Abstract

Menstruation affects over 800 million individuals daily, yet it remains widely misunderstood and stigmatized. Period stigma, rooted in cultural, religious, and social norms, perpetuates harmful narratives that portray menstruation as shameful or impure, limiting open conversation and contributing to health inequities. This stigma hinders menstrual equity by restricting access to menstrual products, accurate health education, and autonomy over reproductive health. Menstruators in India, Bangladesh, and Nepal often face systemic barriers, including lack of self-efficacy, gender inequality, and limited access to care and education, all of which compound the stigma. While previous interventions have attempted to address menstrual health through education or product access, few have successfully integrated multiple approaches or tackled the deeper socio-cultural roots of stigma. This paper explores the historical and structural origins of period stigma and argues for intersectional, culturally informed strategies that combine education, resource access, and community-based change to advance menstrual equity.

Introduction

At a given point each day, 800 million individuals menstruate. Though 26% of the population menstruates, menstruation is a process that is not widely understood, by menstruators and nonmenstruators alike (Rohatgi, 2023). Therefore, period stigma, defined by negative connotations surrounding menstruation, exists worldwide and is impacted by a wide range of cultural, social, religious, structural, and economic factors. It mostly impacts menstruators but has an impact on the larger population by hindering economic and social progress. Specifically, period stigma inhibits the achievement of menstrual equity, or equal access to menstrual hygiene products and the right to education about reproductive health (County of Santa Clara Division of Equity and Social Justice, n.d.). Different cultures have varying taboos associated with menstruation, but an underlying thread is it being perceived as unclean, impure, and something that should not be openly discussed (Barrington et al., 2021; Hennegan, Winkler, et al., 2021). Menstruating women are viewed as unhinged and incapable of making sound, logical decisions. (Johnston-Robledo et al., 2020). Therefore, many menstruators go to great lengths to conceal their menstrual status from others for fear they will be judged or perceived differently if it is known they are menstruating. In this way, menstrual stigma is a perpetual cycle that feeds itself, being both caused by and causing similar outcomes. 

Throughout history, there has been a culture of shame surrounding menstruation, preventing open, healthy discourse on the topic. Many religious texts associate menstruation with shame and corruption. A widely known example of menstrual stigma in religious texts is from the Bible’s Leviticus chapter 15, verses 19-33. This passage states that menstruating women and anything they lie or sit on become unclean. The passage goes on to say that a non menstruating person will become unclean if they touch menstrual blood or anything touched by the menstruator (Leviticus 15:19-33). Other religious texts including the Muslim Quaran and Hindu Veda paint depictions of menstrual blood carrying the sins of the Gods or how a menstruating woman will contaminate or bring bad luck to others (Garg et al., 2015). Popular culture has also encouraged feelings of embarrassment and shame over menstruation. In the 1950s, the popular women’s magazine, Good Housekeeping, published an advertisement for the newly packaged sanitary towels by Modess. They were marketed as being “so skilfully shaped not to look like a napkin box, that the sharpest eyes couldn’t guess what’s inside the wrapping” (Modess, 1950). 

Though it persists worldwide, this stigma disproportionately persists in lower-income countries such as India, Bangladesh, and Nepal, where access to menstrual products and safe disposal areas is limited. The interplay of a lack of access to resources and education as well as the cultural taboos surrounding the discussion of the female body forms the complexity of current-day period stigma. A lack of comprehensive menstrual health education is a major contributor to period stigma. In a study conducted in the capital of Bangladesh, Dhaka, it was found that ⅓ of respondents did not know how to safely use period products. (Akther et al., 2012). In addition to women internalizing stigmas associated with their cycle, period stigma can promote the manifestation of physical ailments such as vaginal infections or undiagnosed conditions like endometriosis which will be discussed in later sections.

