On top of the standard awkwardness that accompanies sex ed, teaching students about menstruation in particular can carry additional cultural and social tension. Teachers in many parts of the world skim over or completely avoid the topic of periods, especially when they’re teaching boys, says Tamar Springer, a certified sexuality educator in Los Angeles who has worked with adolescents for many years. And research shows that lack of education on the subject can create not only social challenges, but also educational barriers and safety concerns, for many young women around the world.
Recognizing this stigma and the harm it can cause, UNICEF and several other nonprofits have begun developing programs that use videos and comic books to teach young people of all genders about menstruation.
In the US, students may learn about menstruation in their fifth grade or middle school health classes, but the curriculum is usually purely focused on biology, says Springer. “There’s avoidance of talking openly about sexual matters, and [menstruation] falls in there, with a special twist because it involves blood and tampons,” she says.
Similarly in the UK, a recent study of 1,000 girls between the ages of 14 and 21 found that less than a quarter said they would feel comfortable talking about their period with boys and nearly half reported feeling embarrassed by their periods.
In other parts of the world, the view of periods as unclean and unmentionable, sometimes combined with a lack of access to menstrual products or clean facilities, can even deter some students from attending school and increase educational inequality between boys and girls. Thirty percent of female students in Afghanistan and 21.3 percent in Sierra Leone stay home when they have their periods, according to a UNICEF study. Another UNICEF study, conducted in Indonesia, found that almost one in seven girls had missed school during their last period, with some citing teasing from boys as a deterrent. (In another survey conducted in Indonesia, 22 percent of men said they’d mocked a woman because of her period.)
“There’s very deep cultural and social beliefs from [some] parts of the world that blood coming from a woman is polluting or powerful or scary or has to be controlled,” says Marni Sommer, associate professor of sociomedical sciences at Columbia University. “I think in countries where there’s an even stronger stigma—where people worry you are dirty or unclean or committed [a breach of] some sort of social rule—they can really disrupt your life. Along with that, it can affect your sense of confidence and how you feel about your body.”
To fight this issue in Indonesia, UNICEF partnered with local organizations to create a video on menstruation targeting boys, as well as a double-sided comic book. One side of the book is for those who experience periods, and the other is to explain what’s happening to those who experience periods and to discourage teasing.
UNICEF gave the comic books to 4,000 children in two communities, and surveyed 245 girls and 129 boys before and after reading them. The proportion of students who considered menstruation normal went up from 81 percent to 97 percent for girls and 61 percent to 89 percent for boys. In addition, the proportion of boys who were against period-related bullying went from 61 percent to 95 percent. Aidan Cronin, Chief of the UNICEF Indonesia’s Water, Sanitation, and Hygiene (WASH) program, says that the comic books now reach more than 30,000 adolescents by being integrated into school curricula.
“This was an opportunity to engage boys in discussion and let girls have a more positive experience,” says Brooke Yamakoshi, a WASH Specialist at UNICEF. Not only is the curriculum intended to reduce stigma, she explains, but actually encourage young men to advocate for the rights of their classmates who experience menstruation.
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In addition to common stigma around periods, Indonesians also face the damaging misconception that their religion looks down on periods, says Cronin. To dispel this myth, UNICEF partnered with the Indonesian Council of Islamic Scholars to write a guidance book on menstruation according to Islamic principles.
Yamakoshi adds that Ethiopia has seen similar success with period education reform, particularly with schools that started co-ed clubs to discuss issues that affect girls, including menstruation. “Their attitudes changed in quite significant ways,” says Yamakoshi. “They saw their role being allies and supporting their sisters and classmates, advocating for their sisters to go to school, and [correcting] incorrect beliefs about menstruation.”
Sommer, the Columbia professor, is working on educational materials for extreme situations: a Menstrual Hygiene Management in Emergencies Toolkit to be distributed in countries affected by conflicts or disasters. It includes guidance for men, teaching them that when picking up supplies during crises or emergencies, they should not forget menstrual hygiene products for family members who experience menstruation.
She also organized the Annual Virtual Conference on Menstrual Hygiene Management (MHM) in Schools, which took place at Columbia University in October. At the conference, people and organizations around the world gave presentations on menstruation educational efforts for people of all genders.
Despite these recent accomplishments, in the US—and around the world—there’s still a lot of work to be done to make menstruation education less gendered, so that trans and nonbinary people are also included, says To Nhu Dao, a behavioral health clinician at San Francisco Department of Public Health. Dao, who is trans, says that many of the trans men he works with want menstruation to stop, but often do not have access to preventative health care, or education on how to achieve that.
“Like many systems of care, reproductive health and fertility services are very gendered,” says Dao. “Women's health culture deters and sometimes intentionally excludes trans men and masculine spectrum people with ovaries from accessing services. … The only option I have is to go to a women’s clinic. That means I’m a man with a beard in a woman’s clinic, and that whole situation is very anxiety provoking.”
Dao discusses options for stopping menstruation with his trans male clients, such as birth control or going on testosterone. He also offers emotional support and anxiety management skills, as menstruation can trigger gender dysphoria. With little to no research on how menstruation affects transgender men, he’s also currently working on a study regarding transmasculine people’s experiences with “women’s healthcare.”
Overall, Tamar Springer says we need to keep up the conversation. “I think it would be nice if people were more comfortable talking about this aspect of the body, and it’s always good when people are invited to ask questions,” she says. “It leads to more comfort with oneself and promotes open conversation and opportunities for education.”