The Palgrave Handbook of Critical Menstruation Studies

Most articles on menstruation start by pointing out that menstruation is a normal biological process. This, of course, is true. But at the same time, menstruation is so much more for many people; in fact, it is fundamental. Menstruation unites the personal and the political, the intimate and the public, and the physiological and the socio-cultural. The chapters in this section demonstrate the importance—and indeed urgency—of considering the lived experiences of all menstruators. These vary widely and are shaped by a range of different factors including religion, culture, political systems, socialization, caste, disability, place of residence, among many others. In many cases, an intersection of factors such as gender and disability, or gender, religion, and caste determine menstrual experiences and the underlying power relations.

McCarthy and Lahiri-Dutt illuminate the menstrual experiences of women living in informal settlements in India. Beginning with a critique of menstrual hygiene management (MHM) and water, sanitation, and hygiene (WASH) framings of women’s menstrual practices, they argue that these approaches ignore important spatial, social, and moral meanings attached to menstruating bodies in informal settlements. To substantiate their argument, McCarthy and Lahiri-Dutt take the reader into the jhuggīs and the lives of individual women who have migrated for work to the New Okhla Industrial Development Authority (NOIDA) area in Delhi, India. The authors show how, despite the congested and cramped conditions, women traverse the structural deficits of informal living to reconfigure notions of privacy and to navigate changing gender relations.

In this chapter, Vora focuses on the lived experiences of menstruation and homelessness. She offers an insight into the ways in which women experiencing homelessness understand and negotiate their leaky, menstrual bodies within contexts of limited financial and material resources. This study explores the scale of the personal, offering a phenomenological insight into the homeless experience of menstruators. Through personal interviews, Vora reveals that menstruation is regarded as a negative, emotional, and expensive experience. The participants are conscious of their doubly stigmatized status as homeless and menstruating, and they mobilize strategic rationalities to manage and conceal their menstrual status. Finally, Vora critically analyzes charitable initiatives that strive to alleviate the challenges faced when menstruating while homeless.

In this personal narrative, Bozelko shares her experience of being without adequate menstrual supplies while incarcerated. She describes the atmosphere of privation, including the shame and humiliation of staining her clothes and having to ask for tampons and pads from male guards. Bozelko argues that the issue is not a shortage of materials but the power differential between guards and inmates. Guards preventing women from accessing menstrual materials is both unnecessarily degrading and a human rights violation.

In this first-person recollection, Roberts describes in frank detail an expert witness in a civil rights case on behalf of former inmates subjected to a strip and body cavity search in a women's jail. As Roberts relates, the procedure was monitored by female deputies and conducted en masse, and those who were menstruating had to remove their soiled tampons or pads in front of the group and, in some cases, bleed down their legs and onto the floor. Deputies are alleged to have verbally abused the inmates during the procedure. This case, Roberts says, has opened her eyes to the ways the shame and disgust that menstruation engenders gets deployed to debase disenfranchised women. Roberts asserts that this is a uniquely misogynist form of punishment, meted out by and against bodies and minds that have been colonized by objectification and self-objectification, becoming a grotesque platform to dehumanize women who land on the wrong side of the law and who live in bodies that menstruate.

Menstruation is often categorized as a function of the female body that affects women. Trans and genderqueer people contest this biological function as a social signal of gender/sex identity. The comics illustrate the gendered interactions trans and genderqueer people must navigate in their daily lives and visually explore four gendered/ sexed social spheres: (1) gender/sex identity, (2) public bathroom attendance, (3) product marketing and messaging, and (4) healthcare. Each of these arenas is permeated by the biologically and socially constructed gender/sex binary, and as a result trans and genderqueer menstruators confront preexisting constraints ranging from social interactions to the built environment. These micro social symbols of gender/sex distinction are symptoms of a larger gender regime in which gender/sex are interpreted, regulatd, and policed.

Steele and Goldblatt argue that menstruation is a key site for discrimination and violence against women and girls with disabilities and that the law has been complicit in sustaining these injustices. The authors make this argument by exploring the law as it relates to sterilization and provide an overview of some of the legal dimensions of menstruation in relation to women and girls with disabilities. The authors offer Australia as a case study of the human rights challenges for this population. The study concludes with a call for critical menstruation studies scholarship to engage with the legal dimensions of menstruation in relation to women and girls with disabilities and consider how mainstream menstruation activism can address this population’s experiences and needs.

Musu Bakoto Sawo takes readers through her personal journey as a former child bride. In demonstrating the relationship between menarche and child marriage, she explains how parents deny girls their right to education by sending them to their marital homes prematurely. Sawo explores the factors that contribute to the high prevalence of child marriage in The Gambia and identifies mechanisms that support curbing it. The chapter then moves to drawing attention to her activism and work in debunking social norms that prevent girls from reaching their potentials. Sawo concludes by sharing her optimism in the eradication of harmful traditional practices in The Gambia and her dream for Gambian women and girls: empowering, uplifting, and safe spaces.

Hawkey, Ussher, and Perz bring attention to the constructions and experiences of menarche and menstruation from the perspective of migrant and refugee women resettled in Australia and Canada. The authors describe how the positioning of menstruation as shameful, polluting, and something to be concealed has implications for girls’ and women’s embodied experiences, as well as for their level of knowledge about menstruation at menarche. They demonstrate how migrant and refugee women variably adopted, adapted, and questioned cultural practices and how this impacted their engagement with their daughters, showing women’s negotiation or navigation of differing cultural contexts following migration. By identifying the women’s experiences, the authors highlight details that are essential to deliver culturally appropriate medical practice, health promotion, and health education.