The large gender disparities present in India, Bangladesh, and Nepal contribute to the negative perception surrounding menstruation. Practices and processes commonly associated with women, such as menstruation, are often neglected, due to women often being viewed as second-class citizens. Additionally, women’s struggles are often undermined and labeled as overreactive, and women are not given the tools they need to properly manage their health.  (Majeed et al., 2022). Women in India, Bangladesh, and Nepal often lack self-efficacy and are unable to make medical decisions on their own. With men typically serving as providers of the family in these countries, women are forced to consult their fathers or husbands if they want to see a provider or have a concern about their health. Many women may feel uncomfortable doing so, leading to them neglecting their bodies (Majeed et al, 2022). Young menstruators report that the fear of being perceived as dramatic inhibits them from discussing their menstrual health with their families (Venetis et al., 2020). 

Previous solutions, specifically in Western countries, have centered around menstrual health educational programs in schools or providing free period products in public restrooms (Koskenniemi et al., 2023; Bowen-Viner et al., 2022). However, few interventions have included a combination of education and product accessibility, leading most to be only partially successful. Most public health interventions in India, Bangladesh, and Nepal have consisted of surveys asking adolescent girls about their experiences with menstruation (Hennegan, Shannon, et al., 2019; McCammon et al., 2020) with few implementing tangible changes in communities. Many health education interventions have proved successful short-term but without also providing affordable period products, these interventions fail to be sustainable (Parasuraman et al., 2022). These interventions focused on increasing menstrual cycle knowledge and teaching good menstrual care practices. Educational programs are often successful in educating menstruators on proper menstrual care and hygiene practices, but fail to deconstruct socio-cultural taboos (Rastogi et al., 2019). 

The specific roots of period stigma are outlined below providing a comprehensive overview of where future and current efforts should be focused. It is critical to take an intersectional approach to period stigma reduction through a combination of structural and educational interventions. This includes increasing access to period products such as pads, tampons, and menstrual cups. Comprehensive menstrual health education is also required to instill safe period care habits, an understanding of the menstrual cycle, and to unlearn the cultural and religious stigma surrounding menstruation. This paper will discuss these solutions in-depth and provide a comprehensive review of current research on period stigma, using that to provide future directions to increase menstrual equity throughout India, Bangladesh, and Nepal. 

Literature Review 

I. Overview

Period stigma in India, Bangladesh, and Nepal leads to menstruators being isolated from their families, feeling unsafe at home, prohibited from entering certain spaces, and less likely to attend school or work (Van Eijk et al., 2016). This stigma is overall harmful to the well-being of menstruators and the country as a whole. Not only does stigma impact physical and mental health, but it can hinder society’s progress in terms of reaching gender equality. Period stigma places an unnecessary burden and shame on female individuals and adds to the already persistent discomfort of menstruation. Various factors contribute to period stigma, including sociocultural and economic or structural factors (Critchley et al., 2018; Hennegan, Shannon, et al., 2019; Van Eijk et al., 2016). 

One of the main sociocultural factors associated with taboos of menstruation is religion (Garg et al., 2015). In Hinduism, a religion native to India, women are prohibited from participating in day-to-day life while menstruating. Religious Hindu texts also mark menstruation as a filthy and shameful process that should not be discussed openly (Garg et al., 2015). Religion throughout India, Bangladesh, and Nepal forces menstruators into extreme isolation due to widely believed ideas about menstruation. This factor is complex and requires a careful solution as it can prove difficult to dismantle the dangerous teachings of religion while remaining culturally sensitive. 

Another sociocultural factor feeding period stigma is the lack of healthy discourse surrounding menstruation. This lack of openness leads to individuals making negative assumptions about menstruation or perpetuating taboos of menstruation being dirty or impure. Open conversation goes hand in hand with education, which is also missing in these communities. A lack of comprehensive menstrual health education is another sociocultural factor contributing to period stigma. The lack of education may be due to individuals’ unwillingness to discuss menstruation as they perceive it as an uncomfortable topic (McCammon et al., 2020). It may also be because menstruation is not considered important enough to discuss in schools or formal settings. This statement ties into gender disparities in India, Bangladesh, and Nepal, and women being viewed as less-than their male counterparts (Kaur et al., 2018). The severe inequality of women and men in these countries and the patriarchal system also contribute to period stigma (Manorama and Desai, 2020). Gender roles in India, Bangladesh, and Nepal prevent women from having a say over how money is spent which can limit access to safe period products (Kaur et al., 2018). 

