Addressing menstrual stigma through sex education in England- taking a sociomaterial turn

Defining menstrual stigma

Menstrual stigma is discussed frequently in academic and activist work regarding menstruation, but its meaning(s) can vary. For instance, although stigma and prejudice can focus on slightly different phenomena (Phelan, Link, and Dovidio Citation2008), the two concepts are used synonymously in some discussions about menstruation (e.g. Dyer Citation2020). Phelan, Link, and Dovidio (Citation2008) argue that much literature on stigma is rooted in Goffman’s (Citation1963, 3) work, which views stigma as a ‘deeply discrediting’ attribute which disqualifies an individual ‘from full social acceptance’. They also argue that, unlike the literature about stigma, much of the writing about prejudice has developed around Allport’s (Citation1954, 9) theory of ethnic prejudice as ‘an antipathy based upon a faulty and inflexible generalisation,’ which focuses on perpetrators (Phelan, Link, and Dovidio Citation2008).

Whilst these differences may seem subtle, the way menstrual stigma/prejudice is conceptualised seems to present different ways of seeing the problem and potential solutions. If menstrual bleeding itself is socially constructed as negative and stigmatising (McHugh Citation2020), then deconstructing such attitudes might address menstrual stigma. On the other hand, if menstruating people are ‘stigmatised’ (Shailini Citation2020, 34), then unpacking the reasons why certain bodies are positioned on the borders of social acceptability might be a way to tackle the issue. The problem can also be seen as a form of prejudice through people perpetrating menstruated-related hostility towards others. For instance, Frank (Citation2020) argues that transgender people may not want to speak to healthcare professionals about their menstruation because they are fearful of professionals perpetrating transphobic abuse. If menstrual prejudice is understood this way, then unpicking power dynamics or holding perpetrators to account might help to challenge it.

Different meanings of menstruation may also contribute to variable understandings of menstrual stigma or prejudice. Drawing on their ethnographic studies of menstruation in different contexts, Buckley and Gottlieb (Citation1988) argue that despite shared biological roots, people experience menstruation differently due to political, religious, geographic and economic factors. Gottlieb (Citation2020) also suggests that taboos associated with menstruation are not consistently negative and provides the example of the practice of Beng women of Côte d’Ivoire who do not touch corpses or enter forests when they are menstruating. She claims their actions are not based on the stigmatising Judaeo-Christian idea that menstrual blood is a curse. Rather, ‘menstrual blood is considered a symbol of human fertility; hence it should be separated from both vegetal fertility (agricultural fields) and death (corpses)’ (ibid, 149). The different practices around menstruation suggest that menstrual stigma or prejudice is not a universally similar or recognisable phenomenon. Dual understandings of menstrual stigma and menstrual prejudice exist. As such, there are a range of situations where menstruation could be linked to notions of social unacceptability – for example, through the variety of ways in which menstrual bleeding is marked as socially unacceptable in a stigmatising way, or through the prejudice of people who perpetrate menstruation-based hostility towards others.

Menstrual stigma and young people

Existing literature highlights a multitude of ways in which menstrual stigma can be problematic for young people. Studies of young people’s experiences of menstruation commonly focus on contexts outside of England, in particular countries in the global South that are characterised by economic marginalisation and a history of colonialism. Studies in Ghana (Rheinländer et al. Citation2019), Kenya (McMahon et al. Citation2011) and Tanzania (Benshaul-Tolonen et al. Citation2020) highlight menstrual stigma in some young people’s everyday interactions, including with teachers in school (Rheinländer et al. Citation2019; McMahon et al. Citation2011), peers (McMahon et al. Citation2011; Benshaul-Tolonen et al. Citation2020), and families (McMahon et al. Citation2011). Research from Tanzania (Sommer et al. Citation2015; Benshaul-Tolonen et al. Citation2020), Ghana, Cambodia, Ethiopia (Sommer et al. Citation2015) and Zimbabwe (Ndlovu and Bhala Citation2016), also links menstrual stigma to negative outcomes for girls, including absence from school (Sommer et al. Citation2015; Benshaul-Tolonen et al. Citation2020), experiences of gendered bullying (Benshaul-Tolonen et al. Citation2020), and low self-esteem (Ndlovu and Bhala Citation2016).

