Consideration of Paid Menstrual Leave as a Women’s Public Health Issue

By Rita Portenti

Introduction: Women’s Public Health Problems

Many women’s public health problems are complex, societal problems that cannot be wholly resolved through policy reform. Laws have evolved to provide legal remedies for domestic violence, which was previously considered a private, family matter.[i] The prosecution of rape no longer requires proof that the victim “resisted to the utmost,” but instead focuses on the victim’s non-consent in the sexual act.[ii] Despite these changes, rates of violence against women remain high, with one in five women experiencing sexual violence in their lifetimes and one in four women experiencing domestic violence.[iii]

The difficulty in resolving women’s public health problems is that they are rooted in sociocultural factors. Therefore, the resolution of such issues requires changing sociocultural beliefs that perpetuate gender inequality,[iv] such as the stereotype that women are weak.[v] One way to address this gender stereotype is to dismantle stigmas surrounding menstruation.

Broadening the Concept of Women’s Public Health

Menstruation is not commonly thought of as a pressing public health problem, but the stigmatization of menstruation is harmful to women. People believe that menstruation creates “intense negative moods and impair[s] decision making”[vi] in women. In addition, women face “discrimination, harassment, and are looked down upon” because people view menstruation as a “form of weakness rather than a necessary biological function.”[vii] This misperception makes women feel “anxious, confused, and ashamed about their periods,”[viii] which has led to the treatment of menstruation as taboo.[ix] In fact, the “communication taboo” is so persistent that dozens of euphemisms exist for menstruation, including “my friend is here[,]” “my time of the month[,]” and “Mother Nature’s gift.”[x]

Menstruation is also a serious public health problem because of the severely painful symptoms it creates in those who suffer from dysmenorrhea.[xi] Dysmenorrhea is the technical term for pain that results from menstruation.[xii] Primary dysmenorrhea is the most common type and is “caused by natural chemicals in the uterus lining.”[xiii] Secondary dysmenorrhea is caused by an underlying medical issue, such as endometriosis.[xiv] Those who suffer from dysmenorrhea typically suffer in silence because of the stigmatization of menstruation.[xv] Stigmatization and consequential silence can be life-threatening for women with underlying medical conditions, as they lead women to delay medical attention for what they believe are normal menstrual symptoms.[xvi]

To combat the dangerous treatment of menstruation as taboo, menstruation must be normalized. This normalization includes openly discussing menstruation as a necessary biological function,[xvii] and acknowledging dysmenorrhea as a chronic health condition.

 

Menstrual Leave as a Means of Normalizing Menstruation

Providing menstrual leave to employees can support this goal of normalization. Menstrual leave is paid or unpaid absence, separate from sick leave, permitted when a person experiences debilitating period pain caused by dysmenorrhea.[xviii] Symptoms of dysmenorrhea include severe and frequent menstrual cramps, nausea, vomiting, fatigue, headaches, and even fainting.[xix] In certain cases, surgery may be necessary to treat dysmenorrhea.[xx]

Menstrual leave is provided by various companies and provinces, but it exists at the national level only in few countries, including Indonesia, Japan, South Korea, Taiwan, and Zambia.[xxi] Menstrual leave was considered by the Russian Parliament in 2013[xxii] and by the Italian Parliament in 2018,[xxiii] but neither proposal was successful. Chile also recently considered a menstrual leave policy for people diagnosed with dysmenorrhea or endometriosis, but the policy was not enacted.[xxiv] In some countries, such as South Korea and Japan, menstrual leave is unpaid.[xxv]

Opponents of menstrual leave claim that this policy actually reinforces the stereotype that it seeks to eradicate—that women are uniquely handicapped in the workplace.[xxvi] Time off due to menstrual leave can be leveraged to withhold equal positions and equal wages for people who menstruate, and it can increase a hiring bias against women.[xxvii] Menstrual leave may support the prejudice that “menstruation makes women unfit for work” and risks branding every person who menstruates as ill.[xxviii] Instead of a blanket policy for menstruation, opponents suggest developing an “overall leave policy” for chronic health conditions.[xxix]

Similar arguments have been made against paid maternity leave. Some argue that requiring paid maternity leave could discourage employers from hiring women.[xxx] However, we cannot deny women necessary care because negative gender stereotypes exist. Employees commonly feel shame in taking any sick leave or general time off.[xxxi] Yet, people do not argue against a sick leave policy, because it could reinforce negative stereotypes of people with chronic illnesses. Stigmatization of chronic health conditions does not mean they should be treated less seriously. Opponents of menstrual leave may be overlooking the fact that denying its necessity actually reinforces its status as taboo, as we continue to perceive menstruation as nothing more than that “time of the month” rather than as a chronic health condition.

