When ‘hygiene’ becomes a dirty word…

28 May 2019.

In honour of global Menstrual ‘Hygiene’ Day (MHD) on May 28th, I thought I’d write about why there is a move to change the name…

Spoiler alert!- It’s not just because hygiene is hard to spell.

This year’s excellent MHD theme is: It’s Time For Action! [You can find out more here]

Over the past few years we have managed to accelerate advocacy and action on menstrual hygiene all around the world. But much more action is needed. Action to change negative social norms and practices, to catalyze progress on MH education, and to ensure everyone has access to products. We need more action from governments, funders, UN agencies and the private sector. Because together we can end period stigma. Together we can make sure all girls are educated about menstruation. Together we can ensure all women and girls have access to hygienic products.”

Click image to see poster!

Note the deliberate and careful wording at the end of this call to action… ‘hygienic products’. This is because, unfortunately, the term ‘menstrual hygiene’ unintentionally reinforces the myth that menstruation is itself dirty.

Obviously, this is absolutely not the intention of the people and organisations behind the establishment of this brilliant global awareness day. But this is why there is a movement in progress to change the ‘H’ [perhaps to stand for ‘Health’, instead]. While nobody is particularly against this change, it apparently takes an awful lot of work to alter an internationally recognised awareness ‘day’. [Update: It turns out that there are plenty of people who are against this name change! The assumption that menstruation is a crisis in hygiene lives on…]

So, in the meantime, we are still promoting MHD19, but taking care to be precise in our wording to avoid implying that it is menstruation that is unhygienic, rather than the lack of access to clean water.

Just as a reminder, here’s some relevant info from a previous myth-busting blog:

Menstrual Myth # 1: Periods are dirty…

Stains can happen to anyone.
  • Periods can sometimes stain clothing but this does not justify associating them with a ‘moral stain’ on the character of all people who menstruate [1]. Ink can also stain clothing but society does not restrict the activities and rights of people who carry a pen in their suit pocket.
  • Menstrual fluid contains hardly any ‘bad’ bacteria, especially when compared to other parts of the body and items that we regularly touch- e.g. hands, mobile phones, cash, credit cards, or uncooked meat [2].
  • Menstrual fluid is not an excretory product like urine or faeces; it is not removing toxins from the body. Periods just help keep the lining of the womb in a healthy condition.
  • Periods are only a ‘hygiene’ issue if people cannot access clean water to wash their hands or menstrual management products [3]. This makes poverty the problem, not periods.
  • Menstrual fluid only smells bad if there is an infection (typically thrush or Bacterial Vaginosis), or it has come into contact with the air, sweat, or the chemicals found in disposable menstrual management products [4].
  • While it is possible to transmit blood-borne viruses/ infections though menstrual fluid, the chances of this happening are extremely low. It would involve an individual’s menstrual fluid somehow entering the blood system of another person e.g. through broken skin. Blood-borne infection transmission is far more likely through unprotected penetrative sex or accidental injury [5].

References:

[1] If you are interested in learning more about how ‘period stains’ have been associated with ‘moral stains’ see: Johnston-Robledo, I. and Chrisler, J. C. (2013) ‘The Menstrual Mark: Menstruation as Social Stigma’, Sex Roles. Springer US, 68(1–2), pp. 9–18. doi: 10.1007/s11199-011-0052-z.

[2] Sadly, nobody has ever bothered doing a proper clinical comparison… However, we do know that although the bacteria ‘flora’ of the vagina is diverse and variable between individuals, the primary colonizing bacteria are always of the ‘good’ genus Lactobacillus. The lactic acid these bacteria produce is thought to protect against infection by pathogenic species, by keeping a low vaginal pH. Whereas, hands, cash, credit cards, mobile phones, and uncooked meat are known to harbour faecal bacteria (from poo!)- a major cause of illness- check out these pages, if you’re feeling brave!  https://www.bbc.co.uk/news/magazine-19834975  and https://www.cdc.gov/handwashing/why-handwashing.html

[3] Without access to clean water, people are unable to properly clean their hands, or their menstrual products, which can lead to vaginal infections, such as BV or thrush. The menstrual fluid itself is not a cause of infection, unless it is unable to leave the body (e.g. in the case of an imperforate hymen), or that individual happens to have a blood-borne disease like hepatitis, or HIV. Used disposable products can also become unhygienic if there is no waste disposal process to get rid of them. Again, this is a problem caused by a lack of access to water, and sanitation infrastructure- not periods.

UPDATE: Chapter 4 of Chris Bobel’s recent book, ‘The Managed body; Developing Girls and Menstrual Health in the Global South’ describes how there is insufficient data to prove any causal link between menstrual management product type or condition (i.e. improperly washed) e.g. cloth, disposable pad, cup, or any other makeshift solution with vaginal infections, or any other form of poor menstrual health. Indeed, the idea that ‘many’ girls miss school due to a lack of access to products also lacks robust empirical data. This is not to say that no girls miss school due to this issue, just that it is not a major issue in any country context. Period pain is a far more likely [and more evidence-based] cause of school absences. This is why menstruation education, access to healthcare or medication, and anti-stigma projects may be more effective approaches to improving menstrual health than product distribution alone.

[4] While it is normal for menstrual fluid to have a musty/ metallic smell (like any other part of the body or blood), a ‘bad’ smell is an indication of infection. A fishy smell indicates BV (Bacterial Vaginosis). A non-fishy smell plus creamy or yellowish discharge can indicate thrush.

[5] The UK Health & Safety Executive lists the most common forms of blood-borne infection transmission as; sex, sharing injecting equipment (needles), accidental skin puncture by needles, and childbirth/ breastfeeding. http://www.hse.gov.uk/biosafety/blood-borne-viruses/spread.htm


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