Interdisciplinary Insights Beyond the Binary: Redefining Menstruation Research with Trans Inclusivity in Mind

This article is based on an interview originally conducted in Spring 2023 by former CSSD Staff Member Tomoki Fukui, Ph.D., with the Menstrual Health and Gender Justice Working Group.

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Late March 2023:

I have just returned from teaching, dumping the various paraphernalia from class to get ready for a chance to speak with Lauren Houghton and Susanne Prochazka, two members of the Menstrual Health and Gender Justice (MHGJ) working group. The current news cycle is filled with reports of the American right renewing its legislative efforts to erase transgender existence, in this instance through the denial of gender-affirming healthcare.

I am feeling isolation and despair.

I am excited to speak with the interdisciplinary research team that MHGJ has created about their newest project, a preliminary study of trans women’s experiences of menstruation. 

Some readers may feel confused by that description. Biological essentialism, a key facet of white supremacist ideology and central to the perpetuation of violence against transgender people, implies that only people with ovaries can menstruate. But part of what is so interesting about this study is the way it demonstrates how biological essentialism actually inhibits our understanding of biology.

As Lauren and Susanne shared with me during our interview, we erase an entire spectrum of experiences from view — whether those of cisgender girls and women who do not menstruate, transgender men and non-binary people who do, or whether we misinterpret the cultural worlds in which menstruation is taking place — because we assume that a universal institution called “sex/gender” exists that makes experiences of gender the same across time and space.

When we gender things like hormones, genitalia, reproductive capacities, work, appearance, and so on, it becomes difficult to actually ask questions about how all of these material things function and interact with one another. “By being more inclusive and studying menstruation among a group that doesn’t have the bleeding part of the menstrual cycle really helps us deepen our understanding about menstruation. We’re really guided by the idea that not everyone who menstruates is a woman, and not every woman menstruates,” Lauren says.

“Our study is really just amplifying and validating the lived experience of trans women.”

Rather than assuming the expertise of scientists, the study uses rigorous interdisciplinary methods to validate and amplify knowledge already held in trans communities. Using a mix of qualitative interviews with trans women, hormonal analysis, and symptom tracking on a menstrual tracking app, it seeks to tease apart ideological assumptions that result in the “gatekeeping of the menstrual cycle and womanhood,” in Lauren’s words. “Our study is really just amplifying and validating the lived experience of trans women that they already know about in their community. It’s not that we’re discovering anything very new. The key is validation and amplification,” Suzanne says. 

“All of my work has been on how science has been limited because we’ve gendered hormones.”

This study is an extremely welcome and urgent one in the context of extensive bias against considering trans women’s experiences of menstruation in scholarly literatures: Houghton and Prochazka observed that they could only find one study mentioning a trans woman’s experiences of menstruation, an article written by A.J Lowik, a non-binary researcher of trans health. The same bias is reproduced at the highest levels of public health research in the United States.

Lauren elaborates on recent work by an established research institution: “They define ‘sex’ as hormones. I don’t know where that’s validated because all of my work has been [about] how science has been limited because we’ve gendered hormones… The fact is that all these genders have all these hormones. So the fact that they’re defining sex by hormones is kind of flat-out wrong.” 

Transgender studies more broadly is a marginalized field of research, and gatekeeping by cisgender researchers and medical professionals have played significant roles in its status as such. And while there have been marked improvements in recent years, there is also a need to critically evaluate its conditions of inclusion into the university: as transfeminist scholar Susan Stryker has observed, the relative absence of transfeminine scholars is striking, and Jin Haritaworn and Riley Snorton have questioned why trans inclusivity has done little to ameliorate an environment of deadly violence against Black trans women. 

“Cisgender women’s health is under attack & transgender health is under attack right now. Our work that’s very inclusive is an antidote to that in a way.”

Houghton and Prochazka name interdisciplinarity as central to their ability to do justice to the complex and understudied field of menstruation research. “Cisgender women’s health is under attack and transgender health is under attack right now. Our work that’s very inclusive is an antidote to that in a way,” Lauren shares.

For her, the importance of accounting for cultural and socio-historical contexts for biological phenomena is linked to furthering science that is more ethical and rigorous: “I think biological and quantitative studies try to strip things to make them objective, but when things are very political you’re actually doing a disservice if you try to strip things of their context,” she says. 

