Dear Mintje,
I want to emphasized that these taboos and deeply rooted negative attitude, restrictions and harmful practices surrounding menstruation is cultural, traditional and religious band.
For some years we at Daniel Iroegbu Global Health Foundation in partnerships with WSSCC have been mobilizing and engaging the traditional leaders on "Breaking the Silent on Menstruation" and Improving Menstrual Hygiene Management for social transformation.
We engaging and partner with the religious leaders and organizations (This weekend we will be breaking the silent on menstruation at Edem-Ani, Nsukka Local government Nigeria in collaboration with the Presbyterian Church of Nigeria Edem- Ani Mission Parish and from 17-22nd April 2017 our team will be in Ububra,Ububra Local government in partnerships with Ububra Urban Ministers Forum to administer Vitamin A supplementation and deworming among under-5 children and to break the silent on menstruation and train the community/Church members on improving MH practice.
For a while now we been engaging the schools and the media on breaking the silent on menstruation and improving menstrual hygiene management.
There is this popular August Women Meeting normally held in August, we use the same medium to breaking the silent on menstruation and improving menstrual hygiene. It involves the Bishops and clergy wives and the older women. We engaged them as agent of social transformation on improving menstrual hygiene management.

Dear all,

It is really interesting to read about the different kinds of taboos and stigmas related to menstruation.
It seems that they all have their origin in cultural practices and beliefs, that are often influenced by religions (e.g. as mentioned in Pakistan), or some other sort of spiritual entities (e.g. in local tribes).

As these groups and religions usually have a big influence on people’s daily behavior, I was wondering if anyone has made experiences regarding involving and collaborating with religious (or other spiritual) groups to break taboos and change certain “critical” practices. For example working together with leading churches in countries, or the Ministry of Religion, Muftis, etc. …

I'm looking forward to your comments on this!

Best,
Mintje

Thanks for all the continued wonderful inputs from around the world! It's terrific to have the diversity of experiences, findings, observations and thoughts on various ways forward to address MHM in different contexts. I haven't heard that girls in the US are taking the pill more commonly for menstrual suppression, but that doesn't mean it's not happening (as my focus is primarily in low-income contexts). We do have a new publication out in the Journal of Adolescent Health, www.jahonline.org/article/S1054-139X(16)30404-9/abstract , that was a systematic review of the evidence on the experiences of girls in low-income contexts in the US around puberty/menstruation and although there is insufficient research on this issue, there does appear to be a gap in information and support, and many of the challenges we find in other countries where they are not receiving adequate, practical guidance.

I look very much forward to continuing to learn from all of you! (and hope you have seen the parallel posting by Therese Mahon on MHM infrastructure and indicator issues).

Dear all,

It's been interesting reading about the situation in other countries, so I thought I would briefly also mention how it is in Germany, in case someone finds it interesting (or it might be boring, as it is probably very similar in most of the other countries of the European Union and other Western countries (with a predominantly Christian/Atheist/non religious population (?), where sex education takes place at school).

But before I do that, I wanted to pick up something that Susannah had said in the post above mine:

encourage young women towards hormone treatnents to minimize or stop menstruation.

I was told that in the U.S. it is nowadays reasonably common to take hormone pills that have a dual purpose: contraception and also menstrual suppresion (see on Wikipedia here for an explanation of what menstrual suppression is: en.wikipedia.org/wiki/Extended_cycle_com...rmonal_contraceptive)

The thinking is that if there is no medical evidence of negative effects of not menstruating then why have the hassle if one is on hormonal birth control anyhow. So apparently, lots of women in the U.S., and probably other countries, do away with the monthly issues of menstruation and live without menstruating. I am not saying this is good or bad but it it just interesting and I wonder if we could get to a situation where women in wealthy countries are less likely to menstruate than women in developing countries for that reason.
Menstruation could be regarded as a celebration of fertility. But in countries where fertility is not so much of a big thing (i.e. being childless is not a stigma) perhaps women say "why bother with menstruation".