Cohen develops a critical approach to menstruation and religion by showing how in both Judaism and Hinduism menstruation is part of larger purity systems concerned with defining the boundaries of identity and community. In so doing, Cohen moves beyond the question of how religious women meaningfully navigate compliance with menstrual practices and restrictions to draw attention to the ways religiously motivated menstrual practices create gendered roles and expectations and channel women’s sexuality for specific reproductive purposes. Through a comparative discussion of how the laws of Niddah in Judaism have evolved and a discussion of the different ways menstruation is linked to communicative states of being in Hinduism, Cohen explores how studying the intersection of menstruation and religion can contribute to better understanding how religious communities and cultures define and (re)produce themselves.

In this personal essay, Tova Mirvis describes her religious evolution concerning the Jewish ritual of mikvah, or women’s immersion into a bath to attain a state of ritual purity. Her initiation begins before her wedding night, when she is accompanied by her mother to the mikvah to be purified before having sex for the first time. The practice continues each month, at the conclusion of her menstrual period. As the years go by, Mirvis begins to experience doubt about her religious observance in general and adherence to the practice of mikvah in particular, chafing at the requirement to ‘cleanse’ herself monthly. Mirvis writes that her discomfort over time leads her to experiment with other forms of ritual immersion and, eventually, she leaves the religious world that had been so central to her.

Deepthi Sukumar uses her personal experiences of menstruation as a Dalit woman to bring out the intersectionality of caste and gender in menstrual taboos. She explains the different cultural backgrounds of women in India and the patriarchal design of using menstrual taboos for male supremacy and caste hierarchy. While exploring and analyzing the different patterns of menstrual taboos and their implications, Sukumar shows the gaps in feminist understanding of the intersectionality of caste and patriarchy. She concludes by observing that the discourse on menstrual taboos should become the focal point to build inclusion and understand gender inequality and oppression within the framework of intersectionality.

Why do so many communities surround menstruation with taboos? And, are all menstrual taboos created equal? Gottlieb opens this chapter with an anthropological approach to the nature of “taboo” itself. From there, the chapter explores the wide variety of ways that the Hebrew Bible in particular, as well as several other religious traditions, have shaped menstrual taboos (including, but going well beyond, the notion of a “curse”). Such taboos have operated in diverse ways and diverse places, hence this chapter also explores how both individual and whole communities may experience them differently, including offering less negative interpretations. As such, the chapter introduces readers to a striking diversity of menstrual experiences. Moreover, people and communities in both the Global North and the Global South increasingly challenge taboos with creative activism. The chapter concludes with a brief survey of what has become a menstrual movement.

This transnational engagement brings together participants from various cultural and religious backgrounds in a dialogue about menstrual practices. They are asked to consider their own experiences with these practices and reflect on how the practices have affected them. The discussion makes clear that participants have varying understandings and views of traditional menstrual practices, and that these views often challenge the common depiction of traditional practices as restrictions that are forced upon women.

This section begins where the subfield itself began—at the site of the human body. Of course we experience menstruation in the body, which is always already embedded in particular interactional and sociocultural discoursesdiscourses.

In this theoretical paper, we argue that menstruation is a source of social stigma for women. The word stigma refers to any stain or mark that renders the individual’s body or character defective. This stigma is transmitted through powerful socialization agents in popular culture such as advertisements and educational materials. We demonstrate, in our review of the psychological literature concerning attitudes and experiences of predominantly American girls and women, that the stigmatized status of menstruation has important consequences for their health, sexuality, and well-being. We argue that the stigma of menstruation both reflects and contributes to women’s lower social status and conclude with suggestions for ways to resist the stigma.

In this chapter, Piran engages with girls at puberty through their narrated experiences of embodied connections to the physical and social world during menarche. Utilizing the theoretical frame of the Developmental Theory of Embodiment (Piran in Journeys of Embodiment at the Intersection of Body and Culture: The Developmental Theory of Embodiment, 2017), Piran focuses on experiences in three domains. First, she shows that girls’ temporary freedom of engagement in the physical territory alongside boys ends at menarche, compromising embodied joy, agency, and positive connection to the physical environment. Second, she examines how strongly enforced ‘femininity’-related discourses at menarche, which are further imposed by menstruation-related discourses, corset the way girls can inhabit their bodies. Third, Piran argues that menarche is a biological event that is associated with embodied demotion in social power and with disrupting relational networks. She concludes that positive embodiment at menarche depends on the availability of relational connections and norms that can counteract these adverse social experiences.

This chapter uses a feminist material-discursive theoretical framework to examine how women adopt the subject position of ‘monstrous feminine’ via the role of premenstrual embodiment. In this examination, Ussher and Perz draw on interviews they conducted with women who self-diagnose as ‘PMS sufferers.’ They theorize that this self-positioning is subjectification, wherein women take up cultural discourse regarding idealized femininity and the stigmatized fat body; according to the authors, this results in distress, self-objectification, and self-condemnation. However, they argue that women can reduce premenstrual distress and resist negative cultural constructions of premenstrual embodiment and fat bodies through women-centered psychological therapy, which increases awareness of embodied change and leads to greater self-care and acceptance of the premenstrual body.

Stubbs and Sterling begin this chapter by discussing pubescent girls’ negative attitudes about their bodies ‘below the belt’ within the context of preparation for menstruation during pubertal education. As menstrual education presents mostly negative expectations for girls, the authors argue that it is a key contributor to girls’ negative attitudes about ‘down there.’ Instead, Stubbs and Sterling offer that menstrual education is a valuable opportunity to provide girls with a more accurate, positive, and embodied view of their genitals to access as they develop a sexual sense of themselves. The authors conclude with suggestions for improving this avenue of learning about ‘down there.’

