Original post on Medium:
By Nikki van de Veerdonk and Danielle Keiser, Menstrual Health Hub
A historic day in period policy history
On November 24th, 2020, the Scottish Parliament announced its unanimous decision to make menstrual products, such as pads and tampons, free to those who need them. A truly historical event, this has made Scotland the first country in the world to provide free period products for all.
The bill, titled The Period Products (Free Provision) (Scotland) Bill, places a legal duty on the Scottish government to set up a universal system to ensure anyone in need of period products can get them without paying, with local Scottish authorities and education providers tasked to make sure that the products are obtainable free of charge. Schools, colleges, and universities will be required to have free menstrual products available for all students and several designated public places such as community centers, youth clubs, and pharmacies must also make the products free and available.
Monica Lennon, the fierce advocate and Member of the Scottish Parliament, who introduced the landmark legislation in April 2019, stated before the vote:
“Scotland will not be the last country to consign period poverty to history, but we have the chance to be the first.’’
— Monica Lennon
In the midst of a global pandemic, this groundbreaking bill sends a powerful message for how governments should understand and accommodate the menstrual health needs of its citizens. Periods don’t stop for pandemics, and free, universal access to period products has never been more needed. Menstrual products should not be a luxury in any circumstances as menstrual care is health care, and there should be absolutely no barriers to their access or use.
The motivation behind the legislation acknowledges that accessing menstrual products can be a challenge for some marginalized or vulnerable groups, and it spotlights that inadequate access to menstrual products and education is not confined to developing countries; it is alive and well and also experienced in countries with developed economies. The debate around the bill also led to the discussion of issues rarely spoken of, such as endometriosis, heavy menstrual bleeding (HMB) and the necessity of waste bins in restrooms.
The vote was avidly cheered around the world and serves as a strong example for how other countries can follow suit and prioritise menstrual health higher within their political agendas, take responsibility and actually get to work.
In the days after the victorious announcement, several activist groups and politicians in surrounding countries (Belgium, The Netherlands, United Kingdom, United States) proposed similar calls to action on their governments to follow Scotland’s example and take decisive measures in providing free period products for all.
Policies like these that focus on providing basic needs like menstrual products — anchored in evidence, voice, and participation — are incredible entry points to addressing wider topics of women’s rights and gender discrimination. While the period revolution should not stop with giving away free products, Scotland’s vote presents an opportunity to examine fundamental values about what roles 1. informed choice; 2., inclusivity and; 3., language play in moving forward good gender-equitable policy.
By ensuring that policy developments are founded on human rights principles and have a comprehensive understanding of menstrual health required to de-stigmatize menstruation in the long run, we now have a chance to take on this momentum to get it right from the start.
1. The importance of informed product choice
In the Scottish Period Products bill, period products are understood ‘as manufactured articles the purpose of which is to absorb or collect menstrual flow, and types of period products include tampons, sanitary towels and articles which are reusable.’ The appointed authorities ‘must provide for (1) period products to be obtainable reasonably easily, and in a way that respects the dignity of persons obtaining them, and (2) a reasonable choice of different period products to be obtainable.’
Although we have yet to see how the implementation of the legislation will unfold in the Scottish society, it is safe to assume that in practice, disposable products (tampons and pads) are most likely to be made available. What offering period products with ‘reasonable dignity’ entails is ultimately up to the local authorities tasked with ensuring that period products are obtainable free of charge.
While tampons and pads are the most commonly used period products, they are not the only period products on the market. As the number of MH businesses is growing exponentially, alternative choices are rising in popularity, including menstrual cups, period underwear or even tampliners (yes!). Continued menstrual product innovation is essential as one product will never meet the needs of every single menstruator.
Menstrual solutions are as diverse as the people seeking them, and the focus should be placed on informed choice, agency, and decision-making, rather than which product considered a better option for the majority of people.
Engender, Scotland’s feminist policy and advocacy organisation, already stressed that this improvement in access should be coupled with the right to choose which product or products are needed during menstruation. According to the organization, unaffordability of tampons can, for example, lead to an exclusive dependence on heavy flow items for the length of a period, which could result in a greater risk of infections or even Toxic Shock Syndrome (TSS).
Menstrual equity is oftentimes incorrectly understood as affordability, accessibility, and safety of menstrual products. This is only partly true. According to its chief architect, Jennifer Weiss-Wolf, menstrual equity was intended to provide a frame for policymakers in the United States to understand and address the urgency of menstrual needs.
Unpacking these needs, menstrual equity is not just about products, but also about providing information, social support and choices around how to manage one’s period.
Therefore, instead of providing a one size fits all ‘best’ option, we must strive to ensure a rights-based, pro-choice approach.
People who menstruate anywhere in the world, should be able to make informed choices and choose the solutions that suit them best. Period positive education and the implementation of policies that explicitly offer the choice to a wide range of free period products — including reusable products, products of varying absorbency, and other product characteristics as well as information on how to use them — is the ideal solution to move the needle on eradicating period poverty and creating more menstrual equitable societies.
Dignity is all about agency, and agency is all about having the freedom to make one’s own choices, by oneself and for oneself.
2. Make menstrual health inclusive to everyone, everywhere
Media reporting on the Scottish vote repeatedly referred to ‘women and girls’ as the target group of the new bill. This remains one of the most persistent misconceptions in menstrual health, as not all people who menstruate identify as women and not all women menstruate.