Economic factors include access to safe menstrual products, clean water, and proper sanitary facilities (Rohatgi et al., 2023). Many areas within India and Bangladesh lack access to safe menstrual products, clean water, comprehensive menstrual education, and proper sanitary facilities. Rural and urban areas differ quite significantly on which period products are used, often due to availability and accessibility (Rahman et al., 2018; Van Eijk et al., 2016). These economic factors and an overall lack of access harm the health of menstruators causing many to develop infections or other health conditions. 

II. Sociocultural Factors 

Religion 

In the Veda, ancient Hindu scriptures, it is written that guilt appears monthly in the form of menstrual flow as women have taken the guilt of the Hindu God, Indra from killing the Vritra demons (Garg et al., 2015). Therefore, period blood is associated with evil spirits and shame. It is believed that menstrual blood can be used for black magic or to impose a woman’s will on a man (Garg et al., 2015). These false ideologies lead to the perpetuation of period stigma in India. Therefore, it is common for women to be prohibited from entering holy spaces such as the prayer or “puja” room or touching holy books while menstruating (Garg et al., 2015). The belief that menstruating women are impure causes women to be excluded from spaces in their own homes such as the kitchen. Cultural practices lead many to believe a woman on her period contaminates anything she touches; therefore, she should not touch or prepare food for others (Garg et al., 2015). Menstruators in Nepal are not permitted to touch plants while menstruating because it is believed they will bring bad luck to growth and vitality (Amrita et al., 2020). Many believe that not obeying these rules is betraying God’s will and will bring misfortune to the woman and her family (Thapa et al., 2021). Religion is an often difficult and complex barrier to navigate due to the importance of cultural sensitivity; therefore, this can be noted as one of the most powerful perpetuating factors to period stigma. 

Many of these cultural beliefs are not supported by science and lead to unnecessary fear, confusion, and embarrassment. For instance, there is a myth that bathing and washing one’s hair during menstruation impedes blood flow (Kaur et al., 2018). Women often feel low self-esteem and difficulty caring for themselves while menstruating, and this myth only exasperates those feelings. Under so much restriction, menstruators can often feel isolated, even in their own homes. Often, this isolation is not a feeling, but physical. In Nepal, women who are menstruating must live separately, outside the home, in a “chhaupadi” or mud hut (Kaur et al., 2018; Majeed et al., 2022; Thapa et al., 2021). The huts used as ‘menstrual huts’ are often livestock huts, exposing menstruators to unclean and unsafe conditions. (Amrita et al., 2020).  This practice also degrades women, equating their lives to that of an animal kept in isolation. It is thought that menstruating women will bring bad luck or poor health to their families if they are near them on their period (Kaur et al., 2018; Majeed et al., 2022). Living in chhaupadis makes a person more vulnerable, making them more likely to experience horrific events such as rapes, animal violence, and fires (Kaur et al., 2018). 

Conversation 

The above cultural factors prevent menstruation from being openly discussed in homes and communities throughout India, Bangladesh, and Nepal. Mentally and physically isolated menstruators often have nowhere to turn with questions about their cycle or menstrual health. Religious beliefs and cultural practices make it common for menstruation to be associated with negative feelings such as shame and embarrassment. Therefore, mothers often instruct their daughters to keep their periods out of the eyes and ears of others, especially men and boys. In a study done with young menstruators in Uttar Pradesh, India, it was found that many girls did not have a confidant for menstrual health-related questions. One participant stated “My mother told me that I should not tell boys about it…[she said] don’t tell your father about it. And don’t open this [sanitary pad] pack in front of your brothers” (McCammon et al., 2020). Once again, this leads to feelings of discomfort and fear in one’s own home and is especially harmful to the developing mind and body of a young girl. Feeling as though their problems must be hidden from others’ views again perpetuates gender inequality and disparities, raising young women to believe they should not take up space or be fully seen. The stigma was so extreme that many respondents in the study were hesitant even to use the phrase ‘sanitary pad’ when answering questions due to its cultural negative connotations (McCammon et al., 2020).