This chapter explores the everyday experiences of women living in and passing through the stages of perimenopause and menopause, a transition that brings both physical change and identity change. Dillaway approaches this subject by examining the myriad uncertainties that women face during this transition, attributing many of them to confusion around the definitions of perimenopause and menopause; ambiguous signs and symptoms; conflicted feelings about ageing; and reflections on both previous and current motherhood and family experiences. Women think about and navigate these uncertainties in varied ways, Dillaway says, and she concludes that part of the everyday experience of this reproductive- and life-course transition is learning to live in and with uncertainty.

Embedded in the centuries-old assertion that the womb was a nomadic entity wandering about the body causing hysteria and distress, persistent menstrual misinformation and misconceptions remain prevalent wherein pain disorders like endometriosis are concerned. Affecting an estimated 176 million individuals worldwide, endometriosis is a major cause of non-menstrual pain, dyspareunia, painful menses and reduced quality of life among individuals of all races and socioeconomic backgrounds. Wide-ranging symptoms may be dismissed as routine by both patients and practitioners alike due to lack of disease literacy, and lengthy diagnostic delays can exacerbate the negative impact of endometriosis on the physical, psychological, emotional and social well-being of those affected. This chapter identifies some of these challenges and explores how obstacles to best practice can be reduced in part through adoption of early educational campaigns which incorporate endometriosis as a major component of menstrual health education.

King’s chapter begins by describing the historical context of ‘premenstrual’ symptoms, which were first formally described in 1931. She then questions the prioritization of mood-based symptoms in the diagnostic criteria for Premenstrual Syndrome (PMS). King argues that population studies suggest that mood-based symptoms are not the most common nor most disruptive of menstrual changes. She then proposes that the trend of ‘psychologizing’ premenstrual symptoms is influenced by the sexist historical assumption of ‘the myth of the irrational female’—the idea that women, due to their reproductive biology, are pathologically emotional and thus have a reduced capacity for reason. The author concludes by calling for a more integrated and rigorous approach to PMS definitions and research to support people who experience cyclical symptoms, without unintentionally pathologizing the menstrual cycle or stigmatizing an entire gender.

This study contradicts extant research asserting that girls rarely connect menstruation with sexuality. Through interviews with post-menarcheal girls, Bobier demonstrates that they relate sexuality with menses, fluidly transitioning between subjects of menstruation and sex. Girls talk about tampons and Trojans in the same breath, discuss “waiting until you’re ready” to describe tampon usage, express a fear of “down there,” and consider “provocative girls” as their opposites. They associate birth control pills with “prostitutes” and express broad apprehension about sexual activity. These attitudes, coupled with their rejection of the pill and tampons, reveal girls’ sensitivity to the taboo surrounding female sexuality and demonstrate their desire to be “good girls.” At the same time, they are aware that they exist within a set of gender and power relations that limit their ability to define their bodies and their sexuality. This is underscored by concerns about rape and resulting pregnancy as an implication of menarche.

Wood offers a new conceptual framework, “the menstrual concealment imperative”, to explain how women’s internalization of menstrual discourse contributes to their disembodiment and self-objectification through menstrual “management”. This chapter critiques the medical system and menstrual hygiene industry for the (bio)medicalization of menstruation that establishes women as diseased and as unable to know their bodies. Wood suggests that women’s vigilance about menstrual concealment is not freely chosen, but a required self-disciplinary practice rooted in menstrual discourse that characterizes menstruation as stigmatized, taboo, and therefore shrouded in secrecy. The concealment imperative is a form of social control and a body project that keeps women disembodied and objectified. As a conceptual tool it has implications to understand the various ways that women’s bodies are regulated both at individual and social levels.

This exchange, our second transnational engagement, is placed against the backdrop of a global increase in attention to both research and advocacy efforts in the menstrual experience, however cognizant of how some voices and bodies remain silent, invisible, and displaced from global efforts The authors argue that these include the experiences of the most vulnerable, who are physically limited in their ability to manage their menstrual health. To demonstrate, this study looks through the lens of women living under three challenging circumstances—women with disabilities, incarcerated women, and women living in a disaster zone—to explore how they understand, manage, and respond to their menstrual needs. The authors show how the double stigma of the women’s condition or context, with that of their menstruating status, exacerbates their vulnerability, creating further boundaries to their health and well-being.

Menstruation has been used as an excuse in many contexts. There is much legal and historical precedent linking menstruation to the category woman, and the limited political rights offered to persons therein. This section looks, in part, at the ways that menstruation has been used as a rationale to purposely curtail women’s political rights, access to legal processes, and/or benefits of citizenship. The way that stories of exclusion are built, often through norms of constructing menstruation as disabling and as a liability, constitute the core of this section.

In this satirical piece, Gloria Steinem scrutinizes the sexist social constructions dominant Western attitudes towards menstruation by imagining a world in which men, not women, are menstruators. Through Steinem’s critical lens, we can see clearly how we we “do” menstruation today—41 years after she originally penned the short essay for Ms. magazine.

In this text, Persdotter advances critical menstrual studies by introducing and developing the concept of menstrunormativity as a way to understand the ways normativities around menstruation affect and discipline menstrual subjects. To do so, she works with the idea of a system of multiple and contradictory normativities that order and stratify menstruation. Persdotter makes four interlinked arguments regarding menstrunormativity: (1) normativities work in clustered, complex ways; (2) the cluster of normativities that surround menstruation produce an impossible ideal subjectivity (the imagined menstrunormate), which follows that we are all actually menstrual monsters; (3) normativities are continuously coproduced by everyone and everything, which means we are all, always, culpable in creating monsters; and (4) there is significant potential in embracing ourselves as both Dr. Frankenstein and as monsters, since such a viewpoint produces more opportunities for livable lives for menstruators and the menstrual countermovement alike.

