Taboo Subject in the Spotlight at Annual Water and Health Conference

A stockpile of MHM supplies in a school in Lundazi, Zambia. Photo credit: USAID/WASHplus

I hurried into the meeting room, reassuring myself that most participants also had not made the 7 a.m. start time for the session. I was wrong. The room was almost full, and I had a challenging time even finding a seat. On the main screen, a representative of the Philippines Ministry of Health was enthusiastically presenting via videoconference. Throughout her presentation, questions popped up on another large screen submitted by participants listening online. This was not a typical conference session: I was attending the 6th Annual Virtual Conference on Menstrual Hygiene Management (MHM) in Schools held within the University of North Carolina’s Water and Health Conference. Throughout the morning and into the early afternoon, presentations from Kenya, Eritrea, Zambia, and other countries highlighted the challenges and successes of addressing MHM globally.  

One of the high points of the day was a presentation on the Menstrual Hygiene Management in Emergencies toolkit, which covered the nuts and bolts of research, design, and monitoring of MHM programs in emergencies. I found both the full and abbreviated versions of the toolkit to be thought-provoking, informative, and well-designed for practitioners interested in developing an MHM program. Reading through the documents, I could not help but reflect on how much traction has been gained for MHM since I began researching the topic in 2013. Now more than ever, governments, donors, and other development organizations are willing to address a topic that still remains taboo throughout much of the world.

For me, the most challenging aspect of MHM is dismantling the incredible stigma associated with menstruation. Many cultures have ingrained beliefs about the impurity of menstrual blood, which results in intense shame and discrimination for menstruating women. The onset of menses often determines whether, when, and how women can access sanitation facilities, even when they own them. Women who lack adequate access to water and sanitation face a triple burden of fetching water; finding a place with adequate privacy for defecating; and for bathing, changing, and washing during their menses. More needs to be done within the water, sanitation and hygiene sector. But we cannot do it alone. To address the underlying beliefs about menstrual blood that often lead to the related challenges, we need to work with the education, social protection, and reproductive health and family planning sectors so that menstruation, like defecation, is seen as a normal, biological process free of stigma and shame.

Read how USAID’s Safe-WASH II activity is working to transform the practice of chhaupadi—an ancient system of taboos surrounding menstruating women that was outlawed a decade ago in Nepal in this Global Waters story.


Nga Kim Nguyen is the senior WASH and social behavior change (SBC) advisor for USAID’s Bureau for Global Health and brings nearly 20 years of field experience in formative research, strategy design, and capacity building in SBC for WASH and other health behaviors. You can hear her discuss behavior change in a recent Global Waters Radio podcast and a webinar.


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Nga Kim Nguyen