Blog of the Society for Menstrual Cycle Research

“Menstrual Hygiene” Explored: Capturing the the Wider Context

December 9th, 2014 by Chris Bobel

This summer, I bought a new camera. I needed it to snap pictures during a research trip to India where I explored diverse approaches to what’s called in the development sector, Menstrual Hygiene Management (MHM). I chose a sleek, high tech device with a powerful, intuitive zoom.

Photo by author

In Bangalore, I captured the sweet intimacy of two schoolgirls as they watched the menstrual health animated video “Mythri” at a government school. In Tamil Nadu, I used my zoom for close shots of skilled women tailors sewing brightly colored cloth menstrual pads for the social business, Eco Femme.

Photo by author

In South Delhi, I used my zoom to preserve the mounds of cloth painstakingly repurposed as low cost menstrual pads at NGO Goonj.

But here’s the problem. These close up shots may please the eye, but they leave out the context that surrounds and shapes each photo’s subject. And what exists outside the frame is at least as important as what is inside. That’s hardly a revelation, I realize, but when it comes to doing Menstrual Hygiene Management work, in an effort to find solutions, the “big picture”—both literally and figuratively—sometimes gets obscured.

Photo by author

For example, when I snapped the picture of the mound of menstrual pads pictured here, I focused on a product, a simple product, that could truly improve the quality of someone’s life. But when I trained my attention on the product, what did I miss?

In short, a wider angle lens reveals the context of menstrual product access—a complicated web of many intersecting issues: infrastructural deficits (safe, secure, and clean latrines and sites for disposal), access to resources (like soap and water), gender norms, and menstrual restrictions rooted in culture or religion.

Imagine that one of brightly colored packages of menstrual pads ends up in the hands of a 15 year old girl. I will call her Madhavi.

Madhavi is delighted to have a dedicated set of her very own clean rags to absorb her flow.

Goonj worker with pads ready for distribution and sale
Photo by author

But does she have access to clean water and soap to wash them?

Does she have family support to dry her rags on the clothesline, in direct sunlight, even though her brothers, uncles, and neighbors will be able to see them?

Does she have a safe, secure place at school to change her rags?

Does she have someone to turn to when she has a question about her menstrual cycle?

These questions are important because they point to what gets in the way of effective and sustainable MHM. My own review of the emerging empirical literature on MHM revealed that the top three impediments to school girls’ positive and healthy menstrual experiences are 1) inadequate facilities 2) inadequate knowledge and 3) fear of disclosure, especially to boys. I want to focus on this last one for a moment by widening the frame a bit more.

Menstrual Hygiene Management is part of a complex and enduring project of loosening the social control of women’s bodies, of working to move embodiment, more generally, from object to subject status—something absolutely foundational to taking on a host of other urgent issues; from human trafficking to eating disorders to sexual assault.

As we know throughout the West, menstrual taboos do not disappear as we upgrade our menstrual care. Without the heavy lifting of menstrual normalization, any menstrual care practice will make a minimal impact.

Thus, menstrual activism must always incorporate an analysis of how gender norms maintain the menstrual status quo. And it must engage the potential of men and boys as allies, not enemies. That’s a tall order that cuts to the very core of gender socialization. But if we don’t take this on, no product in the world will be enough.

Anyone with a camera knows that framing a picture is a choice. Am I suggesting that we should never use the zoom, that we should forgo the rich and textured details possible when we tighten the shot? Of course not, as focus is crucial to our understanding. But when we do aim our figurative cameras and shoot, let’s not forget what lies outside the visual frame. Let’s not forget what else must change for the pad to be a truly sustainable solution.

Literary Menstruation

November 12th, 2014 by David Linton

Given their first-hand awareness of the role it has played in their own lives, it is not surprising that women writers (and researchers) have included references to the menstrual cycle in their books. Even so, social taboos have probably tended to keep the subject from appearing as often as it might have otherwise and literary menstrual references have only come to the surface in the mid-twentieth century. The women appearing in the fiction of Bronte, Eliot, Alcott, du Maurier, and the other major women writers of the 19th century seem to be lacking a menstrual cycle regardless of how otherwise thoroughly detailed their lives were depicted.