Przybylo and Fahs examine a series of new menstrual product advertisements, arguing that they push consumer capitalist goals of selling menstrual gear with an “empowered” message at the expense of co-opting feminist discourses of body and menstrual positivity. Drawing on feminist menstrual scholarship, they argue that menstrual positivity is thinned and transformed when commodified. They argue that “positivity”—while important to feminist menstrual activism, praxis, and theorizing—is easily co-optable within neoliberal marketing cultures. While the authors acknowledge the importance of affirmative messaging, they nevertheless develop a “menstrual crankiness” that draws on positivity but also holds it critically at bay. Aligned with queer theoretical work on the political import of negative affects, they assert the importance of menstrual crankiness in pushing at sexist, transphobic, ableist, and white discourses around bodies and embodiment, arguing that menstrual crankiness is vital to thinking about the material pains and pleasures of menstrual bleeding.

This chapter reviews the scant amount of research that exists about the relationship that boys and men—who are not menstruators—have with menstruation. In looking at this relationship, Erchull sheds light on how boys and men learn about menstruation, what they actually know about it, and what beliefs and attitudes they hold about both menstruation and menstruators. The author pays special attention to fathers and the role they can play in educating their children about menstruation. Erchull concludes that, while there are still many questions and much to be learned, the knowledge, beliefs, and attitudes that boys and men hold about menstruation influence them in their interactions with menstruators.

McHugh introduces the term ‘menstrual moaning,’ to refer to women’s negative communication about menstruation. Women’s talk about menstruation is often negative through its focus on pain, discomfort, and moodiness. McHugh ties menstrual moaning to the stigma associated with menstruation. Cultural attitudes that require girls and women to maintain secrecy and silence regarding menstruation contribute to the experience of menstrual shame. Breaking the taboos against menstrual talk may be a form of resistance. Brown argues that breaking the silence and secrecy taboo may help women to develop shame resilience. However, McHugh suggests that menstrual moaning, by reiterating negative cultural constructions of women’s bodies as flawed, deficient, and diseased, may have a deleterious impact on women’s menstrual attitudes, and perpetuate menstrual shame. Women could develop shame resistance and build community through more positive talk about menstruation, but positive menstrual conversations are rarely documented. McHugh recommends further research and activism on menstrual shame, resistance, and resilience.

This chapter uses qualitative research methods to explore the role that menarche rituals play in making women in Malawi—specifically, the role that ritual and practice play in facilitating the integration of girls into social structures and in providing a means of codifying female behavior. Bacalja Perianes and Ndaferankhande read these rituals through an African ontological position to move beyond understanding African women’s subjectivity through the lens of oppression and gender-based hierarchies. By situating menstruation in local epistemologies, Bacalja Perianes and Ndaferankhande demonstrate how gender can be understood at a personal level, through the collective and relational experience of menstruation in Malawi. Findings from the research suggest that within Malawi, to be female is collectively ascribed, and individually understood, through the active and intelligible performance of menarche rituals and consequent menstrual practices. It is through such traditions, Bacalja Perianes and Ndaferankhande show, that women are “made,” with their newly ascribed gender imbuing them with a locus of power within their communities.

Mendlinger looks at the ethnically pluralistic society of Israel to explore how young women acquire the knowledge informing their health behaviors including those related to menstruation. Beginning with the origin story of her research agenda at a time of mass immigration to Israel, she then offers the main findings from 48 in-depth interviews with mothers and daughters that fall into several categories of mother-and-daughter dyads: native-born Israelis and those composed of immigrants from North Africa, Europe, the Former Soviet Union (FSU), United States or Canada, and Ethiopia, each bringing traditional knowledge and practices to bear on what it means to menstruate. Mendlinger’s work, anchored by the voices of women, vividly demonstrates that four types of knowledge: traditional, embodied, technical, and authoritative that are passed generationally from mother to daughter change through the immigration process.

This transnational exchange captures the diverse voices of those working in the menstrual health field to provide insight on the current state of menstrual education. The discussions in this chapter suggest that menstrual education has moved far beyond the confines of schools, and as such, beyond the limitations of traditional models of a relatively limited, short-term intervention given only to girls in a traditional educational setting. Instead, those working in the field specify that menstruators are taught about menstrual health and menstrual decision-making outside of school, with emphases on health literacy and education through a human-rights or justice-based learning experience. These pieces explore just some of the current integrated approaches to menstrual health that draw upon new technologies, new modes of education, and new kinds of curriculum and learning.

To recognize menstruation as structural, we must tune into the very political dimensions that undergird our institutions, lawslaw, policies, budgets, guidelines, taxation, programs, and datadata collection. Historically, decision-makers have paid limited attention to menstruation—either due to oversight and neglect or due to deliberate exclusion. Yet, the last decade has seen enormous developments; at various levels, menstruation is rising to the level of global awareness. This might be what most distinguishes the current state of the menstrual movement from its past. Menstruation is gaining traction. Against this background, this section offers an overview and early assessment of these developments at various levels including those driven by practitioners, policy-makers, activists, and civil society actors. It seeks to capture these trends and initiatives through a combination of practice-based and research-based chapters that bring together different perspectives, voices, and experiences. This diversity is essential to engage different types of emerging knowledge in this field and to combine practical experience with critical reflection.

