BOOK REVIEW Dissident Blood: Using Critical Feminist Study to Advance the Health and Human Rights of Menstruators
Volume 23/1, June 2021, pp. 293-296
Caitlin R. Williams, Ashley Huff, and Benjamin Mason Meier
The Palgrave Handbook of Critical Menstruation Studies, edited by Chris Bobel, Inga Winkler, Breanne Fahs, Katie Ann Hasson, Elizabeth Arveda Kissling, and Tomi-Ann Roberts (Palgrave Macmillan, 2020)
Half of humanity has personal experience with menstruation, spending approximately half of their lives managing their menstruation, yet it is only recently that “menstrual health” has received more than passing attention in health policy.[1] The emerging field of critical menstrual studies seeks to change that, drawing on lived experience and critical scholarship to frame menstrual health as a human rights concern over the life course. The Palgrave Handbook of Critical Menstruation Studies looks to codify the field, exploring the meaning of menstruation to menstruators and examining menstrual health within diverse social and cultural contexts. The resulting Handbook is a tour de force, presenting work from 134 contributors across 72 chapters. As the global health community shifts its understanding of menstrual health from a sanitation issue to a human rights concern, Chris Bobel et al. provide a comprehensive interdisciplinary analysis to further rights-based approaches to menstrual health policy.
Historically, global health’s engagement with menstruation has been limited to menstrual hygiene management (MHM), which seeks to ensure that menstruators have access to safe and hygienic washroom facilities, menstrual products, and means to dispose of used products. MHM efforts have been framed around narrowing gender inequities in education by preventing menstruation-related school dropout. Such programs emerged in part from “decades of evidence indicating that educated girls contribute to healthier population outcomes.”[2] Thus, despite the inherently gendered nature of menstrual health, MHM has largely been conceptualized as a water, sanitation, and hygiene (WASH) concern underlying education, rather than a matter of sexual and reproductive health and rights.
While this conceptualization of MHM under the WASH sector was intended to depoliticize menstrual health—providing a path for progress in improving girls’ and adolescents’ access to menstrual products and safe and sanitary washroom facilities—this strategy has served instead to marginalize it. The vast majority of sanitation programs ignore menstrual hygiene, focusing instead on hand washing and latrine design, with neither the United Nations’ nor the World Health Organization’s WASH programs promoting menstrual health as a part of their sanitation agendas. Given this neglect of the specific needs of menstruators, the Handbook skillfully demonstrates how MHM’s narrow focus ignores critical dimensions of menstrual health.[3]
The Handbook defines a new field of critical menstruation studies by examining (1) what new lines of inquiry, including research questions and social justice engagements, are possible when menstrual health and politics are considered across the lifespan and (2) what knowledge is gained when menstruation emerges as a dynamic category of analysis. By identifying menstruation as an analytic category upon which systems of power and knowledge are built, the field of critical menstruation studies seeks to uncover the consequences of such social constructions and the ways in which they shape understanding of menstruation and menstrual health. Building from previous scholarship, the Handbook represents a new landscape for menstrual knowledge that both reflects the current diversity of the field and invites further development.
The Handbook is organized into six thematic sections: menstruation as fundamental, menstruation as embodied, menstruation as rationale, menstruation as structural, menstruation as material, and menstruation as narrative. These overlapping themes function as distinct nodes of inquiry, where contributors explore menstruation (from menarche to menopause) and its meaning (both personal and societal). Each section concludes with a “transnational engagement” that is framed as either a dialogue between multiple authors or a collection of distinct responses to a shared set of questions. The Handbook thereby takes an inclusive approach to “studies” in the field, with contributions of empirical research, theoretic essays, first-person narratives, notes from the field, poetry, and visual art. This editorial decision further situates the Handbook within critical feminist studies, which has long emphasized the ways in which expertise coexists inside and outside of academic spaces. The juxtaposition of diverse contributions and contributors effectively articulates the tensions and liminalities between those who menstruate and those who conduct menstrual research (not necessarily mutually exclusive categories)—reflexively considering the sociopolitical environments they inhabit.
Bringing together these contributions, the Handbook foregrounds the central importance of dignity in advancing the menstrual health agenda, framing human rights as foundational to the field. Menstruation impacts a wide range of human rights, from the right to education to the right to participation in cultural life, and promoting the individual dignity of menstruators ensures that their right to exercise meaningful agency is protected under international law. Rather than focusing solely on researchers’ and professionals’ interpretations of menstruation, the Handbook encourages policy makers and program managers to center the experiences of menstruators themselves in crafting a rights-based approach to menstrual health. As seen in the focus on humanitarian settings in chapter 45, early United Nations responses to humanitarian crises conceived of menstrual health needs as encompassing only MHM products; however, sustained rights-based advocacy has pushed humanitarian health initiatives to think more expansively about menstruation, influencing international programs, policies, and guidance. Building from such efforts, the World Health Organization’s Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings now goes beyond product distribution to discuss the relationship between inadequate sanitation options for menstruators and gender-based violence, poor hygiene, and increased school absences. It emphasizes the educational and physiological impacts of poor menstrual health, highlighting the need for menstrual health to be understood as a multilayered human rights issue, not solely a sanitation concern. In re-envisioning menstruation as part of the sexual and reproductive health and rights agenda, various chapters of the Handbook recognize how governments and agencies could be better positioned to address the full range of menstruator’s needs.
