By Emmanuel Chibasa
Lightness Jumapili, 14, quietly adjusts her school sweater around her waist before walking out of the classroom at Kwangwa "A" Primary School in Musoma Municipality, northern Tanzania. It is not because she feels sick. She is afraid that menstrual blood might have stained her uniform.
Rather than asking her teacher for help, she slips away silently.
"I was afraid my classmates would laugh at me. Sometimes the fear of being embarrassed is worse than menstruation itself," she says.
For millions of girls around the world, menstruation is not simply a biological process. It is a moment where fear, shame and silence intersect with unequal social norms, affecting confidence, participation and dignity.
For nearly two decades governments, development agencies and humanitarian organizations have invested billions of dollars in Water, Sanitation and Hygiene (WASH) programmes. Across Africa, Asia, Latin America and other regions, schools have received toilets, handwashing facilities, clean water systems, menstrual products and menstrual hygiene education.
These investments have improved Menstrual Hygiene Management (MHM), helping girls manage their Menstruation more safely. Yet one important question remains: Have these investments reduced menstrual discrimination?
The Global
South Coalition for Dignified Menstruation (GSCDM) argues that while menstrual
hygiene is essential, it addresses only part of the challenge. The deeper issue
is Menstrual Discrimination (MD), a global human rights concern that extends
beyond hygiene and product distribution.
According to GSCDM, menstrual discrimination is not an isolated social problem but a manifestation of deeper patriarchal systems and unequal power relations that shape how societies perceive and treat menstruation. Patriarchy reinforces the belief that menstruation is something impure, shameful or inferior, limiting menstruators' ability to participate equally in education, work, leadership and public life. These unequal power relations are expressed through restrictions, stigma, silence, exclusion, violence and unequal opportunities making menstrual discrimination not only a health or WASH issue but also a gender equality and human rights challenge.
Evidence
gathered by GSCDM from more than 12,000 participants worldwide suggests that
menstrual discrimination begins long before a girl's first Menstruation. Both
menstruators and non-menstruators often learn discriminatory beliefs between
the ages of six and nine through family conversations, community practices,
religious teachings, media messages and everyday observations.
These early lessons
reinforce patriarchal norms and unequal power relations. Girls learn that
menstruation should be hidden, while boys often grow up believing menstruation
is something shameful or inappropriate to discuss. Over time these beliefs
normalize unequal treatment, reinforce gender stereotypes and sustain menstrual
discrimination throughout life.
GSCDM's multi-country research found that 93 percent of menstruators reported experiencing at least one form of menstrual discrimination during their lifetime, showing that menstrual discrimination is not limited to one culture or region but is a global challenge.
For years, progress in menstrual health has mainly been measured through physical improvements: the number of toilets constructed, water points installed, menstrual products distributed and awareness campaigns conducted.
While these achievements are important, advocates of Dignified Menstruation (DM) argue that they do not show whether girls feel respected, included and free from discrimination.
A school may have clean toilets and running water, yet girls may still avoid attending classes because they fear ridicule if they stain their uniforms. Menstrual products may be available but silence and shame may still prevent girls from seeking support.
This investigation explores that gap using Tanzania as a case study. It examines whether WASH systems have moved beyond improving menstrual hygiene to addressing the deeper social structures that create menstrual discrimination.
Are WASH systems creating environments where menstruators can learn and participate with dignity, equality and freedom from discrimination?
The answer may redefine how the world understands menstrual health—not only as a sanitation issue, but as a matter of human rights, gender equality and social justice.
Tanzania's Progress and the Questions That Remain
In May 2025, Tanzania launched the National Menstrual Health and Hygiene (MHH) Guidelines, recognizing menstrual health as an important component of education, health, gender equality and human dignity.
The guidelines acknowledge that menstruation should no longer be treated only as a hygiene issue but as a cross-cutting development concern requiring coordination between health, education, water, gender and local government sectors.
They call for improved WASH services, accurate menstrual health information, community engagement and supportive learning environments for girls.
These commitments align with constitutional and international human rights obligations that recognize dignity, equality, education, health and access to water as fundamental rights.
However,
despite these policy commitments, the experiences of many girls show that
achieving Dignified Menstruation remains a challenge.
According to Tanzania's
National Menstrual Health and Hygiene Guidelines (2025), approximately 15
million girls and women in the country menstruate every month. Managing
menstruation safely requires more than menstrual products. It requires reliable
water, safe sanitation facilities, privacy, accurate information and freedom
from stigma.
Government data
show that 27 percent of schoolgirls miss classes for about three days every
month because of menstruation-related challenges, while 53 percent of women
aged 15 to 49 continue using cloth instead of safer menstrual materials due to
affordability or limited access.
These statistics are often viewed as menstrual hygiene challenges. However, from a Dignified Menstruation perspective, they also reveal deeper social barriers.
Why do girls continue fearing school attendance during menstruation despite national investment?, Why do some girls remain silent even where sanitation facilities exist?, Why does shame continue to influence girls' experiences?