In this conversation, Catarina de Albuquerque, former UN Special Rapporteur on the human rights to water and sanitation, and her former advisor, Virginia Roaf, discuss how menstrual health and menstruation have become critical to understanding the contribution that the water, sanitation and hygiene (WASH) sector can make to ensuring gender equality. They look back at country missions and the many conversations with women and girls that led to a closer examination of how stigma around menstruation limits access to education, work, and a life in dignity. WASH provides a strong entry point for addressing taboos relating to menstruation, but the authors identify that one must get past this often technical understanding to address deeply entrenched gender stereotypes.

Patkar traces the efforts in various countries to break the silence and stigma surrounding menstruation and to develop national policies on menstrual hygiene. She argues that changes in social norms, institutions, and behaviors linked to taboo topics are best facilitated by simple, evidence-based policies anchored in voice and participation. She asserts that men are willing and essential agents of change for gender equality when presented with pragmatic problems and implementable solutions. Basic noncontroversial and essential services and infrastructure, such as taps and toilets, serve as powerful entry points to articulating, exploring, and addressing wider gender and exclusion issues. Drawing on her experiences working with governments in Africa and Asia and reflecting on her journey over the past decades, Patkar outlines a methodology and pathway to transform the silence around menstruation into policy and action.

Proposing a novel framework of menstrual justice, the chapter argues that women’s health needs must be understood as the result of the complex interplay of their everyday gendered experiences of living, their biology, and their medical condition. The Indian state’s health policies fail women because they do not recognize that the marking of women as impure menstruating bodies is a cause of women’s health inequity from birth to death. This very denial by the state policy of women’s gendered experience of health is menstrual injustice. The chapter elaborates on this idea by establishing the links between women’s stigmatization as menstruating bodies, lack of control over their bodies, and ill-health, pointing to the high incidence of a variety of menstrual health problems in pre-menarche, during menstruation, perimenopause and postmenopause. The chapter then identifies the gender-specific biases, blind spots, gaps, and barriers in state policies that impede the security of women’s health across their life-cycles.

This chapter shares the policies and practices enacted as a result of a pilot program in menstrual hygiene management undertaken from 2014 to 2018 in West and Central Africa. Aidara and Gassame Mbaye describe a culture of silence and taboo around menstruation. The pilot program, implemented by the UN Water Supply and Sanitation Collaborative Council (WSSCC) and UN Women, sought to address women’s and girls’ needs, specifically in the WASH sector. In reviewing results from the program, Aidara and Gassama Mbaye show that operational research in and with communities is key to inform public policies. The authors especially focus on the policy dialogue and sensitization efforts undertaken to promote gender equality in the WASH sector.

Weiss-Wolf explains why the menstrual equity frame—which makes the case for an agenda that advances systemic solutions to address the societal and financial impact of menstruation—is distinct in its direct linkage to core principles of democratic participation, citizen engagement, gender parity, and economic opportunity. She describes a social movement that has coalesced in the United States and details recent policy advocacy in which momentum has been both unusually bipartisan and swift. She also shows how related tools can be leveraged—in particular, law and litigation, coupled with extensive use of traditional and social media. Finally, Weiss-Wolf concludes with a preview of policy proposals ripe for further advocacy.

In her essay, Stella Nyanzi describes and analyzes her dissident activism against the president’s unfulfilled promise of providing sanitary pads to schoolgirls in resource-poor communities in Uganda. Named #Pads4GirlsUg, the campaign enabled local and global citizens to contribute toward the distribution of menstrual products and provide critical menstrual health education. Stella Nyanzi powerfully examines the strategies she used for popularizing the campaign, mobilizing citizen participation, and smashing the silence and taboo around menstruation. Above all, she dissects the countertactics employed by the government to discredit and criminalize the campaign. Stella Nyanzi demonstrates that menstruation and women’s bodies are political and politicized—to the extent that her activism and criticism has led to her imprisonment.

Levitt and Barnack-Tavlaris discuss the idea of menstrual leave, a policy option that provides employees with time off during menstruation. They counter the paucity of research surrounding the impacts of such policies on menstruators and the locations offering leave. Levitt and Barnack-Tavlaris argue that without addressing underlying sexist beliefs and attitudes as well as gender discrimination, menstrual leave could have negative effects on menstruators. The authors augment this research with findings from their previous study, which examines attitudes toward and perceptions of menstrual leave. Against this background, the chapter concludes with a discussion of alternative approaches to menstrual leave.

This chapter offers a systematic overview of the strong but currently under-recognized relationship between menstrual health and the main monitoring framework of progress in global development 2015–2030: the Sustainable Development Goals (SDGs). Looking at the overarching principles and intent of the SDG framework, and then goal by goal, the authors draw out particular SDG indicators to explain how monitoring met and unmet needs for menstrual health is essential to planning for SDG success. This chapter then describes some of the major data collection efforts that operate at-scale and could most readily provide new avenues for monitoring progress on menstrual health. The chapter concludes by outlining a way forward to strengthen monitoring and accountability for menstrual health during the SDG era.

Tellier et al. take stock of menstrual health management in humanitarian settings, seeking to shed light on the goals, key components, and coordination efforts to address menstruation needs under duress. The authors are volunteers or staff with WoMena, an NGO that works to improve menstrual health and management in Uganda. Based on this experience and focusing on Uganda and Nepal, this practice note probes how the issue is approached in different contexts and at different stages—comparing urgent response after a sudden onset disaster (for example, earthquakes) to protracted crises (for example, long-term refugee settings). The authors discuss how interventions can be made sustainable beyond the short-term ‘kit culture’ response; they highlight experiences with more developmental approaches involving policy support, community participation, capacity building, and the use of products that are economically and environmentally sustainable.