Academic research and studies conducted by non-governmental organisations focusing on England or the UK also highlight menstrual stigma emerging in schools and through young people’s conversations with peers (Wigmore-Sykes, Ferris, and Singh Citation2020), as well as through advertising (Tingle and Vora Citation2018) and social media (Tomlinson Citation2021). Similar to research from the global South, these UK-based studies highlight links between menstruation, menstrual stigma, and problems for young people, such as girls avoiding participation in sport (Wigmore-Sykes, Ferris, and Singh Citation2020); stress and anxiety (Elston and Hipkiss Citation2020; Briggs Citation2020); and gendered teasing and bullying (Elston and Hipkiss Citation2020; Burrows and Johnson Citation2005). In addition, based on online discussions about the DfE’s free period product scheme with 62 young people aged between 9–19, Elston and Hipkiss (Citation2020) suggest that menstrual stigma can be a problem for young people accessing free products in school, which implies that tackling period poverty alone is insufficient. Young people in their study expressed concern about potentially experiencing additional stigma associated with the use of free menstrual products.

Policy background

Until recently, education policies in England did not address menstrual stigma. Sex and Relationships Education (SRE) (Department for Education and Employment Citation2000), which was introduced to schools in England in 2000 was only partly compulsory (Spencer, Maxwell, and Aggleton Citation2008). The non-statutory SRE policy guidance did not reference stigma but advised schools to prepare girls for menstruation and highlighted how schools were mandated to teach about reproductive health and the menstrual cycle through the National Science Curriculum. Following campaigns about the inadequecy of non-compulsory SRE for addressing contemporary issues like sexting and online abuse (Elgot Citation2017), the government in England made RSHE a mandatory requirement as part of the Children and Social Work Act (Citation2017). The Act legislated for the introduction of the RSHE curriculum, and the Relationships Education, Relationships and Sex Education and Health Education (England) Regulations (Citation2019) made RSHE compulsory¹ in all schools in England (Department for Education Citation2019). Since then, the DfE has released statutory RSHE guidance (Department for Education Citation2019), and schools have started to implement the updated RSHE curriculum (Department for Education Citation2021). Thus, most children and young people in England will receive RSHE-based teaching about menstruation. However, the RSHE curriculum continues to place emphasis on the biological health aspects of menstruation. Menstruation falls within the health element of RSHE, and the guidance instructs schools to teach ‘key facts’ about:

In addition, it is important to note that the RSHE policy guidance advises schools to ‘address stigma around health issues’ (Department for Education Citation2019, 31, our emphasis).

The DfE also argues that schools should take steps to address stigma by implementing the free period product scheme (Department for Education Citation2020), which focuses on the biology of menstrual bleeding. The opt-in free period product scheme involves state-funded primary and secondary schools signing up to receive products from Personal Hygiene Services Limited (PHS), to provide for their pupils (Department for Education Citation2020). There are no stipulations about how schools should distribute the products, but the DfE emphasises that ‘making learners aware of the scheme is vital to making sure they can access period products … and to reduce the stigma surrounding periods’ (Department for Education Citation2020, 17).

As the Department for Education (Citation2020) suggests, free menstrual products and the RSHE curriculum may contribute to destigmatising menstruation by helping young people to manage their periods and learn more about menstrual health. However, both policies focus on the health and biology of menstruation and menstrual bleeding, rather than the ways in which menstruation and menstrual prejudice may appear in young people’s everyday lives such as on television (Rosewarne Citation2012), social media (Tomlinson Citation2021) or through discussions with peers and family members (Fingerson Citation2006; Allen, Kaestle, and Goldberg Citation2011).

Some young people in England and Northern Ireland have argued that learning the biology of menstruation is not adequate for addressing stigma and menstruation education should focus on the everyday, rather than scientific, aspects of periods (Tingle and Vora Citation2018). We build on this argument and suggest that if education policies and practices predominantly focus on health and menstrual management, they may not address the full range of ways in which menstruation might be intertwined with young people’s lives.