Menstrual leave can help the stigmas surrounding menstruation by allowing for open discussion. Open discussion, in a tone that “carries no shock or shame,” can alter the workplace mindset in a meaningful way that spurs progress.[xxxii] It provides the ability for women to “speak openly about their bodies, and to gain social recognition for their role as workers.”[xxxiii] It also presents the opportunity for people to speak about menstruation-related health issues and to take necessary time to recover or seek treatment.[xxxiv]

A menstrual leave policy also helps break down stigmas by recognizing dysmenorrhea as a serious, chronic health condition. People who suffer from dysmenorrhea experience symptoms so severe, such as fatigue, vomiting, and fainting, that they require bedrest.[xxxv] However, only a subset of women, ten[xxxvi] to twenty percent,[xxxvii] report symptoms so extreme that bedrest is required.[xxxviii] Understanding that dysmenorrhea is distinct from other symptoms of menstruation can help break the stigma that menstruation makes people weaker. People are not seeking time off for intense negative moods or impaired decision making;[xxxix] they are seeking time off for the debilitating pain that accompanies dysmenorrhea. Acknowledging the reality and severity of this pain is a necessary step towards shifting the narrative around menstruation.

 

Conclusion: Can Menstrual Leave Really Be Successfully Implemented?

Successful implementation of menstrual leave, as a means of combatting gender stereotypes, requires several measures. The first measure is to discuss menstruation without the use of euphemisms. In Zambia, menstruation is still treated as taboo, despite having a policy of menstrual leave in place.[xl] This perception can partly be explained by the reference to menstrual leave as “Mother’s Day,” which perpetuates the communication taboo and ties womanhood to motherhood.[xli] Dismantling the stigmatization of menstruation requires that it be discussed openly, as a necessary, biological function, separate from the idea of motherhood or womanhood.

The second measure is that menstrual leave must be offered as a paid benefit. In Japan and South Korea, both countries where menstrual leave is unpaid, many employees do not take menstrual leave, even if they feel that they need it.[xlii] In 2017, less than one percent of people in Japan took menstrual leave, and in South Korea, the rate was roughly twenty percent.[xliii] Menstrual leave should be offered as a benefit and not as a disadvantage to employees. If it is not offered as a paid benefit, low-income people will be disproportionately disadvantaged, as they will be less willing or able to take unpaid time off. If the policy is to normalize menstruation, then it needs to be a policy that will actually be effective and utilized by employees.

With such measures in place, the successful implementation of menstrual leave is possible. Such a policy will give people who menstruate the ability to openly discuss menstruation, and will allow for acknowledgement of dysmenorrhea as a serious health condition. In turn, the stigmatization of menstruation and negative gender stereotypes can be broken down, which will be critical in fighting other women’s public health problems.

Citations

[i] Deborah M. Weissman, The Personal Is Political—and Economic: Rethinking Domestic Violence, BYU L. Rev. 387 (2007), https://heinonline.org/HOL/LandingPage?handle=hein.journals/byulr2007&div=17&id=&page=.

[ii] Stephen J. Schulhofer, Reforming the Law of Rape, Minnesota Journal of Law and Equity Vol. 35, Iss. 2 (2017), https://scholarship.law.umn.edu/cgi/viewcontent.cgi?article=1577&context=lawineq.

[iii] Sharon G. Smith, et al., The National Intimate Partner and Sexual Violence Survey, Centers for Disease Control and Prevention (2018), https://www.nsvrc.org/sites/default/files/2021-04/2015data-brief508.pdf.

[iv] Tazeen Saeed Ali, Attitude Towards Gender Roles and Violence Against Women and Girls: Baseline Findings from an RCT of 1752 Youths in Pakistan, Global Health Action Vol. 10(1) (2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964875/

[v] Gender Stereotypes and Stereotyping and Women’s Rights, United Nations Human Rights Office of the High Commissioner (2014), https://www.ohchr.org/documents/issues/women/wrgs/onepagers/gender_stereotyping.pdf.

[vi] Alicia A. Grandey et al., Tackling Taboo Topics: A Review of the Three Ms in Working Women’s Lives, Journal of Management (2019), https://journals.sagepub.com/doi/full/10.1177/0149206319857144.

[vii] Jill Litman, Menstruation Stigma Must Stop. Period., Berkeley Public Health (2018), https://pha.berkeley.edu/2018/06/05/menstruation-stigma-must-stop-period/.

[viii] Id.

[ix] Id. 6.

[x] Ingrid Johnston-Robledo et al., The Palgrave Handbook of Critical Menstruation Studies (2020), https://www.ncbi.nlm.nih.gov/books/NBK565611/.

[xi] Katie Kindelan, Breaking the Stigma of Painful Periods: ‘They Should Not Be Debilitating’, (2021),  https://www.goodmorningamerica.com/wellness/story/breaking-stigma-painful-periods-debilitating-81226040

[xii] Id.

[xiii] Id.

[xiv] Id.

[xv] Jacquelyne Froeber, Period Stigma and Health Risks, Healthy Women (2021), https://www.healthywomen.org/created-with-support/period-stigma-health-risks.

[xvi] Id.

[xvii] Id. 7.

[xviii] Kylie Logan, Could Corporate America Embrace Paid ‘Period Leave’?, Fortune (2021), https://fortune.com/2021/10/30/paid-menstrual-period-leave-us-companies/.

[xix] Dysmenorrhea, Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/dysmenorrhea.

[xx] Id.

[xxi] Aneri Pattani, In Some Countries, Women Get Days Off for Period Pain, The New York Times (2017), https://www.nytimes.com/2017/07/24/health/period-pain-paid-time-off-policy.html.

[xxii] Maham Javaid, Asian Countries Have Been Offering Females Paid Menstrual Leave for Almost 70 Years, Timeline.com, (2016), https://timeline.com/asian-countries-have-been-offering-females-paid-menstrual-leave-for-almost-70-years-401056aeb1ec.

[xxiii] Id. 21.

[xxiv] Id. 10.

[xxv] Julia Hollingsworth, Should Women Be Entitled to Period Leave? These Countries Think So, CNN Business (2020), https://www.cnn.com/2020/11/20/business/period-leave-asia-intl-hnk-dst/index.html.

[xxvi] Id. 21.

[xxvii] Id. 21.

[xxviii] Id. 21.

[xxix] Id. 21.

[xxx] Id. 25.

[xxxi] Bryan Robinson, American Workers Are Afraid to Take Time Off, New Study Finds, Forbes (2021), https://www.forbes.com/sites/bryanrobinson/2021/05/13/american-workers-are-afraid-to-take-time-off-new-study-finds/.

[xxxii]  Julia Wuench, The Economic and Moral Case for Menstrual Leave, Forbes (2020), https://www.forbes.com/sites/juliawuench/2020/08/17/the-economic-and-moral-case-for-menstrual-leave/.

[xxxiii] Emily Matchar, Should Paid ‘Menstrual Leave’ Be a Thing?, The Atlantic (2014), https://www.theatlantic.com/health/archive/2014/05/should-women-get-paid-menstrual-leave-days/370789/.

[xxxiv] Id. 10.

[xxxv] Id. 6.

[xxxvi] Yosola Olorunshola, Zambia Gives Women One Day of Menstrual Leave Each Month, But Not Everyone Is Happy About It, Global Citizen (2017), https://www.globalcitizen.org/es/content/zambia-periods-menstruation-gender-equality/.

[xxxvii] Id. 25.

[xxxviii] Id. 6.

[xxxix] Id. 6.

[xl] Id. 36.

[xli] Id. 36.

[xlii] Id. 25.

[xliii] Id. 25.