This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries (LMIC) about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result? Using a structured search strategy, articles that investigate young girls’ preparedness for menarche, knowledge of menstruation, and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included. Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls’ knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate, and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls. LMIC must recognize that lack of preparation, knowledge, and poor practices surrounding menstruation are key impediments not only to girls’ education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.

Within the context of growing recognition of the importance of menstruation in women’s lives and the resulting expansion of interventions to address menstrual needs, Hennegan takes a step back to look beneath the enthusiasm and best intentions and explore whether these interventions are actually effective. She finds that most efforts are untested, and that there is limited evidence to inform effective practice. She then provides a critical analysis of the evidence for menstrual health interventions in low- and middle-income countries, and concludes with a discussion of the approaches that have been trialed to date, their findings, key gaps, and pathways forward.

These transnational engagements gather together voices of representatives from key organizations from around the world to reflect on and discuss the current state of menstrual hygiene and health programming. These experts assess a decade’s worth of efforts to dissolve menstrual-related barriers through implementing different programs. They assess both the risks and rewards of this work, and the roles that organizations, donors, governments, and the media play in changing perceptions and practices. Finally, they turn to approaches and solutions that will be required to productively move forward.

The varying meanings attached to menstruation, the stories we tell about it, the ways we manage it, and even how we experience menstruation differ depending on time, place, cultureculture, and individual embodimentembodiment. But menstruation itself should seem self-evident. Menstruation is a biological reality, after all—a material fact, a fluid produced by the body that can be seen and felt, a reality that gives rise to a range of materials and products designed to absorb or contain it. And yet, as the chapters in this section show, despite its seemingly obvious materialitymateriality, menstruation must nonetheless be made to “matter.”

Vostral provides much-needed insight into the link between women’s bodily experiences with tampons and twentieth-century developments in material science, corporate research, and gynecological observations about menstrual cycles. She examines how design modifications to tampons, changes in material composition, and the cultivation of women test subjects exposed scientific assumptions, ideas about safety, and attitudes concerning gendered and menstruating bodies. Focusing on the practical work of tampon testing, Vostral examines the impact of broad cultural conditions: prevailing ideas about women’s bodies, gender differences, and the role of science and medicine in optimizing well-being. Finally, she shows how patterns of social power and privilege configured this research, with evidence taking different forms over time.

Reame reflects on her role as an early researcher on tampon safety and assesses the climate of vigilance today, demonstrating that 30 years after the discovery of the link between tampons and toxic shock syndrome, efforts to improve tampon safety protections have languished. In drawing on her past research, Reame shows how critical it is to innovate research methods and materials and to ensure that federal standards for tampon absorbency ranges and nomenclature, as well as testing procedures for tampon safety, don’t lose ground. Reame draws attention to the fact that tampon producers continue to introduce various product innovations with little government oversight for testing standards or ingredient disclosure. She concludes by offering suggestions for crucial ways in which activists in the ‘second menstrual moment’ can partner with the federal research enterprise to improve the research ‘vagenda’ in menstrual health.

Benshaul-Tolonen et al. shine a light on two methodological issues impacting a research question that has received much attention recently: whether the provision of menstrual hygiene products reduces schoolgirls’ absenteeism in low-income countries. First, they identify bias in data sources, such as school records and recall data. Second, they show that limiting the focus to menstrual-related absenteeism obscures other threats that menstruation poses to educational attainment, health, and psychosocial well-being. To address these issues, the authors recommend the use of mixed methods, pre-analysis plans, and thoughtful consideration and validation of variables prior to study implementation. They also caution policymakers against overreliance on absenteeism as the sole outcome and overinterpreting results from existing studies that often lack scope and precision. They conclude with a call for more research on the links between menstruation and concentration, learning, self-esteem, and pain management.

Houghton and Elhadad offer a new and needed perspective on approaches for measuring the menstrual cycle and identifying underlying hormonal profiles that can help determine risk factors for chronic diseases such as breast cancer and endometriosis. The authors discuss methods that have been applied historically and how those have shown vast variation in menstrual cycle characteristics around the globe. They then review and explore how innovation in technologies can be used to detect and disseminate new menstrual cycle knowledge. Additionally, the authors show how interdisciplinary efforts across anthropology, public health, and data science can leverage the advances in mobile menstrual tracking and hormone measurement to better characterize the menstrual cycle at the population level. This analysis concludes with a breakdown of how personalized menstrual norms and predictions can help individuals to be better stewards of their own menstrual health.

Fox and Epstein interrogate and reimagine menstrual tracking technology, focusing on mobile applications designed to document and quantify menstrual cycle data. While such technology promises to provide users with new insights and predictions, the authors highlight how these apps are inscribed with particular visions of menstruation and encourage users to extract intimate information about their bodies. Apps regularly assume, for instance, that all possible users are women, heterosexual, and monogamous, have a “normal” cycle, and use tracking techniques exclusively to gauge fertility. Fox and Epstein present two case studies: (1) examining core issues of usability and inclusion in the design of existing applications; and (2) using participatory approaches to highlight the lived experiences of menstruators and introduce alternatives to dominant menstrual app protocols. In offering this two-part analysis, they point to important openings for exploring how these technologies might support the needs of a multiplicity of menstruating bodies.

