Talking about a taboo—survey reveals stigma around women's menstrual health practices in Bangladesh

Ludwig Maximilian University of Munich (LMU) economists have investigated social influences on the menstrual hygiene of workers in Bangladesh.

Silvia F. Castro and Clarissa Mang from the LMU-Department of Economics have conducted a study on how stigma in Bangladesh affect women's menstrual health practices. Their paper "Breaking the silence—Group discussions and the adoption of menstrual health technologies" is now being published in the Journal of Development Economics, at almost the same time as this year's Menstrual Hygiene Day.

Castro discusses their findings here.

What are women in Bangladesh up against during their period?

They're up against a massive stigma surrounding menstruation. While this is present worldwide, in many parts of the Asian subcontinent it restricts women's access to much desired menstrual products.

Surveys in low-income settings show that most women simply use a piece of repurposed cloth to manage their menstruation. This can work well if it's properly washed and dried. But as women try to conceal their menstruation due to the stigma, they're shying away from using their community's washing facilities or hanging the cloth to dry in the courtyard.

Instead, they may wash it in places that offer privacy but are unhygienic, like the floors of public latrines. At home, they might store the cloth when still damp, again trying to keep it secret. This can result in various health problems, especially in a humid country like Bangladesh.

Are sanitary products from the pharmacy too expensive or not well known enough?

Previously, it was believed that lack of knowledge or funds deterred women to transition to alternative menstrual products available in the market. But despite significant investment in education and access over the past decade, period-specific menstrual technologies are still not universally adopted.

My group therefore looked at the process of buying the disposable pads in which the women are—again—confronted with stigma. Pharmacies in Bangladesh are mostly situated in public, crowded places and, almost exclusively, run by male vendors. This discourages many women from purchasing pads, particularly in social contexts where it is deemed inappropriate for a woman to buy female sanitary products from a male seller.

The women hence face a trade-off: the benefits of accessing a different menstrual product versus the discomfort and potential social embarrassment in a shop or pharmacy.

How could this situation be helped?

Our hypothesis was that open discussions about menstruation could lift the taboo, alter women's perceptions of menstrual health and change their behavior. So far, the stigma on periods and the concealing of anything related prevents discussions even at home between mother and daughter. We therefore investigated how weakening this taboo by simply talking about periods would affect women's access to alternative menstrual products.

How was the study designed?

Our empirical investigation involved female workers in a large garment factory in Bangladesh. Women in the treatment group engaged in one-hour discussions with 15 to 20 female peers.

In this safe environment, they were encouraged to share personal experiences and they engaged in open and honest discussions about menstruation as part of their lives. For many of them, this was the first time they talked openly about such a crucial part of women's lives.

We then monitored the effects of the discussions on the willingness to buy or collect products and compared them to a control group that had not joined the discussions. To reflect real-life conditions, the collection of these products was arranged in a convenience store on the factory's grounds which is run by a man.

The study then used two metrics: how the women validated the familiar sanitary pads, but also how they adopted a formerly unknown, novel product: an antibacterial reusable underwear. To better understand the underlying mechanisms of the women's choices, we employed a "discrete choice experiment," varying product price, shopkeeper's gender and purchase privacy.

What were the results?

Our experiments showed that the women taking part in the discussions were willing to pay 25% more for menstrual pads, showing a substantial shift in their validation of these. Here, we distinguished between women who usually use repurposed cloth and those who use pads, who either buy these products themselves or send their husbands to the shop.

We found the strongest effects among women who relied on their husbands, thus saving them potential embarrassment in the shop. Also, the discussion group was 14% more likely to pick up the novel menstrual underwear which was provided for free—compared to 71% in the control group. The discrete choice experiment validated the main findings that women were considerably more deterred by stigma-related issues than monetary ones.

This underlined that stigma-related issues were strong factors preventing women from buying the sanitary products they wanted—and it seemed that talking about the topic gave women more confidence to do so.

Our study is the first to experimentally demonstrate that normalizing the topic of menstruation and sparking conversations around it empowers women to access better menstrual products. From an economist's view, menstruation has effects on half of the world's work force—on a monthly basis.