Susanne shares, “The study we’re doing is so rooted in the interdisciplinary approach of the working group. From my understanding, it’s pretty much one-of-a-kind, and I wish it was in existence in other universities—these working groups that fund and encourage studies like this.” The study grew organically out of the MHGJ working group. Through conversations and connections that emerged out of Menstruation, Gender, and Rights, a course that the working group had developed, and a conference they organized, they were able to form a well-informed research team bringing different kinds of expertise to the study of menstruation. Meeting A.J. Lowik and engaging with their research in particular was very formative.

The group hopes to create a toolkit and consulting service in the future for other researchers who want to implement mixed-methods approaches into their research. Adding to the Palgrave Handbook of Critical Menstruation Studies, university seminar on menstruation, and collaborations with the Mumbai Global Center, both the study and consulting service will be a cutting-edge contribution to interdisciplinary work in public health.

In the face of continued violence to trans communities generally and challenges to transgender rights and health in particular, the MHGJ working group's pioneering study on trans women's experiences with menstruation serves as a powerful antidote. By challenging prevailing biases and embracing inclusivity, the research not only validates the lived experiences of trans women but also demonstrates the urgent need for more interdisciplinary and inclusive approaches in scientific inquiry. As scholars and researchers navigate this complex field, the study and its future initiatives seek to pave the way for a more ethical and rigorous understanding of menstruation, transcending traditional boundaries and contributing to the advancement of critical menstruation studies.

Written by Tomoki Fukui, Ph.D.

Edited by Evan Berk

Introducing The Palgrave Handbook of Critical Menstruation Studies

It has been said so often it is now cliché—“menstruation is having its moment!” But what is this moment actually about? What are we talking about when we talk about menstruation?

The Palgrave Handbook of Critical Menstruation Studies invites the reader to explore menstruation from nearly every possible angle, including dimensions that you might not yet have considered: the historical, political, embodied, cultural, religious, social, health, economic, artistic, literary and many more. With 72 chapters on more than 1000 pages, the Handbook--the first of its kind--establishes Critical Menstruation Studies as a rich field of research.

The editors, Chris Bobel, Inga Winkler, Breanne Fahs, Katie Ann Hasson, Elizabeth Arveda Kissling, and Tomi-Ann Roberts together bring almost a century of expertise in studying menstruation. Over the last three years, they have sought out 134 contributors in more than 30 countries to address a wide range of menstrual matters in the Handbook.

DEFINING FEATURES:

Timely & Critical Scholarship: The time for this Handbook is now, at a moment when menstrual health moves from margin to center as a subject of urgent concern and enthusiastic exploration. The Handbook fills a crucial gap. It exposes myths, fallacies, and false claims. And while it advances the knowledge of the field, it acknowledges that there is a lot we don’t know yet. It is the critical companion for anyone interested in menstruation.

Deliberate Diversity: The coherence of the Handbook lies in its deliberate diversity—in content, experiences, formats, and authors representing diverse forms of knowledge and expertise. From traditional research chapters to policy and practice notes, menstrual art, personal narratives, and "Transnational Engagements" across cultures and countries, the Handbook seeks to engage a wide range of readers.

Menstruation as a Lens for Gender Justice: The Handbook establishes Critical Menstruation Studies as a robust and multifaceted category of analysis and a potent lens that reveals, complicates and unpacks inequalities across social, cultural, embodied, and historical dimensions. Through the Handbook we aim to demonstrate the richness of Critical Menstruation Studies, a field that is finally coming into its own.

Across this diverse content, the varied questions asked and answered address menstrual health over the life course from menarche to menopause:

• Do you want to understand how menstrual stigma prompts us to conceal any sign of menstruation? Are you curious how stigma limits the understanding of menstruation of young people around the world and can lead to delays in reproductive health diagnosis and care?

• Do you want to learn about efforts to improve menstrual education, including for men and boys, through films, apps, and other innovative means?

• Have you thought about how culture shapes the experience of menstruation and how menstruators engage with religious practices in diverse ways?

• Do you want to read about the first-hand experiences of trans and non-binary persons, menstruators with disabilities, menstruators with autism, migrants and refugees, girls forced into early marriage, or Dalits?

• Are you curious about menstrual advocacy efforts--past and present--, the pushback activists face, and their successes, including efforts to include menstruation in national policy, in the UN Sustainable Development Goals, and in the context of human rights?

