MANstruation: A cyberethnography of linguistic strategies of trans and nonbinary menstruators.

Trans and nonbinary experiences of menstruation are subject to menstrual discourse that is deeply gendered. Terms such as "feminine hygiene" and "women's health" make trans and nonbinary people acutely aware that they fall outside of the ideal of the default menstruator. To better understand how such language affects menstruators who are not cis women and what alternative linguistic strategies they adopt, we conducted a cyberethnography of 24 YouTube videos created by trans and nonbinary menstruators, along with their 12,000-plus comments. We observed a range of menstrual experiences-dysphoria, tensions between femininity and masculinity, and transnormative pressures. Using grounded theory, we identified three distinct linguistic strategies vloggers adopted to navigate these experiences: (1) avoiding standard and feminizing language; (2) reframing language through masculinization; and (3) challenging transnormativity. The avoidance of standard and feminizing language, coupled with a reliance on vague and negative euphemisms, revealed feelings of dysphoria. Masculinizing strategies, on the other hand, navigated dysphoria through euphemisms-or even hyper-euphemisms-that showed an effort to reclaim menstruation to fit within the trans and nonbinary experience. Vloggers responded through tropes of hegemonic masculinity, using puns and wordplay, and sometimes relying on hypermasculinity and transnormativity. Transnormativity, however, can be polarizing, and vloggers and commenters who rejected stratification of trans and nonbinary menstruation challenged it. Taken together, these videos not only uncover an overlooked community of menstruators who demonstrate unique linguistic engagement with menstruation, but they also reveal destigmatization and inclusion strategies that can inform critical menstruation activism and research as a whole.

The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries.

Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.

Menstruation, Myopia, and Marginalization: Advancing Menstrual Policies to "Keep Girls in School" at the Risk of Exacerbating Inequalities.

As countries across the world adopt policies addressing menstruation, it is imperative to identify who benefits from such policies and to understand the dynamics of inclusion and exclusion. We examine such policies through the lens of human rights, as a framework that demands addressing marginalization, ensuring substantive equality, and guaranteeing inclusive participation to ensure that the menstrual needs of everyone, everywhere are met. Our review is focused on four countries (India, Kenya, Senegal, and the United States) and is based on data from 34 policy documents and interviews with 85 participants. We show that girls, particularly school-going girls, are the main target group of policies. Due to this myopic view of menstrual needs, policies risk leaving the needs of adult menstruators, including those experiencing (peri)menopause, unaddressed. Moreover, the intersection between menstrual status and markers of identity such as disability and gender identity produces further policy gaps. These gaps can be attributed to the exclusion of marginalized menstruators from decision-making processes by creating barriers and failing to ensure meaningful inclusive participation. To address inequalities, policy makers need to make a concerted effort to understand and accommodate the needs of menstruators in all their diversity.

The persistent power of stigma: A critical review of policy initiatives to break the menstrual silence and advance menstrual literacy.

Menstruation is shrouded in stigma and shame-that is the common refrain in burgeoning initiatives on menstrual health and hygiene. Public policies alone cannot undo stigma and enact social change, but they do interact with social norms. They can reflect and adopt stigmatizing attitudes and, as a result, institutionalize, formalize, and legitimize stigma; or they can actively challenge and denounce it and mitigate existing discrimination. Against this background, we explored whether and how policies on menstrual health and hygiene address menstrual stigma and advance menstrual literacy based on an analysis of 34 policy documents and 85 in-depth interviews with policy-makers and advocates in four countries: India, Kenya, Senegal, and the United States. We found that policies recognized menstrual stigma and set out to break the silence surrounding menstruation and advance menstrual education, but they did not contribute to dismantling menstrual stigma. Policy-makers seemed constrained by the very stigma they sought to tackle, resulting in hesitancy and missed opportunities. Policies raised awareness of menstruation, often with great noise, but they simultaneously called for hiding and concealing any actual, visible signs of menstruation and its embodied messiness. Educational initiatives mostly promoted bodily management and control, rather than agency and autonomy. As a result, policies might have succeeded in breaking the silence around menstruation, but stigma cannot be broken as easily. We first need to recognize its (invisible) power and its impacts in all spheres of life in order to actively challenge, dismantle, and redefine it.

'You don't just do it because someone else said so': Menstrual practices and women's agency in the Hindu diaspora of Trinidad.

