Abstract
This data-rich chapter digs into MHM’s problem frames that establish the menstrual body as precarious if not contained and concealed through management of the body. MHM advocates establish the urgency of this problem by making two main claims: (1) girls are getting sick, and (2) girls are missing, even dropping out of, school. I scrutinize the bases of these claims and find they largely lack solid evidence, often relying on anecdote, exaggeration, and poor citational practices. Operating in a competitive arena with limited resources and rooted in assumptions about life in the Global South and the comparative superiority of Western standards of embodiment, MHM responds to these pressures by intervening first and asking questions later.
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Notes
- 1.
Industry data on menstrual care product consumption is typically proprietary and, thus, hard to access. A CDC study reported that 62% of US women, for example, use pads and 42% use tampons (Branch et al. 2015). A Euromonitor study includes a world map showing tampon use. Menstruators in the US, Germany, and Austria are the biggest tampon users. Countries in Africa and much of Asia register negligible or nonexistent use (Chalabi 2015).
- 2.
I explore MHM’s use of the trope of dignity in Chap. 6.
- 3.
The choice of the word rag (associated with dirt) over cloth (associated with clothing) is a subtle but meaningful move toward constructing traditional methods as suspect.
- 4.
The practice varies across regions of the country. It is most prevalent in the Far-Western Region (30%) than in the Mid-Western Region (11%). Even more granular differences are significant. In the Mid-Western Mountains and Far Western Hills, 52% and 50% of women and girls practice chaupadi (Nepal Central Bureau of Statistics/UNICEF2012, 108).
- 5.
To avoid any confusion about numbers, 62 interviews (42 of which were formal) were conducted with a total of 70 individuals. I describe my methods in Appendix A.
- 6.
Of course, as I point out in “Notes on Language,” all adolescent girls do NOT menstruate. The assertion that they do is unfortunate as it erases menstruators who do not identify as girls (or women) as well as girls who, for a variety of reasons (such as malnutrition, illness, or anatomical differences), do not menstruate. The essentialism exhibited here is typical of MHM discourse from the grassroots to the highest levels of national and international agencies. In the Global South, gender-inclusive menstrual discourse is not normative, not even among activists. Each time I suggest the use of gender-inclusive terms, I am told by advocates, often with a weak smile and a shake of the head, that their local area is not ready for this shift.
- 7.
UK-based Chella Quint offers a helpful distinction between secretions—useful materials produced by the body that are then released (like menses, sweat, mucous)—and excretions, such as urine and feces, which are strictly waste products.
- 8.
I will expand upon the menstrual cycle as fifth vital sign in Chap. 8.
- 9.
- 10.
Gratitude to Chella Quint, who points to a similar representation in Western menstrual care ad campaigns of the twentieth century. See, for instance, the 1926 ad, “A Great Hygienic Handicap that Your Daughter will be Spared,” from Cellucotton Products Company (available at https://repository.duke.edu/dc/adaccess/BH0243).
- 11.
Mythri is a Sanskrit word meaning (female) friend.
- 12.
I cannot locate this study. I suspect it is a misspelling of Sandhana, a journalist who published a piece in The Guardian in 2012. As mentioned above, Sandhana’s article references the AC Nielsen study.
- 13.
I must point out that Emily Wilson, co-founder of Irise, alerted me to this review during a discussion where she expressed frustration about the pervasive claim “poor MHM is making girls sick.” She had already located the relevant research and assessed study designs and conclusions. I make this point to illustrate the many MHM advocates themselves are quite aware that the research base is immature.
- 14.
This is a reference to Demba et al. (2005).
- 15.
It is common knowledge that tampons are rarely used across most of the Global South, a point I heard reinforced throughout my data collection. This explanation from Sierra Leone-based One Girl/LaunchPad (2018) is representative of explanations for why internally worn materials are less common in these regions:
More than 90% of the women in Sierra Leone have undergone Female Genital Cutting (FGC). This means that they find is incredibly painful to insert anything into their bodies.
Additional, virginity is valued very highly in Sierra Leone. Teenage girls would be unable to use tampons or cups for fear of ruining their future chance of marriage.
It is generally considered taboo to use any of these products in developing countries, therefore the reliable sanitary pad is a much more socially acceptable option! (www.onegirl.org.au)
- 16.
Another problem associated with menstruation that has yet to enjoy scholarly attention: dehydration. In a study of 332 schoolgirls in three schools in Tamil Nadu, Daniels (2016) found that 59% of the girls drank less while menstruating, presumably because they were reluctant to use inadequate WASH facilities. While menstruation was the top reason girls drank less, many of the girls did not explaintheir reasons for reducing fluid intake (or how much it varies throughout the menstrual cycle). Further research is needed (70).
- 17.
One reason for this gap in knowledge might be the difficulty of reliably measuring attendance. Attendance logs can be inaccurate, failing to capture, for example, girls that leave midday, often after the midday meal; and girls may report being “sick”—a vague term that can mean anything from a cold, the flu, or a headache, to severe menstrual cramps, or it can serve as menstrual-stigma reflecting code for menstruating and lacking the means to comfortably care for their bodies. At the 2017 MHM Virtual Conference, Erin Hunter presented a new measure for assessing MHM interventions—a self-efficacy scale. To this, MHM expert and co-organizer of the conference Marni Sommer delightedly responded, “Everybody—donors and governments—want school attendance as a measure, but it’s complicated.… Finally we have a new way to measure MHM!”
- 18.
While the context is Nepal, not an African country, a WaterAid study looking at four Nepalese schools found that the major reason for girls missing school was lack of privacy for cleaning and washing (WaterAid in Nepal 2009). Another WaterAid (2006) study—this one situated in Bangladesh—found when a school provided separate toilets for girl and boys, attendance rose by 11% per year, on average, over seven years. These studies suggest that there are many co-factors contributing to the impact of menstruation on girls’ school experience.
- 19.
Note the flattening of the African continent. One study—in Sierra Leone—can become a study that describes the experience of girls across an entire continent of 645,000 million women and girls (UN 2017).
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Bobel, C. (2019). “Can You Imagine?” Making the Case for a Bloody Crisis. In: The Managed Body. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-89414-0_4
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