Seeing the colour red: Menstruation in global body politics

ABSTRACT

In this article, we set out how menstrual activism is emerging as a novel strand in global feminist health demands that challenge the norms and practices which condone and institutionalise gender inequalities. Menstruation has moved from being understood principally as a biological function, invisible in the public sphere, to a vibrant form of global body politics with a flourishing set of diverse practices. We examine how menstruation has been brought to global attention in two ways: one through a global development discourse that promotes menstrual health by improving hygiene and the sanitary infrastructure in the Global South; and two through the upswell of feminist groups involved in menstrual activism around the world. The article is a contribution to moving closer towards productive alliances between these two strands as together they contribute to important changes in menstrual health and sexual rights.

KEYWORDS:

• Body politics
• menstrual hygiene management
• water sanitation and hygiene
• menstrual activism
• sexual and reproductive health and rights

1. Introduction

In the last few years, the importance of menstruation in determining women’s health and social well-being has become well-recognised in global public health politics. This hitherto silent form of gender inequity is breaking through social and cultural taboos in numerous ways. A few telling examples: US Cosmopolitan Magazine declared 2015 year of the period. The 28th of May is now annual Menstrual Hygiene Day. Academics offer courses on menstrual studies. Women’s movements demand that menstruating women can enter places of worship in India. Athletes practice free bleeding in London. Funders channel development aid money into menstrual products to reach young girls in different parts of the Global South as integral to their gender empowerment programmes (Bobel, 2019). In short, menstrual activism involves literally millions of menstruators around the world in activities that range from advocacy in the UN and public health centres to protest via social media and contemporary art galleries to everyday practices or micro-politics. As we illustrate in this article, menstruation has moved from being understood principally as a biological function, invisible in the public sphere, to a vibrant form of global body politics through a flourishing set of diverse practices.

In this article, we examine how menstruation challenges the norms and practices which condone and institutionalise gender inequalities by looking at the global development discourse that promotes menstrual health by improving hygiene and the sanitary infrastructure in the Global South (Gaybor, 2020); and the upswell of feminist groups involved in menstrual activism around the world (McCarthy & Lahiri-Dutt, 2020). From theoretical, policy and political dimensions, we explore some of the overlaps and the existing tensions and how these could become productive.

Our discussion begins by querying the propositions put forward by Bobel and Fahs (2020, p. 958) in their recent article in Signs. Their article calls for ‘a new vision of menstrual activism that prioritizes […] radical menstrual embodiment’. They are critical of a ‘Band-Aid approach to solving menstrual stigma’ through ‘respectability politics’ (Bobel & Fahs, 2020, p. 957) that has mainstreamed menstrual activism into global public health accompanied by a ‘hypervisibility of menstrual products’ (Bobel & Fahs, 2020, p. 957). They argue that professionals working in the water, sanitation, and hygiene (WASH) sector of development have transformed (pinkwashed) menstrual activism into menstrual hygiene management (MHM), garnering unprecedented media, funding, and policy interest (Bobel & Fahs, 2020, p. 961). This, they suggest, culminated in 2018 when the UN’s Commission on the Status of Women (2018) stated the world governments must ‘take steps to promote educational and health practices to foster a culture in which menstruation is recognized as healthy and natural and in which girls are not stigmatized on this basis’. And, according to Bobel and Fahs: ‘These words formally put menstrual health on the map as a matter of gender equality on a global scale’ (Bobel & Fahs, 2020, p. 961). Such appropriation of menstrual activism, they argue, failed to ‘take up the gendered, raced, and classed social construction of embodiment that sets in motion cultural discomfort with the menstruating body’ (Bobel & Fahs, 2020, p. 959). And shows how ‘menstrual activism is vulnerable to capitalist exploitation and becomes yet another reinscription of gender norms’ (Bobel & Fahs, 2020, p. 959).

We begin with Bobel and colleagues because they established critical menstrual studies (see Bobel et al., 2020). Bobel (2008, 2010) has conducted considerable research on menstrual activism in North America. Bobel (2007, p. 2008) coined the gender-neutral term menstruator to recognise that not only women menstruate, challenging a normative understanding of sexual difference (Guilló-Arakistain, 2020, p. 874). Bobel’s helped make visible a critical framing of menstruation in global health and reproductive justice debates. Their work shows how important it is to take menstruation out of a medicalized framing in order to conceptualise it as a gendered public health concern. This requires framing menstruation not only in terms of a biological and technical knowledge but also in terms of how culture, social and emotional meanings shape the menstrual experience (Guilló-Arakistain, 2020, p. 967).