Men too have been menstrual-averse. The cycle played no part though later male authors, notably William Faulkner, did include specific menstrual details if only to capture a male chart in the lives of the women in the novels of Hardy, Conrad, James, Dickens, Lawrence or Hawthorne, to name a representative few. Men seem to be “in avoidance,” if not “in denial” about the cycle’s presence. Even male writers such as Updike and Roth for all their frank depictions of sexual behavior have treated menstruation gingerly, in the case of Roth using it in two novels to express characters’ kinkiness.

The more permissive climate of the past 60 or 70 years not only saw the rise of a new generation of women writers, but a greater openness to the inclusion of menstrual material in their stories. Toni Morrison, Joyce Carol Oates, Anne Patchett, and Margaret Atwood, to name a few of the most noteworthy, have built entire scenes or even complete plot lines around menstrual tropes.

This is a subject rich in possibilities for a wide variety of investigations in literary studies, women’s and gender studies, communication and media, sociology, psychology, and even religious studies. With the exception of Dana Medoro’s path breaking book, The Bleeding of America, the subject is virtually untouched. Readers are urged to dig into this treasure trove of material.

So, the purpose of this blog post is to invite suggestions of literary sources that are fertile ground for cycle commentary. Help build the menstrual canon with mention of “sightings” that have come to your attention.

Call for Abstracts for SMCR 2015 in Boston

September 25th, 2014 by Chris Bobel

Women Break The Taboo Around Menstruation By Sharing Hilarious Period Reminders

September 23rd, 2014 by David Linton

Without endorsing the sites, readers of re:Cycling might be interested/amused by this item from Lauren Braun at BioWink that was received recently by a member of the blog team:

Women Break The Taboo Around Menstruation By Sharing Hilarious Period Reminders

Menstrual cycles are still a taboo subject, and this discomfort with talking about them results in both misinformation and lack of information about menstrual health.

But earlier this week a tweet went viral when @pamwishbow customized her Clue period reminders, a new feature we launched last month. As of today, she had 348 retweets and 458 favorites.

We were so inspired by how Pam confidently owned her period in this public way that we decided to encourage other Clue users to share how they made the period reminders their own through customization. The uniqueness of the reminders seems to represent the uniqueness of each person’s cycle.

Sharing something that’s so personal helps break the stigma and open the door to more honest conversation. We’re proud to be part of this growing trend of empowering women with knowledge about their bodies, so that they can make the most informed decisions about their reproductive health. We’re asking women to #OwnYourCycle.

Examples:

Pam Wishbow’s Viral Tweet with 800+ Retweets and Favories

Bettie Whorechata’s Tweet

Blogger’s Customization of Reminders

Here is our website: http://www.helloclue.com/

In Defense of Hating My Period

August 25th, 2014 by Chris Bobel

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Chris Bobel originally appeared October 1, 2012.

Okay. Enough. I gotta say something.

 

Because I am committed to various efforts to reclaim the menstrual cycle as a vital sign and subvert the dominant narrative that menstruation is obsolete and/or a badge of shame, many people assume my periods are all drum circles, red jewelry and a week-long love affair with my Diva Cup.

More insidious still is the pervasive assumption that thinking differently about our cycles necessarily points to LOVING our cycles. As if there are ONLY two choices on the menstrual menu: I’ll have the Obsolete Shaming Nuisance or My Cycle is Womb-alicious. That doesn’t work for me as I suspect it does not work for others. There’s a whole lot of territory between refusing to see menstruation as meaningless OR as proof positive that my body is unruly, out of control, and a source of deep-seated shame AND embracing my menses as the Sine qua non of my gender identity or the gift that keeps on giving, about every 28 days.

I gotta ask: can’t I resist the shame and still find the monthly uterine shedding a royal pain in the vagina? Because, dear reader, that’s how I feel about MY menstruation. Most of the time, I really hate my period.

I am a heavy bleeder– a seven full days of gushing, clotting, and without fail, staining usually both my sheets and my underwear. My period is a week of carrying an extra pair of underwear with me in my backpack, sleeping on a towel (that always bunches up and makes me miserable as I try to find a comfortable sleeping position) and scrubbing stains out of my underwear.

