en los últimos años, por lo tanto, en la menstruación. Las agencias de desarrollo internacional han comenzado a impulsar la agenda de la gestión de la higiene menstrual (GHM), pero su utilización de un enfoque médico requiere ser repensado críticamente. Este artículo sostiene que a través de clases de GHM, la menstruación es medicalizada para construir nuevas, represivas expectativas de normalidad para el cuerpo femenino. Una construcción médica tampoco se ajusta a los procesos biológicos naturales de la menstruación dentro de la gama de las prácticas socioculturales existentes. En consecuencia, la menstruación se vuelve asociada con la necesidad percibida de una sanitización del cuerpo femenino de las mujeres pobres rurales, pero también para convertirlo en un cuerpo trabajador que es capaz de desempeñar sus tareas productivas y reproductivas sin parar y “normalmente”. Destaco que el éxito de la medicalización se basa en la separación del cuerpo de su supuesto desecho, la sangre menstrual. Una vez que la menstruación es confinada a la condición patológica, tratable sólo por los agentes públicos tales como doctores y bienes producidos comercialmente tales como toallas femeninas, una esencia definitoria de la mujer es así disociada del cuerpo de la mujer.
将月事医疗化：南亚的月事卫生管理政治经济学之女性主义批判
女性用水在某一方面与男性有本质上的不同：女性用水清洗月事来潮的身体。因此，水、灌洗与卫生（WASH）部门将“女性置于核心”的发展保证，在近年来开始聚焦女性月事。国际发展组织已开始推动月事卫生管理（MHM）议程，但它们所使用的医疗方法，却需受到批判性的再思考。本文主张，透过MHM的课程，月事被医疗化，用以建构对女性身体的崭新且压迫性的期待之规范。医疗建构亦拙劣地在既存的所有社会文化实践中考量月事的自然生理过程。在穷困的乡村中，月事因而被认为关乎需要淨化的女性身体，但同时将其转化为能够不断且“常态性地”从事其生产与再生产家务的工作身体。我指出，医疗化的成功，仰赖将身体从其所据称的废弃物分离开来——亦即月事的经血。一旦月事被限定于病理状态、并仅可由诸如医生等公共代理人和卫生棉等商业产品加以治疗之时，女性的关键本质便因而从女性的身体被分离开来。
Acknowledgements
I wish to express my gratitude to Dr Aparna Nair for undertaking the initial literature survey, and to Professor James Fox, Dr Colin Filer, Dr Zoe Sofoulis, Dr Margreet Zwarteveen, Dr Deepa Joshi and Professor Elizabeth Kissling for their constructive comments on this paper. Versions of the paper (‘The secret river made public: Waste-ing menstrual blood’) were presented at the ‘Tapping the Turn: Water's Social Dimensions’ conference in 2012 and in the ‘The “Back End” of Consumption: Anthropological Perspectives on Economies of Waste’ panel session at the Australian Anthropological Society's 2013 Annual Conference at The Australian National University, and the paper has benefited from the rich comments from the audience in these two sessions. Comments from two anonymous reviewers were also helpful.
Notes
1. This has a reference to Maggie Black and Ben Fawcett's 2008 book, titled The Last Taboo: Opening the Door on the Global Sanitation Crisis (Routledge).
2. Here, I thank the GWA for giving me the opportunity of listening to various world experts and international academics, and for funding the GWA Training of Trainers programmes in which I acted as a resource person.
3. Given my complex identity arising out of my current location outside of India, I would like to emphasise that the article is neither a product of the feeling of moral superiority, nor judgemental. I have spent much time in rural India, and have used ‘the field’ with other rural women for the purposes used by them. I have written about gender issues in services, and acknowledge here some of the real difficulties that women experience in these conditions.
4. For contemporary menstrual activism, see Cochrane (Citation2009), Bobel (Citation2010), as well as multimedia presentations – Giovanna Chesler (dir.) (2006), Period? The End of Menstruation (film), see http://www.periodthemovie.com (accessed April 12, 2013), Ingrid Berton-Moine (2009), Red is the Colour (art exhibition), http://www.map2009.co.uk/Ingrid_Berthon-Moine/ (accessed December 11, 2011) and Elissa Stein and Susan Kim (2009), Flow: The Cultural Story of Menstruation, St Martin's Griffin, New York (popular culture book).
5. Lifetime incidence of menstruation has increased dramatically. Women today experience an average of 400 episodes of menstruation, contrasted with the nineteenth- and twentieth-century average of 150. This is due to falling fertility rates, fewer pregnancies, earlier onset of menarche, later menopause and changes in breastfeeding duration (Coutinho and Segal Citation1999).
6. Some international donors even connect the incidence of rape and other forms of physical aggression on women with the lack of toilets.
7. Such as the ‘menstruation sash from Tiaxcala, Mexico’, the photograph of which was published in Man to illustrate ‘the more personal aspects of female life’ that ‘are not known in the literature primarily because it is difficult for male investigators to gather information on such subjects’ (Schwerin and Schwerin Citation1961).
8. Dasgupta and Sarkar's Citation2008 West Bengal study of menstrual hygiene revealed that 97% of girls did not know the source of menstrual blood, although most understood it was a normal physiological process. These reports, without a reference to cultural attitudes, tend to contest each other's findings. Some young college students in India are reportedly less prepared than their American counterparts, although, unlike Americans, Indian women considered it a natural, intrinsic part of womanhood (Hoerster, Chrisler, and Rose Citation2003).
9. Although, in rare instances, grass-roots-level self-help groups have been mobilised to help to make cheap pads from absorbent material for local use.
10. The video is available here: http://youtu.be/UxEQvvgJb_M (accessed March 28, 2013).
11. See the call for funding proposals at: http://www.wsscc.org/resources/resource-news-archive/request-proposals-effects-poor-sanitation-women-and-girls-india (accessed March 28, 2013).
12. Yamson (Citationn.d.) suggests pads are a silent health threat.
Additional information
Notes on contributors
Kuntala Lahiri-Dutt
Kuntala Lahiri-Dutt is a Senior Fellow at the Resource, Environment and Development group at the Crawford School of Public Policy, College of Asia and the Pacific, The Australian National University.