We agree with Bobel and Fahs (2020) that it is crucial to consider intersectional feminist goals in relation to menstruation, but we take a more positive view than they do of menstrual activism. We argue that it is important to see where WASH and menstrual activism overlap but not to conflate the two. Menstrual activism emerges from diverse feminist practices. WASH is a sector with an institutional strategy that brings menstrual health and hygiene into development practice and policy and research arenas. Both are valid and needed. We disagree that menstrual activists (MAs) have adopted an ‘anemic view of menstruation that is fixated on sanitizing the menstrual experience, avoiding the root causes of stigma, and eschewing radical activist politics in favor of changing the system from within’ (Bobel & Fahs, 2020, p. 959). We argue instead that menstrual activism is alive and well, building on decades of advocacy from NGOs and a growing movement work (see Sommer et al., 2015, pp. 1306–1307). The strategic choice of MAs to work from within WASH and specifically development policy, via the ‘politics of respectability’ (Sommer et al., 2015, p. 959) is just one-way feminist health advocates have brought public attention to menstruation through funded projects (with its attendant concerns we address below). The strategies of WASH and menstrual activism both have their place as two intertwined trends in global body politics – the transnational political struggle of people to claim control over their felt and lived biological, social, and cultural embodied experiences (Harcourt, 2009).

Our article looks at these trends in the following way. First, as critical development scholars we unpack some assumptions around menstrual health and stigma in the development policy context of WASH. While we recognise that WASH is shaped by racialized development practices, white Western privilege and inequality, WASH, is nevertheless a key vehicle to bring menstruation into global body politics. Operating in an institutional environment WASH strategies necessarily differ from what Bobel and Fahs call ‘radical menstrual embodiment’. Secondly, we aim to nuance the argument by Bobel and Fahs (2020) that menstrual activism has been co-opted. We argue that activist concerns around menstrual products having environmental and fiscal impacts on public health are important part of menstrual activism. The focus of MAs on ensuring environmentally sound and user-friendly products are critical for public health, menstruator’s health and bodies. This form of activism takes into account not only sexism and gender discrimination but also class privilege and a broader concern about the wellbeing of people and the planet. Such goals, we show, do not ‘trivialize menstrual activism and lessen its potential political impact’ (Bobel & Fahs, 2020, p. 971).

Our guiding question is: ‘how does menstruation play out in global body politics?’ We address this question by presenting: a short description of global body politics in development policy; our collaboration and methods; a discussion of WASH in global development discourse and practice and menstrual activism in the Global North and South; an exploration of the tensions; and a brief conclusion on the implications for global health policy.

2. Global body politics in development

Global body politics is a fraught and at times risky politics, as it intentionally brings what is intimate, private and personal to the public sphere in order to claim rights for the body (Harcourt, 2009). Global body politics unsettles the gender social order by disrupting codes of how women (and gendered others) are expected to behave, breaking taboos that have led to impunity towards what are seen as ‘deviant’ bodies. Global body politics, which is place based and context specific, brings together the struggles and demands of marginal groups globally ranging from protests against feminicide, rape and sexual harassment, to rights of abortion, freedom of sexual choice, access to contraception. Underlying these demands is a refusal of the dominant gender order that informs economic, social and culture discourses including the biomedical understanding of bodies in medicine, health and sanitation (Fausto-Sterling, 2000; Laquer, 1990). In relation to global public health, body politics seeks to unpack the gender bias of western medicine which reduces ‘women’s health’ to their sexual and reproductive cycle, disregarding the gender perspective of illnesses while at the same time ignoring social inequalities which determine access to health (Guilló-Arakistain, 2020, pp. 878–879).

Global body politics in development policy settings was established in the 1990s when feminist advocates became involved in global public health at the UN level. Transnational feminists engaged in the struggles around gender equality, Sexual and Reproductive Health and Rights (SRHR) in gender and development in processes leading to the 1990s series of UN conferences (Harcourt, 2009; Petchesky, 2003). Feminist health advocates brought the demands of national and regional movements to the global level, challenging the deeply embedded power relations that underlined health inequities (Sandler, 2015). In a fluid process of coalitions feminist advocates demanded an end to systematic exclusion and marginalisation of people based on gender power relations that put the collective interests of privileged men and boys over those of other genders (Baksh & Harcourt, 2015). They brought to the UN arena body political concerns such as intimate partner violence, rape as a weapon of war; denial of SRHR; sexual oppression; the need for global access to health and an end to discrimination based on race, ageism and ableism. In this vigorous and concerted effort of global body politics, feminist advocates made visible how racialized and gendered the process of public health is in global political discourses (Desai, 2015).