Boys and men are often removed from discussions surrounding menstruation due to periods being viewed as a gendered topic. Often boys are discouraged from discussing menstruation as it does not directly affect them (Gundi et al., 2020). This makes boys hesitant to understand the physiology of menstruation and unable to empathize with the social experiences that menstruators have, further deepening the stigma (Gundi et al., 2020). Additionally, boys then grow up with the notion that menstruation is a ‘woman’s problem’ and something that should not concern them, when rather all individuals need to understand. Young boys are also then left to learn about menstruation from the internet or gossip between friends, giving them an inaccurate and incomplete view of the topic (Kaur et al., 2018). Without providing concrete facts and comprehensive education, human beings fill gaps in knowledge with their own, often incorrect or harmful assumptions. This highlights the importance of menstrual education, which unfortunately is lacking across all three countries.

Education 

A comprehensive meta-analysis shows that just 25% of girls knew that the uterus was the source of bleeding during menstruation (Van Eijk et al., 2016). Most adolescent menstruators are not prepared for the onset of menarche, or the first menstrual cycle, due to a lack of education and awareness (Rahman et al., 2018). This leads to menarche being associated with high rates of school dropout in India. In Bangladesh, a study found that 40% of female Bangladeshi students in Bangladesh skip school during menstruation due to poor restroom facilities (Rahman et al., 2018; Vashist et al., 2018). This highlights the need for schools to create a period-friendly environment, meaning one where there are free period products available and quality menstrual health education. A lack of education leaves young menstruators in the dark about how to manage their periods and period care products. Even if resources to manage menstrual health are present, menstruators must feel that caring for their menstrual health is a priority for the facilities to be effective (Schmitt et al., 2021). 

86% of adolescent female students use old cloths during menstruation. This can be due to a lack of education and a lack of proper resources. Of those individuals, only 12% wash it properly with soap and dry it under the sun for best hygiene practices (Rahman et al., 2018). Unsafe menstrual cycle practices due to a lack of awareness lead to Toxic Shock Syndrome (TSS), Urinary Tract Infections (UTIs), scabies in the vaginal area, and other vaginal diseases (Kaur et al., 2018; Majeed et al., 2022). Studies show more than 50% of girls do not manage their menstrual cycle safely in low-income countries such as India (Majeed et al., 2022). Additionally, inadequate education leads to underdiagnosis of reproductive health conditions such as endometriosis, a chronic inflammatory disorder that leads to extremely painful periods and pain while urinating, passing bowel movements, or engaging in sexual intercourse (Falcone et al., 2018). Another condition, premenstrual dysphoric disorder (PMDD), can go undiagnosed in menstruators and lead to poor mental health. Premenstrual Syndrome (PMS) is associated with symptoms such as anxiety, depression, mood swings, insomnia, and social withdrawal and can range from mild to debilitating. Many girls and women assume their PMS symptoms are normal when they are extremely severe, indicative of PMDD, and could benefit from medical intervention. Leaving menstruators under-educated on their bodies can lead to the development of PMDD when least expected and cause more school absences or dropouts in young girls (Mayo Clinic, 2022). 

Comprehensive education looks like education on the menstrual cycle itself, reproductive health conditions such as those discussed above, safe disposal methods, menstrual health management practices, and un-learning of false negative narratives surrounding menstruation. This education must also target gender disparities and empower young girls to feel confident in taking charge of and caring for their bodies. Menstruators and non-menstruators must be engaged in active group discussions, workshops, and role play from an early age to provide them with the tools and resources necessary (Choudhary et al., 2023; Garg et al., 2015; Gundi et al., 2020). Information sessions must include families, both male and female members, of the adolescent menstruators to ensure caregivers are capable of supporting menstruators’ reproductive health. It is especially important to engage non-menstruators, to promote healthy, open discussions about menstruation and ensure menstruators feel safe at home, specifically around their male family members, while menstruating (Choudhary et al., 2023; Garg et al., 2015; Gundi et al., 2020). This can be done through arranging events like “Uthan Baithak”, a focus group discussion often held in homes of rural areas of Bangladesh (Rahman et al., 2018). Focus group sessions are effective in creating open discourse and vulnerability and are especially important when discussing topics surrounded by stigma such as menstruation. 

