‘We like things tangible:’ A critical analysis of menstrual hygiene and health policy-making in India, Kenya, Senegal and the United States

Over the last decade, many countries have adopted policies addressing menstrual needs. Our research explores the opportunities and challenges that have shaped these initiatives and critically examines their scope and substantive focus. Our study analyses developments in four countries: India, Kenya, Senegal, and the United States. It is based on an analysis of 34 policy documents and interviews with 85 participants active in policy-making or advocacy. Across countries, we found a predominant policy focus on tangible and material outcomes, such as menstrual products and facilities, that is informed by a narrow perception of menstrual needs as the management of bleeding. A number of drivers influenced policy-makers to keep this focus, especially the key narrative around menstrual pads as a perceived solution to school absenteeism combined with sensationalisation in the media and the quest for quantifiable results. Menstrual stigma is so ingrained that it continues to constrain policy-makers and advocates themselves by perceiving and presenting menstruation as a problem to be fixed, managed, and hidden. When considering new policy directions, we need to create capacity for a holistic menstrual policy landscape that overcomes systemic barriers to addressing the needs of menstruators that are largely rooted in menstrual stigma.