Since the 1990s, feminist advocates for global body politics, both inside and outside public health institutions, have continued to open up spaces for gender equality, SRHR and intersectional justice. Though some of this advocacy has been necessarily institutionalised and the radicalism in UN corridors is not the same as on the streets, bringing feminists concerns around, gender, bodies, race, to formal global health policy arenas has been key to public acceptance, legal support and resources for women’s health. This global advocacy work enabled the current challenge to the stigma and restrictions associated with menstruation. Following feminist health activists who fought to put SRHR at the centre of the population debate in the 1990s (Harcourt, 2009) MAs were able to adopt similar strategies building on those networks and to create their own to transform social and cultural taboos with respect to menstruation. Recent studies of menstrual health document how menstrual activism is bringing menstruation into the framework of sexual and reproductive health and rights as advocates challenge discrimination and violence and argue for menstrual health as a human right including the right to dignity and autonomy (McLaren & Padhee, 2021, p. 133; Sommer et al., 2015, p. 1306).

3. Collaboration and methods

3.1. Positionality

Our engagement in menstrual activism, including the writing of this article, belong to the collective histories of feminist exchange around policy and research on body politics as feminists have looked at the body in terms of subjectivity, corporeality and identity as they opened up questions around rights over one’s body and questioned violation of such rights. We reflect on and document how global body politics plays out in the bodies and lives of those who menstruate by looking at contestations of power and knowledge in collective protest, individual embodied resistance, and research strategies. The writing of this article is shaped by our shared experiences of self-reflection and collaboration around menstruation as a difficult topic to bring into academe and the public arena.

As feminists we consider it important to be clear how our feminism shaped our research including our relationship, as teacher, student, researchers, and activists. These lived shared experiences determined how we conducted the research and enabled the dialogues about our embodied self-reflections on menstruation which inform this article.¹ In this section what we want to set out is how our shared embodied experience as feminists concerned to end stigma around menstruation was harnessed in not only our earlier writing but also as activists, teachers, and researchers.

Our research builds on two years of face-to-face qualitative interviews conducted in Argentina and Ecuador and five years of online and phone interviews from 2015 to 2020. In total 70 interviews were conducted with MAs, social businesses and menstrual pad corporations working on the broad field of menstrual health in the Americas, South-Asia and Europe. Although we do not discuss these interviews in this article, they have been our point of reference in the process of conducting the literature review. Drawing on these interviews and extensive field notes, we identified which issues and discussions recurred both within and across MAs, social enterprises,² UN agencies,³ (I)NGOs,⁴ scientific publications, and the private sector from 2015 to 2021.

Therefore, the core of the article builds on the critical analysis of existing grey and scientific literature⁵ on MHM and menstrual activism compiled between 2015 and 2020 during Jacqueline’s PhD and 2021 over the course of writing this article. As a method for data analysis, we categorise the data by dividing them into different debates within the 2015–2021 timeframe: WASH perspectives and development initiatives around menstrual health; menstruation in global body politics in relation to SRHR advocacy and environmental activism; private and public funding on menstruation and; menstruation and women’s empowerment in development literature. Our literature review is complemented with a historical-comparative approaches of body politics between the 1990s, 2000s and 2010s.

For this article, we used self-reflection as the primary method based on our experiences as advocates and researchers in the field and engagement in the recent debates on menstrual activism and global body politics. This feminist methodology approach makes visible the processes and lived experience of researchers and advocates. Feminists do research ‘otherwise’ as they go beyond traditional academic notions of what is valid scientific knowledge. Following feminist practice and commitment we refer openly to our personal, emotional and political ideas that inform our research. We set out the lived experience of how we collaborated by drawing out what connected us intellectually, emotionally, and politically.⁶

In addition, our article emerges from our engagement as feminist researchers working on body politics, global public health, international development, and menstrual activism. We collaborated first in a supervisor/student role, which evolved into collaborators in different feminist research and teaching projects. The article is based on these conversations around Jacqueline’s PhD research, our joint writing, on-going readings and discussions on menstrual activism and global body politics over the last six years.

