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By Jackson Okata
Nairobi, Kenya- According to the World Health Organization (WHO), menstruation or the menstrual cycle is a natural, monthly biological process occurring in women, girls, and certain gender-diverse individuals. This cycle is regulated by hormones and typically lasts between 21 and 35 days.
During the first half of this cycle, the uterine lining thickens. An egg is subsequently released from an ovary around the midpoint (a process called ovulation), and if no pregnancy occurs by the end of the cycle, this lining of blood and tissue is shed as menstrual blood.
The WHO provides guidelines for dignified menstruation and emphasize that menstruators must be educated and supported to manage their cycles with dignity across their lifetime: preceding their very first period (menarche), throughout their reproductive years, and up until the transition in later life when menstruation finishes (perimenopause).
According to Dr. Wanjiku Ndung’u, a consultant gynecologist based in Nairobi, lack of adequate education surrounding menstrual health often leads to the discrimination of individuals who menstruate. This exclusion heavily affects gender-diverse or non-binary menstruators, a group that includes intersex individuals, transgender men, and other queer community members born with a uterus and ovaries.
To guarantee equity, the WHO states that menstruators must have prompt access to accurate, age-appropriate information. They should also be provided with affordable, effective menstrual products, proper water, sanitation, hygiene (WASH) infrastructure, and reliable waste management services. Furthermore, the framework outlines their right to timely medical care for menstrual disorders, protection from discrimination, and the autonomy to freely participate in all aspects of life throughout their entire menstrual cycle.
“Most of our menstrual policies, the education system, and public messaging are designed with the assumption that menstruation is an affair only for women and girls, and this is where discrimination starts’’ she said.
Menstrual Health as a Fundamental Human Right
In July, 2024, during its 56th session, the United Nations Human Rights Council adopted a landmark resolution on menstrual hygiene management, human rights and gender equality, highlighting the essential role of MHM in advancing the human right to health and gender equality.
The resolution calls for universal access to affordable, safe, and clean menstrual management products and facilities, including in schools and vulnerable environments. It also calls for integrating MHM into relevant national policies and promoting access to appropriate information and education on MHM.
Ryan Muiruri, the programs director at the Intersex Persons Society of Kenya, observes that the design of menstrual programmes around a binary understanding of sex and gender leaves underserved people who menstruate at higher-than-average risk for poor menstrual health outcomes.
“In the Global South, the conversation on menstrual health has wrongly been centred around girls and women. We have deliberately left out key populations like the Intersex and the queer menstruators, which is an outright violation of their rights’’ said Muiruri.
Muiruri argues that “flawed health policies in East Africa have rendered intersex menstruators invisible”.
He argues that although dignified menstruation is not explicitly recognised as a standalone human right in international treaties, it is fundamental to the realisation of several human rights.
“Menstrual dignity is closely linked to the rights to dignity, equality, non-discrimination, health, education, information, bodily autonomy, and participation in public life. Menstrual discrimination can undermine physical and mental health, contribute to school and work absenteeism, limit social participation, and reinforce gender inequality,” Muiruri said.
International frameworks such as the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and the Convention on the Rights of the Child (CRC) support the principles of dignified menstruation, which include access to accurate menstrual health information, affordable and safe menstrual products, clean water and sanitation, and an environment free from stigma, shame, and discrimination.
Menstrual Discrimination Beyond the Binary
Dr. Ndung’u notes that the world cannot achieve Dignified Menstruation if some menstruators, like non-binary menstruators, are excluded simply because their bodies do not fit binary expectations.
“Our menstrual programmes both in schools and health facilities are designed in a way that automatically discriminates against intersex people. The education and health architecture and even our media messaging rarely recognize intersex menstruators,” said Dr. Ndung’u.
She says such discrimination, whether unintentional or not, can have real consequences on Intersex menstruators.
Dr. Ndung’u says that menstrual policies and services must adopt a human rights-based, inclusive approach.
“Policy formulators and implementers must realize that menstruation cannot be confined to cisgender women and girls only. We must be cognizant of the needs of other key populations like transgender men, non-binary, and intersex people,” she said.
The Global South Coalition for Dignified Menstruation (GSCDM) defines Menstrual Discrimination as an umbrella term that includes silence, stigma, taboos, exclusion, restrictions, violence, and deprivation of services and resources throughout the life course.
For non-binary menstruators, menstrual discrimination may come in different forms, including exclusion from menstrual education, denial of appropriate healthcare, inaccessible or inappropriate services, social stigma and invisibility in policies and programmes.
According to Dr. Radha Paudel, founder and CEO of GSCDM, menstrual discrimination affects all menstruators, not only women and girls.
GSCDM’s Dignified Menstruation framework is grounded in dignity, equality, bodily autonomy, participation, safety, and freedom from discrimination.
“Dignity cannot be selective. We cannot talk about dignified menstruation when one group of menstruators is excluded. We must treat inclusion as a core principle of dignity,” she said.
For a long time, society has applied selective standards of dignity by deciding whose bodies deserve recognition. Patriarchal power structures and deeply entrenched gender stereotypes have framed menstruation as something that only women and girls experience, erasing intersex, transgender and some non-binary menstruators from public conversations.
These assumptions are reflected in government policies, school curricula and healthcare systems, which are often designed around a narrow understanding that only women and girls menstruate. The result is that many menstrual health programmes overlook the needs of gender-diverse people, perpetuating exclusion even as they seek to promote dignity and equality.
A Lifecycle of Exclusion
Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), observes that menstrual discrimination in the Global South often begins during childhood, a factor she attributes to a lack of inclusive menstrual education.
“Menstrual discrimination begins at home when parents fail to guide their children by being economical with the right information. It gets worse and more complicated for intersex children’’ said Munyasia.
Munyasia adds that for many menstruators, the home environment fails to adequately prepare them for the kind of discrimination that the society and school environments advance towards them.
“We have menstruators who feel ashamed of speaking to their parents when they notice those body changes, and this is because the same parents have never talked to them about the subject of menstruation’’ she said.
The menstruation advocate says societal stigma, fear of disclosure, discriminatory policies, and non-inclusive home and school environments are some of the biggest impediments to achieving dignified menstruation for all.
According to Munyasia, menstrual discrimination in East Africa and the Global South at large is a systemic problem deep-rooted in the health system, education system, and workplaces.
East Africa’s Case
Kenya has made significant progress in promoting menstrual health and hygiene through national policies and free sanitary pad programmes. However, the country’s menstrual health policy and related guidelines largely define menstruation as an issue affecting only women and girls. This framing excludes intersex people who menstruate, potentially limiting their access to healthcare, education, menstrual products, and dignity.
Growing up, Amani Cherop received her first lesson in menstrual health in High school, but she still had trouble fitting in because her teachers taught it only to girls.
“There was little room to ask questions about an experience that did not fit into society’s definition of sex or gender’’ said Cherop.
Cherop says Kenya’s menstrual management policy has never fully reflected reality.
She argues that Kenya’s menstrual policy formulation seemingly considered intersex people as an “invisible group”
Toni King’ori, Executive Director of Jinsiangu, a Kenyan organisation championing the rights of Intersex, Transgender, and Gender Non-Conforming (ITGNC) individuals, argues that Kenya’s menstrual health framework overlooks a section of the population whose needs remain largely absent from policy discussions.
“The omission is not merely semantic because it ultimately affects the planning of health systems, schools and public programmes which often fail to plan for the needs of key populations of menstruators,’’ said Kingor’i.
Kingor’i says the diversity of intersex experiences is precisely why menstrual health policies should avoid assumptions about who menstruates.
“We must define menstruation as a human rights issue, not just a health issue, or simply a women’s issue,” he said.
On Kenya’s education curriculum, Kingo’ri describes it as largely binary, saying menstrual lessons are often designed around girls, while excluding other menstruators like intersex learners from critical discussions.
“When policies only mention women and girls, they inadvertently leave out people who also need information, products and healthcare,” Kingo’ri said
For Cherop, accessing menstrual health services in government-managed health facilities remains a challenge, as they lack a clear policy on the consultation and treatment of intersex people.
“There are no standardised guidelines on advancing SRH services to Intersex people, and this discourages them from seeking healthcare altogether, increasing the risk of delayed diagnosis, untreated reproductive health conditions and poor mental health outcomes,’’ Cherop said.
Lessons from Uganda
Across the border in Uganda, intersex advocates report many of the same challenges faced by their colleagues in Kenya.
According to the Support Initiative for People with Congenital Disorders (SIPD), although awareness of intersex rights has grown in Uganda, menstrual health programmes still tend to focus exclusively on women and girls.
Kaggwa Julius, SIPD technical advisor, says that menstrual health policies across East Africa may need to evolve to recognise biological diversity better and ensure that no one is excluded from essential health services.
“Our health and education systems have been designed solely around binary gender identities. Inclusive menstrual health programmes, language, products, and facilities ensure that everyone who menstruates fully enjoys their human rights without discrimination,” said Kaggwa.
According to Kaggwa, changing policy language alone will not solve the problem.
“We need to go beyond just developing an all-inclusive policy and focus on implementing such policies. We must ensure that our healthcare workers receive specialised training on how to handle different kinds of menstruators,” said Kaggwa.
He further recommends that teachers and school environments be well-equipped to effectively serve all menstruators, including creating safe spaces for intersex menstruators who might feel discriminated against.
“Governments should involve intersex communities in policy design from the outset rather than treating them as an afterthought,” Kaggwa advises.
Kaggwa says dignified menstruation will not only be achieved when most menstruators are included but when every menstruator can manage menstruation with dignity, safety, equality, bodily autonomy, and freedom from discrimination.
“The issue is not whether existing menstrual policies meet the needs of intersex people; it is whether those frameworks guarantee dignity to everyone who menstruates,” Kaggwa said.
The production of this story was supported by the Global South Coalition for Dignified Menstruation.
