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

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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