Intended for healthcare professionals


There can be no gender equality without menstrual justice

BMJ 2023; 382 doi: (Published 12 September 2023) Cite this as: BMJ 2023;382:p2079

Linked Opinion

Menstrual health must be prioritised in global policies

  1. Lillian Bagala, regional director1,
  2. Therese Mahon, regional programme manager South Asia2,
  3. Arundati Muralidharan, coordinator, co-founder34,
  4. Emily Wilson, chief executive5
  1. 1Irise Institute East Africa
  2. 2WaterAid
  3. 3Global Menstrual Collective
  4. 4MHAi
  5. 5Irise International

Menstrual justice should be at the heart of health and gender equity interventions, write Emily Wilson and colleagues

The menstrual cycle and menstruation are normal, physiological processes. But the experience of menstruation is shaped by social, economic, and structural factors and associated inequalities. These factors pose substantial challenges to accessing information about their bodies, menstrual products, toilets, water, disposal facilities, and health services to women, girls, and other people who menstruate.123 A menstrual justice lens can facilitate action to tackle the inequities that underlie poor menstrual health, bringing about change for menstrual, sexual, and reproductive health, and gender inequality.

“Menstrual injustice” refers to the stigma and discrimination faced by women. The effects are profound across low and middle income countries, but period poverty is also widespread in high income countries. The use of unhygienic products and poor menstrual hygiene practices increases the risk of urinary and reproductive tract infections.45 Poor knowledge of the menstrual cycle adversely affects family planning and contraceptive use.6 These factors are obstacles to equal participation. For instance, girls miss school and women miss work during their periods.78 For many people—including those with disabilities, LGBTQIA+ people, and people in humanitarian settings—additional dimensions of stigma and vulnerability intersect with discrimination related to menstruation. This further compromises their health, access to opportunity, and human rights.91011

There has been a growing focus on menstrual health and hygiene in the past decade.1213 But progress is threatened by fragmented, short term interventions and policy investments. There is limited tracking of interventions that would be useful for accountability and to demonstrate the potential to scale up promising initiatives. Investments to tackle the root causes of inequalities and for building the grassroots movements required to achieve long term, systemic change for menstrual health is also lacking.

Urgent collective action is needed to prevent further reversal of the progress that has been made towards gender equality, and to facilitate sustainable progress in the years ahead. We must increase investments in initiatives that seek to transform the inequitable power structures that sideline, silo, or silence gender equality matters.

Menstrual health cuts across many areas, including education, sexual and reproductive health, economic empowerment, and water, sanitation, and hygiene, all of which can catalyse progress towards gender equality. A feminist lens can highlight the policy and actions needed to tackle the harmful power structures and social norms that drive menstrual injustice and gender inequality. Menstrual health is a critical entry point and a high priority intervention area for investment—both in its own right and within the broader interconnected areas highlighted above. For example, while comprehensive sex education is politically sensitive in some countries, menstrual health education can be a more accepted entry point that supports understanding of the body, bodily autonomy, and health seeking behaviours. Tackling harmful social norms and discrimination through menstrual education and social behaviour interventions during adolescence can engender positive social norms, potentially acting as a powerful upstream social determinant of long term health outcomes. Black women in the UK, for instance, are disproportionately affected by menstrual disorders as they are less likely to seek access to healthcare and treatment because of systemic racism.14 Additionally, more period friendly toilets that are safe, private, and accessible are needed and would have benefits for sexual and reproductive health such as reduced risk of urogenital infections and gender based violence.

At Women Deliver 2023, the largest global conference on gender equality, a new call for menstrual justice for all was created.15 To achieve gender equality, policy makers and donors must recognise and invest in menstrual health as leverage for improving intersecting gender, race, economic, and climate inequalities. A feminist lens should be applied when developing strategies and policies for gender equality. This involves creating a framework for interventions that prioritise transforming harmful, inequitable power structures and increasing investment in grassroots and advocacy movements that facilitate changes in social norms and policies at all levels.

We urge implementers and researchers to centre lived menstrual experiences in programmes and research, and strengthen inclusion of people from diverse backgrounds in initiatives to end menstrual injustice, particularly those who are disproportionately affected. Implementers must recognise and promote menstrual health as a first step on the sexual and reproductive health journey and continue support across the life course.

Finally, we call on all stakeholders to collaborate to drive coordinated global, national, and local efforts to track the determinants of menstrual health including education and access to menstrual materials and sanitation facilities, treatment for menstrual disorders, supportive social environments, and the impact of interventions. Such data should be grounded and accessible at all levels to inform advocacy. This is vital to show the opportunity menstrual health offers to forge an innovative way forward in gender equality investment, policy, and programming. The matter must be at the heart of future gender equality agendas. There can be no gender equality without menstrual justice.


  • Conflict of interest: none.

  • Provenance: commissioned, not externally peer reviewed