Methodological approaches and the missing material

Existing studies on menstruation and young people highlight some of the ways in which menstruation can be part of young people’s experiences. Some studies take discursive approaches which focus on human language and practices and highlight stigmatising menstruation discourses in young people’s lives. For example, human-centred research from different continents including Oceania (Shire and Gunn Citation2019) North America (Simes and Berg Citation2001) Africa (Rheinländer et al. Citation2019; Hennegan et al. Citation2019) and Asia (Rashid and Michaud Citation2000) emphasise discourses that position menstruation as shameful and something that should be hidden. Some discourse studies also explore potential ways to disrupt menstrual prejudice (e.g., Shire and Gunn Citation2019; Tomlinson Citation2021). Based on their analysis of interviews and observations with teachers and pupils in New Zealand, Shire and Gunn (Citation2019) argue that menstrual shame can be disrupted when pupils are exposed to alternative discourses.

Other existing enquiries use qualitative methods to understand young people’s perspectives on their menstruation experiences. Studies in England that take this approach highlight some of themenstruation-related problems young people face in school like taunting (Burrows and Johnson Citation2005; Elston and Hipkiss Citation2020), lack of access to products (Briggs Citation2020) and dissatisfaction with menstruation education (Tingle and Vora Citation2018). Thus, whilst existing studies provide useful insights into young people’s perspectives and experiences, most research generally employs human centred methodologies which overlook non-human materiality. By this term, we refer to material things in young people’s lives such as period products, clothing and digital technology that exist as part of a menstrual assemblage. Here, we use the concept of assemblage, as propounded by Deleuze and Guattari (Citation1987), to describe the non-linear arrangements of heterogenous entities (for example a young woman buying material tampons in a supermarket might be considered a menstrual assemblage through the organisation of the physical building, arrangement of consumer products and the packaging of the tampons, all of which play a part in structuring the woman’s experience of ‘shopping for tampons’).

Human-centred studies do not explore how everyday non-human material things are actively involved in young people’s menstruation-related activities, such as discussing or experiencing menstruation. Although some human-centred enquiry explores young people’s lack of access to material menstrual products (e.g. Briggs Citation2020; McMahon et al. Citation2011), the material is only considered in the context of deficit. Barad (Citation2003, 801), the renowned feminist physicist philosopher, argues that language has been granted ‘too much power’ and materiality ‘does not matter’ enough in discussions about the social world. To borrow their insight, it seems that matter does not matter very much when it comes to understanding young people and menstruation. But, as Miller (Citation2010) argues, material ‘stuff’ is part of culture, as shown by the way that people use and engage with things like clothing and digital technology, as well as bathrooms, toilet facilities and period products (McGregor Citation2020; Lane et al. Citation2021). Thus, an appreciation for the entanglement between material things, menstruation and young people’s experiences could help broaden understandings about how menstruation and menstrual stigma feature in their lives. We draw on Barad’s (Citation2007, ix) concept of entanglement to refer to non-linear relationality and ‘the lack of an independent, self-contained existence.’ This way of thinking could also support practitioners and policymakers to work with young people, and centre their everyday experiences with menstruation, when developing and implementing education policies to address menstrual stigma.

One possible way of understanding more about menstruation and young people could therefore be to use sociomaterial approaches to research which centre around the idea that:

Below, we explore sociomaterial approaches and suggest how they might support enquiries into young people’s everyday engagements with menstruation.

Why sociomaterialism?

The apparent absence of focus on material things, evident in menstruation-related education policies and existing research, led us to consider the burgeoning literature positing theoretical ideas broadly defined as sociomaterial. As Lupton (Citation2021) sets out, sociomaterial research draws attention to the material, as well as the discursive and conceptual aspects of people’s lived experiences and routines. Latour (Citation2005) argues that the social world is continuously built and rebuilt by humans and non-humans. Miller (Citation2010) posits that the way materiality contributes to human subjectivities is not always obvious and that material ‘stuff’ can unconsciously prompt people’s actions. Drawing on these arguments, we suggest that sociomaterial approaches may help explore and explain the (potentially taken for granted) ways that materiality matters for young people’s everyday experiences with menstruation.

