Improving South Africa’s policy on menstruation

Research Insights No.1

The South African Constitution protects the right of South African citizens to dignity, equality, health and education.ⁱ This obligates the South African government to ensure that all South Africans citizens have these rights. Menstrual health and hygiene management, if ignored, hampers the attainment of these rights. Existing international agreements and national policy commit the government to guaranteeing adequate provision for menstrual health and hygiene management.ⁱⁱ

Menstruation is a normal activity of the female reproductive system, and a natural part of life for approximately 22.85 million women and girls in South Africa.ⁱⁱⁱ Throughout the majority of their lives, those who menstruate face the frequent need to manage menstruation. On average menstruation lasts for five days every 28 days, which equates to approximately two months of every year. Managing menstruation is not optional – it is a necessity.

Three factors impact on South Africa’s obligations regarding menstrual health and hygiene management. These are: national information regarding menstruation; the cost of menstruation management materials; and the Sanitary Dignity Framework.

Information on menstruation

International data on menstruation collates information on at least the following four topics:

• awareness of menstruation before menarche;
• private place to wash and change;
• participation in activities during menstruation;
• use of menstrual materials.

Despite the importance of effective menstruation management, and the fact South Africa has established policies regarding menstruation, no holistic data on these topics is collected. It should be noted that this lack of data is not unique to South Africa.^iv Our research indicated that

• none of the national surveys conducted by Statistics South Africa ask any questions that directly relate to menstruation;
• one nationally representative survey that incidentally collected data is the 2016 All Media and Products Survey, conducted by the South African Audience Research Foundation. The questions it asked provide limited insight into menstruation and the prevalent barriers to menstrual health and hygiene management.
• several small studies have been conducted, but do not provide a nationally representative understanding of menstrual health and hygiene in South Africa.

Cost of Menstruation Management Materials

A significant consideration when it comes to managing menstruation is the cost of menstruation management materials. This is exacerbated by the fact that managing menstruation is a necessity. It was found that

• the monthly cost of single-use menstrual pads and tampons represents 6.5% and 4.33%, respectively, of the average monthly household income of those in the poorest quintile.
• using more environmentally friendly menstrual products, such as menstrual cups and reusable menstrual pads, produces significant long-term savings.
• the initial cost of the menstrual cup and reusable menstrual pads represents 49.26% and 64.12%, respectively, of the average monthly household income of those in the poorest quintile.
• barriers to reusable menstrual products include: high initial cost, lack of decent water, sanitation and hygiene (WASH) facilities, and limited availability.

It should be noted that the average real monthly cost of menstrual pads and tampons in South Africa decreased slightly between 2018 and 2019, but affordability has declined since then due to falling incomes.

The Sanitary Dignity Framework

The Sanitary Dignity Framework, published in 2019, represents South Africa’s first step towards formulating national norms and standards regarding menstrual health and hygiene management. The following limitations were identified:

• It is not grounded in context-specific information about menstruation in South Africa.
• It lacks detailed, fit-for-purpose norms and standards.
• It does not cover access to accurate and timeous information on menstruation.
• The scope of the Framework reaches beyond promoting menstrual health and hygiene management.
• It does not define the functions of the inter-ministerial committee.
• Implementation has been slow and unequal across the provinces.

Recommendations

• Questions regarding menstrual health and hygiene should be included in the General Household Survey conducted annually by Statistics South Africa.
• A new panel study that includes questions regarding menstrual health and hygiene should be conducted.
• Government programmes distributing menstrual materials can reduce their costs by providing menstrual cups or reusable menstrual pads.
• Programmes that choose to distribute menstrual cups and reusable menstrual pads must conduct awareness-raising campaigns around the use of these menstrual materials.
• The Sanitary Dignity Framework should be redrafted based on credible evidence-based research. The updated Framework must include detailed norms and standards and a clear, phased implementation plan.

Cornerstone Economic Research

End notes

1. South African Government. 1996. The Constitution of the Republic of South Africa. Available: https://www.gov.za/documents/constitution-republic-south-africa-1996.
2. Department of Women, Youth and Persons with Disabilities. 2019. Sanitary Dignity Framework. Available: https://genderlinks.org.za/wp-content/uploads/2017/06/Menstrual-Hygiene_South-Africa_SanitaryDignityFramework_2019.pdf;
   United Nations. 2022. Sustainable Development Goals: Goal 6. Available: https://sdgs.un.org/goals/goal6
3. This estimate is based on the assumption that, on average, women between the ages of 10 and 65 menstruate. Statistics South Africa. 2021. Mid-year population estimates. Transgender men and non-binary people can menstruate, but do not identify as women or girls.
4. Plesons, M., Patkar, A., Babb, J., Balapitiya, A., Crason, F., Caruso, B.A., Franco, M. Hanse, M.M., Haver, J., Jahangir, A., Kabiru, C.W., Kisangala, E., Phillips-Howard, P. Sharma, A., Sommer, M. & Chandra-Moli, V. 2021. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. Reproductive Health. 18(31). Available: https://doi.org/10.1186/ s12978-021-01082-2.