While it may be a difficult concept to wrap one’s mind around, a menstruator is a person — regardless of their gender — who menstruates and therefore has menstrual health needs; this includes girls, women, transgender, and non-binary people. When we keep talking about only women and girls, the menstrual experiences of menstruators not identifying as cis-women are often forgetten, ignored, and disregarded. It is also important to note that there are many cis-women who have had cancer or reproductive health issues that cause them to not menstruate, and that cis-women who have experienced menopause also do not menstruate.
We need to work towards menstrual health as an inclusive field in which all menstrual experiences are valued and given attention, regardless of gender.
The bill itself makes no notion of specific gender groups, and references the person’s needs for period products as arising from whether the person menstruates, and the motivation behind the legislation was largely directed at ensuring product access for marginalized or less advantaged groups, as menstrual health matters to everyone, everywhere.
Policymakers aiming to follow in Scotland’s footsteps must take the needs and requirements of specific marginalized populations into account when formulating new laws.
This means, for example, that the spaces chosen to distribute free menstrual products facilitate safe access for all people who menstruate and that anyone can access them without consequences.
And even when ‘women and girls’ is used as a shorthand term to increase the readability of an article or communication, a simple asterisk explaining that this wording of women and girls refers to all menstruators regardless of gender identity could be an excellent and necessary first step towards more inclusive policy action.
3. The need for progressive, period-positive language
Words like ‘hygiene’ and ‘sanitary’ were still overwhelmingly used by the media to describe the products that will be available through the Scottish vote. Language is power and using these terms can be problematic and limited as they reinforce gender-based discrimination and negative notions that menstruation is inherently unhygienic, dirty, and that the vagina needs to be sanitized or cleaned up. Furthermore, words like these insinuate that menstrual products are the quick-fix solution to the ‘unhygienic’ ‘problem of menstruation. It also puts the responsibility on the menstruator to ‘clean themselves up’ rather than looking at menstrual health as a larger, societal issue.
This choice of language did not appear out of nowhere. Advertisements and conversations about the monthly cycle are oftentimes coded with terms like ‘feminine hygiene’, ‘sanitary protection’, and ‘intimate areas’. Language like this might make it easier for people to talk about menstruation, but it reinforces the stigma attached to a very natural human process. Why is there no mention of the vagina, uterus or menstrual blood? Menstruation is still seen as unpalatable even if it is a human vital sign and a core function of the human reproductive process.
Periods are not dirty or any more unhygienic than any other bodily function, and the menstrual products we use to manage our periods are just one element of a complex menstrual health puzzle.
Education, body, literacy, and skill development are equally important, all of which need to be delivered in a socially supportive environment along with the provision of water sanitation and hygiene (WASH) facilities that are up to par.
Put forward by UNICEF’s Guidance to Menstrual Health and Hygiene in 2019, adding ‘health’ to the menstrual equation not only evokes more positive connotations, but it takes on a more holistic and broad understanding of the menstrual experience. Using ‘health’ also does not disregard hygiene, which falls under the umbrella of health: hygiene is a habit that people form to maintain a healthy lifestyle, which makes hygiene an actual indicator of health.
A menstrual window of opportunity
As a catalyst for widespread policy change, Scotland’s monumental vote provides a blueprint for other governments to use as an entrypoint to address broader gender and health topics. Countries that are now entering the MHH policy field or looking into expanding their menstrual health program could benefit from the menstrual momentum pushed forward by Scottish bill, and seize the opportunity to look beyond access to products.
When it comes to product choice, there is an opportunity to discuss disposable and reusables equally. The responsibility of those working on MHH is both to educate and inform with evidence-based information as well as to create the opportunity for people to access any and all of those options. Together, this enables people who menstruate to make informed choices about their own bodies and health.
With regard to inclusivity,
it is critical to understand and address the lived experiences of all menstruators, and take the needs and requirements of specific marginalized populations into account when formulating new regulations,
such as what we’ve seen in the Scottish bill. We cannot move forward towards gender equality if we leave those at the margins behind. The focus should be on destigmatising menstruation, acknowledging individual differences and creating period-inclusive public places.
When considering language, using period-positive and uncoded language is required to change the conversation because it rejects stigma and creates new norms and realities around body literacy, the menstrual experience, and the role those play in enabling confidence. As a society, it is imperative to progressively adjust the way we talk about periods in ways that do not perpetuate taboo, stigma, and secrecy.
That Scotland’s milestone legislation is unique shows that menstrual health has yet to be perceived as a top-priority issue, and still needs to find its place in general policies and become institutionalized. There is a need for high-level ownership and recognition. We need to address the underlying structural causes of unmet needs and take into consideration the role of the public institutions, community organizations, and businesses, and how their actions and omissions can have a direct impact. We need more studies to understand what the needs are for different populations, because we lack post-implementation data on MH policies. The focus on tangible outcomes like products, facilities, and infrastructure makes the implementation of policies focusing on menstrual education and training difficult. Learning from Scotland’s experience and establishing which improvements can be made to legislation and implementation supports the development of tailored national policies that ensure barriers to accessing menstrual products are eliminated.
With a clear agenda for change, together we can influence the policy agenda to improve menstrual health for this generation and those to come. The systematic and disproportional discrimination against people who menstruate has gone on for long enough.
We are ready for the period revolution. Let’s get it right from the start!
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About the authors:
Nikki van de Veerdonk is a Program Officer at the Menstrual Health Hub and has a masters in Public Administration and Applied Ethics.
Danielle Keiser is the Executive Director of the Menstrual Health Hub (MH Hub), a Berlin-based non-profit focused on strengthening the global female health ecosystem. She is also the Relationships Director at Madamí, the MH Hub’s sister consulting agency focused on gender and female health.