Patriarchy and Gender Inequity 

Unequal rights between women and men lead to the persistence of period stigma and the neglect of menstruation care. In India and Bangladesh, men remain the major decision-makers for families and have control over funds (Kaur et al., 2018). Often, men do not prioritize the purchase of menstrual products for their menstruating family members due to a lack of education, awareness, or empathy. This encourages unsafe menstrual practices such as using pads and tampons for longer than intended or using dirty cloths to collect period blood (Kaur et al., 2018). As discussed above, this leads to the development of dangerous health conditions such as infections. 

Additionally, because drains and pipes exiting the household are often uncovered in India, Bangladesh, and Nepal, women may feel self-conscious about using those restrooms as they do not want male family members to see blood leaving the drains. To effectively reduce this, men must be included in discussions on menstruation both individually and with their female family members to foster a safe, healthy environment. This is further enforced in rural communities where there may not be plumbing at home (Kaur et al., 2018). Efforts to reduce period stigma should focus on the empowerment and mobilization of girls and women to advocate for their rights. A double standard and the persistence of gender roles are strongly prevalent in India, Bangladesh, and Nepal and greatly hinder a society’s ability to achieve menstrual equity (Manorama and Desai, 2020). 

III. Economic/Structural Factors

Period Products 

The use of menstrual products varies greatly by region throughout India and Bangladesh. In urban areas, pads and tampons are typically used. Rural areas are dominated by the use cloths that are washed and reused (Van Eijk et al., 2016). Though awareness of period product use is important, a meta-analysis found that economic factors were the main reason for the use of cloth over pads (Rahman et al., 2018; Van Eijk et al., 2016). This indicates education alone is not enough to reduce period stigma and eradicate period poverty. There is limited access to pads and tampons in rural communities, and even if they are available, products are expensive and unattainable for most (Rahman et al., 2018). Similar to lack of education, not having access to safe period products leads to physical and mental health conditions and barriers to achieving gender equality. Beyond increasing access and affordability of menstrual products, research has shown that promoting menstrual cycle management practices on various media platforms and increasing consumer trustworthiness of period products can encourage menstruators to engage in those practices (Rahman et al., 2018). Transparency is critical, and consumers must feel that these products are safe and good to use. To do this pad and tampon companies must enhance their marketing strategies and increase distribution channels to make products more affordable. They should discuss the benefits of using pads over sanitary cloths such as health and convenience factors. 

Sanitation Facilities and Safe Disposal  

Though the distribution of period products is critical for menstrual health management, an often overlooked factor is the presence of clean and accessible sanitation facilities such as restrooms (Schmitt et al., 2021). Having access to proper disposal areas is also important to encourage proper menstrual health management practices. Many restrooms in India, Bangladesh, and Nepal typically lack waste bins to dispose of used pads and tampons, leading to disposal of these products in toilets or left in corners of the bathroom (Hennegan, Shannon, et al., 2019; Kaur et al., 2018). The presence of a bin in restrooms is associated with increased confidence in managing one’s menstrual period (Hennegan, Sol, et al., 2020). If bathrooms are clean and disposal areas are provided, stigma and shame will also decrease as menstruators will feel they can bleed with dignity as they have a designated location to discard their menstrual products. 

It is reported that out of 113 million adolescent girls in India, 68 million attend schools (Van Eijk et al., 2016). Lack of access to appropriate sanitary resources and education prevents regular attendance. In a survey of Bangladeshi students, only 7% of girls reported they were ‘very confident’ managing their periods at school, compared to 57% of girls reporting the same level of confidence at home (Hennegan, Sol, et al., 2020). The study in Uttar Pradesh, India, collected menstruators’ attitudes toward using public restrooms to change their pads. Many explained how the bathrooms were dirty and they feared getting infections so they avoided using them for the entirety of school (McCammon et al., 2020). Similar findings in Bangladesh highlighted how poor sanitation facilities are a leading cause of school absence during menstruation (Rahman et al., 2018). These reasons provide the basis for the statistic that 40% of girls in a study conducted in Delhi, India were absent from school during their period (Thapa et al., 2021).

