Dignity, gender and period poverty: approaches to improving menstrual health outcomes

改善月经健康结果是女性面临的机会不平等这一全球挑战的一部分（Bobel, 2019）。不平等的领域包括教育、健康、福利、更广泛的社会（Criado Perez, 2019），以及女性有尊严和安全地管理月经的基本权利，这在全球南北国家尚未实现（Plan International UK, 2018; Karki and Espinosa, 2018）。此外，更好的妇幼保健成果与实现若干可持续发展目标（sdg）直接相关，包括目标4（确保包容和公平的优质教育，促进全民终身学习机会）、目标5（实现性别平等并赋予所有妇女和女童权力）和目标6（确保人人享有水和卫生设施并进行可持续管理）（联合国经社部，2015年）。关于MH的文献指出了四个挑战：缺乏关于MH管理的教育和信息；不良的卫生保健做法；缺乏对医院友好的设施，以及对经血的禁忌（Bobel, 2019）。在一个复杂的背景下，贯穿始终的主题是羞耻、缺乏尊严和禁忌。例如，将月经视为“诅咒”的观念导致在管理妇女保健做法时产生羞耻、恐惧、排斥和孤立感。对月经的禁忌对数百万妇女和女孩造成了侮辱，但它也造成了更糟的情况：严重缺乏设施和适当的卫生用品可能会使月经期女孩暂时甚至永久地辍学（WSSCC, 2013:3）。关于尊严和月经健康的论述（Bobel, 2019）支撑了监督团队Tiwari和Brimicombe之前关于改善印度比哈尔邦和北方邦农村月经健康结果的研究（Tiwari, 2021）。关于尊严的文献可以追溯到亚里士多德关于人类繁荣的论述。人的尊严也与没有歧视、羞耻和被重视的生活有关（Hojman和Miranda， 2018）。在MH话语中，术语的使用仍然存在一些歧义。例如，经期卫生管理（MHM）和（或缺乏）大多数机构使用的“经期贫困”侧重于卫生习惯、有关月经周期的信息以及有尊严地管理经期，而不会感到不适或恐惧。最近，联合国儿童基金会将月经与健康、福祉、性别平等、教育、公平、赋权和权利联系起来的MHM和更广泛的系统性因素纳入其中。国际计划英国（2018年）进一步将“月经健康”作为一个总括性术语，涵盖了月经的社会、教育、健康和获取层面。用“月经卫生”一词来指代它，暗指需要清洁，从而分散了人们对月经是女性正常身体机能的认识。近年来，提出并实施了若干办法，以解决月经健康不良后果和经期贫困问题。在英国，这些措施包括最近的《苏格兰经期产品法案》（2020年11月20日），规定所有需要经期产品的人都可以免费获得经期产品，在2020年3月的预算中取消了有争议的5%增值税“卫生棉条税”，将所有经期产品归类为“非必需品、奢侈品”，以及在英格兰所有公立学校和16至19家教育机构免费使用经期产品。此外，自2020年3月以来，大多数非政府组织已开始在其食品银行供应中添加卫生用品，以减轻疫情对期间贫困的不利影响。一些国家正在出现以尊严为重点的改善月经健康的战略

Improving menstrual health (MH) outcomes is situated within the global challenges of inequalities of opportunities experienced by females (Bobel, 2019). The domains of inequality include education, health, wellbeing, wider society (Criado Perez, 2019) and the fundamental right of women to manage their menses with dignity and safety, which has yet to be achieved in countries of the global North and South (Plan International UK, 2018; Karki and Espinosa, 2018). Further, better MH outcomes are directly linked to achieving several of the Sustainable Development Goals, (SDGs), including Goal 4 (Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all), Goal 5 (Achieve gender equality and empower all women and girls), and Goal 6 (Ensure availability and sustainable management of water and sanitation for all) (UNDESA, 2015). Literature on MH indicates four challenges: lack of education and information about MH management; poor MH practices; lack of MH friendly facilities, and taboos around menstrual blood (Bobel, 2019). Located within a complex context, the cross-cutting themes throughout are shame, lack of dignity and taboo. For example, the idea of the menses as 'a curse' leads to feelings of shame, fear, exclusion and isolation in the management of women's MH practices. The taboo of menstruation helps inflict indignity upon millions of women and girls, but it also does worse: the grave lack of facilities and appropriate sanitary products can push menstruating girls out of school, temporarily and sometimes permanently (WSSCC, 2013:3). The discourse on dignity and menstrual health (Bobel, 2019) underpins the supervisory team Tiwari and Brimicombe's previous research (2018-19) on improving menstrual health outcomes in rural Bihar and Uttar Pradesh, India, (Tiwari, 2021). The literature on dignity can be traced back to the Aristotelian discourse on human flourishing. Human dignity is also associated with a life free of discrimination, shame, and being valued (Hojman and Miranda, 2018). There remains some ambiguity in the use of the terminology in the MH discourse. For example, menstrual hygiene management (MHM) and or lack of it 'Period Poverty' which is used by most agencies, focuses on hygienic practices, information about the menstrual cycle, and its management with dignity without discomfort or fear. More recently, UNICEF has included both MHM and the broader systemic factors that link menstruation with health, well-being, gender equality, education, equity, empowerment, and rights. Plan International UK (2018) has gone a step further deploying 'Menstrual Health' as the umbrella term that captures social, educational, health and access dimensions of menstruation. Referring it by the term menstrual hygiene alludes to requiring cleanliness, thus distracting from recognition of menstruation as a normal bodily function of women. Several approaches have been proposed and implemented to address poor menstrual health outcomes and period poverty in recent years. In the UK these include the recent Period Products Scotland Act (20, Nov 2020) making period products available free of cost for all those who need them, scrapping of the contentious "tampon tax" of 5% VAT in the March 2020 Budget that categorised all menstrual products as 'non-essential, luxury goods', and free access to period products in all state-maintained schools and 16 to 19 education organisations in England. Additionally, most NGOs have started to add sanitary products in their food bank provision since March 2020 to mitigate the adverse impact of the pandemic on period poverty. Dignity focused strategies to improve menstrual health are emerging in several countries