Wendy comes from Australia and Jacqueline from Ecuador. When we were writing the article, we were both employed at the International Institute of Social Studies of Erasmus University Rotterdam in The Netherlands. This institute, with its colonial history as well as its critical development teaching and research, forms the back drop to our discussions and our singular and joint encounters with how menstrual activism and the role of WASH are emerging as a subject in critical development studies. We discussed the racialisation of development practice (including our own privileged positionality) and the difficulty of bringing feminist questions of embodied self to knowledge that is couched as disembodied and neutral expertise. In the context of an international community, we also found it important to reflect on our teaching and learning from the lectures and debates we conducted.

We also learnt from recognising the ways academic discourse is shaped by activism but also how difficult it was to bring menstruation into research and activism. We supported each other’s discomfort as we thought through privilege in relation to gender, race and geographical positioning.

Right up to her public defense Jacqueline had to deal with very strong audience responses to the taboos she was breaking in speaking about menstruation as something to be studied in the development context. Her talks and lectures evoked interested surprise and puzzlement to outright disgust.

Wendy has been involved in global body politics since the 1980s as a feminist activist first as a feminist advocate sexual and reproductive health and rights in Australia and then transnationally in UN and European advocacy spaces. She recognised in the public response to Jacqueline’s talks similar patterns of acceptance/non acceptance in her own engagement and writing as a feminist advocate in global contexts around the issue of sexual and reproductive health and rights.

4. WASH in global development

Historically, the WASH sector has focused on preventative health care programmes which have been related to the provision of water and improve sanitation to reduce the spread of disease⁷ (Engel & Susilo, 2014). WASH efforts have centred on the improvement of infrastructure and service coverage (Engel & Susilo, 2014). WASH literature has been mostly located in technical fields such as engineering or medicine. WASH has been traditionally perceived as a male-dominated sector with feminist researchers pointing to a biased western masculine thinking (Lahiri-Dutt, 2015). WASH language ‘has long been one of taps, toilets, and soap, with people absent from the conversation’ (Patkar, 2020, p. 486).

WASH’s engagement with gender in the 2000/2010s in its research and practice can be ascribed to four main reasons (MacArthur et al., 2020). First, the recognition of the biological challenges women and girls face in relation to water and sanitation, including menstruation, and pregnancy. Second, the acknowledgment of the gendered roles and distribution of household responsibilities including water fetching, cleaning, and cooking. Third, WASH sees a gender-focused approach as useful overall for sustainable development, including improved health and economic livelihoods. Fourth, its pursuit of gender equality fits well the Sustainable Development Goals (SDGs), specially target 6.2. Moving from the masculine focus on infrastructure, with this discourse WASH now, in the name of gender equality, asks for particular attention for girls and women in schools and health facilities (Fisher et al., 2017).

In the 2010s, the WASH sector took up MHM as a public health concern and as a domain of scholarship and interventions. Bharadwaj and Patkar (2004) was seminal in the growing interest on MHM in WASH. From 2008-2018, MHM emerged as a clear trend in the literature. After water (60%), MHM (16%) became the second major research focus area, followed by sanitation (15%) (MacArthur et al., 2020). MHM was largely developed by scholars and practitioners from or based in the Global North focusing on the Global South predominantly in Sub-Saharan Africa and South Asia (Dasgupta & Sarkar, 2008). In MHM literature, menstruation is perceived mostly as a biological event which creates practical challenges for girls’ and women in terms of managing their menstrual flow in a hygenic and sanitary fashion. Infrastructure (i.e. separate toilets for boys and girls) and menstrual product’ provision are seen as the appropriate solution to these challenges. MHM incorporation into WASH programmes, is part of the discourse of equity and inclusion (Fisher et al., 2017). Better facilities and menstrual products are promoted to close the gender gap in education and foster women’s economic empowerment (Crofts & Fisher, 2012; Lahiri-Dutt, 2015). Limited access to disposable menstrual products has been pointed to as another reason for constrained school attendance because of ill health due to reproductive tract infections caused by the use of cloth (Garg et al., 2012). There has been little empirical research to substantiate the proposed link between menstruation ‘poverty’ and inaccessibility of education and the use of cloth and ill health (Gaybor, 2020). Nevertheless, the WASH sector has jumped into providing infrastructural and product-based solutions (Bobel, 2019). The lack of evidence clearly indicates that more research is needed before solutions are designed.