Period stigma in both India and Bangladesh is a multi-dimensional issue rooted in sociocultural, economic, and structural factors. Interventions must target multiple levels of the system in order to be successful in improving reducing menstrual stigma and ultimately promoting menstrual health (Thapa et al., 2021). Socioculturally, religious beliefs, a lack of comprehensive education, low open discourse, and gender inequality perpetuate period stigma, a vicious cycle feeding off of itself. In addition, structural factors such as a lack of access to safe period products and proper sanitation facilities worsen the issue, preventing menstruators from menstruating safely, healthily, and with dignity. 

Proposed Solutions

Addressing period stigma in India, Bangladesh, and Nepal requires an intersectional approach involving educational programs, community engagement/empowerment, policy changes, and promoting access to resources. Without the resources that promote menstrual health such as affordable and accessible period products or clean water and restrooms, no significant changes can be made to period stigma.

Additionally, community engagement and menstrual education programs are required before policy changes for those initiatives to be favorable to the public. Therefore, effective solutions would include a four-pronged approach targeting multiple levels, beginning with providing resources and educational seminars in two forms: one focusing on period care management logistics and the other working to deconstruct stigmas and misconceptions associated with menstruation. The fourth prong is policy change on a governmental level that mandates affordable or free-period products in public spaces as well as outlines comprehensive menstrual education standards (Office of the State Superintendent of Education, n.d.). 

I. Resource Management 

The first step in ending period stigma is providing resources for adequate menstrual cycle management. This requires access to clean water and safe sanitation facilities which is limited for many women and girls living in rural areas lacking resources (Torondel et al., 2022). Many places in India, Bangladesh, and Nepal, specifically rural areas, lack access to clean water and safe sanitation facilities. This presents yet another complex barrier to caring for one’s menstrual health. A strategy to improve water quality, access, and restroom facilities is a key part of promoting effective menstrual health management. Previous studies have found that those in areas with in-house restrooms and bathing areas with access to piped water reported they were better able to manage their menstrual cycles (Torondel et al., 2022). Therefore, more funding should be diverted to projects focusing on increasing access to clean water and in-house bathing areas. 

Additionally, menstruators require safe and hygienic period products to use while menstruating. Therefore, communities should provide free or very affordable period products, especially in school buildings (Office of the State Superintendent of Education, n.d.). The choice of what period products to include should be based on the specific needs of the community at hand. For instance, some communities may not use tampons because of cultural beliefs, so mainly sanitary pads should be provided. In certain rural areas, reusable cloths are preferred to using commercial period products such as pads (Van Eijk et al., 2016). Therefore, intervention organizers and researchers must meet with community members to understand their needs and best tailor the intervention for those individuals. Though reusable cloths are more widely used in rural communities to hold menstrual flow, a discussion should be had to understand the scope of why this is so. For instance, it may be because menstruators in those communities do not have another option. Therefore, this prong of the intervention could include bringing in menstruators from urban areas in the same country to share their experiences using commercial period products with rural menstruators. This can be conducted through a small-group or partner discussion to ease discomfort and increase open conversation. 

To be sustainable, resource distribution must be supported by local policies and mandates which will be discussed in the later section on government involvement. One way resources could be funded is by community non-profits organizing donation drives to provide free menstrual products in the form of ‘period pantries’. There are multiple global organizations such as the PERIOD. movement, Aunt Flow, and Helping Women Period which have local chapters within communities that work to end period stigma and achieve menstrual equity (PERIOD., n.d.). A part of the intervention could include setting up local chapters of an organization such as PERIOD. in the community which would organize drives and also advocate for period-forward policies. A limitation of resource implementation is that they are not effective if individuals are not educated on the importance and logistics of using them. Another limitation is that it may be difficult to garner the proper funds to continuously provide menstrual products to a community. 

