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Menstruaction Teaser

Why ‘MenstruAction’ is a gender-transformative approach: BMZ and GIZ‘s commitment to a movement that has come a long way

How a neglected yet vital issue has climbed up the development agenda, why it matters and what still needs to be done.

 ‘I am thrilled about BMZ’s feminist development policy. We have worked for many years to get the menstruation issue on the German development agenda, but there was little interest in it and little money for it. With this new momentum, we will get more things done,’ says Valerie Broch Alvarez, a public health expert with decades of experience in the field of sexual and reproductive health and rights for Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ).

Looking back at the rise of menstrual health in German development cooperation over the past seven years makes her glad and a little proud. What began as a niche topic in a project component in Nepal has turned into an issue that has the explicit backing not just of countless colleagues in Germany and partner countries, but also of the GIZ Gender Commissioner, Dr Angela Langenkamp, and even the Minister, Svenja Schulze, herself. How did this come about – and what will come next?

MenstruAction and the ‚three Rs‘ of Feminist Development Policy

By encouraging people of all ages, including boys and men, to start talking about menstruation and women’s and girls’ menstruation-related needs and rights in a positive and affirmative way; by integrating it in schools’ standard curricula, in schools’ WASH routines and in schools’ infrastructure, the MenstruAction approaches supported by German development cooperation strengthen women’s and girls’ rights and resources and ensurethat their menstrual needs and rights are represented in the public discourse. 

A harmful practice in Nepal sheds light on a neglected topic

 ‘Around 2016, our project sought to improve adolescent health services, focusing on contraception and the prevention of sexually transmitted infectious diseases and HIV/AIDS. Yet when we asked young people which health issues mattered to them, menstrual health and the stigma around it kept coming up,’ says Broch Alvarez. ‘Around the same time, the national press reported on several cases of girls who died as a result of Chhaupadi. This was a clear signal for me that we had to step up.’ In the following years, the Nepali-German project began to tackle the taboos and problems linked to menstruation, including on the need for affordable and biodegradable menstrual products and for school toilets that ensured privacy for menstruating women and girls.

In a remote region of Nepal, menstruation is sometimes accompanied by a practice known as Chhaupadi which banishes menstruating women and girls to cattle sheds or caves (see this article).

A national summit boosts a country-wide Menstrual Health movement

In 2018, Valerie and her team supported the Nepalese Ministry of Health in organising a national summit on menstrual health, entitled ‘MenstruAction’ (see this article). More than 500 participants attended the conference to discuss issues that had up to now been shrouded in silence.  Dr Marni Sommer, Professor at Columbia University and an expert on menstruation, gender and sexual and reproductive health, was invited as one of the summit’s keynote speakers:

Other conferences I had attended on Menstrual Health were mainly attended by delegates from international organisations and by researchers from across the globe. This MenstruAction summit in Nepal was different: Most delegates were Nepali and their discussions were both passionate and inclusive.

Dr Marni Sommer

Sommer remembers how one Nepali transgender delegate took the mike to share his difficulties in obtaining the menstrual product he needed. In her view, the fact that he did not hesitate to do so in front of a large Nepali audience testifies to the exceptional spirit of the event.

‘At the summit many people approached me to express their full support’ says Broch Alvarez. ‘They understood that this issue does not just affect women’s health, but their economic development and their equality, too. Our project’s aim was to let young women grow more confident and to support women’s leadership.’ To keep the MenstruAction momentum alive following the conference, the Nepali-German project continued to support  Nepal’s Menstrual Health and Hygiene Management Partner’s Alliance (MHM PA), a knowledge-sharing platform for local, international, civil society and governmental organisations working on menstrual health issues (see this article).  

Menstrual health and hygiene as integral part of school health routines 

In the Philippines, the German-supported Fit for School programme acknowledged schools’ crucial role in tackling menstrual health taboos, both in terms of including it in the curriculum and in terms of school infrastructure and practices. This has meant, for example, ensuring that all schools have menstruation-friendly toilets and informing 27 million Filipino students about menstrual health, dispelling many myths and taboos.

In addition to providing straightforward practical guidance to schools, Fit for School made sure that these new standards and practices are included in the Ministry of Education’s routine monitoring system so that they are assessed on an annual basis and, where found wanting, are followed up upon and brought up to standard.

With GIZ’s support, the Philippines is today far more advanced when it comes to integrating menstrual health and hygiene into their school monitoring system. It can be seen as a guiding light for other countries to learn from.

Marni Sommer

In their March 2022 publication about suitable indicators for national menstrual health monitoring, Sommer and her Global Consortium included the Fit for School WASH indicators as an example of best practice. ‘Now it’s time to help other countries get to where the Philippines is,’ adds Sommer.

Young influencers change the public discourse about matters of menstruation 

In a similar vein, German-supported projects in Nepal, Albania and the Philippines have been involving local social media influencers and celebrities to shatter taboos around menstruation (see this article). In Albania, for example, the #LetsTalkPERIOD campaign launched by presenter Fatma Haxhialiu has been a viral success. She encourages girls and women to talk openly about periods. Only a few months after the campaign was launched, over 1,5 million people had viewed the videos on social media – in a country with a population of 2.9 million people.

Over the last three years, the #LetsTalkPERIOD campaign in all three countries has reached over 5 million people, engaging both male and female influencers as Goodwill Ambassadors and using social media to spread the word to audiences far and wide.

And why is it gender-transformative to tackle menstruation issues?  

‘Working with influencers has helped us to break the taboos around menstruation,’ says Dr Angela Langenkamp, GIZ’s Gender Commissioner. In her view, it is high time for the topic to be brought out of its niche to show the full extent to which it affects women’s and girls’ lives:

Where women and girls do not have access to affordable menstrual products this restricts their participation in education, in the economy and in public life. This puts them at a disadvantage vis-à-vis their male peers and competitors. Gender-transformative action means addressing the root causes of such disadvantages and of any discrimination related to gender. Menstruation as such is not the problem but the way we deal with it.

Dr Angela Langenkamp

According to the Canadian government which – just like Germany – promotes a feminist approach to development, access to pads and tampons must be treated as a basic need and doing so will improve equity, reduce stigma, and create healthier, more inclusive workplaces.

Should German development cooperation step up as champion for menstrual health and rights?

Jan Schlenk, GIZ advisor in the fields of Water, Sanitation and Hygiene (WASH), recognised early on that it could be a game changer to acknowledge how menstruation and its management affects women’s and girls’ lives. He initiated GIZ’s collaboration with social media influencers and the production of video clips that, with their positive and empowering messages, quickly went viral in Nepal, Albania, the Philippines and beyond. Although he himself works in GIZ’s WASH division, he is convinced that the time has come to change the image, and name, of the menstruation topic in the development arena:

In some ways, ‘Menstrual Health and Hygiene’ is a misnomer. The menstruation topic goes far beyond questions of health and hygiene – it is a question of equality and of rights. How about calling it MHR – menstrual health and rights?

Jan Schlenk

Marni Sommer believes that, though much work remains to be done, menstrual health and rights researchers, development practitioners and activists have come a long way in putting menstrual health on the international development agenda. In her view the German contributions have been instrumental in this. And she hopes that a development partner will come forward as long-term menstrual health and rights champion to consolidate and further what has been achieved to date. Might Germany step up?

Inna Lazareva and Anna von Roenne,
May 2023

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