While MHM brings menstruation into global health as a gender equity issue (mirroring the SDGs focus on poverty and education gaps), there are still some important observations from a critical development perspective. Within WASH menstruation continues to be viewed as a biological event determining the female body (Wilson et al., 2021) with little awareness to how menstruation is ‘a socially mediated biological process’ (Lahiri-Dutt, 2015, p. 1165). A study of texts between 2008 and 2018, shows that MHM focused-research comes mostly from medicine and public health journals, 72% of which are quantitative in approach (MacArthur et al., 2020, p. 823). Quantitative data does not capture how cultural, economic, environmental and religious contexts create meanings and relations around menstruation. Additionally, hygiene is understood according to western standards. The underlying assumption is that girls and women in the Global South manage their menstruation in an unhygienic, incorrect, dirty, unhealthy or ignorant way (Crofts & Fisher, 2012). Such behaviour is attributed to limited access to menstrual products and washing facilities, which as pointed above, have been also signalled as the reasons for constrained school attendance and ill health. In a racialized trope that ignores centuries of menstrual practice, women and girls of the South are depicted as backward, needing through development interventions to learn how to manage their menstruation and aspiring to be like the ‘more developed’ women of the West (Mohanty, 1988).

MHM falls into the modernising mission of development, through a racialized biopolitics where the Global South and the black and brown menstrual bodies who inhabit that imaginary are seen as requiring expert instruction and deliverance from ignorance (Gaybor, 2020). The following excerpt illustrates how this racialisation operates in an MHM framework:

[…]. In emergencies, UNICEF provides dignity kits to women and girls, which include sanitary pads, a flashlight and whistle for personal safety when using the toilet. Hawa [a student from Danamadja, Chad] said: “Before the dignity kits I didn’t have money to buy soap or sanitary pads. The kits gave me the courage and the confidence to come to school every day”. (UNICEF, 2018)

This excerpt depicts girls as silent victims of poverty, poor black bodies in a deprived ‘backward’ country, who are unable to take charge of their own bodily functions. They need to be empowered through kits to live a life with dignity and go to school. These unproblematized narratives reproduce structures of domination based on racial hierarchies and identities. Dignity is mobilised to argue for menstrual product access as if ‘once poor girls use commercial sanitary pads, all other aspects of a comfortable life […] will follow’ (Lahiri-Dutt, 2015, p. 1170). Such narratives raise important concerns around the power of the white gaze of development and its global reach. The white gaze of development (Pailey, 2020) plays a fundamental role in the success of MHM, showing how the ‘knowledge of menstruation derives from global centers and is broadcast to the peripheries, [since] women [on the South] are portrayed as lacking knowledge of their bodily functions’ (Lahiri-Dutt, 2015, p. 1170).

MHM, as the academic literature makes clear, is a framework in evolution, (Bobel, 2019; Patkar, 2020). The interdisciplinary diversity of critical menstrual studies is now informing WASH, and there is evidence of it questioning instrumental solutions and a product-focused agenda. For example, the Guidelines published as an outcome of the Sanitation Action Summit organised by the Water Supply and Sanitation Collaborative Council (2016, p. 7) emphasises that: ‘[t]he challenge is not just to build infrastructure like toilets but to fight stigma and prejudice that discriminate against women, girls, transgender persons, sanitation workers and many more’.

WASH has played a critical role in the early development of menstruation in the public health debate, and it is broadening and deepening its scope. As Patkar (2020, p. 502) highlights,

“[m]enarche and menstruation symbolize much more than a monthly period to be managed: sexual and gender identity, desire, sense of self, voice, choices, womanhood, and rites of passage. They offer a powerful hook for the realization of multiple human rights”.

Menstrual health rather than MHM was proposed as part of SRHR policy, programming, and funding in the Nairobi International Conference of Population and Development 25 (ICPD25, 2019) a sign that policy on menstruation is moving from just menstrual products to gender justice.