II. Education

Menstrual Health Management 

Resource distribution should be made in conjunction with educational seminars given to community members about how to effectively manage menstruation such as how often to change period products, how to properly clean and dispose of period products, and the risks of not doing so. Seminars and workshops should be delivered to both rural and urban communities but must vary in delivery based on the audience. For instance, leaders of the seminars must acknowledge the cultural practices of a community such as the preference of pads to tampons in one community or the inability to access commercial period products in another. Educational events must be led by individuals who are familiar with the community or are a part of the community themselves. An example of this is having the organizer of the workshop, if they are an outsider to the community, meet with members of the community who are interested in collaborating to design the workshop. A board can be formed and individuals can be given various roles to ensure the best success of the seminars. Members of the community themselves should always be the final decision-makers for anything that is to be implemented as they will be the ones directly affected. Efforts can be unsuccessful because they are not aligned with community values or the wants and needs of said community. These seminars would be effective in mobilizing menstruators to better manage their menstrual cycles. However, these educational seminars alone cannot eradicate period stigma which is ingrained in religious and cultural beliefs. 

Cultural Taboos 

A second set of educational seminars should target cultural taboos rooted in religious beliefs that paint menstruation as something women should deal with in secrecy and with shame. These seminars should take care to be culturally sensitive and not disrespect any religion, rather explain that menstruators should be able to bleed with dignity and display how certain practices such as being forced to live in a “chhaupadi” during menstruation are harmful to one’s physical and mental health (Kaur et al., 2018). This should be done using science and facts rather than scorning a community for past behaviors as that is ineffective (Garg et al., 2015). Educating menstruators on menstrual cycle management has proven effective throughout educational workshops, demonstrations, and seminars, but it is more difficult to address socio-cultural taboos and the stigma faced by menstruators (Rastogi et al., 2019; Bowen-Viner et al., 2022). Once again, these seminars can be effective in reducing cultural taboos, but it may be difficult to end the shame around periods caused by religion. These seminars should be culturally sensitive, but even so, may come off as offensive to some. 

III. Non-Menstruators

Effective solutions must include the engagement of non-menstruators, including men and boys. India, Bangladesh, and Nepal are patriarchal societies where men have a profound impact on overall women’s health. Much of the reason women and girls hide their menstrual cycles with shame is because they do not want men to know they are menstruating (McCammon et al., 2020). Community engagement should include focus groups with men and boys where they are educated on the biology of the menstrual cycle as well as how to provide support to their female loved ones who are menstruating. This education must occur at a young age to prevent teasing and taboos associated with menstruation in grade school as it is more difficult to unlearn stigmas that have been ingrained in one’s mind as one grows older. With engagement and education, boys will have a more solid grasp on menstrual cycle physiology and can empathize with the experiences of menstruators (Gundi et al., 2020). Additionally, involving boys and men is important as in these countries, men often make financial decisions about what is purchased and are seen as the ‘head of the household’. Helping men have a positive outlook toward menstruation makes them more likely to purchase period products such as pads and tampons for menstruators in their homes. However, it may prove difficult to engage men and boys due to community pushback as it has been long believed that menstruation is a “women-only” issue. Additionally, many men might be hesitant to engage in discussions about period stigma due to feeling uncomfortable. 

IV. Legislation 

Another solution would be a federal or local governmental policy that mandates comprehensive menstrual health education beginning at a certain age. This has been partially implemented in the U.S. such as with the Washington, District of Columbia Menstrual Health Education Standards that took effect in the 2023-24 school year. The D.C. public school system became the first in the U.S. to require comprehensive menstrual education beginning in the fourth grade and continuing throughout high school. The educational standards are tailored for each level and discuss the menstrual cycle, how to access period products, and period stigma (Lumpkin, 2023). In conjunction with education, there should be a mandate to provide free menstrual products in public restrooms. Washington, D.C. has also done this by requiring that all public female and gender-neutral bathrooms provide and maintain free menstrual product dispensers (Office of the State Superintendent of Education, n.d.). Though effective in creating sustainable change, these policies might not be supported by most people. This may be due to religious beliefs or generational stigma that is difficult to dismantle. Therefore, it may be difficult to get certain laws surrounding menstruation to pass as people may not see them as important or necessary. To overcome this, it is important to engage elders in a community in educational workshops, specifically the ones dismantling religious taboos and stigma. Focus groups and small group discussions could be facilitated between younger menstruators and older individuals in the community to foster open discourse and create more empathy. 