Starting from the assumption that menarche and menstruation are overwhelmingly negative events for developmentally disabled women, Steward et al. conduct much-needed research focusing on the experiences of women with autism. This preliminary investigation is a brief online survey on post-menarcheal autistic (n=123) and non-autistic (n=114) respondents. Although autistic respondents report many overlapping issues and experiences with non-autistic respondents, they also highlight distinct—and sometimes distressing—issues relating to menstruation, especially a cyclical amplification of autistic-related challenges, including sensory differences and difficulties with regulating emotion and behavior, which have a significant, negative impact on their lives. These initial findings call for systematic research on the potential causes, correlates, and consequences of menstrual-related problems in autistic individuals—across the spectrum and the lifespan.

Hasson provides an examination of menstrual suppression technologies and the implications they have on understanding menstruation as both quintessentially natural and socially constructed, and even what ‘counts’ as menstruation. Taking the case of birth control pills, Hasson studies menstrual suppression by analyzing medical journal articles, FDA advisory committee transcriptsmenstrual suppression, and website marketing. Across these contexts, she finds that new definitions of ‘menstruation’ converge on the distinction between bleeding that occursmenstrual suppression when women are taking hormonal birth control and when they are not. Finally, Hasson draws attention to the concept of redefining a biological process that is deeply significant for gendered embodiment, as well as a challenge to consider both the social and material construction of genderedembodiment bodies.

While there are isolated cases of reverence for menstruation, many societies impose a strict set of rules about the visualization of menstrual blood in art and visual culture. Green-Cole examines these hegemonic and patriarchal codes controlling discussion, commemoration, or visualization of menstruation, which have been internalized by millions of women worldwide as negative and shameful. One of the main tools used to maintain menstrual stigma is to erase the presence of the scene of menstruation in speech, image, and representation. Green-Cole argues that by publicly acknowledging menstruation and making it visible, the artworks discussed in this chapter are instrumental in undermining this stigma. She demonstrates how this process of undermining also changes what we assume to be the function and value of art. Finally, Green-Cole analyzes the ways in which artists have used paint to signify or stand in for blood as a challenge to the decorum of modernist formalism, which conveniently erased women’s issues.

Art holds powerful potential to break the social and cultural stigma around menstruating bodies by making the invisible visible and pushing the boundaries of what we know about the menstrual cycle. This chapter presents a selection of artwork and artists’ statements from Widening the Cycle, a historic exhibit curated by Jen Lewis and first shown at the 2015 Society for Menstrual Cycle Research conference in Boston, USA.

The introduction of commercialized disposable pads and tampons during the twentieth century changed the experience of the menstrual body in many (but not all) countries of the world. From a Latin-American perspective, this new way to menstruate was also understood to be a sign of modernization. In this chapter, Tarzibachi describes and analyzes how the dissemination and proliferation of disposable pads and tampons have unfolded first in the United States and later in Latin America, with a particular focus on Argentina. She pays particular attention to how the Femcare industry shaped the meanings of the menstrual body through discourses circulated in advertisements and educational materials. Tarzibachi explores how the contemporary meanings of menstruation are contested globally, as the traditional Femcare industry shifts its rhetoric in response to challenges from new menstrual management technologies, new forms of menstrual activism, and the increasing visibility of menstruation in mainstream culture.

Punzi and Werner offer an incisive analysis of the role of social entrepreneurs in the so-called ‘period revolution.’ The authors explore not only the market strategies and social media messaging of social enterprises, but also how other activists in the menstrual equity movement question or support their work. Building on interviews with 35 social entrepreneurs, communication with current and former Femcare employees, and participant observation of menstrual activists, this study provides a 360-degree view of the surprising number of social entrepreneurs who have entered the menstrual products space, their efforts to innovate and disrupt the industry, and the opportunities and potential pitfalls they face.

Bacalja Perianes delves into the relationship between capitalism and social change by focusing on how three companies balance profit-making with forging a menstrual health sector that promotes education, advocacy, gender equality, and women’s health. In the push to acquire new customers, companies wade into complex issues surrounding menstrual health needs in countries around the world. In light of efforts by social enterprises, start-ups, and large corporations to capitalize on the market and social opportunity of women’s bodies, Perianes asks the provocative question: Is this a good or bad trend? Does reframing consumption and consumer choice as activism actually undermine the effort needed to achieve gender equality? Or are we witnessing the rise of a new form of activism that works to achieve social change and improve the lives of women, girls, and their communities by means of business innovation?

Personal stories, urban legends, literature, media representationsrepresentation, and other kinds of narrativesnarrative provide means of sharing information about menstruation, including what women and other menstruators should and should not do during their periods. For instance, no book has had more impact upon pubescent North American girls than Judy Blume’s 1970 Are You There God? It’s Me, Margaret. Girls growing up in the 1970s and onward, in a cultural milieu where they were encouraged to silence their questions and hush their bodies, had a protagonist with whom to identify and empathize.

Guilló-Arakistain examines the ways in which alternative politics of menstruation are challenging the paradigm of sexual dimorphism and heteronormativity. She does this through consideration of discourses which challenge the ideology of menstrual normativity and the rigid, hegemonic, medical, and pathological approaches to the western biomedical vision of menstruation. Guilló-Arakistain links these discourses to specific bodies, incorporating experiences of non-menstruating cisgender women as well as transgender menstruators. It is necessary, she asserts, to dispense with the idea that menstruation is determinative of a very specific gender and social identity and the subsequent normative and reductionist take on menstrual experience (and more generally human experience).