I do not celebrate my flow during my menses. At the same time, I am grateful that my body is signaling All Operations Normal and Functioning. Yes. I AM appreciative of the reminder to practice self care, to slow down, to pause…. but  I rarely do, if I am honest.  Truth is, even in the context of all this gratitude for what my body is doing to keep me healthy, I groan when Aunt Flo comes a-calling.

But admitting that has not come easily because I am privy toan awful lot of menstrual talk (on this blog and in the wider world) and the two OPTIONS ONLY discourse is pervasive. You either hate it (shame on you for shaming on you) or you love it (Fool. Join the 21st century!). See?

My point is simple. Let’s not trade one dogma for another. Messages on either pole fail to listen to women and instead, PRESCRIBE how we should THINK about our embodied experiences. Some menstruators DO welcome their periods and find ways to celebrate them. Some menstruators spend Day 1 on the floor of the bathroom, clutching the rim of the toilet. Some menstruators are damn grateful to see bloody panties as a signal of Not Pregnant or Right on Schedule and then pretty quickly shift into dogged management mode. Some menstruators  _________________ (your experience here).

The different menstrual world I want is a bigger one, one shaped by a more  (not less) pluralistic menstrual discourse that makes the way for as many menstrual attitudes are they are menstrual experiences. This stuff is personal and individual and yet, because of FemCare ads, industry-sponsored menstrual education in schools and increasingly Big Pharma’s awkward melding of high tech body meddling so that women can menstruate like their Paleo ancestors, it is hard to hear our OWN voices over the din.

Here’s my voice: thanks for the free monthly wellness check but I wish it were not so much work. But I will be damned if I will whisper that I need to change my pad or be seduced by a slick ad campaign that enlists me as a paying research subject. I just need better pads (longer, anyone?) and maybe a terry cloth fitted sheet. And someone to do my laundry.

What does it really mean to be #LikeAGirl?

July 17th, 2014 by Elizabeth Kissling

As published June 2014, Marie Claire, US edition

Always™ and its corporate owner, Procter & Gamble, have been receiving a lot of praise around the interwebs these days for their #LikeAGirl campaign, launched June 26, 2014, with a video produced by Lauren Greenfield. The video has been viewed 37 million times and counting. Last week, HuffPo actually called it “a game changer in feminist movement”, which I suppose reveals how little Huffington Post knows about feminist movements, more than anything else.

But before you applaud the efforts of Always to raise girls’ self-esteem, remember that they’re also the people who bring you these ads. Because that stench of girl never goes away, and you can’t spend all day in the shower, use Always.

The contraceptive doctor–patient disconnect

June 17th, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

There seems to be a growing disconnect in recent years between physicians and their patients, and women are especially susceptible to this given our reliance on doctors for information about contraception. When compared to the questions many of us ask our doctors, the information we receive isn’t always up to snuff.

Patient autonomy, as defined by medical dictionaries, is “the right of patients to make decisions about their medical care without their healthcare provider trying to influence the decision.” Based on many conversations with other women, in addition to my own personal experiences, patient autonomy often does not exist for women seeking information about contraception. And this is a huge problem. Deadly (and rare) birth control side effects have become a hot-topic in the news as of late – which is likely contributing to this physician–patient disconnect – but the growing patient interest in control and autonomy means that this cannot simply be dismissed as a side effect of the media.

A recent study, published in the Journal of Contraception, asked both women and healthcare providers to rank the importance of 34 questions relating to contraceptive options. They found that the things that are most important to women are often not as important to their healthcare providers. For example, knowing exactly how a method works to prevent pregnancy was ranked by women as the most important piece of information, whereas how to use a method correctly topped the list for providers. Effectiveness, while still important, was ranked fifth by women, which is a stark inconsistency if you consider just how central a method’s effectiveness is in ads and in the media. The study also found that questions regarding potential side effects ranked in the top three for 26% of women, but only 16% of providers.

These stats may seem inconsequential – after all, physicians should be educating patients about proper use of contraceptive methods. But here’s the problem: the methods suggested by physicians don’t always align with a woman’s stated preferences. I’m certain I’m not the only woman who has been pressured to use a hormonal method (despite my voiced concerns) simply because these methods are considered to be easy and effective. While it seems like a logical solution for physicians to advocate for hormonal methods over methods with higher typical-use failure rates, this approach is ultimately a detriment to women.