Now some quick observations regarding menstrual taboos in Germany:

1. In general, girls and young women are well informed, they learn about menstruation in school (in our school it starts with 9 years old). I think the curriculum is very well thought through. I would say most girls are also happy to talk about it with their mothers or older sisters and later with their friends. Overall, the taboo about menstruation as such is relatively low.
2. Girls and women all have access to hygiene products, it's not seen as something expensive but more like toilet paper. It's just available. (I read the same is not true for poor women in the U.S.) I would guess that most girls start out with disposable pads but then relatively quickly switch over to tampons which are very widely used. One reason for tampon use is that girls and women want to continue to do sports, including swimming, and for that tampons are better than pads. For most German girls, there is no issue with that verginity aspect (i.e. not wanting to insert something), although this might well be different for the Muslim people in Germany, I am not sure but am guessing.
3. Menstrual cups are an alternative to tampons but are still not well known in Germany (time and time again, I am the first one to tell someone about them). I have the feeling that menstrual cups are better known in the UK than in Germany.
4. Regarding taboos, while I said above there are little general taboos there is of course still huge embarrassement if one leaks and blood stains are visible on one's trousers. However, this kind of taboo in my opinion is just human nature, just how it would be embarrassing if you pee your pants or if you wet your bed or fart or burp etc. I can't imagine that it would ever go away completely?
5. I cannot recall any cases of boys teasing girls about menstruation, except perhaps saying things like "are you on your period?" or "do you have PMS?" (premenstrual syndrom) when a girl or woman is in a bad mood. This can be annoying but it is not that bad. In general, I would say boys and men are not that keen to talk about it (talking of blood can make them queasy) although I think most men are OK with knowing when their girl-friend or wife is menstruating etc. In general, they are reasonably well informed, although more could be done.
6. Teenage girls sometimes can enjoy having a "common secret" and I think are generally quite open in talking to each other about it, e.g. at school or in the soccer team "I have a bit of stomach cramping, I am on my period, do you have any tips for me?".

I wonder which country is "the best" and most open with regards to menstrual hygiene issues? Probably Sweden or one of the other Scandinavian countries once again which is the winner in almost all social aspects.

Regards,
Elisabeth

I agree Hina. My literature review shows plenty of evidence of development workers dismissing local practices, expressing irrational disgust which is easily transferred so people feel ashamed of practices which may have merit, are adapted to that environment, and may even be helpful to women elsewhere.
My local UK focus groups show how openly sharing enables attitudes to relax allowing practices to be adopted or discarded . Our problems in UK are; extreme poverty that is hidden inside homes; disposal of pads and especially tampons which clog drains and litter beaches; social taboos which inhibit adaptive change and encourage young women towards hormone treatnents to minimize or stop menstruation.

The menstruation is tabooed topics in world except few countries. Every country has their kind of taboo which may also different with in a country due to its geographic location. Mainly culture defines these taboos and somewhere religion also. So to address the taboos and breaking silence around MHM needs, one major STEP is to identify the exact taboos rather than to impose your own perceptions. Normally this is happened when ever data is collected around MHM, the researchers has their own experience and mind set and as this topic is not openly discussed, so many times some universal taboos come from research. Therefore all struggles go in waste as we are not targeting original taboo.
Then the second STEP is to design a behavior change campaign. As many researches show that each society/community has their own set of norms so campaign should be designed by keeping the community setting in mind rather than just follow some standards of awareness raising methods. And third STEP is the time frame. You can’t change practices in days, it is long process. Therefore give enough time for this process. And off course the persons those involved in this process, their capacities also matters.

I am not in the Caucasus, although I would like to have been able to go to Armenia. I am based in the UK, and have been researching existing menstrual management strategies both here and across the world, by all means available to me as an independent, unfunded individual. The Caucasus was one area that I noticed had been under-researched, and I have as yet no data on existing practices. As I failed in my (funding-) bid to arrange a visit myself, I wonder if you could forward me any information on how women manage their menstruation in that geographical area?
I realise that any data will be localised and sample-specific, however it is all useful, even when it is "just the same as everyone else".
Thank you for your reply!
Susannah

Hello!

Great to hear about this important work in Nigeria and your challenges trying to break the silence with boys and men on this topic. I just wanted to share this link: www.growandknow.org/books.html

From it, you can download the two boy's puberty books that we have developed (though participatory research with boys in two countries - Tanzania and Cambodia) - to create books that can be handed to boys when girls receive their own puberty books. The boys' books include content on menstruation, and we hope that together the books can help girls and boys (and their teachers) to feel more comfortable with the topics around their changing bodies, and support each other.