This chapter explores the protest strategies of Periods for Pence, a collective of Indiana menstruators and allies who organized in response to the passing of extreme antiabortion legislation, House Enrolled Act 1337, by then-Governor Mike Pence in 2016. Through an analysis of the group’s transcribed calls to Pence’s office, as well as various social media posts, Conner illustrates how Periods for Pence engaged in acts of narrative sharing, humor, and symbolic reversal to craft a cohesive account of varied experiences with menstruation. The study also draws on logics of menstruation to rhetorically re-moralize abortion as necessary. Conner concludes by demonstrating how critical study of menstruation-related activism asks scholars to rethink traditional conceptualizations of static “waves” of feminism and feminist rhetorical theorizing.

The chapter engages with feminist theories of the monstrous, performativity, and new materialism to examine how menstruation is negotiated and performed by young menstruators in the context of YouTube videos. It further asks what menstruation and menstruators can be(come) in the intersection of mediation and multiple cultural, material, affective, and discursive agents at play. By examining two YouTube videos that address menstruation, Andreasen explores how menstruation is entangled with “the monstrous” and how this relation makes new emergences of menstruation and menstruators possible. With the reservation of racial, bodily, and social privileges in mind, the chapter concludes with a proposal for a feminist affirmative critique, where the videos can be read as imaginative work and as possibilities for menstrual change for some.

Drawing from life history narratives of 84 women in Nepal, we examine women’s particular lived experiences of cultural rituals, traditions, and taboos surrounding menstruation, as well as the practice of seclusion, which in it extreme form, sequesters menstruating women into menstrual huts (chaupadi). Grounding our analysis in the specific sociocultural context of Nepali women themselves reveals important dynamics about gender formation, the perpetuation of power, relationships with one’s own body, and resistance to gendered constructions. These findings can then inform effective policies and programs to create awareness and change people’s understandings of and practices surrounding menstruation not only in the context of Nepal, but elsewhere as well.

In this essay, Ghanoui examines two menstrual education films of the 1950s widely used in the United States: Molly Grows Up (1953) and As Boys Grow (1957). Ghanoui discusses how the films portrayed the menstrual cycle and how educational literature received the films. She argues that the films became popular because they eased the teaching responsibilities of school instructors without taking away their authority—the films supplemented traditional menstrual education in schools while teachers maintained jurisdiction in their classrooms.

Rydström works within a post-constructionist framework to critically explore the nature of menstruation, which many perceive to be a strictly female bodily function despite many scholars’ recognition that menstruators are of various gender identities. In challenging menstruation as a cisnormative phenomenon, the author explores various menstrual experiences among trans people and argues that cis and trans menstruators come to matter differently. More specifically, menstrual activism, public bathrooms, menstrual products, and the healthcare sector are problematized as areas wherein trans menstruators are Othered. Finally, Rydström calls for a recognition of the multiplicity of menstrual experiences as they exist and a degendering of menstruation as phenomena.

This study analyzes qualitative interviews with 40 women across a range of age, race, and sexual orientation to examine experiences with sex during menstruation. Results show that 25 women describe negative reactions, two describe neutral reactions, and 13 describe positive reactions. Negative responses involve four themes: discomfort and labor to clean ‘messes,’ overt partner discomfort, negative self-perception, and managing partner’s disgust. Positive responses cohere around physical and emotional pleasure from sex while menstruating and rebellion against anti-menstrual attitudes. Race and sexual identity differences appear: White women and bisexual or lesbian-identified women describe more positive feelings than women of color or heterosexual women. Bisexual women with male partners describe more positive reactions than heterosexual women with male partners, implying that heterosexual identity relates to negative attitudes more than heterosexual behavior. Those with positive attitudes also enjoy masturbation more than others. Additionally, interviews address sexual and racial identities’ informing body practices, partner choice affecting body affirmation, and resistance against ideas about women’s bodies as ‘disgusting.’

This chapter explores variations in the experience of menopause among 28 postmenopausal women belonging to lower socioeconomic strata from the Indian state of Haryana. Singh and Sivakami base their research on in-depth qualitative interviews with the women to gauge their perceptions and experiences of menopause. They analyze the interviews thematically and identify three dominant narratives: menopause as a normal biological process, an insignificant event that goes unnoticed in the chaos of life; menopause as distress in silence, the distress arising from the intersection of poverty, gender, and patriarchy; and menopause as freedom—freedom from societal restrictions and monthly distress. These narratives are distinct but often co-occur; for example, some women experience freedom after going through distress. Additionally, the authors report that participants express the need for emotional and social support during menopause and the desire to be understood rather than to be treated.

In this chapter, Bobel and Fahs first describe a brief history of menstrual activism alongside its more recent iterations in both policy and radical social activism. They review the collective call to reduce stigma and shame around menstruation as part of the enduring project of loosening the social control of women’s bodies. The authors then turn to an analysis of menstrual humor, menstrual art, and menstrual activism today, respectively. This is followed by an examination of the hazards and possibilities of doing menstrual activist work, including politics of menstrual language and the trivializations and hostilities that can plague this work. Finally, Bobel and Fahs offer a politically charged outline for the future of menstrual activism.

In this chapter, Perianes and Kissling examine informal interviews about menopause experiences and discourse conducted among participants in four nations: British-Iranian Shardi Nahavandi interviewed her Persian mother; Swetha Sridhar interviewed her mother and grandmother, all currently from different regions of India; Ursula Maschette Santos spoke with three women from her community in São Paulo, Brazil; and Jennifer Poole conducted a focus group discussion with 17 participants of the NGO Medical Services Pacific in Fiji, which included six men. Noting that each nation and community has its own norms and traditions, the authors find common themes of ambivalence around aging, community silence about menopause, and insufficient education or preparation for the menopause transition.