Fails at Reducing Menstrual Stigma

by Alexandra Brewis and Amber Wutich

It’s amazing—but understandable to us anthropologists—how little people understand about the basics of their own menstruating bodies. In one recent study of undergraduate students in Australia, only 1 in 8 said they felt “completely confident” to manage their own menstruation, even though they must do so every month.

Much of this is because menstruation is so stigmatized. It’s something people are constantly reminded needs to be treated as private and personal. Revealing a period to others is shameful. It becomes the basis for being judged by others, to be seen as something dirty and disgusting. And accordingly, there is little open conversation about what menstruation is and how to manage it. Then, misinformation fills in the gaps.

These types of menstrual stigmas are so taken for granted that they are rendered invisible, along with the idea that menstruations should be too. Ads use a blue liquid as a proxy for blood because seeing red is simply too close to actual menstrual blood. Our conversations around menstruation similarly use softened metaphors like “Aunt Flo." Just the image or word “tampon” is often treated as something taboo, not to be mentioned in polite company.

Period poverty

There is an additional complication to how periods and shame go together—a common phenomenon called “period poverty." This is when those who menstruate cannot access the basic materials needed to manage it, like menstrual products, private spaces, or even adequate water. It places them at risk of feeling negative judgments from others. COVID-19 has worsened period poverty for many in the US and elsewhere, too, given unstable income and the high cost of purchasing disposable menstrual products.

Such stigma complicates menstruation, implicating it in creating worse health for women all around the world. Some of the effects are well recognized. It greatly inhibits social activities and undermines both physical and economic wellbeing. Women struggle with untreated and often debilitating period pain, assuming it is normal, often because their doctors consider it “normal” as well. Where period poverty is common, so is emotionally devastating teasing and school absenteeism among menstruating teens.

Recently, we have been analyzing interview data on menstrual stigma from very water-scarce communities in South Asia along with anthropologist and menstruation expert Kate Clancy. That study has revealed the many ways women in water-insecure households struggle to maintain basic dignity around menstruation. They hide small amounts of water or feel forced to avoid leaving the house to work. It’s stressful and it’s discouraging, and reminds them how little power they have to control their own lives.

Policy efforts

So, what can be done to normalize the messy realities of periods and remove the struggles that menstrual stigma creates? Government policies and public health practices should matter to the wider effort, playing a central role in reducing menstrual stigma and period poverty.

A new study out this week in PLOS Global Public Health used in-depth interviews to capture what policymakers around the globe are doing toward this effort. This included analyzing data from 85 different policymakers in 4 countries with significant period poverty and menstrual stigma: India, Kenya, Senegal, and the United States. This included government officials, staff in NGOs, and local experts on menstrual health and hygiene.

The study authors identified that policymakers in all the study locations identified stigma as a major detriment to menstrual health, and recognized the need for social change. They were working toward this through efforts at growing public discussion and education. But they also found that—even while general awareness around menstrual stigma was growing, it really had little overall impact on what people would experience as stigma on the ground. The policymakers seemed squeamish about the mess and blood and seemed unable to make menstruation truly visible. As the study authors noted, this resulted in lots of mixed messages being generated by policymakers like “Yes, let’s talk about menstruation. But please do so in a 'respectable' way." Bleeding was still meant to stay hidden and remain private, even in anti-stigma efforts.

So, despite efforts, policy efforts reinforced that menstruation remained something that individuals needed to “control.” Their recommendation: Policy efforts to address menstrual stigma must shift the messages from bodily control to bodily autonomy, empowering menstruators to learn and make informed decisions about their bodies without shame or secrecy.