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: