Where’s the Bloody Queen? Women and girls’ barriers to schools and work – a policy brief on menstrual health

Prabha Gimire, 36, a teacher, addressing her class in Malhanma, Lahan, Nepal, April 2021.
Image: WaterAid/ Sailendra Kharel

About 500 million women and girls* face challenges in managing their periods. This policy brief provides an overview of the links between menstrual health and the barriers women and girls face to participate in school and work, as fundamental dimensions of women’s economic empowerment, and highlights society’s shared responsibility.

Clean water, decent sanitation and good hygiene are crucial for women and girls to take care of their menstruation safely, hygienically and with dignity. However, many women and girls struggle to manage their periods because their workplaces and schools are not adapted to their needs. 

  • Globally, 546 million children attend a school that doesn't have a basic water service. 
  • In Bangladesh, 30% of schoolgirls say they miss an average of 2.5 days of school a month when menstruating.
  • In Uganda, 19% of women usually miss work during their period. 

Women who cannot attend work during menstruation, or who are less productive due to menstrual-related challenges and discriminatory working conditions, lose wages and are often viewed as unreliable workers. This not only diminishes their options for advancement but also results in lower productivity and has a negative impact on a country's GDP.  Without adequate water, sanitation and hygiene (WASH) facilities to help manage their periods, women and girls are also at risk of various health problems, including urinary and reproductive tract infections, and poorer mental health and wellbeing. 

Women and girls need somewhere private, clean and secure to change their sanitary cloths or pads at school and at work; somewhere with clean water and soap, and a place to dispose of used materials safely. These essentials mean they can attend school for longer, and participate in the workforce more effectively. 

And this not only benefits women and girls; it has positive impacts for wider societies and economies. Higher levels of education increase women’s chances of formal employment, as well as pay parity. And as well as being a human rights and social justice issue, the economic empowerment of women helps to reduce poverty, improve women's independence and gender equality, and strengthens economic growth and development. It is therefore in the interests of all societies to invest in menstrual health and ensure women and girls can remain in school and paid employment.

This policy brief is intended for development partners, donors, governments, and anyone interested in understanding the links between menstrual health and women and girls’ barriers to participation in school and at work, as fundamental dimensions of women’s economic empowerment.

The key recommendations of this policy brief are:

  • Governments must ensure that schools, workplaces and public institutions support women and girls who menstruate so they can participate fully in education, and economic and social activities without discrimination. 
  • Governments, donors and business must invest in gender-responsive WASH and menstrual health to increase women’s economic empowerment, countries’ economic growth, and to create more gender-equal societies. 
  • Governments must increase the amount of national data collected that incorporates indicators from the JMP for Menstrual Health, as well as the shortlist of priority indicators for adolescent girls’ menstrual health, to build evidence and demonstrate progress. 
  • Menstrual health should be approached as a multi-sectoral development challenge by expanding the intervention mandate and collaborating with experts from different fields, such as WASH, SRHR, education, and gender equality.

Find out more about WaterAid Sweden's Where’s the Bloody Queen? campaign

*A note on terminology: Not all women and girls menstruate, and not all people who menstruate are women. The term "women and girls" is used as a shorthand term to increase readability, but refers to all people who menstruate, including girls, women, transgender, and non-binary persons.

Top image: Prabha Gimire, 36, a teacher, addressing her class in Malhanma, Lahan, Nepal, April 2021.