These questions suggest that infrastructure alone cannot solve menstrual discrimination.
The Dignified Menstruation-Friendly WASH Indicators developed by GSCDM encourage governments and practitioners to measure not only infrastructure but also dignity, inclusion, participation, accessibility, privacy and freedom from discrimination.
The Fear Is Not Menstruation—It Is Being Seen
At Kwangwa "A" Primary School in Musoma Municipality Tanzania, menstrual discrimination does not always appear through formal rules. Instead it appears through fear, embarrassment and silence.
Lightness Jumapili says the biggest challenge begins when a girl starts menstruating while at school.
Instead of
concentrating on lessons, she begins worrying about whether her uniform is
stained, whether classmates will notice and whether she will become a source of
laughter.
"What hurts us most is not menstruation itself. It is the fear that someone will discover you are menstruating. When that happens, you stop concentrating in class because all you can think about is whether people are looking at you," she says.
She explains that even when teachers are supportive, many girls hesitate to seek help because they have been taught that menstruation should remain private.
"Sometimes you feel like you are carrying a secret that no one should know. Instead of asking for help, you just keep quiet because you are afraid people will think differently about you," she adds.
For Gladness Jackson, a 12-year-old pupil at the same school, menstruation affects how girls participate in school activities.
"When you are menstruating, sometimes you become afraid to move, to stand up or even to laugh because you keep wondering whether something has happened to your clothes," she says.
She believes girls need respect rather than sympathy.
"We need people to understand that menstruation is normal. We don't want sympathy; we want respect."
She adds that boys should also receive accurate information about menstruation because lack of understanding contributes to teasing and exclusion.
Their experiences reflect GSCDM findings that menstrual discrimination often operates through everyday social attitudes rather than official policies. Silence, ridicule and exclusion gradually affect girls' confidence and participation.
At the same school, Kulwa Gervas, the teacher responsible for guidance and counselling, says sanitation facilities have improved compared to previous years. However, she believes infrastructure alone has not removed the barriers girls face.
"We now have better toilets than before, but dignity cannot be built with bricks alone," she says.
According to Gervas, some girls still avoid class participation or request permission to go home because they fear humiliation.
"A girl
may have access to a toilet, but if she is still afraid of being laughed at,
then we cannot say she is learning in a safe environment. A
menstruation-friendly school must also be emotionally safe."
She believes schools need private spaces where girls experiencing menstrual challenges can rest with dignity and that teachers should create environments where girls can seek support without fear.
Outside schools, organizations working on menstrual health have reached similar conclusions.
Bakari Nyamsosa, Executive Director of Rising Hope Organization Tanzania, says his organization initially believed that distributing menstrual products would solve most absenteeism among girls.
"Providing sanitary pads is important. However we quickly realized that the biggest barrier was not always the absence of products. Many girls were living in environments where menstruation itself was treated as something shameful," he says.
The organization later expanded its programmes to include boys, teachers, parents and community leaders.
"You can distribute thousands of sanitary pads, but if society continues teaching girls that menstruation makes them inferior or unclean, discrimination will continue. Dignified Menstruation requires changing attitudes as much as improving facilities."
Beyond Infrastructure: A New Global Agenda
Global efforts to improve menstrual health have traditionally focused on Menstrual Hygiene Management through WASH infrastructure, menstrual products and education. These interventions have improved the lives of millions of girls and women.
However, GSCDM argues that these measures alone cannot remove deeper social and structural barriers.
Menstrual discrimination is expressed through stigma, shame, restrictive cultural beliefs, exclusion and unequal treatment throughout life.
Tanzania's 2025 National Menstrual Health and Hygiene Guidelines represent an important policy shift by recognizing that myths, stigma and harmful social norms remain barriers to menstrual health and gender equality.
However, translating policy into reality requires more than building toilets or distributing sanitary products.
Schools must become spaces where girls feel respected. Teachers must be prepared to challenge stigma. Boys must be included in menstrual education so they become allies rather than contributors to discrimination. Parents, religious leaders and communities must confront harmful beliefs.
Development partners and WASH practitioners must also rethink how success is measured.
The question should not only be how many toilets have been built or how many menstrual products have been distributed, but whether girls feel safe attending school, whether stigma has decreased and whether menstruators can participate equally.
The experiences of girls in Musoma reflect a global challenge. Menstrual discrimination exists in different forms across countries and income levels. It is not only an African issue or a poverty issue; it is a human rights challenge rooted in social norms and gender inequality.
The future of menstrual health therefore requires a shift from asking, "How do we improve menstrual hygiene?" to asking, "How do we eliminate menstrual discrimination?"
Ultimately, menstruation should never determine whether a girl attends school, participates in class, plays sports or pursues her ambitions.
The true measure of progress is not only access to menstrual products and clean toilets. It is whether every menstruator can experience menstruation without fear, shame, exclusion or discrimination.
Because when dignity becomes the measure of success, menstrual health becomes more than sanitation it becomes a matter of human rights and social justice.
