Water or the lack thereof, touches the lives of everyone, the world over. It also courses through the 2030 Agenda for Sustainable Development—the ambitious and comprehensive development agenda agreed to by UN Member States in 2015—in ways that are palpable and affect the health of millions of people. For women and girls, water access is a key determinant that affects hygiene, schooling, and work. Lack of access to clean water contributes to maternal mortality and morbidity; the inability to effectively manage menstrual health undermines girls’ education; and, when clean water is not easily accessible, women and girls are burdened with collecting water, which can endanger their health and safety.
As governments convened at the UN this July to report and discuss progress on the 2030 Agenda and its 17 Sustainable Development Goals (SDGs), the International Women’s Health Coalition (IWHC) partnered with WaterAid, the government of Nepal, and the European Union, for a parallel event, “A Rights-Based Approach to Menstrual Hygiene Management: Integrating Water, Sanitation, Health, and Gender Equality to Achieve the Sustainable Development Goals.”
While access to water, sanitation, and hygiene (WASH) is central to proper menstrual hygiene management, the discussion, which explored the complex realities and potential solutions in Colombia, Kenya, and Nepal, highlighted that menstrual hygiene is also intrinsically linked to success across the SDGs. This is particularly the case for the SDGs related to education—including comprehensive sexual education—gender equality, sexual and reproductive health, child marriage, sustainable consumption, and economic opportunity, among others.
Despite the fact that 800 million women and girls menstruate every day, menstruation remains shrouded in silence and taboos. Women and girls lack dedicated, integrated services and information to menstruate in dignity, obstructed not only by lacking infrastructure—including the fact that one in three women live without a decent toilet—but also deeper challenges of gender norms, myths, and stigma.
A recent survey conducted by IWHC and the period-tracker app Clue found that in some countries, close to half of respondents felt they did not have sufficient information or education about starting their period. Lisa Schechtman, director of policy and advocacy for WaterAid America, shared that in India, 70 percent of girls did not know what was occurring when they began their first menstrual cycle. This lack of information perpetuates stigma and leads to violence against women as bleeding is often viewed as a sign of sexual activity, a taboo for unmarried girls and women.
As is often the case, rural and indigenous communities are disproportionately impacted by the lack of information, proper WASH facilities, and menstrual supplies. Elizabeth Okumu, program manager for Trust for Indigenous Culture and Health (TICAH), an IWHC grantee partner in Kenya, illustrated this point, sharing that 28 of the 30 girls in her after-school program lacked a toilet at home.
Without proper facilities at either school or home, girls are presented with few options for privacy and safety. Girls living in poverty have limited access to menstrual hygiene products, which are primarily disposable and cost-prohibitive, posing problems for access, sustainability, and hygienic waste management. An absence of proper facilities and sanitary products, in addition to traditions that isolate girls during menstruation—often in dangerous environments—leads to a sharp decrease in school attendance, with girls missing up to 20 percent of the school year in sub-Saharan Africa due to their period. This reality compounds the importance of building local capacities and engaging all actors in society in a holistic approach to raise awareness about the importance of menstrual hygiene and its linkages to broader issues of gender equality—a theme stressed by the panelists.
Combating stigma is central to addressing menstrual hygiene management and connected issues such as child marriage. In many cultures, girls are considered women—and therefore available for marriage—as soon as they begin menstruating. Child marriage undermines girls’ education, reproductive health and rights, and full participation in society; however, with comprehensive sexual education that dispels stigma and myths about menstruation, girls can be prepared for a transition to womanhood without judgement or punishment.
Menstrual hygiene management is crucial to achieving gender equality. Solving these complex and interrelated challenges requires a comprehensive, collaborative, and intergenerational approach that engages both boys and girls. It must address access to toilets and availability of sanitary supplies, but also account for issues like stigma, gender norms, and gender-based discrimination. It requires solutions grounded in unique local contexts that ensure that girls have comprehensive and accurate information about their bodies, their options, their rights, and are able to make informed decisions about their health.
As the panel concluded, it is only through a holistic and multi-sectoral approach that applies gender equality, education, human rights, and sustainability perspectives that we can empower girls to take control of their bodies and, ultimately, their lives. Without addressing these linkages, governments’ efforts to achieve the SDGs will fall short.
Photo: Kate Holt / WaterAid