• Are you among the millions of users of menstrual tracking apps and want to learn more about the role of technology, social entrepreneurs, and menstrual advertising in shaping our understanding of menstruation?

• Do you want to see how menstruation is represented on Twitter, on YouTube, on TV, in films, and in visual art?

• Are you interested in the unique challenges menstruators face in diverse settings such as prisons or jails, humanitarian crises and refugee camps, informal settlements, and conditions of homelessness?

The Handbook addresses all these questions and many more. But it doesn’t seek to provide definitive answers. Whether contributors address religious rituals, menstrual leave, or menstrual sex, they defy easy answers and avoid monolithic views. The Handbook invites the reader into the conversation by considering different perspectives and engaging with apparent contradictions and tensions. It aims to stimulate dialogue and further inquiry and to leverage that knowledge to effect meaningful change.

Contributed by the Menstrual Health and Gender Justice workin group

Do Menstrual Health and Hygiene Policies Matter? – A Human Rights Assessment

In November 2019, Kenya adopted the world’s first stand-alone policy on menstrual hygiene. India has been integrating menstrual hygiene efforts in its sanitation policies for more than 10 years. And in the United States, we are counting down the States that still tax menstrual products. – These are just some of the policy developments in the menstrual health space.

Over the next year, the Institute for the Study of Human Rights will conduct a review of policies on menstrual hygiene and health policy in India, Kenya, Senegal, and the United States. Purvaja S. Kavattur, the project researcher explains: “We are excited to work alongside in-country stakeholders to learn from their expertise and compile lessons learned to address the marginalization of menstruating bodies. We hope to explore what’s happening in terms of policy development and who benefits: Do policies matter for the lives of menstruating individuals? And do they matter for all people?”

Over the past ten years, there have been significant developments in the nascent field of menstrual health. Increasingly, countries are adopting legislative and policy frameworks on menstrual hygiene and health. Policies cover different aspects such as menstrual hygiene, de-taxing menstrual products, or ensuring provision of menstrual products to specific population groups. South Asia and Eastern Africa house two hubs for menstrual health policy action and our selected countries are at the forefront of these developments. It is, therefore, an opportune time to reflect on recent policy developments.

However, amidst growing momentum, there are risks of adopting policies that are narrow in scope and that focus on hygiene needs, infrastructure and access to products. Menstrual health also affects education, economic security, empowerment, and self-confidence. As such, there is a need for a more comprehensive understanding of menstrual health as it is shaped by menstrual stigma, healthcare access, educational attainment, as well as civic and public life, which should be addressed through policies. A more comprehensive approach that examines the social determinants of menstrual health is needed to better identify causes of marginalization, substantive foci beyond menstrual hygiene, and the subsequent policy gaps.

Inga Winkler, the project’s PI and director of CSSD working group Menstrual Health and Gender Justice, explains: “We are at a critical point. We want to move along with this momentum and continue building off the work already happening on the ground. But in doing so we want to ensure that policy developments in this emerging field are grounded in human rights principles of non-discrimination and equality, participation, and accountability. We hope to identify what levers forward policies grounded in human rights considerations to alleviate the marginalization of menstruating bodies.”

Through this review, we seek to explore whose voices, interests and needs are centered and whose are marginalized in these policies and the processes leading to their adoption, and how this influences the framing of policies both in terms of their scope and the targeted populations. We will, therefore, conduct a process-oriented review informed by human rights principles as well as substantive human rights guarantees in the four countries.

The project is funded through a grant from the Water Supply and Sanitation Collaborative Council, which has been active in supporting governments in developing policies and programs on menstrual hygiene for years.

We hope that in conducting this review, we will uncover ways policies normalize and destigmatize menstruation, shape budget allocations and service provision, and create mechanisms for accountability. We hope that our review will highlight areas of success, areas of improvements, and gaps to help create a roadmap for other governments looking into expanding their menstrual health and hygiene policies.

Contributed by Purvaja S. Kavattur, Menstrual Heath and Gender Justice working group Staff Associate

January 21, 2020

Menstrual Health and Gender Justice Working Group Launches with Expert Panel: Menstruation is Having its Moment – How Can Scholars Engage?