A growing number of women seem to be turning to withdrawal, and while this isn’t inherently bad, it becomes bad when a patient isn’t educated on how to properly use it simply because her physician is hesitant to discuss “unreliable” methods. This means that women are turning to potentially unreliable internet sources (or, worse, misinformed friends) for this information. The same can be said for diaphragms, cervical caps, and fertility awareness-based methods. If we want to continue to drive down unintended pregnancy rates, dismissing patient concerns and eliminating patient autonomy isn’t the route we should take. Contraceptive methods aren’t one-size-fits-all, which should be obvious by the huge differences in side effects experienced from person to person. So why do so many contraceptive consultations continue to be carried out in this one-size-fits-all fashion?

Empowering women through family planning is more complex than simply prescribing the most effective methods. It must be coupled with engagement in an open dialogue, including acknowledgement of patient concerns and a respect for patient autonomy. Patients are increasingly demanding autonomy, and if healthcare providers wish to remain a respected part of a woman’s health, it’s time to set aside contraceptive biases and listen.

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

Congressional Action on Menstrual Hygiene Day

May 28th, 2014 by Saniya Lee Ghanoui

Maloney press release for the Robin Danielson Act of 2014

As I’m sure you’re well aware, today is Menstrual Hygiene Day and there are activities all across the globe to commemorate this day.

The SMCR is excited to announce that it contributed to the day by endorsing the Robin Danielson Act of 2014, a legislation that would require the National Institutes of Health (NIH) to research whether menstrual hygiene products contain synthetic additives that pose health risks (including risk of Toxic Shock Syndrome). What’s more, Congresswoman Carolyn Maloney (D-NY) introduced an updated version of this Act today, on Menstrual Hygiene Day! According to Maloney’s office, she first introduced legislation regarding tampon safety in 1997 with the Tampon Safety and Research Act; subsequent versions of this bill were introduced in 2003, 2005, 2008, and 2011.

Now it’s time to take more action: turning this introduced legislation into law. Stay tuned for more information regarding petitions of support and other forms of activism and assistance. In the meantime, step one is to write your local congressperson and voice your support for the Robin Danielson Act of 2014. You may find a list of Representatives (and search for your local Rep.) on the House of Representatives website and you may read more about Maloney’s bill (in which SMCR member and President-elect Chris Bobel is eloquently quoted)  on her site.

Happy Menstrual Hygiene Day!

We Bring Our Bodies to Work

May 23rd, 2014 by Heather Dillaway

“Woman Working,” courtesy of Open Clip Art

A recent study by researchers at La Trobe University and Monash University in Melbourne, Australia, suggests that working women “need more managerial support [while] going through menopause.” This “Women at Work” study explored the health and wellbeing of working women and women’s satisfaction at work, yet focused on working experiences in or around menopause. The lead researcher, Professor Gavin Jack, reports that “menstrual status did not affect work outcomes” but that “if a woman had one of the major symptoms associated with the menopause — for example weakness or fatigue, disturbed sleep or anxiety, then this did influence how they regarded work.” Jack is further quoted as saying: “What is really important is not the fact of going through the menopause in itself, but the frequency and severity of symptoms which women experience, and how these factors affect their work.”

This study has been described in several news sources over the past few weeks, such as the International Menopause Society, Science Daily, and IrishHealth.com. I have many reactions to this research, both positive and negative.

