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

改善月经健康(MH)结果属于女性所经历的机会不平等的全球挑战(Bobel，2019年)。不平等的领域包括教育、健康、福祉、更广泛的社会(Criado Perez，2019年)，以及妇女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(国际计划英国，2018年；Karki和Esposa，2018年)。此外，更好的卫生保健成果与实现若干可持续发展目标(可持续发展目标)直接相关，这些目标包括目标4(确保包容性和公平的优质教育，促进人人享有终身学习机会)、目标5(实现两性平等，并赋予所有妇女和女童权力)和目标6(确保人人享有和可持续地管理水和卫生设施)(联合国经社部，2015年)。有关MH的文献指出了四个挑战：缺乏关于MH管理的教育和信息；糟糕的MH实践；缺乏MH友好设施，以及对月经血的禁忌(Bobel，2019年)。在一个复杂的背景下，贯穿始终的交叉主题是羞耻、缺乏尊严和禁忌。例如，月经是一种“诅咒”的想法会导致在管理女性MH实践中产生羞愧、恐惧、排斥和孤立的感觉。对月经的禁忌有助于对数百万妇女和女孩造成侮辱，但它也造成了更糟糕的情况：严重缺乏设施和适当的卫生用品可能迫使经期女孩暂时、有时甚至永久失学(WSSCC，2013：3)。关于尊严和月经健康的论述(Bobel，2019年)支持了监督小组Tiwari和Brimicombe之前(2018-19年)关于改善印度比哈尔邦和北方邦农村地区月经健康结果的研究(Tiwari，2021年)。关于尊严的文学可以追溯到亚里士多德关于人类繁荣的论述。人的尊严还与没有歧视、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，大多数机构使用的月经卫生管理(MHM)和/或缺乏月经卫生管理的“经期贫困”，侧重于卫生做法、月经周期信息及其有尊严的管理，而不是不适或恐惧。最近，联合国儿童基金会纳入了MHM和更广泛的系统性因素，这些因素将月经与健康、福祉、性别平等、教育、公平、赋权和权利联系起来。英国国际计划(2018年)更进一步，将“月经健康”作为总括术语，涵盖了月经的社会、教育、健康和获取方面。提到月经卫生这一术语，暗指要求清洁，从而分散了人们对月经是女性正常身体功能的认识。近年来，为解决月经健康结果差和经期贫困问题，已提出并实施了若干办法。在英国，这些措施包括最近的时期产品苏格兰法案(2020年11月20日)，向所有需要的人免费提供时期产品，在2020年3月的预算中废除有争议的5%增值税的“卫生棉税”，将所有经期产品归类为“非必需品、奢侈品”，并在英格兰所有公立学校和16至19个教育机构免费获得时期产品。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的规定中增加卫生产品，以减轻大流行对时期贫困的不利影响。几个国家正在出现注重尊严的改善月经健康的策略

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