5. Menstrual activism in the Global North and South

5.1. Menstrual products accessibility and safety

The activist struggle to ensure menstrual products access and safety brings together law, the needs of menstruators and public policy. Menstrual activism involvement with the government in a fight for structural change is not new. Campaigns to scrap the tampon tax and advocacy for menstrual equity are the most publicly known faces of contemporary menstrual activism in the Global North and South (Crawford et al., 2019). They are concrete and visible cases of inequalities to which people can easily relate (Weiss-Wolf, 2017). That does not mean that products’ safety and accessibility is ‘dangerously accommodationist [or that] it strives for social acceptability’ (Bobel & Fahs, 2020, p. 956). This form of activism can carry serious life repercussions. For example the Ugandan menstrual activist Stella Nyanzi (2020), was imprisoned for her high profile advocacy for menstrual equity.

Campaigns to scrap the tampon tax challenge the discriminatory tax system against menstruators. Menstruators bear an unfair tax burden when menstrual products are not considered first necessity products, such as food and medicines. Kenya, India, Colombia, Mexico, and some states in the United States are successful examples of countries that have eliminated the tampon tax. On the other hand, menstrual equity, a term coined by Weiss-Wolf (2017) in the U.S.A. context, describes the right of all menstruators to have access to menstrual products in public spaces, schools, prisons, and shelters to be full participants in society (Crawford et al., 2019). The safety of menstrual products has also been a pillar of menstrual activism. Activists draw attention and demand the state fund more scientific research about the safety of menstrual products. In Argentina, for example, the campaign #Menstruaccion petitioned the state to conduct more research on menstrual safety since 2017 (Gaybor, 2018).

5.2. Challenging stigma

Menstrual activism also encompasses the radical intention to change the menstrual culture of stigma and concealment. Free-bleeding activism is an example of this manifestation which in a world of digital networking has reached large audiences. In 2015 Kiran Gandhi, menstrual equity advocate, ran the London Marathon without using any menstrual products, unashamedly presenting a bloody, messy but also realistic version of menstruation in order to challenge stigma (Gandhi, 2015). Another example comes from Candidatura de Unidad Popular from Manresa, an extreme left, feminist political party of Cataluña. In 2016, La CUP proposed a motion to their city council to hold workshops on free bleeding in schools. Free bleeding, in addition to losing the fear of staining in public, also consists of a practice of self-knowledge where menstruators can voluntarily control when to discharge menstrual blood (Orjuela, 2017).

Art is a provocative way by which menstruation is politicised and stigma is challenged. In Rupi Kaur's ‘Period.’ photo series (2015), the artist posted a picture of herself on Instagram lying down on a bed with stains of menstrual blood visible on her clothes and the bedsheet. In 2017, four of the central metro stations of Stockholm housed a controversial menstrual art exhibition by the artist Liv Strömquist (Hunt, 2017). In 2001, the Indian artists Shilpa Gupta (2001) held an installation and video using cloth pieces stained with menstrual blood. Menstrual art also happens in the everyday life art expressions of women who come together to paint with their menstruation provocative art pieces as political actions.

MAs are also transforming the meanings of menstrual blood from waste into products for self-care (e.g. using blood for making cosmetic products or facial masks) (Gaybor, 2020). They see this as a radical political act that challenges the dominant emphasis on hygiene, also endorsed by WASH, by which menstruation is something dirty to be sanitised (Gaybor, 2020). For example, the Independent Political Menstrual Network in Argentina, an anonymous and nonhierarchical group has been vocal in questioning the International Menstrual Hygiene Day and its emphasys on hygiene. For them, ‘MAY is the MONTH OF THE VISIBILIZATION OF THE MENSTRUAL CYCLE […]. Hygiene hides, whereas visibility brings to light something hidden. […].’ [Emphasis in original] (Independent Political Menstrual Network in Argentina, 2021). In India, Sinu Joseph (2016), has been another critical voice to the de-contextualised scope of MHM and the sanitised framework of MHM.

Diverse menstrual experiences among the struggles of the trans and non-binary communities have also become part of the activists’ agendas to challenge stigma. Cass Bliss authored the colouring book The Adventures of Toni the Tampon, advocates for the recognition that menstruation is not a uniquely (cis) women's experience. Bliss posted online a photo depicting a period stain in their pants while holding a sign that reads: ‘Periods are not just for women #BleedingWhileTrans’ (Bliss, 2017).

The above examples provocatively and publicly unveil a menstrual stain or blood. They have been controversial and have triggered enormous discussion (some highly negative) by the public. In the case of Kaur (2015), the photo was censored and deleted twice by Instagram, demonstrating the depth of stigma around a menstrual body that does not conceal its bleeding status.

