Millions of adolescent girls around the world face a miserable cycle of pain, discomfort, shame, anxiety, and isolation when their menstrual period arrives every month.
In many low-income and middle-income countries, access to sanitary products such as pads, tampons, or cups is limited, and girls often resort to using proxy materials such as mud, leaves, or animal skins to try to absorb the menstrual flow.
Appropriate and hygienic infrastructure—including waste disposal mechanisms, soap and water for washing, and safe, private, and accessible toilets—is rarely available or sustainable. This absence of facilities, coupled with the shame and fear of exposing their menstruation, mean that many adolescent girls are forced to miss school during their period; consequently, in many rural resource-poor settings, adolescent girls who are already disadvantaged by social norms miss a quarter of their education opportunities.
And this is not confined to developing countries—a recent study by Plan International UK also reported menstrual-related school absences. One in ten girls aged 14–21 years in the UK can't regularly afford menstrual products, forcing some to stay home from school, and 42% have resorted to using makeshift sanitary ware such as paper and socks.
However, period poverty is a broader issue than one of economy. Because of entrenched stigma and taboos, menstruation is rarely discussed in families or schools, and menarche often arrives suddenly to girls with little or no knowledge of what is happening.
A UNICEF study showed that one in three girls in south Asia had no knowledge of menstruation before their first period, and 48% of girls in Iran thought that menstruation was a disease. Often considered a shameful, dirty, female weakness, the secrecy surrounding menstruation has permeated every aspect of society, nurturing superstitions and taboos that are passed on between generations. In many communities, menstruating girls and women are still banned from kitchens, crop fields, or places of worship.
For most girls, management of menstrual pain is a key concern, yet little sympathy or attention is given to those facing this regular pain, let alone management of irregular or pathological periods. In the UK, nearly 80% of adolescent girls have experienced concerning menstrual symptoms (such as unusually heavy or irregular bleeding) but hadn't consulted a health professional; 27% of those said they were too embarrassed to discuss the topic. The rooted silence surrounding periods is putting lives at risk.
Menstruation is a normal and regular event in every healthy adolescent girl's life. Yet drastic changes are needed to encourage positive social norms and ultimately enact behavioural change. Global Menstrual Hygiene Day on May 28, led by WASH United and supported by more than 400 organisations globally, aims to achieve that. This year, the focus is on empowerment.
Adolescent girls need the support of their governments to provide adequate infrastructure, access to affordable sanitary products, and gender equity for them to manage their periods. Progress is beginning: Kenya now provides free sanitary pads to girls in education, and Ethiopia has established menstrual hygiene management clubs in schools. In these and other countries, such as India and Pakistan, change is happening because influential ministers, both male and female, are prioritising the needs of menstruating girls and women.
Community leaders, health workers, and teachers are perfectly positioned to negate menstrual stigma, and parents and wider family members need to be educated about their cultural traditions and superstitions, which might be unintentionally causing harm to women and girls. But to establish sustainable social change, education is key. All girls and boys must be educated about menstruation and reproductive health to empower them to talk comfortably and candidly about periods and sexual health.
We applaud the increasing efforts worldwide to empower, educate, and engage country leaders, communities, families, and adolescent girls and boys about menstruation, and to highlight the right of women and girls to hygienically manage their periods. Enormous advances have been made in global child and adolescent health, maternal health, and women's rights.
Yet the needs of the 300 million women and girls menstruating on any given day remain buried low on the global health agenda, simply because many are too embarrassed for frank discussions about menstruation. It is time to finally abolish the absurd silence and shame that shroud this natural biological event. Menstruation, a sign of good health, must be normalised, and celebrated.