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Menstruation is a natural and unavoidable part of the lives of women and girls. Accommodating the menstrual needs is a key issue for the human rights to safe drinking water and sanitation. A woman’s access to toilets is not assured if she is forced to avoid going to the toilet particularly during her period. A girl who drops out of school at the start of puberty because of a lack of adequate access to water and sanitary products to manage her menstrual cycle does not fully enjoy her human rights.

On International Women’s Day in March 2019, the Special Rapporteur on the human rights to safe drinking water and sanitation, together with a group of Special Rapporteurs, called on the international community to break the taboo around menstrual health, and to take concrete action to ensure that discriminatory mindsets are changed, and to protect women’s and girls’ menstrual health.

On Menstruation Hygiene Day on 28 May 2019, the Special Rapporteur again drew attention to this fundamental part of the human rights to safe drinking water and sanitation.

Supporting reports

In 2016, the Special Rapporteur presented a report on gender equality and the human rights to water and sanitation to the Human Rights Council (A/HRC/33/49), in which he underscored the importance of placing a strong focus on the water and sanitation needs of women and girls at all times, especially when it comes to human rights. The Special Rapporteur outlined recommendations to challenge social norms, stereotypes and intra-household patterns, to address women’s material needs by improving access to affordable menstrual products, and to formulate gender-responsive interventions that prioritize the implementation of women’s specific needs.

The statement to the 33rd session of the Human Rights Council is available here. Practices and beliefs are different in every culture, but in many places, a dominant view exists that sees menstruation as something unclean, shameful and impure. Contact between men and women during menstruation can be banned, and people who are menstruating can be barred from certain locations. Girls all over the world grow up with an understanding that they should keep their menstruation secret, and be embarrassed by this natural process. Teachers in Bolivia have noted that simply introducing the topic of menstruation embarrassed girls and increased teasing from boys (Report on gender equality, A/HRC/33/49, para. 23).

As a result, the lack of access to toilets and water during menstruation is a hugely detrimental experience to women’s lives and to their ability to fully enjoy their rights. In a world where the human rights to water and sanitation are enjoyed by all, a woman would be able to menstruate in safety and dignity: with access to toilets, hygienic products and a safe and continuous supply of water.

In order for all women and girls to enjoy their rights, we must focus on safeguarding the normative content of the human rights to water and sanitation: Availability, Accessibility, Affordability, Safety and Privacy and Dignity.

Facilities meeting hygiene requirements must be available wherever there are toilets or latrines, where water is stored and where food is prepared and served. These are required particularly for hand-washing, menstrual hygiene, the management of children ’s faeces and the preparation and consumption of food and drink.

Menstruation is a natural part of a girl’s life. Yet for many around the world, experiencing their first menstruation can signal the start of a reduction in the choices they are able to make for themselves. In many cultures, girls are considered adults after their first menstruation and may drop out of school, marry and start having children.

Many girls are unable to manage their menstruation alongside their studies and are forced to drop out of school entirely because toilets in schools are not equipped with menstrual hygiene facilities or not properly maintained.

Workplaces without adequate sanitation facilities expose women to the same problem, exacerbating economic and social inequalities.

Hygiene facilities must be physically accessible for everyone within or in the immediate vicinity of each household, health or educational institution, public institutions and places, and the workplace. Ideally, they should be located inside or adjacent to toilets. Hygiene facilities need to be accessible on a reliable and continuous basis, to satisfy all needs throughout the day. Access to hygiene facilities should be secure and convenient for all users, including children, elderly persons, persons with disabilities, women, including pregnant women, and chronically ill people who may have particular hygiene requirements.

The importance of menstrual hygiene as a part of the human rights to water and sanitation highlights many cross-cutting issues. When women and girls lack adequate access to water and sanitation and at the same time might suffer from poverty, live with a disability, suffer from incontinence, live in remote areas, lack security of tenure, are imprisoned or are homeless. In these cases, they will be more likely to lack access to adequate facilities, to face exclusion or to experience vulnerability and additional health risks. Social factors such as caste, age, marital status, profession, sexual orientation and gender identity can further aggravate and multiply the barriers faced by people who menstruate in fulfilling their human rights to water and sanitation.

Use of hygiene facilities and services must be available at a price that is affordable to all people. The main costs, other than for installation, are associated with supplying water, soap and cleaning products for hand-washing, food hygiene, personal hygiene and washing clothes, and for sanitary napkins or other products required for menstrual hygiene. Assistance should be provided to households or individuals who are unable to afford soap and cleaning products, or sanitary products for women and girls.

As discovered during the previous Special Rapporteur’s visit to Kiribati in July 2012, it is common for adolescent girls to miss three days of school per month because sanitary pads are unaffordable for many families. On top of this, sanitary products are expensive and often not available for free in poor and rural communities. In Kiribati, it was increasingly common for women and girls to use disposable baby nappies during menstruation because they last longer and are cheaper (Report on the 2012 visit to Kiribati, A/HRC/24/44/Add.1, para. 36). In water-scarce areas and slums in Kenya, girls were unable to wash their single pair of underwear during menstruation (Report on the July 2014 visit to Kenya, A/HRC/30/39/Add.2, para. 81).

Hygiene facilities, such as hand-washing stations or disposal units for sanitary products, must be safe to use and easy to clean. Sanitation facilities must ensure access to safe water for hand washing, menstrual hygiene, and anal and genital cleansing. They must also include mechanisms for the hygienic disposal of menstrual products and nappies.

This stigma around menstruation has powerful effects on the human rights of women and girls. Data collected in Senegal shows that, owing to shame, menstrual material, once washed, is mainly dried in secluded, private and dark locations, such as tiled rooms or even under pillows, instead of in direct sunlight, which would reduce the risk of infection by ensuring that pathogens do not grow (Report on the 2011 visit to Senegal, A/HRC/33/49, para. 23).

Hygiene facilities must be private, and not shared with men. Stigmatization of menstruation should not stop women from being able to obtain sanitary products, or attend school or work.

Sanitation facilities that are private and appropriate for menstrual hygiene needs are a key factor in ensuring dignity of women and girls.

On top of the stigma and practical issues, many women find themselves increasingly vulnerable to violence and harassment during their menstrual cycles. Many women and girls in Kibera, Kenya expressed to the Special Rapporteur their fears of being victims of violence, including sexual violence, when using public restrooms at night (Report on the 2014 visit to Kenya, A/HRC/30/39/Add.2, para. 81).