Reflecting on Changing Perceptions around Menstrual Hygiene Management

USAID Water Team
May 26 · 6 min read
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Community members welcome visitors from USAID, CARE, and Global Environment & Technology Foundation (GETF) with a traditional dance. Photo credit: Stephanie Ogden/CARE

Every May 28, Menstrual Hygiene Day is celebrated around the world to combat stigma and raise awareness about the vital role MHM plays in ensuring health, dignity, and opportunity for women and girls around the globe. Please join USAID and its partners in celebrating the transformative power of improved menstrual hygiene to unlock empowerment opportunities for women and girls.

Glancing over the room in Dowa, Malawi, as men and women farmers of all ages openly discuss menstrual hygiene — a topic that is rarely addressed in coed groups — with comfort and ease left a significant impression on me. In my experience as a gender specialist, conversations around menstruation have typically been met with shyness, faint whispers, or even silence.

Last December, I traveled to visit She’s SMART project communities in Dowa and Kasungu, Malawi, about two hours from the capital city of Lilongwe. The program engages farmer-producer groups and village savings and loan associations (VSLAs) in both gender equality and women’s empowerment dialogues. The program’s goal is to address the taboos, traditional beliefs, and practices related to menstruation. The project is implemented under the Water & Development Alliance, a partnership between USAID and the Coca-Cola Company and Foundation.

She’s SMART uses the long-standing farmer field school approach as a forum for both men and women to jointly discuss menstrual hygiene management (MHM) issues related to women’s full participation in agricultural labor. The community dialogues contribute to the overall goals of promoting economic growth and improving households’ agriculture and nutritional status by identifying and overcoming barriers to women’s equal participation in society.

“The MHM dialogue sessions facilitated by the project focus on exploring and overcoming taboos, recommended MHM practices, and the role of men,” explains Daniel Soka, She’s SMART project manager. “These sessions have triggered engaging discussions around menstruation between the project participants with their partners. Already, we have seen more women now able to ask for support from their spouses when they are menstruating.”

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The women’s group enthusiastically listed out the traditional beliefs on MHM. Photo credit: Victoria McLeod

The Economics of Managing Menstruation

Historically, USAID’s support of MHM has focused on girls’ access to appropriate sanitation facilities and supplies at schools. Over 800 million adolescent girls and women worldwide are menstruating on any given day, and over 2.3 billion people do not have access to basic sanitation facilities such as toilets or latrines, lessening women and girls ability to manage their periods with dignity at work, school, and home.

More recently, USAID has expanded its support and efforts to better understand the experiences of working adult women and the relationship of MHM to women’s participation in economic activities. Menstrual aged girls and women (12 to 49 years) represent a significant and growing portion of the 1.2 billion women employed globally, with women representing nearly half of the global labor market.

In 2019, the She’s SMART program in Ghana and Malawi expanded to include a focus on MHM at the community level — engaging farmer producer groups and VSLAs to better understand and address the taboos, traditional beliefs, and practices related to menstruation.

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The Cooperative presented the agricultural calendar that showed the farmers’ activities throughout the year, a standard practice promoted in Farmer Field Schools. Photo credit: Victoria McLeod

In Malawi, Breaking the Silence on Menstruation

Walking alongside community members in Dowa through vibrantly colored maize fields that have flourished under a new irrigation system and improved agricultural practices, there was a newfound sense of pride from the farmers for their thriving crops.

While visiting the neighboring community of Kasungu, I observed this same sentiment among the men and women smallholder farmers who excitedly pointed to flourishing fields of legumes, maize, and groundnuts.

After visiting the agriculture fields in both communities, I joined the discussion with the farmers. The men and women were split into single sex groups to discuss the taboos and customs related to MHM, which included:

  • While menstruating, women should not salt food, as it is believed that this leads to contamination and could result in pale skin for those consuming the food.
  • While menstruating, women should not harvest crops, such as tomatoes and peppers, as it is believed that the plant will die as a result.
  • Women should not irrigate crops during menstruation, as it is believed that their blood will drip onto the plants in the process and contaminate/kill the crop.
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After a facilitated discussion on menstruation taboos and stereotypes, each focus group presented their findings in plenary. Photo credit: Victoria McLeod

After future discussion and open group dialogue, the men and women concluded that these beliefs and practices severely limited women’s participation in many aspects of community life. As a result, the community members committed to listening to women speak about their concerns and preferences, including MHM, as part of their efforts to increase women’s overall participation in the community.

Ellen Chipwaila, a resident of Chiwale II Village in Kasungu, explains, “Through the MHM dialogue sessions, which I participated with my husband, I am now able to follow all good menstrual hygiene management practices such as drying sanitary materials outside under the sun at all times and my husband is also supporting me in providing some materials when I am menstruating. I am now a happy woman since I am free to move without shame.”

The Power of Involving Men and Boys

Observing the Malawi community members together discussing and tackling the sensitive topic of MHM was encouraging. The experience cemented my perspective that MHM is a critical aspect of addressing women’s and girls’ empowerment, and programs and partnerships like She’s SMART that engage men and boys as part of the solution, is essential. The entire community benefits when men and boys speak about menstruation more freely and are better able to support the MHM needs of women and girls in their family and their communities.

In the She’s SMART communities, the men-only focus group undertook a lively discussion of men’s and women’s roles in agricultural production, and how traditional beliefs and practices affected women’s participation. Jack Steward Phiri, a young man who participated in MHM training in his village, says, “I’ve also started supporting my sister with household chores and when she has started showing symptoms of menstruation if she is not feeling well.”

While the She’s SMART program is ongoing in Malawi and Ghana, two further observations provide possible pathways for future programming and investment:

  1. The women in this community walk three hours round-trip to collect clean water. This reality, paired with the hygiene-related needs discussed during the facilitated community discussions, highlight the need for water, sanitation, and hygiene access to be integrated into every facet of this program. Though the MHM–focused dialogues are in an early stage, it is clear that much of the stigma is related to cleanliness of a woman during menstruation. When water availability is limited, families have to prioritize the use of their clean water for drinking and cooking, and bathing/MHM is not always a priority. By providing access to clean water, the project could directly support women in maintaining their hygiene and dignity during menstruation.
  2. Program implementers observe an increase in shared responsibility between husband and wife at the household level (e.g., chores) as well as a marked increase in joint decision-making. Future activities can build upon this important behavioral change to social and gender norms, for example, by promoting women’s leadership in the cooperative structure.

By Sylvia Cabus, Senior Gender Advisor, USAID’s Office of Gender Equality and Women’s Empowerment

This article appears in Global Waters, Vol. 11, Issue 2; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.

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Global Waters

Global Waters tells the story of USAID's water-related…

USAID Water Team

Written by

USAID and its partners improve access to clean water and safe sanitation to create a healthier and more #WaterSecureWorld. For more, visit Globalwaters.org.

Global Waters

Global Waters tells the story of USAID's water-related efforts around the globe, featuring in-depth articles exploring solutions to local as well as global water challenges, opinion pieces by development professionals, and first-hand accounts from stakeholders and beneficiaries.

USAID Water Team

Written by

USAID and its partners improve access to clean water and safe sanitation to create a healthier and more #WaterSecureWorld. For more, visit Globalwaters.org.

Global Waters

Global Waters tells the story of USAID's water-related efforts around the globe, featuring in-depth articles exploring solutions to local as well as global water challenges, opinion pieces by development professionals, and first-hand accounts from stakeholders and beneficiaries.

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