5.3. Menstrual health literacy

Menstrual literacy is about strategies to build contextually relevant knowledge and resist deeply entrenched cultural norms around the menstrual body. In this strand, there is a strong continuity with the women's health movement of the early 1970s with a focus on menstruators having control and knowledge over their bodies. MAs challenge masculine and the ‘objective biomedical’ authority that has historically denied women and other genders their agency and power over their own bodies. In Argentina and Spain, groups of women come together to discuss, and self-examine their bodies to collectively lose the fear of knowing about their anatomy and learn about their menstrual cycles and SRHR (Gaybor, 2018; Orjuela, 2017).

MAs claim control of their own bodies and health by developing contextually relevant sources of information. Menstrupedia, a (digital) platform from India tried to close the information gap via a blog, comic books, and videos providing information in an easily comprehensible format. (Online) communities created to learn about the menstrual cycle and discuss the body politics of menstruation are becoming more common. Other virtual platforms, such as Soy1Soy4 (IamIam4) function as a menstrual school/transnational community of menstruators through which discussions on SRHR are held collectively.

A fast-growing faction of menstrual activism aims to promote women's SRHR attention on advancing literacy on endometriosis. For example, associations of Women affected by endometriosis in Cataluña, EndoCataluña, or France, EndoFrance, and online support groups or communities, such as the Endometriosis Support Group Nigeria (2020) are some of the attempts to raise the awareness and enabling communication about endometriosis.

5.4. Menstrual activism and the environment

Menstrual activism has been linked to the environmental and consumer rights movements (Bobel, 2008). In 1989 the Women's Environmental Network (WEN) (2018) launched a campaign to persuade producers of disposable menstrual products to stop chlorine bleaching of wood pulp, as bleach discharge emissions are highly dangerous. MAs have also focused on finding alternatives to reduce deforestation. Primary forest is being logged in the Amazon to cultivate pine and eucalyptus, to extract wood pulp (Korol, 2013). MAs in Argentina established a direct alliance with the NGO Forest Bank, through which for each purchased menstrual cup, a donation is made to the NGO to protect the Amazonian primary forest (Maggacup, n.d.).

In Argentina, activists develop strategies and alliances with the environmental movement, for a change of mindset in the population (Gaybor, 2018). Their arguments are careful to avoid individually blaming menstruators for waste production. They acknowledge that a sustainable solution requires structural economic and technical changes. They highlight that menstrual stigma prevents open discussions on the subject and functions as a barrier to a conversation about the environmental impacts of disposable products.

6. Exploring tensions

Menstruation has emerged as a lively and contested subject of global body politics with different approaches which goes further than the personal and intimate and beyond the biomedical. Both MHM and menstrual activism have made menstruation visible with greater public acceptance, legal support and resources. The MHM framework helped to position menstruation as a subject of global body politics in governments and UN policy documents. But, unlike MAs who do not see menstrual blood as something to be hidden from public view, WASH advocacy operating in the development sector, continues to treat menstruation as dirty and only recently has started challenging shaming practices. Nevertheless, WASH plays a vital role in mainstreaming menstruation through the international development agenda. Even if WASH remains technically focused on hygiene and products, it has opened up an important avenue for discussion about menstruation as a global public health issue.

Of key importance has been ‘the way that researchers and advocates leveraged the multisectoral nature of the public health problem, both in the players documenting the evidence and those advocating for the issue’ (Sommer et al., 2015, p. 1309) clearing the path, for example, to the possibility for MAs to develop successful advocacy campaigns to influence policies and tax reforms in the North and South. These actions help to destigmatize menstruation often in public defiance of the different patriarchal gender regimes in which they operate.

Despite WASH's increasing attention to MHM and products to manage menstruation, menstrual waste has not been a focus of WASH, even if menstrual product waste is a major challenge for solid waste management (Pathak & Pradhan, 2016) and a burden to the environment. While WASH has demeaned the practice of using cloth and reusable menstrual pads, labelling them as unhygienic and backward, in contrast, menstrual activism values their use, as a healthy practice for the body and the environment. This lack of engagement in environmental concerns by WASH contrasts with MAs’ campaign to raise awareness about the large amounts of waste from disposable products and promote reusables as zero-waste alternatives (Gaybor & Chavez, 2019).