On September 20, 2018, the Center for the Study of Social Difference (CSSD) and the Institute for the Study of Human Rights sponsored the launch of a new CSSD working group: Menstrual Health and Gender Justice. The event featured an expert panel addressing some of the most pressing questions related to menstrual health. 

Panelists provided insights into how the working group can address and engage with the recent surge in public interest surrounding menstruation in their research.

The panel brought together various perspectives: established scholars and new voices, birds-eye views on ongoing developments and insights from communities, socio-medical and cultural perspectives on menstruation. Inga Winkler, the director of the working group, led five panelists and experts in the field in discussing the methods, opportunities, and risks involved in generating sustainable, evidence-based outcomes and in challenging common misconceptions of menstruation. Both the panelists and attendees of the launch event offered professional and personal perspectives on the current menstrual movement, its history and significance, and the potential ways in which the working group can contribute to meaningful, inclusive change.

• Nancy Reame from the Columbia School of Nursing challenged the idea that menstruation is only now having its moment and drew our attention to research and advocacy on the Toxic Shock Syndrome outbreak in the 1980s.

• Norma Swenson, one of the co-founders of Our Bodies, Ourselves, provided advice on how to develop the current moment into a long-term movement for women’s health.

• Vanessa Paranjothy, an Obama Foundation Scholar and co-founder of Freedom Cups stressed the importance of listening to women and following their lead when working with communities.

• Trisha Maharaj, a graduate student in Human Rights Studies, shared research on attitudes towards menstruation amongst Hindu women in Trinidad. She challenged the conventional wisdom that cultural and religious practices often contribute to stigma based on her findings that women in Trinidad do not perceive them as stigmatizing.

• Chris Bobel from UMass Boston cautioned us that the menstrual health space is driven by assertions and assumptions that are not yet properly explored. She witnesses a heavy focus on providing products to the detriment of addressing underlying issues of institutionalized and embodied shame about menstruation.

Among the diverse perspectives present, the panel agreed that several issues are integral for moving the discussion on menstrual health forward, including: (1) promoting menstrual literacy and body literacy; (2) supporting scholarship aimed to fill knowledge gaps; (3) addressing stigma associated with menstruation; and (4) involving and encouraging collaboration with diverse groups, sectors, and movements. Moving forward, the Menstrual Health and Gender Justice working group will engage in critically evaluating existing developments in the field of menstrual studies, contributing to the body of research and sharing knowledge.

If you would like to get updates and news from the Menstrual Health and Gender Justice Working Group, please email Michelle at mc4225@columbia.edu.

Contributed by Sydney Amoakoh, Michelle Chouinard and Inga Winkler.

Professor Inga Winkler Speaks at UN Event on Menstrual Health

On July 11, 2018, Simavi and WSSCC hosted a panel discussion during the UN’s High-level Political Forum on Sustainable Development, about “Putting Menstrual Health on the 2030 Agenda,” which featured Institute for the Study of Human Rights professor Dr. Inga Winkler as both the keynote speaker and a panelist. Dr. Winkler is director of the Menstrual Health and Gender Justice working group at the Center for the Study of Social Difference at Columbia University.

In her keynote address, Dr. Winkler emphasized the importance of removing Menstrual Hygiene Management  (MHM) strictly from the Water, Sanitation, and Hygiene (WASH) sector in order to unpack and address issues around menstruation at all levels. She stressed the need to look at the numerous ways that people are affected by menstruation and how menstruation is directly linked to many of the Sustainable Development Goals (SDGs) on the 2030 agenda, such as Good Health and Well-Being, Quality Education, Gender Equality, Clean Water and Sanitation, Decent Work and Economic Growth, and Responsible Consumption and Production.

Dr. Winkler stressed the importance of including women and girls in the discussion, especially those who are traditionally marginalized or excluded. The range of experiences individuals have with menstruation should be addressed in order to leave no one behind. For example, indigenous women, women with disabilities, refugee and migrant women and girls, homeless individuals, incarcerated women, and the LGBTQI community all face overlapping forms of discrimination and are often left out of the MHM conversation.

Dr. Winkler also noted the large role that religion and culture play in regards to menstrual practices, but that it should remain up to the menstruating individual whether or not to partake in them. In this way these individuals maintain their agency, which is the driving force behind the SDGs.

Written by Human Rights graduate students Trisha Maharaj and Tori Miller.