Dear Brenda
I am amazed at how taboos resemble each other, despite the distances. In my country (Bolivia) it is also believed that menstruating women should not touch plants or harvest fruit, as plants will die. It is sad that a natural fact as menstruation, becomes a stigma, transforming women (givers of life) into carriers of death.
Also the subject of shame about absorbent products is very similar in my country. Girls do not like to admit they use cloth. And when they can access a commercial product, they leave it for more hours, to obtain the maximum use of it. This ultimately causes stains, smells and therefore, more shame.
However I think people are beginning to talk and think much more about menstruation, I hope this will provoke internal changes in people, especially the younger generations. Little by little there is improvement.

Hi Susannah,
which country in the Caucasus are you working in?
Claudia

Hi Claudia - I'm very interested in existing practices for menstrual management in the Caucasus. Can you direct me to any data about what materials menstruators use for absorbing menstrual fluid and how they are worn, and any other practices? Many thanks, Susannah

I would like to share a proposal and a response to our MHM discussion, that reached me via email from Bernard Miti from the Zambia WASHE Advocacy Network (This email address is being protected from spambots. You need JavaScript enabled to view it.):

The Thematic Group: on Menstrual Hygiene Management in Schools in Zambian Context:

BARRIES:

It has been concluded in a number of MHM studies conducted both in Zambia and other development countries that Girls miss classes for a number of reasons during Menstruation. Challenges may come from a limited knowledge of MHM. Some cultures view Menstruation as taboo, resulting in a wide range of myths and misconceptions .In schools, a lack of access to suitable facilities and adequate materials (private toilets, Water, Soap, and Disposal facilities) make menstruation management difficult.

In the MHM pilot study that was carried out in 2013 in rural parts of Eastern, Luapula, Northern central province in Zambia, it was estimated that girls missed up to 36 days per year each with the majority ( 81%) of Girls who were interviewed missed school for entire period of menstruation.

• Lack of understanding among girls on the biological process of menstruation exists.
• Girls have no formal information on menstruation prior to menarche.
• Male teachers are hindered by cultural barriers to adequately address MHM within school curriculum, especially in rural areas.
• There is limited access to affordable hygienic menstrual management materials.
• Most girls from low-income households are not able to buy disposable sanitary pads and instead use pieces of old cloths material or chitenge.
• 58% prefer to re-use old pieces of clot because of their availability and affordability.
• 47% of girls in rural areas don’t o to school when they are menstruating due:
• Discomfort as a result of fear of soiling their dress, poor sanitation, lack of sanitary materials and menstrual plan.
• GIRLS miss up 36 days each per year due to menstruation; this is greater than 10% of all learning time missed each year.
• Cultural, Restriction, Taboos, Myths and Misconception: 70% of girls had restriction placed on them during their menstrual period. These include avoiding playing with males, not being able to cook, and restriction on movement, including going to school in some instances. Myths and misconception exist about MHM that can affect girl’s behavior after menarche and during menstruation.
• Stigmatization by Boys. Boys tease the girls when they are menstruating especially when the girls stain their skirts/ dress.
• Support: What about support at school from teacher? Not just in education but in understanding .Such as letting girls use the bathroom when they wish or having school clubs that mentor young girls. Opportunities to engage parents.

TABOOS:
Some women are forced to abstain from household chores, such as cooking and being around babies and children, as they are considered impure during menses Menstruation.
In some regions, a menstruation woman is not allowed to pray, the cost of sanitary materials makes them unaffordable for many women and girls, who the many use unsanitary pieces of cloths instead.
Girls are often absent from school during menstruation for fear of being noticed and ridiculed by other pupils (especially boys)
Resistance from parents to the use of sanitary pads, some parents perceived the distribution of menstrual Hygiene management materials at school to be an act of Satanism and blood on the pads would be used ritual purpose. They are also rumors girls who used pads would go mad or die.
Use Community based women’s groups to disseminate Menstrual Hygiene Management information and scale up menstrual hygiene Management intervention.

Kindely also see his proposal attached, as he is looking for project and funding partners.

PROJECT PROPOSAL INSIGHTS

The insight is that, the organization is looking for well wishers for the contribution towards raising a total of $ 20,570.00 for the implementation of Rural Menstrual Hygiene Management for girls, Zambia is facing challenges in primary schools and its effects on attendance of lessons in Zambia due Discrimination and lucky of advocacy and awareness programmes. The Organization is looking for a partner to help us raise these funds; please refer to the Proposal you received earlier.