By drawing attention to the social and material aspects of young people’s engagements with menstruation, sociomaterial enquiries could present a more nuanced understanding of menstrual stigma and offer new ways of working with young people. Braidotti (Citation2019, 67) argues that: ‘a concept becomes thinkable as it loses consistency and self-evidence, and thus ceases to be a ruling principle.’ Following this argument, if the ways that material things contribute to young people’s engagements with menstruation remain implicit, the stigmatising discourses or practices that they may help to produce remain ‘all the more powerful’ (ibid, 67). It therefore follows that sociomaterial research that ‘unveil[s] the mechanisms by which’ (ibid) menstrual prejudice is produced in young people’s lives, could also help policymakers and practitioners to disrupt menstrual prejudice.

Sociomaterial enquiries could also provide new insights to support teachers to disrupt menstrual prejudice by drawing attention to the relationality between materiality and education practice. Existing human-centred methodologies may provide a framework for understanding how teachers and/or pupils shape education about menstruation. However, these approaches overlook human connections with non-human materiality. Kuby and Christ (Citation2019, 967) argue that pedagogy is a ‘lively packet of relations’ in which teachers, pupils and non-human materiality are in a constant process of becoming with each other. By drawing attention to how material things matter for young people’s experiences and routines, sociomaterial research may also prompt practitioners to consider the ways in which education about menstruation might be ‘affected by materials’ (Sørensen Citation2009, 2). Although the DfE’s free period product scheme involves school staff making material menstrual products more available to young people, the policy focuses on a lack of the material. It does not encourage schools to consider what the material actively does in education. In teaching, as Sørensen (ibid, 2) argues, ‘materials may be used by humans, but they may also use the humans and influence and change the educational practice.’ Sociomaterial enquiries could offer teachers a framework to understand the relationality between non-human things, young people, and menstruation, but also how materiality might contribute to, and become part of, teaching practices that disrupt menstrual stigma.

Using relational ontologies

Considerations for conducting relational sociomaterial research

Taylor and Hughes (Citation2016) suggest that research methods, including randomised controlled trials, which help practitioners and policymakers draw conclusions about an external world are among ‘the most valorised’ (ibid, 5) in the education sector. Following this argument, sociomaterial approaches might seem challenging to apply methodologically in educational research. Rather than choosing methods to find an objective truth or interpret an external world, as researchers in the positivist or interpretivist paradigms might try to do (Hultin Citation2019), relational sociomaterial approaches require methods that will provide data relevant to the inseparability of the social and the material (Fenwick et al. Citation2015). Researchers can employ different methods to achieve this. Post-qualitative scholars posit that researchers using relational ontologies should reject traditional qualitative research methods like interviews or observations because they privilege representing ‘the “now”’ rather than attending to emergence and ‘becoming in entanglement’ (Patti and St. Pierre Citation2013, 630). Fox and Alldred (Citation2018, 7), on the other hand, suggest that traditional methods can ‘still serve as sources of data in a more-than-human study’ so long as participants are considered ‘key informants’, rather than ‘privileged’. Furthermore, whilst sociomaterial studies generally employ qualitative methods, Moura and Bispo (Citation2020) point out that some sociomaterial researchers also use quantitative methods. Thus, the way to do sociomaterial research is not fixed. This means that researchers could utilise a variety of methods to consider the relationality between menstruation, young people, stigma and materiality. For example, the first author plans to use observations, photography, focus groups and object interviews in her ongoing research on menstrual stigma and young people.

