In 2012, the Water Supply and Sanitation Collaborative Council (WSSCC) spoke to 12,000 women and girls in five states of India over 56 days during the Nirmal Bharat Yatra, which was a massive national campaign around sanitation and hygiene. We created a safe space to talk about menstruation and the response was tremendous: women and girls gathered in large numbers with mothers, grandmothers, sisters and friends to discuss, share and ask the most intimate of questions. They tested simple training and communication tools and partnered in developing methodologies to break the silence and create safe menstrual hygiene management conditions together.

In 2014 WSSCC took this approach to West Africa and launched the Joint Programme ‘’Gender, Hygiene and Sanitation” with UN-Women. The programme undertook a series of studies aimed at breaking the silence on menstruation and menstrual hygiene in the region.

One of the most significant barriers for women is the social restrictions, beliefs and myths that influence the management of menstruation. The studies’ findings echo the silence and concerns from many countries around the world. A first—and very critical—problem is limited or incorrect knowledge and information. Many girls do not understand what is happening when they start menstruating and have limited knowledge on biological processes. As one girl in Cameroon explained: “My periods started when I was in the field with my mother. Since I was ashamed I didn’t say anything to her… when my mother realized that it was my period, she discreetly took me into her bedroom and took out a sanitary cloth and explained to me how to wear it. She also told me not to greet any boys anymore, because if I did I would fall pregnant straight away.”

Due to a lack of facilities at school, at work and in public spaces, women often prefer to manage menstruation at home, meaning they are unable to participate in cultural, educational, social and income-generating activities. Poor practices and unsafe materials compound this problem. In addition, many women and girls lack access to safe and hygienic materials. They report drying menstrual cloths in private and dark locations, which does not guarantee the elimination of germs. In fact, inadequate cleaning and drying of materials is a major cause of infection. Where women use disposable materials, they usually dispose of used materials into toilets and latrines that cannot handle this waste, leading to clogging, overflowing and pollution.

One of the most significant barriers for women is the social restrictions, beliefs and myths that influence the management of menstruation and, as a result, affect the daily lives of women and girls. When menstruating, women and girls are subjected to various religious, food-related, domestic or sexual prohibitions, which often lead to further isolation or stigmatization.

Finally, perceptions of menstruation affect how many cultures perceive girls. Starting to menstruate is often viewed as a sign of maturity, meaning girls have reached a potentially marriageable age. Yet early marriage significantly increases the risk of child pregnancy, repeated pregnancy without adequate birth spacing, and complications such as obstetric fistula.

Despite the veil of secrecy shrouding menstruation, menstrual hygiene management provides a powerful entry point to empower women and girls, dispel myths, change practices and remove restrictions. In fact, all participants in our studies were eager to discuss menstruation. They asked a wide range of questions about sexual and reproductive health and early pregnancy, highlighting the need for comprehensive sexuality education. It is especially imperative that adolescent girls be able to access correct, basic information before they have their first period.

Menstrual hygiene management provides a powerful entry point to empower women and girls. At the same time, WSSCC has witnessed great openness among policy-makers to address menstrual hygiene once they become aware of the broad implications it has for women’s and girls’ lives and see the urgent need to address it. For example, last year the Government of Senegal signed a memorandum of understanding to improve women’s and girls’ rights to water and sanitation. The agreement is an integral part of the Ministry of Water and Sanitation’s aim to include the issue of menstrual hygiene management in the updated national sanitation policy.

To achieve such broad change, WSSCC calls on national and local governments to articulate clearly the need for menstrual management in policies. Policy reforms need to be bolstered by dedicated budgets and resources for policy implementation, as well as capacity development in institutions. This should include programme implementation officials working in the WASH, education, health and environment sectors. WSSCC will continue to support trainings on menstrual hygiene and develop capacity for outreach and awareness campaigns to demystify menstruation among women and men. It is essential to raise awareness among religious, community and other leaders to support the participation of women and girls in decision that concerns their lives, and it is also important to work with women and men as well as girls and boys.

 While some people are still reluctant to discuss it, menstrual hygiene has proven to be a powerful entry point to raise broader issues around gender equality and women’s and girls’ empowerment, including challenging issues such as sexuality education, sexual and reproductive health and rights, child marriage, fistula and female genital mutilation. With this in mind, countries must aim to eliminate all forms of discrimination against women, including discrimination based on social norms surrounding menstruation that harm the physical integrity and human rights of women and girls. Menstruation is a sign of female health and vitality and can no more be shrouded in fear, shame or embarrassment. Breaking the silence around menstruation is essential for women and girls to be able to reach their full potential.