Making menstrual health more inclusive: how-to and why it matters

By Marissa Schut, @menstruamorphosis

In reality, not all women menstruate (i.e. due to illness, age, or being trans) and not all those who menstruate are women (i.e. some trans men, nonbinary people), therefore, it is important to shift the conversation and broaden the scope of MH practices to be inclusive to all those with menstrual cycles.

Working on making menstrual health more inclusive

First off, let me introduce myself. I am Marissa (they/she), a 29-year old MA student at the Gender Studies program at Utrecht University. Since 2017 my artistic and academic research has centered on the menstrual cycle and its physical, social, and symbolic aspects. 

As I myself am a nonbinary person who menstruates, my research centers on "queering the cycle” and opening up the discourse around menstruation and menstrual health to reflect the vast diversity of the menstrual experience. This has also been the focus of my internship at Simavi.

During the five months I worked for Simavi, I reviewed their MH Manual in order to make it more inclusive, especially focusing on the inclusion of non-cis menstruating experiences (please note this reviewed version is yet to be published). Cis or cisgender refers to people who identify with the gender they were assigned at birth.

In this blog, I would like to share my findings in hopes that it will kickstart and advance the process of making MH practices gender inclusive, not just at Simavi but throughout the MH community.

Why it matters

While the main approach in the sector is to center women and girls in menstrual health focused programmes, it is imperative that when speaking about menstruation, the scope is expanded as menstruation is a non-gendered experience; not just a “women’s issue”. 

Moreover, while menstruation is a subject that transgresses many borders, it cannot assume a universal subject in the sense that there is not one “normal” menstrual experience.

Thus, menstrual discourse has to be nuanced and be inclusive to all those who menstruate if it really wants to “leave no one behind” and achieve the Sustainable Development Goals (SDGs) related to Menstrual Health. 

Former UN secretary Ban Ki Moon said it himself in 2015 when he declared: 'There are 17 Sustainable Development goals all based on a single, guiding principle: to leave no one behind. We will only realize this vision if we reach all people regardless of their sexual orientation or gender identity.' 

So, how doe we make Menstrual Health (MH) more inclusive?

Throughout my research, I identified three steps that are needed to make MH programs inclusive. These are part of a method I named “planting seeds” and consists of disconnecting naturalized assumptions; use of inclusive language and terminology; and acknowledgement of systemic oppression. In the following paragraphs I will explain each of these steps in short.

Step 1: disconnecting naturalized assumptions

The first step centres around breaking the link between menstruation and womanhood. The idea that menstruation equals womanhood is rooted in popular beliefs, for example the statement that the onset of menarche (the first period) means a transition into womanhood. 

While for some this entry into womanhood is true for them and celebrated (which is perfectly ok, don’t get me wrong), it does not mean this is an objective truth for everyone. 

Therefore it is important to have more nuance in this discourse. For example, it is important to emphasize that sex does not determine gender and having a period or not does not define a person. This does not only refer to those outside of the gender binary who menstruate, but also cis-women who may not menstruate (anymore) because of illnesses or age, for example. 

Moreover, the notion that menstruation equals womanhood is often used as a gatekeeper to argue that trans women are somehow not “real women” or that trans men are actually women because they do menstruate, which is transphobic. Therefore it is important to be mindful of the language and terminology we use.

Step 2: inclusive language and terminology

Linked to the practice of disconnecting naturalized assumptions is the use of inclusive language and terminology. As language plays a huge role in how we create meaning to things, it is important to also change the words and phrases we use. 

Within MH practices, the word “menstruator" is already becoming a more popular term used by most organizations as a way to be more inclusive. But, just changing “women” to “menstruators” is only a first step into being more inclusive.

Terms like “the female body”, the “female reproductive system”, “lady parts”, “female hormones” etc. are more ways in which gender is imposed on physiology. So these also have to be adapted to become gender inclusive or gender neutral. 

In these cases, it is best to describe what you are referring to, think: “the pregnant body” or “the menstruating body”. It is also possible to acknowledge the construction of these gendered terms by saying, for example, “the assigned-female body”. This way gender is no longer imposed on a body, but rather described in neutralized language: a small step that can go a long way.

Step 3: acknowledgement of systemic oppression

As written in the article “Living on the Extreme Margin in Bangladesh” by Khan et al. (2009), “without deconstructing rigid gendered social structure and social systems, only superficially dealing with transgender people is a dangerous endeavour” (p.450). 

By changing terminology without a deeper reflection on the systems implied in that language, we only deal with inclusion and diversity on a shallow level. In order to truly bring about change, it must go deeper than that, which involves naming and acknowledging systems of oppression that come into play. 

This means being mindful of power dynamics we (sub)consciously perpetuate, and becoming aware of how we are complicit to keep (some of) these systemic oppressions in place.

Conclusion

To conclude, the process of be(com)ing truly inclusive involves many steps, but it is an important aspect in achieving the focus of the SDGs: to leave no one behind. Adapting terminology, working on unlearning naturalized concepts, and partaking in critical self reflection does not take away from the goal of MH practices; it only broadens its reach to help all those who menstruate to achieve menstrual equity. In order to do so, we must work together and listen to, and learn from, each other.

Connect with me or follow Menstruamorphosis

If you want to connect with me, or hire me to support your organization through these updates, please feel free to email me at marissaschut@gmail.com or find me on LinkedIn. You can also follow me on Instagram: @menstruamorphosis

**UPDATE** Simavi updated the Menstrual Health Manual in November 2022.