Meanings of menstruation are deeply embedded in culture and religion. The current dominant narrative presents menstrual practices as restrictions and often describes Hindu women as 'subjected to' these practices, characterising them as the oppressed victims of their religion. This article seeks to complicate this oversimplified narrative by exploring women's motivations, choices and decisions related to menstrual practices in a small-scale study based on semi-structured interviews and focus groups with women in the Hindu-Trinidadian diaspora. Our findings indicate that the women we interviewed exercise agency in the cognitive, emotional, religious and socio-cultural spheres. Many of them accept the ritual 'impurity' but overwhelmingly restrict this label to the spiritual sphere and separate it from their menstruating bodies. Many reject the idea that the practices are restrictive or stigmatising. They do not understand religion as the source of menstrual stigma but instead value or accept menstrual practices as part of what it means to be a Hindu woman-motivated by religious observance and/or the desire to be part of a community that upholds tradition. These varied manifestations of women's agency challenge the understanding of menstrual practices as necessarily-and-always oppressive and call for acknowledging the nuance and complexity of women's lives.

'We like things tangible:' A critical analysis of menstrual hygiene and health policy-making in India, Kenya, Senegal and the United States.

Over the last decade, many countries have adopted policies addressing menstrual needs. Our research explores the opportunities and challenges that have shaped these initiatives and critically examines their scope and substantive focus. Our study analyses developments in four countries: India, Kenya, Senegal, and the United States. It is based on an analysis of 34 policy documents and interviews with 85 participants active in policy-making or advocacy. Across countries, we found a predominant policy focus on tangible and material outcomes, such as menstrual products and facilities, that is informed by a narrow perception of menstrual needs as the management of bleeding. A number of drivers influenced policy-makers to keep this focus, especially the key narrative around menstrual pads as a perceived solution to school absenteeism combined with sensationalisation in the media and the quest for quantifiable results. Menstrual stigma is so ingrained that it continues to constrain policy-makers and advocates themselves by perceiving and presenting menstruation as a problem to be fixed, managed, and hidden. When considering new policy directions, we need to create capacity for a holistic menstrual policy landscape that overcomes systemic barriers to addressing the needs of menstruators that are largely rooted in menstrual stigma.

The messiness of the menstruator: assessing personas and functionalities of menstrual tracking apps.

OBJECTIVE: The aim of this study was to examine trends in the intended users and functionalities advertised by menstrual tracking apps to identify gaps in personas and intended needs fulfilled by these technologies. MATERIALS AND METHODS: Two types of materials were collected: a corpus of scientific articles related to the identities and needs of menstruators and a corpus of images and descriptions of menstrual tracking apps collected from the Google and Apple app stores. We conducted a scoping review of the literature to develop themes and then applied these as a framework to analyze the app corpus, looking for alignments and misalignments between the 2 corpora. RESULTS: A review of the literature showed a wide range of disciplines publishing work relevant to menstruators. We identified 2 broad themes: "who are menstruators?" and "what are the needs of menstruators?" Descriptions of menstrual trackers exhibited misalignments with these themes, with narrow characterizations of menstruators and design for limited needs. DISCUSSION: We synthesize gaps in the design of menstrual tracking apps and discuss implications for designing around: (1) an irregular menstrual cycle as the norm; (2) the embodied, leaky experience of menstruation; and (3) the varied biologies, identities, and goals of menstruators. An overarching gap suggests a need for a human-centered artificial intelligence approach for model and data provenance, transparency and explanations of uncertainties, and the prioritization of privacy in menstrual trackers. CONCLUSION: Comparing and contrasting literature about menstruators and descriptions of menstrual tracking apps provide a valuable guide to assess menstrual technology and their responsiveness to users and their needs.

Menstrual health: a definition for policy, practice, and research.

The term "menstrual health" has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition.

The Politics, Promises, and Perils of Data: Evidence-Driven Policy and Practice for Menstrual Health.

Data determine what we know about the menstrual cycle; they inform policy and program decisions; they can point us to neglected issues and populations. But collecting and analyzing data are complicated and often fraught processes, because data are political and subjective, decisions on what data we collect and what data we do not collect are not determined by accident. As a result, despite the significant potential of the current rise in attention to menstruation, we also see risks: a lack of a solid evidence base for program decisions and resulting sensationalization; concerns about data privacy; an overreliance on participants' recall, on the one hand, while not involving participants adequately in decision making, on the other hand; and a lack of contextualized and disaggregated data. Yet better communication, contextualization, and collaboration can address many of these risks.