The choice of methods for enquiries into young people’s engagements with menstruation inevitably have complex ethical implications. Standard ethical principles common to social science research, including confidentiality, protecting young people’s safety, and avoiding harm, will be important for enquiries into young people’s menstruation-related experiences and routines. Whilst menstruation is a biological process that around half of the human population experience in their lifetime, people do not always discuss this experience openly (McHugh Citation2020) and periods might be a sensitive, or even dangerous, topic for some young people. Chrisler et al. (Citation2016) argue that some transgender men and non-binary people may fear being ‘outed’ by revealing their menstrual status, as well as risking consequential violence. Girls have reported experiencing bullying related to menstruation whilst in school (Tingle and Vora Citation2018) and some research highlights a link between menstruation as a marker of sexual maturity and cis-male violence against girls and women (Mason et al. Citation2013).

For researchers concerned with questions about menstrual stigma, young people and schooling, relational sociomaterialism affords an ethical approach that could help to shift the conversation in educational settings. Feminist new materialists (Barad Citation2007; Braidotti Citation2019) argue that relational ontological assumptions mean that ethics is not simply ‘a matter of separate individuals following a set of rules’ (Davies Citation2018, 121). Instead, feminist new materialists posit that a focus on relationality, emergence and becoming raises questions about ‘what is being made to matter’ through research and ‘how that mattering affects what it is possible to do and think’ (Davies Citation2018, 121). For relational sociomaterial enquiries with young people and menstruation, ethics might involve considering how the research itself is entangled with young people’s menstruation experiences, as well as how such entanglements might have ‘specific material consequences’ (Lenz-Taguchi Citation2012, 278) for education policies and practices. A researcher questioning young people about periods would, in and of itself, be part of young people’s menstruation experiences and routines. Furthermore, the way researchers frame enquiries might affect how teachers and policymakers think about, and take action to address, menstrual stigma. Sociomaterial research that centres young people’s experiences with menstruation, rather than biological knowledge, could encourage new discussions about how to address menstrual stigma through education. For example, such research may help teachers to consider the sociomaterial aspects of their pupils’ engagements with menstruation, as well as how pupils’ first-hand experiences might feature in teaching that aims to address menstrual prejudice.

Conclusion

Throughout this paper, we have argued that sociomaterialism rooted in relational ontologies could offer alternative ways of understanding young people’s engagements with menstruation and menstrual stigma. We have also suggested that, in turn, this could help policymakers and practitioners challenge menstrual prejudice through education. The DfE in England has a history of advocating for evidence-based policy and practice (Coldwell et al. Citation2017). Given this paper’s focus on education policies, including the DfE’s free period product scheme and RSHE, it concludes with a brief evaluation of the potential for sociomaterial enquiries to provide an evidence base for challenging menstrual prejudice through education.

Relational sociomaterial enquiries will not contribute to linear evidence-based policy processes in which research is assumed to provide universal answers about what policies or practitioners should do. This is because relational approaches involve recognising the situated nature of knowledge and how the researcher is entangled with the phenomena under study (Davies Citation2018). Thus, relational sociomaterial research into young people and menstruation would not claim to provide the DfE with objective truths about ‘what works’ for tackling menstrual prejudice, or as Haraway (Citation1988, 581) puts it, ‘to see everything from nowhere.’ Even so, this does not negate the potential for sociomaterialism to contribute to what Landri (Citation2014) calls ‘complex, and ongoing negotiations in the field’ of education policymaking. Drawing on a case study in Italy, he argues that education policymaking does not follow a linear structure but instead involves complex assemblages and reassemblages of humans and non-humans such as headteachers, teachers, pupils, schools, spaces and data. He suggests that, in the enactment of policy, negotiations are always taking place between heterogenous actors.

It follows therefore that relational sociomaterial enquiries into young people’s everyday engagements with menstruation may raise questions, spark debates, or reorientate discussions about RSHE and the free period product scheme. By so doing, relational sociomaterial enquiries might reshape what is ‘made to matter’ (Davies Citation2018, 121) when it comes to understanding menstruation in young people’s lives. In this way, sociomaterial enquiries may become actors in, and therefore contribute to, negotiations in menstruation-related education policy and practice. But for this to happen, research needs to step beyond traditional human-centred methodologies and, instead, explore the entanglements between material things, young people, menstruation, and menstrual prejudice. Our purpose in exploring this potential is to invite a sociomaterial turn in a domain of research and practice traditionally embedded in humanist, biological knowledge.