July 24, 2020

Reframing Menstrual Hygiene Management for People with Disabilities

By Tian Wells

Menstrual Hygiene Management (MHM) is the use of a clean material to absorb menstrual blood which can be changed privately, including pads, tampons, and menstrual cups, while also cleaning the body as needed with soap and water. MHM is a universal necessity for all those who menstruate (1). However, access to MHM is often dependent on the individual’s level of cognitive and physical ability, a factor that has received little attention in research fields. A possible explanation for this is that MHM is viewed and treated largely as a social issue (2). Historically, a major barrier to prioritizing MHM on a global scale has been the taboo surrounding the topic, in both low- and high-income countries (2). Particularly in low-income countries, access to MHM is overlooked while the focus is turned to sexual and reproductive health issues such as HIV and sexually transmitted disease prevention (1). Though attention to reproductive health issues is understandable, it begs the question of why MHM is not addressed as uniformly under the public health umbrella. For instance, why have water, sanitation, and hygiene (WASH) practitioners yet to integrate people’s menstruation needs into their efforts for better hygiene infrastructure in schools? Researchers point to the existing divide between MHM and general public hygiene. Instead of bridging this divide, the issue of MHM has largely been delegated to the individual’s families to address privately (2). Reframing MHM access as both a public health and social issue may be the answer, and can help push the topic of menstruation into global and small-scale health agendas. 

In the past decade, significant progress has been made in laying the groundwork for MHM solutions. United Nations agencies, grassroots organizations, feminine hygiene companies, and social advocacy organizations have all converged to address the shortfalls of MHM resources worldwide (2). However, there is still a lack of MHM access in marginalized communities. 

People with disabilities make up one group often overlooked by MHM policymakers and the public health market (3). In 2010, 5.2% of children and adolescents (age 5-17) in the US, or 2.8 million, had disabilities (4). Out of these 2.8 million, 1.2 million were teenagers with varying cognitive abilities (consisting of 80% with a mild disability, 12% with a moderate disability, and 8% with a severe disability) (4). Both cognitive and physical disabilities can have implications for an individual’s MHM access, depending on the severity of the disability. This is because those with an intellectual disability that causes them to struggle with conceptual, social, and practical understanding and skills can struggle with managing their menstruation (3). Similarly, those with physical disabilities that limit their mobility can struggle significantly with MHM (5). Many with disabilities turn to medications or surgeries to suppress their menstruation, an option that is attractive to those that rely on others for hygiene assistance, but this can come with medical, social, legal, and ethical ramifications (4, 6). Currently, there are no treatments that can completely suppress menstruation in the long term without detrimental physical effects, such as reduced bone marrow density (7). The decision to suppress an adolescent’s menstruation is often made as a last resort, often without substantial medical guidance. A study on adolescent girls (12-18) in Melbourne found a significant lack of menstrual information in healthcare for families with children with disabilities related to cerebral palsy (5). A lack of information makes it difficult for families to make beneficial decisions regarding their children’s MHM, particularly when deciding whether or not to medically suppress their teenager’s period. 

Currently, the majority of menstrual products on the market are not designed with those with disabilities in mind. Products such as tampons, menstrual cups, and pads all require a level of upper body strength and dexterity to use. The market’s lack of consideration for marginalized groups and the evolving needs of those who menstruate can further stigmatize menstruation for disabled. However, there have been some strides in recent years to open MHM access to those with disabilities. Companies like Keela Cup and Flex have engineered a modified menstrual cup that makes insertion and removal easier for those with physical disabilities that affect their grip and reach (8). TINA, a startup, is testing a handheld assistive device that attaches to a tampon, streamlining the tampon insertion process to a linear movement that requires little grip strength (9). Efforts like these are small scale, but signs of a shift towards market inclusivity.

Though feminine hygiene companies have made some headway, making MHM more accessible to those with disabilities will require expanding on the limited research in the field and spreading awareness throughout healthcare. There is no cure-all solution to increase MHM access for all, but future innovations can create more options for people with disabilities and will be a step in the right direction.

 

References:

  1. Sommer, M., & Sahin, M. (2013). Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls. American journal of public health, 103(9), 1556–1559. https://doi.org/10.2105/AJPH.2013.301374
  2. Sommer, M., Hirsch, J. S., Nathanson, C., & Parker, R. G. (2015). Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue. American journal of public health, 105(7), 1302–1311. https://doi.org/10.2105/AJPH.2014.302525
  3. Slater, J., Ágústsdóttir, E., & Haraldsdóttir, F. (2018). Becoming intelligible woman: Gender, disability and resistance at the border zone of youth. Feminism & psychology, 28(3), 409–426. https://doi.org/10.1177/0959353518769947
  4. Elisabeth H. Quint, Rebecca F. O’Brien, The Committee on Adolescence, The North American Society for Pediatric and Adolescent Gynecology Pediatrics Jun 2026, e20160295; doi: 10.1542/ped.2016-0295
  5. Zacharin, M., Savasi, I., & Grover, S. (2010). The impact of menstruation in adolescents with disabilities related to cerebral palsy. Archives of disease in childhood, 95(7), 526–530. https://doi.org/10.1136/adc.2009.174680
  6. Kirkham, Y., Allen, L., Kives, S., Caccia, N., Spitzer, R., & Ornstein, M. (2013, June 11). Trends in Menstrual Concerns and Suppression in Adolescents With Developmental Disabilities. Retrieved July 03, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S1054139X1300253X
  7. Albanese, A., & Hopper, N. W. (2007). Suppression of menstruation in adolescents with severe learning disabilities. Archives of disease in childhood, 92(7), 629–632. https://doi.org/10.1136/adc.2007.115709
  8. Eveleth, R. (2018, November 05). This User-Friendly Menstrual Cup Is What Happens When Design Is Inclusive. Retrieved July 03, 2020, from https://www.vice.com/en_us/article/vbk5ky/keela-flex-menstrual-cup-design-bias
  9. Tampons: TINA Healthcare. (n.d.). Retrieved July 03, 2020, from https://www.tinahealthcare.com/