LHC Publications

Welcome to the LHC Blog

Every other week we publish a blog post here. These posts are centered on personal and professional experiences with policy and advocacy. If you're interested in contributing, email us at lhc@uab.edu.

May 20, 2020, by Sara Harper, LHC Student Assistant


Humor me, if you will, and think back to the first time you learned about periods. As I was entering the dreaded "tween" years, my mother pulled me aside for yet another "big girl talk," conversations about impending physical and social changes in my life. I didn’t learn much about my period that day. However, I did gain a sense that it was not something I should openly talk about. I learned I should hide my period because even the idea of menstruation could make others uncomfortable. Queue many years of figuring out the best way to grab a tampon or pad and get to the bathroom without suspicion…

Even as an adult, this needless taboo is still deeply ingrained in me. In honor of the upcoming Menstrual Hygiene Day, I have decided to write this blog to coax myself and readers out of our comfort zone and examine how shame, culture, and money can influence menstrual hygiene around the world.

Barriers in the US Education System

Beyond parent-child conversations, learning about menstruation can happen in biology or sex-ed courses taught in some schools. However, only 29 states in the US require sex education in public schools. Each school decides the degree to which they choose to teach sex-ed and only 13 states mandate the information to be medically accurate. Therefore, if an institution believes menstrual education is unnecessary, entire cohorts of students graduate without comprehensive knowledge on an essential part of sex education. Without proper education, some youth may only be able to refer to their peer’s anecdotes about their menstrual experiences. Others refer to the internet for answers or even struggle in silence for months before asking for help managing their menstrual hygiene. 

sex ed policies legislationImage credit: University of Southern California Department of Nursing

Economic Barriers

Mandatory sex education remains a challenge to achieve in every country, but inequities in education and hygiene access can lead to higher rates of “period poverty” in some populations. Period poverty is a concept that includes lack of access to both menstrual hygiene products and educational support for those who menstruate, which can lead to social and economic consequences. Even in countries that have adequate menstrual hygiene supplies, cost can be a barrier to proper menstrual hygiene. In the US, 35 states place a tax on period products because they are not considered to be a necessary expense. Additionally, neither SNAP nor WIC cover these products, leaving some to resort to using absorbent materials like toilet paper or even clothing.

Culture of Shame

Starting the conversation about menstrual hygiene has become a public health initiative around the world, most notably in low- and middle-income countries where there is the greatest opportunity for positive growth. Researchers note a “culture of silence” in Uganda around the idea of discussing menstruation and an overall lack of support services in schools and families in Kenya. East and Southern African taboos restrict girls from touching water, cooking, attending religious ceremonies, or participating in community-wide events while they are menstruating. Some Nepali communities still practice the custom of sending girls to live alone in unheated, unprotected Chhaupadi huts, far away from the rest of society. This custom is by far the most isolated and dangerous measure I have come across while researching, sometimes even leading to the death of the menstruating woman. These taboos perpetuate a culture of shame and misinformation that negatively impact the health of those who menstruate as well as the children who rely on them. Maintaining an open and bilateral conversation about menstruation can diminish the mysticism and shame that clouds the opportunity for necessary education.

Girls ClubGirls' club members discuss menstrual hygiene at school in Sheno, Ethiopia. Several schools in the region launched clubs like this one as a way to tackle the problem of girls dropping out because of shame and discomfort around the topic of menstruation. The goal is to replace silence and misconceptions with open discussion and information. © UNICEF/UN064418/Tadesse

Gender Achievement

Keeping girls in school is one of the most effective ways to promote positive growth within a country. Educated women have the ability to find jobs and create their own stream of income, making them less dependent on male counterparts. Women with primary education typically have fewer children and are able to increase their family’s quality of life. However, many pubescent girls in Sub-Saharan Africa find themselves missing school due to their lack of menstrual hygiene education and resources, further widening the gender achievement gap. In extreme cases, some girls will participate in transactional sex to obtain money to buy sanitary towels so that they can continue to attend school. Schools that provide adequate menstrual support are giving their students the dignity and autonomy to manage their own menstrual hygiene and avoid unnecessary absenteeism. 

