Menstruation is a natural and essential part of the reproductive cycle. However, in most parts of the world it remains a taboo subject that is rarely talked about. These taboos restrict the participation of women and girls in society during menstruation. In addition, limited access to clean water, proper sanitation facilities and sanitary napkins make it difficult for women to manage their menstruation hygienically. As a result, many (young) women around the world face considerable physical and social challenges during their menstruation period.
More than one fifth of the world’s population consists of women of reproductive age. On average, a woman spends seven years of her life menstruating, making menstruation a natural and essential part of the reproductive cycle. In addition to menstruation, women also experience other forms of vaginal bleeding and at the end of the reproductive cycle they experience menopause. It is an essential human right to have the ability to manage menstrual health and all other forms of vaginal bleeding with adequate knowledge, safety, and dignity and without stigma. However, when menstruation begins many women, girls and other menstruators in low-resource settings aren’t well-prepared for it and lack knowledge of other forms of bleeding.
Cultural and religious norms around menstruation create barriers for women to participate in normal daily life, go to school and work or participate in religious ceremonies. Furthermore, women and girls lack access to the information, products and infrastructure that is needed to manage menstruation with dignity. This has a severe impact on their health, well-being, and the realisation of their rights. It should be noted that adolescent girls, and girls and women living with a disability, are especially vulnerable to negative outcomes related to menstruation, including effects on their overall self-esteem and confidence.
Menstrual health defined
Simavi uses the term ‘menstrual health’ to describe both menstrual hygiene management practices and the broader interventions that link menstruation to health, wellbeing, gender, education, equity, empowerment and rights . In Simavi’s work on menstrual health we incorporate other episodes of bleeding between menarche and menopause and refer to these as ‘other types of vaginal bleeding’. And, although we focus on women and girls, we recognize that there are women and girls who don’t menstruate due to health or anatomical reasons, trans men that menstruate, trans women who do not menstruate and intersex people who do or do not menstruate.
Menstruation as a starting point
In many cultures a girl’s first menstruation marks her transition into womanhood. With that transition comes a broader set of restrictions and roles that girls are expected to align to. For Simavi, interventions that aim to improve women and girls’ experience of menstrual health are an opportunity to address a broader set of barriers and tackle issues surrounding gender (in)equality and sexual reproductive health. Our aim is to improve the overall wellbeing of girls, women and other menstruators by supporting them to improve their menstrual health and challenge the restrictions they face in regard to their menstruation and other forms of vaginal bleeding. We combine the following five approaches In our programmes:
- Empower, educate and inform
Using a comprehensive rights-based menstrual health training manual, Simavi works with teachers, (peer) educators, health workers and other stakeholders to educate women and girls, and teach them the necessary skills for managing their menstrual health, menopause and other forms of vaginal bleeding. In addition Simavi educates gatekeepers, with a special focus on men and boys, to play a supportive role in ensuring menstrual health. Building on this knowledge, we work with women and girls and their communities to address existing norms and other barriers that restrict their participation in daily life during their period. In our work to raise awareness on menstrual health and other forms of vaginal bleeding, we make use of traditional methods such as school-based education as well as more innovative methods, including our Happy Periods App.
- Access and use of services and products
To ensure women and girls have access to gender sensitive toilets, we work together with them and their communities to realise these facilities. Through awareness-raising, capacity-building and social accountability methods such as resources mobilization, we work with schools and communities to prioritise expenditure and access available government budget to realise the construction of toilets. Regarding access to products, our aim is to enable women and girls to make an informed decision by providing information on the use of several products to manage bleeding, including instructions on the use of cloth. Where necessary, we work with (business) partners, like TNO to create access to menstrual products through sustainable business models, promoting female entrepreneurship and environmental friendly solutions for disposal whenever possible.
- National advocacy and policy influencing
Advocacy towards policy or implementation of policies is an important instrument in creating sustainable change. Therefore in our programmes we work closely together with local and/or national governments to ensure that our work on menstrual health, menopause and other forms of vaginal bleeding is sustained through government programmes and/or policies. We implement our programmes alongside existing policies and advocate for inclusion of menstrual health in government curricula and the availability of women and girl-friendly toilets in schools and communities.
- International advocacy
In addition to our work on national level, Simavi advocates for increased prioritisation of menstrual health on the global level. To increase priority and build capacity on menstrual health, Simavi engages with researchers, UN agencies, (i)NGOs and the private sector to organise side-events at conferences and events such as the High Level Political Forum (listen to the recording here). Simavi is also a founding member of the MH Alliance, together with WASH United and Global Citizens.
- Evidence informed programming
There is a need for more rigorous and systematic research on the specific barriers to menstrual health, as well as evaluations of menstrual health programmes, to better inform future programmes and messaging. Simavi works closely with researchers to ensure our programmes are evidence-informed and contribute to the evidence base on menstrual health. An example of this is our Ritu programme, in which we work closely with the Erasmus University, Maastricht University and Johns Hopkins University on a Randomized Controlled Trial of 4000 girls involved in the programme.
- Sharing and learning
It is important for Simavi to learn from others and, at the same time, share our learnings with our partners and other interested stakeholders. We do that through several different channels. For example, as an activity under the MH Alliance, Simavi, WASH United, World Vision and GIZ organised a series of five MH webinars. Furthermore, Simavi has shared its knowledge on a range of different conferences and events, such as the;
– High Level Political Forum
– First East and Southern Africa Regional Symposium
– Water and Health Conference
Want to know more about our expertise? Our Menstrual Health Training Manual offers an interesting read completed with suggestions for activities and small questionnaires, to challenge students and participants’ knowledge on menstrual health matters.