Its manifestations may vary, but menstrual stigma is universal

Once you witness the repercussions of menstrual stigma, they become impossible to overlook. Globally, people who menstruate often hold misconceptions and negative feelings regarding menstruation, which can result in anxiety and psychosocial stress. Menstrual education is largely inexistent or inadequate, leaving people feeling unfamiliar with their bodily processes. Numerous menstruators have come to accept menstrual pain and hesitate to seek medical advice even when it exceeds routine cramps, often due to past negative experiences and being told “it’s all in your head.” In public spheres, individuals experiencing menstruation are frequently derided as “too emotional” or “hysterical” with significant implications for their perception and performance in professional settings.

In the recent public health literature, menstrual stigma and taboos are frequently discussed—but mostly in the context of the global South. In fact, we have often been faced with some variation of this question in our work in the global South: “How do you encourage women and girls to discuss menstruation openly, given its taboo nature?” Yet, why is it that we do not encounter a similar inquiry when conducting work in the global North? Is there a presumption that menstrual stigma is not as prevalent in the global North?

The opposite is true. We argue that menstrual stigma is universal. While its manifestations vary significantly, menstrual stigma persists globally. In this reflection, we draw on our work on menstruation in Nepal and in the United States, supplemented by our experiences living and working in a range of other settings. Through these experiences and our collective reflections over the years, we have arrived at the paradoxical realization that stigma surrounding menstruation persists irrespective of whether it is concealed (i.e. invisible) or openly discussed (i.e. visible).

In the United States, menstruation is seen as a hygienic crisis—one to be hidden at all costs. ¹ Menstrual products, usually labeled as “sanitary items” or “feminine hygiene products,” are marketed as hiding menstruation from view, controlling body odor, and even omitting any sound that would indicate one’s menstrual status by selling menstrual products in “noise-free” packaging. The overall message is that no one, at least publicly, must know that you are menstruating. Passing as non-menstruator is considered essential to live up to the (male) norm of a body that does not leak. ²

In Nepal, menstruation is considerably more visible. Since most women and girls across the country engage in some form of menstrual practice—such as abstaining from worship, eating or sleeping separately, or using separate walking paths—people living in their household or their community can readily discern someone’s menstrual status. ³ Notably, a 2020 study in Kathmandu revealed that almost half of the participants openly discuss menstruation; ⁴ even where this is not the case, there exists a notable awareness of menstruation in everyday life. Many perceive these practices as stigmatizing, as they single out individuals due to their menstrual status and mark them as “impure.” ⁵

We are well aware that forms and severity of oppression and discrimination linked to menstrual practices vary widely, and, indeed, much of our work focuses on dismantling oppressive practices. However, we need to be careful not to conflate cultural and religious practices with societal stigma. While the Western media has sensationalized the practice of chhaupadi, or menstrual seclusion, ⁶ menstrual practices in Hindu religion and culture are much more multifaceted, ³ and not all women consider them stigmatizing. In Trinidad, for example, Hindu women explained that they separate ritual impurity from menstruation as an embodied experience. As such, they do not consider menstruation dirty. They value their religious menstrual practices as part of their identity. ⁷ Similarly, many women in the Nepali diaspora that we spoke with across the United States hold onto certain menstrual practices, which we argue is a form of agency.

Given these examples, we begin to uncover the complexities of menstrual stigma. Stigma persists when menstruation is hidden, and also when it is visible in everyday life. Stigmatization can be understood as the process of dehumanizing, degrading, discrediting, and devaluing people based on a socially constructed “us” and “them” divide between menstruating and non-menstruating individuals—defining what is normal and what is abnormal. ⁸ Feminist theorists argue that the root of menstrual stigma is the perception of the menstruating body as abject and inferior, signaling the “monstrous feminine.” As a result, it “requires” either isolating menstruating individuals from others or if they are allowed to “roam free among men” to keep menstruation concealed. ⁹

Ultimately, stigma (re)produces unequal power relations through social dynamics. ¹⁰ Stigma serves as a rationale for discrimination, making discrimination seem justified, natural, and even desirable. Unearthing these processes allows us to challenge them at all levels. Teachers have the power to withhold or impart information; health-care providers can choose to dismiss patients or to take them seriously; employers can decide whether to label people who experience menstruation or menopause as unfit or to accommodate their needs; religious leaders can enforce religious prescriptions or enable menstruating individuals to decide for themselves if and how they want to follow menstrual practices.

The present moment offers an opportunity to tackle menstrual stigma and shift these complex power dynamics. With increasing momentum to make menstruation a public concern, we are witnessing the emergence of a global menstrual movement. Major news magazines report on menstruation and menopause. Artists across the world present powerful pieces ranging from the aesthetic to the provocative which use menstrual fluid. Some initiatives seek to advance menstrual literacy that not only deliver comprehensive information on bodily processes but also acknowledge the socio-cultural meanings, enabling people to make sense of their menstrual experiences. Activists run campaigns that put menstruation in the public eye and encourage people to be open about their menstrual needs.

This emerging menstrual movement is transnational and translocal. Even if the manifestations, dynamics, and contexts vary, menstrual stigma is universal. Therefore, we benefit from learning from each other’s experiences and building alliances. Together, we have the power to bring about change in how we view menstruation—to remove the stigma.