Positive Steps

Non-governmental organizations around the world are working to make inequities due to menstrual hygiene a thing of the past. The organization behind Menstrual Health Day (May 28) raises awareness through sale and donation of menstruation bracelets. These bracelets can be used as period trackers to help young people stay aware of where they are in their cycle in the absence of other tracking resources. Wearing the bracelet signifies that you are refusing the stigma around periods and standing in support of improving menstrual health across the globe. Grassroots groups have seen improvements just by creating girl’s clubs that provide a safe space for youth to voice their questions and concerns without fear of being shamed. Some schools have found success in simply switching girls' uniforms to darker colors in order to prevent possible staining. Improving menstrual hygiene can help achieve up to six of the Sustainable Development Goals and increase the overall quality of life for those of us who menstruate. These successes prove that menstrual health equity is possible with the correct supportive measures in place. 

bracelet alexandra klobouk facebookImage Credit: menstrualhygieneday.org

May 8, 2020, by Sean McMahon and Sara Harper, LHC Staff


The COVID-19 pandemic seems to have launched us into the great unknown. It’s hard to predict what will change in the world outside the safety of our homes. While news outlets are operating a constant stream of pandemic-related updates, there are other changes going on that don’t make as many headlines. Even in normal times, every policy change leads to unintended consequences, side-effects of the change that are not in line with the goal of the policy. Stay-home orders have certainly slowed the spread of SARS-CoV-2 (the novel coronavirus which causes COVID-19), but what else have those orders done? We’ve rounded up some of the news of the last two months that may be side-effects of staying at home. 

April 23, 2020, by Aarin Palomares, Deputy Director, Global Handwashing Partnership (FHI 360)


There is often a misconception that the private sector has no role in public health. However, the private sector can be a valuable partner in addressing poverty, injustice, and inequality around the world. Especially in times of crisis, companies work in tandem with governments, public authorities, and other stakeholders to address public health issues and support sustainable systems.

The novel coronavirus (COVID-19) pandemic has created a humanitarian and economic crisis and provides a call to action for stronger and more resilient public health systems. Government leadership is crucial – that we know. However, companies and civil society organizations also play a vital role in working together to respond to this immediate crisis. For two years, I have worked for a public-private partnership housed at FHI 360. Private sector engagement, especially through public-private partnerships like the Global Handwashing Partnership, can play a significant role in developing both immediate and long-term solutions. 

April 9, 2020, by Sean McMahon, LHC Program Manager


We’ve all had our experiences with fake news. I mean real, legitimately fake news. The catchy headlines that beg you to click them because they’re so outrageous and you’re already biased towards believing anything so infuriating about the people who disagree with your interpretation of reality.

Wait a minute. I don’t want to get ahead of myself here. It’s hard to remain unbiased, especially when we’re surrounded by news outlets propelled by a 24-hour news cycle and the expectation of high viewership. It’s hard to remain unbiased when we typically surround ourselves with people who agree with us. It’s hard to remain unbiased when we’re human.

Maybe we shouldn’t be trying to beat fake news at its own game – inciting anger, promoting tribalism, and engaging in all sorts of fallacies. Instead of diving into some of my more recent experiences with crazy, incendiary headlines in the past few months (off-the-wall commentaries on presidential candidates, the president himself, the current pandemic, and a host of other things), let’s look into why the click-bait works so well, and how these sorts of things spread.

March 26, 2020, by Ariann Nassel, LHC Director of Geospatial Data Visualization


census graphicThe first wave of letters containing Census forms were mailed out to approximately 140 million households two weeks ago and last week those letters were followed up with reminder letters for households that had not already responded. If you’ve been busy and haven’t gone through the pile of mail on your kitchen counter, stop everything, find the letter, and fill out the form either online (https://my2020census.gov/) or over the phone (https://2020census.gov/en/ways-to-respond/responding-by-phone.html). If neither of those options works for you, a form will be mailed to you later in the month.

I received my letter on March 12th at 5:52 pm. Including the time it took to open the letter, sit down on the sofa, and log on to the internet, I had completed it by 6pm. That’s, right it only took me 8 minutes.

But, there might be a few other things going on right now that have your attention. You might be wondering, "Why bother with the Census?"