Looking ahead in advancing the human rights of menstruators, broader and deeper scholarship on the significance of menstruation among marginalized communities is needed. The Handbook provides a glimmer of the richness of experience that lies just beyond the boundaries of mainstream menstrual studies, drawing on firsthand accounts of menstruation among marginalized populations—people who are homeless, incarcerated, transgender, living with disabilities, and from low castes. Yet, while these personal accounts capture a range of experiences, moving past mere documentation of stigma, such perspectives are missing from later sections on policy and advocacy. The policy and advocacy agendas highlighted in the Handbook largely reflect the priorities of mainstream second-wave feminism—achieving parity with an imagined (white, heterosexual, middle-class) male reference—rather than the more transgressive and disruptive futures envisioned by subaltern analyses. While policies that, for example, reduce the cost of menstrual hygiene products are an important step toward gender parity, they fail to institutionalize the more transformative changes for which newer generations of activists are advocating. This limitation in the Handbook raises an imperative in the field to mainstream intersectional analysis on sexual and reproductive health and rights in the development of menstrual health policy. With human rights demanding special attention to vulnerable populations, the dearth of scholarship on marginal experiences of menstruation contributes to the neglect of these groups’ rights in menstruation-related policy, programming, and practice.
Building from the successes of the Handbook and responding to calls for the decolonization of global health, future editions would be strengthened by including a broader range of contributions from researchers and advocates working in the Global South. While the editors acknowledge this limitation, it is an important one that obscures vibrant feminist advocacy throughout the world. For example, despite extensive critical feminist scholarship and praxis around menstruation in Latin America, the Handbook includes only a single chapter on the region, describing the evolution of the femcare industry in the Americas (inclusive of the United States). This is a crucial missed opportunity, as Latin American activists have often used rights-based framings to advance policy agendas—as seen in the promotion of laws addressing gender inequality and “period poverty” (the inability to afford menstrual hygiene products) by distributing free menstrual hygiene products in schools (for example, in the state of Michoacán, Mexico) and exempting these products from value-added tax (for example, in Colombia). Proposed legislation in Argentina seeks to extend this human rights framing, focusing on vulnerable populations (with bill 1409-D-2019 seeking to guarantee free menstrual products through schools, universities, health facilities, homeless shelters, mental health institutions, and prisons) and climate justice (with bill 5749-D-2020 seeking to guarantee sustainable menstrual products, including reusable pads, menstrual cups, and absorbent undergarments, and require that menstruation-related policy and programming be construed in accordance with environmental protection standards).[4] The inclusion of such perspectives would avoid any misconceptions that contestation over the meaning and impact of menstruation is “owned” by the West rather than an ongoing part of the human experience across both place and time.
Despite these limitations, The Palgrave Handbook of Critical Menstruation Studies provides a central academic foundation for future progress, exploring menstrual studies in a range of formats, creating spaces for transnational discussion, and consolidating scholarship dedicated to menstruation. As menstruation gains necessary attention in global health, this timely scholarship provides a springboard for launching a broader rights-based agenda to advance menstrual health.
Caitlin R. Williams, MSPH, is a PhD candidate in the Department of Maternal and Child Health at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
Ashley Huff is a public policy student at the University of North Carolina at Chapel Hill, USA.
Benjamin Mason Meier, JD, LLM, PhD, is a Professor of Global Health Policy at the University of North Carolina at Chapel Hill, USA.
References
[1] J. Hennegan, et al., “Menstrual health: A definition for policy, practice, and research,” Sexual and Reproductive Health Matters 29/1 (2021).
[2] M. Sommer, J. S. Hirsch, C. Nathanson, and R. G. Parker, “Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue,” American Journal of Public Health 105/7 (2015), p. 1302.
[3] I. Winkler, and V. Roaf, “Taking the bloody linen out of the closet: Menstrual hygiene as a priority for achieving gender equality,” Cardozo Journal of Law and Gender 21/1 (2015), p. 15.
[4] Cámara de Diputados de la Nación de Argentina, 1409-D-2019: Programa Nacional de Salud Menstrual (April 3, 2019). Available at https://www.hcdn.gob.ar/proyectos/textoCompleto.jsp?exp=1409-D-2019&tipo=LEY; Cámara de Diputados de la Nación de Argentina, 5749-D-2020: Ley Integral de Menstruación Sostenible (November 4, 2020). Available at https://www4.hcdn.gob.ar/dependencias/dsecretaria/Periodo2020/PDF2020/TP2020/5749-D-2020.pdf.