Muted roars: Exploring the pain and stigma of a natural cycle

What would you do if your body's natural rhythm was deemed a shameful secret? What if seeking knowledge about your own health was discouraged and stigmatized? What if a fundamental aspect of your identity was treated like a taboo topic?

For millions of women and girls in Ghana, these questions are a harsh reality they face every month due to the pervasive stigma surrounding menstruation.

As Becky Bailey astutely observes, "Our perceptions shape our identity, influencing how we interact with others and our worldview."

Yet, in Ghana, misconceptions and stereotypes have perpetuated a culture of silence and shame around menstruation, forcing females to hide behind euphemisms like "Red carpet" and "Auntie Flo" in reference to menstruation.

This feature article seeks to shatter these stigmas by exploring the complex historical context, far-reaching implications, and innovative solutions aimed at empowering women to take control of their menstrual health.

Through personal stories, expert insights, and groundbreaking initiatives, we aim to spark a conversation that will help create a more inclusive and supportive environment for women and girls to thrive.

Historical background

The stigmatization of menstruating women has a long-standing history, dating back to ancient times. Various religions imposed stringent restrictions on women during their menstrual cycles, excluding them from religious activities. In Jewish cultures during the B.C. era, women were required to maintain physical distance from men for the duration of their menstrual bleeding. Women were deemed ritually impure, and any object they came into contact with was also considered tainted. A menstruating woman couldn't even hand an object to her husband without it requiring re-blessing/sanctification by a rabbi. Menstruation was regarded as a taboo, shrouded in shame and secrecy, particularly during the Middle Ages and Early Modern Period (15th – 19th centuries). Across Africa, menstrual management practices varied widely, with women often utilizing natural materials like leaves, bark, and animal skins as makeshift menstrual pads. Rituals and restrictions surrounding menstruation were also prevalent.

Price of stigmatization

The stigmatization surrounding periods is leading women and girls to conceal their menstrual struggles, potentially preventing them from discovering underlying disorders or gaining adequate knowledge about their unique menstrual cycle.  

A 2020 study by Shamsudeen Mohammed which examined the menstrual knowledge, socio-cultural  restrictions and barriers to Menstrual health among adolescent girls revealed that 53.6% of the girls had poor knowledge about menstruation and some boys who were questioned in the study described menstruation with terms such as ‘Red card’ and ‘Palm Oil’. 

The consequences of this knowledge gap are affecting mental health, relationships, and overall quality of life. Women and girls are suffering in silence, unable to seek medical attention or support due to fear of judgment or ridicule. The lack of open discussion and education about menstruation is perpetuating the stigma, making it challenging to recognize abnormalities and seek help.

Social impacts

As humans, we inherently desire a sense of belongingness and community. We even make certain decisions and compromises in order to get approval from others, live in harmony with them and create happy memories as well. It is therefore very sad that women who are in their periods in some cultures do not get to mingle with friends and family just because they are regarded ‘impure’. Studies from Nepal and India have revealed that menstruation-related stigmatization imposed several restrictions on girls’ daily routines, movements, and menstrual hygiene management practices .Some of these restrictions include ritual bathing, not making physical contact with a male member of the family, plant, tree, or fruit, not eating dairy products, eating alone, and other mobility limitations inside and outside the home for fear of making others unclean 

Experts such as Thérèse Mahon and Maria Fernandes from international NGO, WaterAid, note that these menstruation-related stigmatizations can cause adolescent girls and young women to exclude themselves from social activities 
Also, a research on rural urban variation in exclusion from social activities due to menstruation among adolescent young girls and young women in Ghana revealed that About 21.65% of the respondents indicated that they excluded themselves from activities during menstruation with slightly higher rates for rural AGYW (22.2%) compared to their urban counterparts (21.11%).

Educational impacts

Menstrual stigma has a profound impact on girls' education, causing them to miss school, feel ashamed, and fall behind their peers. In rural Ghana, a disturbing trend has emerged: girls are absenting themselves from school during their menstrual period to avoid ridicule and humiliation.

According to a study by the United Nations Children's Fund (UNICEF), "1 in 10 girls in Africa miss school during their menstrual cycle" (UNICEF, 2019). This stigma has severe consequences, including:

•    Missed opportunities for education
•    Compromised academic performance
•    Feelings of isolation and embarrassment
•    Lack of understanding and support

As noted by World Vision Ghana, "menstrual stigma is a significant obstacle to girls' education, and it's essential we address it to ensure girls can reach their full potential" (World Vision Ghana, 2020).

Economic impacts

Period poverty, characterized by the inability to afford proper menstrual hygiene products, significantly exacerbates the challenges faced by individuals who menstruate. Women with heavy flows, in particular, encounter additional obstacles in managing their menstrual health.

