Why the menstruation and sanitation revolutions need to talk

The headlines about Kiran Gandhi, the woman who ran the London Marathon with nothing to staunch her menstrual bleeding were, to me at least, amazing and heartening. It wasn’t just her courage that struck me, but how far we’ve come in breaking taboos in talking about menstruation – particularly the fact that so many women around the world have to suffer in silence, without access to the products or facilities to manage their menstruation with safety and dignity.

Women’s right to good menstrual health management is an issue close to my heart. This both came out of, and now informs, my work at Stockholm Environment Institute on improving access to sustainable sanitation. After a decade and a half of working with gender and development in sub-Saharan Africa, the problems that women and girls face when menstruating first really struck me during a project that asked Zimbabwean schoolgirls how school toilet blocks could better meet their needs. The girls wanted washing facilities inside the toilet block, along with lights and doors so they could deal with their menstruation in private. For most of us, these would seem like the basics; for these girls, it was a dream.

According to a 2011 survey by AC Nielsen, only an estimated 12% of women and girls in India use decent sanitary protection while menstruating; others resort to whatever absorbent materials they have to hand, mostly rags, putting themselves and others at risk of infection. Another study in e-Thekwini municipality in South Africa found that 99% of the girls interviewed skipped school during menstruation rather than face the indignities and risks associated with poor menstrual health management.

A new era of awareness

The recent headlines are not the only sign that things are changing. During the last four years a growing number of practitioners and researchers, along with organisations like WSSCC and the Bill and Melinda Gates Foundation, have responded to and amplified the wake-up call on menstrual health. This has helped to lift menstrual management high up the political agenda, raised public awareness, and – most important – led to real action to support menstrual health management in developing countries.

What about waste?

While the progress in access has been remarkable, we cannot ignore the practicalities of what to do with all those pads. Even as they provide new levels of freedom, dignity and safety for millions of women and girls, used pads are a challenge for health, the environment and waste management. In many communities, women have little choice but to throw them out in the open and, when mixed with solid waste, they can add to the many health hazards faced by waste-pickers. A recent Swedish study highlighted concerns that commercial pads and tampons contain hazardous chemicals from the bleaching process, which could leach into water and soils. The absorbent polymers in most commercial pads make on-site incineration a dangerous option.

And the volumes are huge. Even now, with only around 12% of women using commercial pads, according to the AC Nielsen survey mentioned above, India alone generates around 432 million used pads every month – nearly all in urban areas where solid waste is usually better managed.

Sanitation vs menstrual health management

One of the least explored aspects of the menstrual waste question is how used pads interact with sanitation development.

The simple fact is we don’t know enough, but it’s no secret that tampons and pads can block many existing sanitation systems. In a global survey, SEI found menstrual waste to be the main contributor to failure in waterborne systems. They can also quickly fill up the pit latrines on which millions of households rely.

So what will happen as pads go ever more mainstream? How can we avoid an almighty clash between sanitation and menstrual health management? Solutions are likely to include better design of sanitation systems, promotion of alternative products (including reusable products such as menstrual cups), and ensuring there are safe disposal options to hand. And how can we avoid downstream environmental problems? To find clear answers to these questions, we need integrated thinking, and more research.

We must not lose the momentum behind increasing the use of hygienic, convenient menstrual hygiene products. But alongside this essential work, policy-makers, practitioners, researchers and communities need to:

• Make sure women and girls have clean, private facilities where they can manage menstruation, wash, and safely dispose of menstrual hygiene products
• Educate women and girls on how to dispose of pads
• Equip designers and planners of sanitation systems with the knowledge and awareness they need to provide systems that meet the needs of all people, and that will not be put out of action by menstrual hygiene products.

We’ve started on the marathon for universal menstrual health management. Let’s make sure no-one else has to run it with nothing to stem the flow.

Source: Guardian Development Professionals Network, WSSCC partner zone