Menstrual Hygiene Day, on 28 May, is a day to shout about a natural process that millions only dare whisper about. Menstruation is a sign of a woman’s health and fertility, yet it is surrounded by shame, secrecy, humiliation, fear, taboo, stigma and embarrassment. The women and girls without access to the water, toilets, materials, disposal facilities, privacy and information they need to manage their menstruation safely and with dignity suffer most. This situation is completely unacceptable in 2015. A growing number of people are demanding an end to both physical barriers and stigma – in communities and as high as the UN. In September, UN member states will finalise the post-2015 Sustainable Development Goals (SDGs). The goals are a once in generation opportunity to enable all girls and women to manage their periods hygienically. WaterAid is calling for an indicator to be included in the SGDs to measure the presence of hygienic, safe and private places for women and girls to manage their periods – which feature toilets, washbasins, water and soap – in homes, schools and healthcare facilities. A global indicator will help hold governments to account and ensure that menstrual hygiene management for all is not just an empty promise, but a reality. Many women struggle to dispose of pads and cloths hygienically after use. In Nagbabal, Nepal, schoolgirls resort to pushing their sanitary pads into the toilet walls. Photo: WaterAid/Shruti Shrestha Why is this such an important issue? Menstruation and the onset of puberty in girls should not raise an eyebrow. It should be recognised as simply a normal part of growing up. Instead, for millions of people it leads to huge disadvantage and prejudice. A colleague, telling me of her experience growing up in Uganda, illustrated this vividly. She remembers that when she started her periods any hint of conversation about it brought such an air of embarrassment that she soon learned to keep it to herself. With no sanitary pads available she used toilet paper to stop the flow of blood – an agonising endeavour during her 10km walk to school. The hard paper caused painful bruising and open wounds on her thighs. Although her school did have toilets, they were dirty and without water, so she couldn’t clean herself. A need for education The stigma made it difficult for her even to find out what was happening to her body. Eventually she was taught about puberty in biology lessons, but there was no discussion in class about what this meant in society, and nobody challenged the negative beliefs associated with menstruation. “It was too embarrassing,” she said. “Boys bullied us and made fun of us. They would write sticky notes on my back – ‘I am dirty’ or ‘I am stinking’ – and the teachers refused to intervene.” Boys and girls later went to separate lessons on puberty, she recalled. Boys emerged from their sessions feeling proud of the changes in their bodies, whereas girls were embarrassed and ashamed. Education about menstruation and simple, hygienic facilities to manage menstruation can help keep girls in school and help change their futures. These students at a government high school in Mithi, Pakistan, have lessons on menstrual hygiene management. Photo: WaterAid/Mustafah Abdulaziz Menstruation, human rights and equality A recent paper by academics Inga Winkler and Virginia Roaf, Taking the bloody linen out of the closet, provides a detailed analysis of the human rights framework with respect to menstrual hygiene management. It shows that, without proper facilities and information, the human rights of women and girls – and true, substantive gender equality – cannot be guaranteed. The stigma associated with menstruation is still a major driver of gender inequality in many countries. Many cultural and religious norms, often grounded in patriarchal assumptions, seek to prevent others from having contact with menstruating women and girls to ‘avoid contamination’ or avoid ‘becoming impure’. Such practices reinforce the subjugation of and discrimination against women, rather than treating periods as a natural biological process and a mark of fertility. Menstruation should not be a matter of shame or impurity. It should be associated with pride and dignity. The stigma and disadvantage begins right at the onset. Girls who are menstruating at school need sanitary towels, latrines, places to change and safe water. They also need non-judgmental, factual information. Without these facilities the school environment is unhealthy, discriminatory and dangerous, to the extent that menstruation is one of the main reasons why girls in developing countries leave education. How do we address this? In keeping with analysis by Sandra Fredman of the University of Oxford, Winkler and Roaf suggest we should take the following steps: Redress disadvantage, by promoting girls’ education and the construction of toilets in schools. Address stigma and stereotyping, by educating not only girls but also men and boys on the intricacies of menstruation, to provide opportunities for discussions to shed light on a topic currently surrounded by shame and confusion. Embrace difference and achieve structural change by addressing menstrual hygiene management at all levels – from legislation and policies, to financing and tax reforms, institutions, and down to the very practical necessity of disposal units for menstrual towels. Enhance voice and participation, because substantive equality means enabling women and girls to decide how they want to handle their menstruation in an informed way and not to be judged for them. An opportunity not to be missed Including menstrual hygiene as an indicator for the SDGs is an opportunity we must not miss. It will address a huge and pressing practical problem for billions of women and girls, while also taking a big step towards gender equality. Don’t whisper it. We have the chance to advance gender equality in one giant leap. We must not fail. Louisa Gosling is WaterAid’s Programme Manager – Principles. She tweets as @louisagosling1 and you can read more of her blogs here. This piece was originally published by Devex. For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter.