Menstrual health must be prioritised in global policiesBMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p2109 (Published 15 September 2023) Cite this as: BMJ 2023;382:p2109
- Jennifer S Martin, global director1,
- Joan Masinde, communications specialist2,
- Antonia Cañizares, Global Youth Council3,
- Sidra Irfan, Pakistan correspondent4,
- Arush Lal, master of philosophy and doctorate of philosophy candidate5
Menstrual health is the gateway to promoting sexual and reproductive health rights, building body autonomy and self-efficacy, elevating women’s leadership, and improving health literacy. However, its full potential has not been recognised by global leaders, and menstrual health has been omitted from key global conventions.
It has been 29 years since the International Conference on Population and Development (1994) acknowledged that sexual and reproductive health is an essential human right. Yet, as global health leaders convene in New York this month for the 78th United Nations General Assembly, there is still a lack of commitment to driving meaningful change by prioritising menstrual health1 (including menstrual disorders, perimenopause, and menopause).
If governments were encouraged by global treaties and targets to enact menstrual health policies, it would empower women, adolescent girls, and people who menstruate. This could result in them being able to fully contribute to a healthier and more equitable world. Reinforcing countries’ commitment to menstrual health and highlighting its place on the international agenda would also advance universal health coverage, sexual and reproductive health rights, gender equality, and the rights of the child.
A human right
Framing menstrual health as a human right promotes the health and wellbeing of women, adolescent girls, and people who menstruate. It upholds human dignity and prevents discrimination.2 Menstrual health is often seen solely as a component of sexual and reproductive health, adolescent education programmes, or water, sanitation, and hygiene. Yet it is a cross-cutting issue that needs to be integrated and made mainstream in global policies that capture health, work, education, contextual and cultural norms, and broader society.3
The tenacity of grassroots organisations working in menstrual health has begun to transform global health leaders’ perceptions of the importance of tackling poor menstrual health. Nonetheless, there are still several global conventions that have neglected to include it.
The Convention on the Elimination of All Forms of Discrimination Against Women (1979) is a core human rights treaty. It highlights the importance of reproductive health and requires states to ensure equal access to healthcare services, including family planning and prenatal care.4 Yet it contains no mention of menstrual health, perimenopause, or menopause. As this convention was passed by the United Nations General Assembly, the Committee on the Elimination of All Forms of Discrimination Against Women, which monitors the implementation of the convention, could issue a comment recognising all facets of menstrual health and their impact.
This comment should highlight the barriers to menstrual health, which include menstrual stigma, lack of access to products, inadequate education, and inappropriate water, sanitation, and hygiene facilities. These barriers prevent full participation in the workforce, education, and society. Neglecting to tackle them perpetuates many inequalities, such as compromising the ability of women and people who menstruate to progress to or maintain leadership positions.
Menstrual health discrimination (including menstrual disorders, perimenopause, and menopause discrimination) is also absent from the International Labour Organisation’s Violence and Harassment Convention, 2019 (No. 190). Women and people who menstruate could be menstruating monthly for most of their career. Not acknowledging this reality and how it can shape people’s participation in and experiences of work is a form of reproductive health discrimination.5 The International Labour Organisation must amend convention 190 to include menstrual health discrimination, as well as other reproductive health rights. Everyone deserves to have their sexual and reproductive health rights met in the workplace.
Another convention of the United Nations General Assembly that excluded menstrual health is the Convention on the Rights of the Child (1989), which came into force in September 1990. It is a legally binding agreement that establishes the political, civil, social, economic, and cultural rights of every child. Despite including provisions about health, education, safe water, and dignity, the convention does not specifically mention reproductive or menstrual health. This omission could indicate inadequate education and awareness of menstrual health, social stigma surrounding the topic, or that it is a low priority—all obstacles that can prevent the provision of menstrual health.
The Committee on the Rights of the Child should issue a comment that recognises menstrual health is fundamental to the rights of the child in relation to articles 24, 28, and 29 of the Convention on the Rights of the Child. These articles cover legal rights, health, and education.6 This could expand the rights, dignity, and self-efficacy of girls.7 It would also acknowledge the importance of menarche and underline that menstrual health should be included in age-appropriate comprehensive sexuality education.
Accelerating progress on the sustainable development goals
Mainstreaming menstrual health across global policies and treaties could reinforce the need for legislative measures at the national and regional levels, which mobilise resources, challenge societal attitudes, and preserve the rights and wellbeing of everyone who menstruates.
Furthermore, this could accelerate progress towards many of the United Nations’ sustainable development goals, particularly the target to achieve universal health coverage.8 As the goals are interconnected, several would benefit from recognising the right to menstrual health, including the goals to end poverty, promote health and wellbeing, achieve gender equality, provide clean water and sanitation, promote decent work, reduce inequalities, and limit climate change by reducing menstrual waste and promoting reusable products when appropriate. Enshrining the right to menstrual health would set an important precedent for protecting women, adolescent girls, and people who menstruate, thereby promoting equal treatment and opportunities for all individuals.9
Incorporating menstrual health into these global conventions will put increased pressure on policy makers, raise more awareness at international forums, and reshape agendas to appreciate the value of menstrual health. Including menstrual health in specific global policies will require discussion between policy makers and grassroots organisations, strengthening global coordination and the diversity of people that are heard.
The clamour of voices advocating for menstrual health is growing.10 Their calls should be heeded in global treaties that demand government action if we are to drive forward equality, and improve the rights and dignity of women, adolescent girls, and all the people who menstruate globally.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.