I’ll present my positive feelings first: I appreciate the fact that researchers are talking about the fact that menopausal women are a large part of the workforce and that menopausal experiences matter for individual women. I also applaud the attention given to the fact that workers are human beings with bodies, and that bodies matter. The idea that employers should recognize that paid workers have bodies and that paid workers may be affected by their bodies is an excellent one. I agree that employers should be educated to be more sensitive to menopause and other bodily experiences that their paid workers might have, and simple adjustments in work policies and work environments can go a long way in making employees happier and more productive (plenty of research has already shown this). Finally, and maybe most importantly, as one article in Science Daily notes, “Not enough attention is paid to the experiences which people go through at different stages of life — the workplace treats this very unevenly.” I couldn’t agree more. Especially when it comes to midlife and aging, we forget that paid workers are still dealing with bodily transitions. We forget the range of chronic illnesses that paid workers might have at midlife and beyond, as well as the many normal health transitions that any midlife or aging individual deals with. Anything from the acquisition of bifocals (and learning to see differently through bifocal lenses) to the hassles of dealing with back pain, neck pain, arthritis, hearing impairments, insomnia, etc., can affect one’s work. Not to mention menopause, prostate conditions, and other aging health concerns that can involve a range of different signs, symptoms, and stages. Starting at midlife, it is also much more common to deal with caregiving for elderly parents, divorces and remarriages, putting kids through college (or putting up with adult kids living at home), deaths of parents and spouses/partners,  and other social transitions, and all of these things will impact how a paid worker feels and acts on the job. There is much to pay attention to about paid workers in their 40s, 50s, 60s, and beyond, and I believe that this research is a good start on that. Middle-aged paid workers may be reaching the peaks of their careers and may be excellent at their jobs, but they’re still dealing with a multitude of other life circumstances at the same time. And if they’re not performing well on the job, it may well be because of these very same issues. Paid workers are people, with full lives and physical bodies that they can’t leave at home (no matter how much they try).

No Snack, Just Tampons

April 24th, 2014 by Heather Dillaway

I was flipping through the May 2014 issue of Working Mother Magazine the other day and landed upon a small article about a working mother’s recent “faux pas”: on a “crazed morning” she accidentally packed her bag of tampons in her 7-year-old son’s camp bag and took her son’s snack to work with her. Not only did this mistake leave her son without a snack for the day but also with an “inappropriate” item in his camp bag. The article, titled “The Big Switch,” told of this mother’s horror when she realized that she packed tampons in her son’s camp bag. It told of the constant agony and mortification she felt in just thinking about what might happen at school if anyone found the tampons in her son’s bag. She called her friends and they laughed, offering no advice. She braced herself for the end of the day but, when the end of the day came, she found out that her son had received a special treat of Oreos at school because he had no snack. Her son arrived home happy and unphased. The story ends without us finding out whether the son ever even realized that he had tampons in his school bag. We are also left to think, “Phew, disaster averted.”

Mothers naturally make mistakes all of the time (indeed, it’s maybe one of the things we do best!). However, this mistake was high stakes because it challenged an important social norm: a concealment norm. Women should not let anyone know that they menstruate and they should definitely not involve and/or show kids the evidence. This mother worried for her son’s potential willingness to “share” his knowledge of the tampons in his bag among his friends. She envisioned moments within which everyone at camp would know that she had packed tampons in her son’s bag and was concerned about potential repercussions. This mother worried that camp counselors might even call Protective Services if they found out about the tampons in her son’s bag, and that other parents might find out and complain as well. She knew there could be real consequences….but there weren’t consequences. In fact, in the end, this mistake seemed trivial. Perhaps the son saw the tampons and didn’t think they were a big deal, or perhaps he never saw them.

When we go against concealment norms and “show” to others that women/moms menstruate, we realize exactly how powerful those concealment norms are. This mother spent an entire day on the edge of her seat, unable to engage in her paid work, worried about what would happen to her son and to her because of this mistake. She thought about all of the possible problems and solutions, and engaged in quite a bit of emotional work trying to deal with the fact that she had made this mistake. This illustrates exactly how much work women invest in the concealment of menstruation, how much time and energy it entails yet also how fragile concealment is over time. Women must continually engage in concealment (and also be ready to do damage control) to make certain that menstruation can remain hidden.

This is also a story about how working mothers are constantly negotiating whether they are “good” mothers. This mother provides lots of excuses for why the “big switch” happened – everything from having deadlines at work to being a single mother. Thus we see another set of social norms at work as well in this story: social norms about who is a “good” mother. According to our social norms, there is only one kind of good mother at the end of the day: the mother who does not make mistakes. How silly is that? The ending of the story even seems to suggest how silly these motherhood norms might be, because the son turned out just fine — tampons didn’t hurt him, nor did his lack of snack.

In the end, this small story is just one more representation of the tightropes that women walk, and the impossible demands that social norms place on women. Let it be known that women menstruate and that mothers make mistakes. No social norm has the power to discount those facts.

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.