There are notable tensions when the WASH sector embeds menstruation in policies related to hygiene management, education for girls along with the provision of sanitary products. For example, racialisation and development paternalism informs the push by MHM of menstrual products promoted by private-public sector arrangements as solutions to girls dropping out of schools in the South. The drive to promote products ‘prioritizes the efficient hiding’ (Bobel & Fahs, 2020, p. 956). But at the same time the products also fill a practical need. Menstrual products are required but not through a one-size-fits-all solution. MAs make an important critical contribution to challenging structural inequalities that affect accessibility, demanding research to guarantee product safety and problematising menstrual products from an environmental justice perspective. MAs campaigns raise awareness about deforestation and waste production have helped to shift a blind spot in MHM development programmes moving the conversation towards a more productive discussion within the context of environmental sustainability (Gaybor & Chavez, 2019). These campaigns are not ‘accommodationist’, or ‘striving for social acceptability’ (Bobel & Fahs, 2020, p. 956). These are radical positions to take, and such grassroots menstrual politics means that activists face social rejection and even violence (Gaybor, 2021).

Another tension is the radicalism of the MAs who speak of menstruators, the celebration of menstrual blood through art, free bleeding, and the goal to ‘know’ their own bodies through self-knowledge in contrast to WASH. Such radicalism challenges dominant menstrual representations and narratives including around sexual diversity and gender binaries. The WASH discourse of MHM does not often embrace such radical positions around sexuality and identity. However, by not taking up this agenda WASH can help to reach policy makers and more conservative institutions. What is important is to encourage conversations that break down the shame of menstruation and that see menstruation as part of a holistic approach to health, part of self-care, SRHR and gender relations. What is important is that menstruation is visible and accepted as a healthy part of life, neither defining nor shaming particular bodies.

We argue that what is required is sensitivity to context and listening to the voices of menstruators and their embodied and contextualised experiences in order to avoid essentialism, racism and lack of cultural awareness. The new menstrual studies can help to do this by looking at menstruation, as part of body politics, health policy and changing gender relations that avoid western-centric ‘white gaze’ and can build knowledge across academic disciplines and the different forms of activism, careful to avoid co-optation by profit seeking Femcare industries. Different strategies are needed which activists and WASH protagonists can learn from each other, learning from histories how to speak each others’ language. Both approaches are necessary to make menstruation visible with greater public acceptance, legal support and resources. We hope that this paper is a contribution to moving towards further productive alliances between these two strands as together they contribute to important changes in menstrual health and sexual rights.

7. Conclusion

What we can learn from body politics in development is that there is no pure radical position in the world of global and national policies. Actors deal with different political and economic power interests, tropes and histories. There are overlaps and productive tensions in the global public health discourse between MHM in WASH and the wide range of vibrant menstrual activist practices as part of an emerging global body politics. MHM is evolving and learning from MAs. Ultimately, we suggest, both strands play an important role in ensuring menstruation remains visible in the global health agenda.

While the tensions are there, WASH and menstrual activism are shaping evolving conversations and practices around menstruation. WASH opens an important space for policy and legal action (Wilson et al., 2021). Menstrual activism demands that menstruation is a visible accepted part of life, something that does not need to be ‘managed’ by different medical and social institutions. Each strand works out the strategic spaces to end the stigma of menstruation. The goal to end menstrual stigma is crucial to global public health given that there are millions of menstruators who experience differing levels of social, and micro-political and economic discrimination just because they menstruate. The end of menstrual stigma and with it the possibility for an affordable, environmentally sustainable, and socially acceptable set of menstruation practices are basic to the demands of intersectional reproductive justice that undergirds feminist global health policies.

Disclosure statement

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

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 Further literature reviews which provide the background to our reflections can be found in Gaybor (2021) and Harcourt (2009).

2 Goonj, Maggacup, EcoFemme, Be Girl, Ruby Cup, Irise, The pad project, Thinx, Afripads, Zana Africa, Pad Up Africa, Lena Cup, Meluna.

3 UNICEF, UNESCO, OHCHR, WHO.

4 Plan international, SIMAVI, Wash United, World Vision International, Water Aid, Oxfam, Save the Children.

5 Scientific publications on menstrual activism and MHM were selected from Scopus. We included declarations and resolutions from UN agencies and INGO’s engaged in MHM.

6 Our understanding of feminist methodology can also be found in a volume which we edited with two other colleagues on feminist methodology, to be published in December 2021 by Palgrave Macmillan.

7 More on WASH’s behavioural change strategies related to end open defecation as a form of race-based humiliation can be found in Engel and Susilo (2014).