The economic burden of menstruation disproportionately affects vulnerable populations, including low-income households, marginalized communities, and individuals living in poverty. With limited financial resources, families may not prioritize purchasing pads or tampons, instead opting for cheaper alternatives like local menstrual cloths (Amonsi) which can be less effective and hygienic.

Negative perceptions and stigma surrounding menstruation further compound the issue, leading some families to view menstrual products as non-essential expenses. This perpetuates a cycle of poverty and neglect, where individuals are forced to compromise their health and dignity due to financial constraints.

The prevalence of period poverty highlights the need to address the economic challenges associated with menstruation, including:

•    High costs of menstrual products
•    Limited access to affordable options
•    Inadequate financial support for low-income households
•    Regressive taxation policies, such as period taxes, that disproportionately affect marginalized communities

Measures to address stigmatization and improve menstrual hygiene

Various measures, including education and donations, are being undertaken by Non-Governmental Organizations (NGOs) to address menstrual stigma and improve hygiene.

Globally, Menstrual Hygiene Day is celebrated every May 28th, initiated by the German non-profit WASH United in 2013. The 2024 theme was "Together for a #PeriodFriendlyWorld." 

NGOs like Touching the Lives of Girls Foundation International, with patron Lady Julia Osei Tutu, wife of Otumfuo Osei Tutu, the Asantehene, are working to educate and monitor proper menstrual hygiene practices among adolescent girls. During their outreach, common questions included: "Does sex reduce menstrual cramps?" and "Can I have sex during my menstruation?"

Other organizations, such as World Vision Ghana, have made significant impacts, distributing over 2000 pads to 790 girls in five communities. The Ministry of Education (MoE) and Ministry of Health (MoH) have also instituted the School Health Education Program (SHEP) to break the culture of silence on menstruation and support students' reproductive health.

Additionally, gynecologist education has highlighted the risks of sexual intercourse during menstruation, and activists have organized campaigns, such as the "Don't Tax My Period" parade, to draw attention to period poverty. These efforts have shed light on the issue and served as interventions to sensitize and support young girls in Ghana.

What more can be done?

Intensifying educational programs is crucial to address menstrual health and hygiene. This can be achieved by developing comprehensive menstrual health curricula for schools, incorporating interactive sessions and visual aids. Incorporating menstrual health into school curricula can help normalize menstruation and promote a culture of inclusivity. Age-appropriate lesson plans and materials can be developed, and teachers can be trained to effectively deliver menstrual health education. Student-led initiatives and peer-to-peer support can also be encouraged. 

Expanding outreach initiatives is also vital to reach a broader audience. Organizing community events, such as menstrual health fairs, can provide a platform for open discussions and resource sharing. Partnering with local organizations, like the Ghana Health Service, can amplify messaging and impact. Utilizing social media platforms, like Facebook, X and TikTok, can also help share engaging content and resources, reaching thousands of young people.

Providing accessible resources is essential to support menstrual health and hygiene. Encouraging the use of user-friendly websites and mobile apps, like the Period Tracker app, can offer personalized menstrual health advice, tracking, and reminders. Developing affordable, eco-friendly menstrual products can also help address period poverty. Establishing resource centers with free sanitary products and counseling services can provide a safe space for individuals to seek support.

Engaging influential individuals can help amplify messaging and promote menstrual health advocacy. Partnering with local leaders, celebrities, or thought leaders can help share menstrual health experiences and reduce stigma. For example, the "Don't Tax My Period" campaign in Ghana, led by the Women's Wing of the Socialist Movement of Ghana, has brought attention to period poverty and advocated for policy change.

In conclusion, the stigmatization of menstruation has far-reaching consequences for women and girls in Ghana, affecting their health, education, and economic empowerment. As Dr. John Bosompim, an Obstetrician-Gynecologist, aptly puts it, "Menstruation is a natural process, but the stigma surrounding it is a societal construct that needs to be dismantled."

However efforts put into addressing this social canker can help us work towards a future where menstruation is no longer a source of shame or limitation. As Lady Julia Osei Tutu, patron of Touching the Lives of Girls Foundation International, emphasizes, "Empowering girls and women to take control of their menstrual health is crucial for their overall well-being and development."

The initiatives and efforts highlighted in this article demonstrate the power of collective action and the importance of prioritizing menstrual health and hygiene. 

In the words of a young Ghanaian girl, "I want to be able to go to school without worrying about my period, I want to be able to play with my friends without feeling ashamed, I want to be able to be myself, without fear of judgment." Let us work towards making this vision a reality.

Article written by Joyce Kpeglo, Belinda Nketia, Jennifer Nartey and Amina Yakubu.