It is important to remember that including an interplay of all the above solutions will be most effective. Access to proper resources such as affordable period products, clean water, and safe sanitation facilities are critical and can be made possible through policy changes focused on menstrual equity. Simultaneously, it is important to mobilize the community through a two-tier educational intervention targeting menstrual health management practices as well as stigma and socio-cultural attitudes towards menstruation. All educational seminars must engage men and boys in addition to menstruators using focus groups to have men play an active role in menstrual equity to support menstruating loved ones. This is especially critical in strongly patriarchal countries such as India, Bangladesh, and Nepal where women have little say over financial decisions such as whether or not period products should be purchased. A study on menstrual justice found that women’s health should be understood as a product of the intricate interaction of daily experiences shaped by gender, biological makeup, and specific medical situations (Manorama and Desai, 2020). Therefore, period stigma cannot be solved without addressing gender disparities and discrimination. Menstruators must be valued in the same way non-menstruators are and allowed to express their needs to better their health and overall lives. Therefore, empowering women and girls to use their voices and recognize their boundaries is an important aspect of properly combating period stigma. 

Conclusion 

Though period stigma persists throughout many regions, it is woven especially deep into many Eastern cultures most prevalent throughout India, Bangladesh, and Nepal. Period stigma can be understood as the taboos associated with menstruation that may come from religious, social, or cultural biases, or may be a product of the economic structure and resource management practices of a community. For instance, if a community is not educated about menstruation, it can lead to the development of stigmas or negative assumptions about the process. A lack of comprehensive education is seen throughout the world, but especially in these countries, where open discourse is also minimized. Much of this stigma arises from religious texts that have painted menstruation in a negative light. The Hindu Vedas, Muslim Quaran, and Christian Bible are a few notable religious texts that have associated menstruation with impurity and shame. Centuries of religious teachings lead to misinformed and dangerous societal standards that keep menstruation out of public discourse, isolating and instilling fear in menstruators. 

Additionally, society uses a woman’s fluctuations throughout her menstrual cycle to posit that women cannot hold positions of power or responsibility (Johnston-Robledo et al., 2020). This increases gender disparities by giving individuals more reasons as to why women should be viewed as ‘less’ and enforces already restrictive gender roles in India, Bangladesh, and Nepal. In addition, not having the proper resources or knowledge to manage one’s menstrual cycle can bring feelings of shame, confusion, or uncertainty. These feelings may lead a menstruator to hide their period and refrain from discussing their menstrual health with anyone. Because menstruation is a huge factor in female health, this silence around the topic can lead to dangerous health conditions such as endometriosis or severe premenstrual syndrome that may go undiagnosed in menstruators. 

Many previous studies have found that a multi-faceted approach works best to dismantle period stigma and cultural taboos surrounding menstruation. Much of this includes comprehensive menstrual education, the engagement of non-menstruators in the topic, providing proper resources to manage one’s menstrual cycle, such as safe period products, clean restrooms, and period-forward policies. To be most effective, education must include both workshops to deconstruct period stigma and taboos as well as general menstrual health education. Resources provided in communities must be tailored to the specific needs of that population which can be assessed through surveys or questionnaires. Policies surrounding menstrual equity will be instrumental in funding and mandating the necessary resources such as free or affordable period products and safe disposal areas in restrooms. 

Empowerment of menstruators must be present in both education on menstrual health management practices and the deconstruction of cultural stigmas and taboos. Further, instilling a sense of confidence in menstruators, specifically young girls, should be at the forefront of these menstrual education initiatives. Without lifting how female individuals view themselves in their society, period stigma cannot be dismantled (Manorama and Desai, 2020). Governments will fail to provide the proper resources and education to menstruators if they do not view girls and women as equals in society to their male counterparts. 

There are many complex sources of period stigma and multiple consequences of the issue. In using the four-pronged approach of providing resources, informing on menstrual hygiene practices, education targeting taboos and gender discrimination, and policy changes, India, Bangladesh, and Nepal can achieve menstrual equity and end period poverty. 

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