Period Pain: Student Perceptions of the Ongoing Stigma Surrounding Menstruation at the University of Warwick and Potential Interventions to Counter Such Stigma

Naomi Carter, University of Warwick

Abstract

With ongoing menstrual stigma maintaining a culture of silence and secrecy in academic institutions, this research seeks to reveal student perceptions of this stigma at the University of Warwick, and understand their suggestions for how the University can better support menstruating students. Drawing on findings from a focus group of six menstruating students at the University of Warwick, the paper suggests that menstrual stigma persists at the University, affecting students’ wellbeing and academic performance. Participants expressed frustration at the lack of understanding of, or institutional support for, the difficulties of menstruation; including (but not limited to): debilitating pain, negative assumptions about the body, inaccessible menstrual products and inadequate hygiene facilities. However, certain students appear to be countering the cultural pressure to remain silent about menstruation, calling for the University to implement proactive measures to improve menstrual education, counter stigmatising assumptions and help menstruators mitigate the effects of pain and menstrual management. The research also calls attention to the elements of privilege present in such discourses, highlighting the need for further research into students’ menstrual needs and potential institutional interventions, with a particular focus on the intersecting difficulties faced by marginalised students.

Keywords: Menstrual equity, menstrual stigma, gender inequality in higher education, period poverty, period pain

Introduction

Menstruation is more than a biological process: it is loaded with political, social, cultural, medical and religious meanings (Bobel, 2020; Medina-Perucha et al., 2020). Despite recent progress towards gender equality, the topic of menstruation and how to deal with it is still surrounded by deeply entrenched shame and stigma, exacerbating ongoing inequalities in education, healthcare, and workplaces (Johnston-Robledo and Chrisler, 2013; Plan International UK, 2018; Sang et al., 2021; Sommer et al., 2021).

This stigma has led to menstruation being historically neglected in academic and professional settings, with research about menstruation remaining scarce and often dismissed by male-dominated research cultures (Bobel and Fahs, 2020 Bobel, 2020; Medina-Perucha et al., 2020; Munro et al., 2021). Despite increasing anecdotal evidence of period poverty, shame and stigma, there remains insufficient empirical evidence into the lived experiences of menstruators (Briggs, 2021; Munro et al., 2021). The menstrual experiences and needs of university students specifically remain under-investigated, despite conditions of high stress and anxiety that can significantly affect their menstrual experiences, confidence and wellbeing (Munro et al., 2021). In marginalising the experiences of menstruating students and staff, universities can inadvertently reinforce stigma, while negative mental and physical health effects remain unaddressed (Briggs, 2021).

Despite the dearth of academic investigation, in recent years menstrual activism aiming to challenge stigma has gained increasing media and political attention (Bobel, 2020; Medina-Perucha et al., 2020; Plan International UK, 2018). At the University of Warwick, this has been led by Student Union officers, including myself, campaigning for free period product provision and gender-inclusive language since 2015 (Warwick SU, 2015; Warwick SU, 2022). This is an important step in increasing accessibility of menstrual products, with 1 in 7 girls in the UK having struggled to afford sanitary products (Plan International UK, 2018), and a lack of access to menstrual products at university campuses causing distress and disruption for students and staff (Bobel and Fahs, 2020; Sang et al., 2021). However, scholars have suggested that campaigns for menstrual equity must go beyond period product provision to challenge ongoing menstrual taboos and consider how this impacts individuals’ dignity and human rights (Briggs, 2021; Loughman et al., 2020; McLaren and Padhee, 2021; Sang et al., 2021). Moving beyond a focus product provision can link menstrual health across different domains to structural, social and cultural obstacles to gender equality (Bobel and Fahs, 2020; Loughman et al., 2020; McLaren and Padhee, 2021).

Thus, this research attempts to link students’ perception of current menstrual activism to ongoing menstrual stigma and potential university-level interventions. The University of Warwick provides an important location for this research as a leading Higher Education (HE) institution in the UK, with just under 30,000 students enrolled (University of Warwick, 2022). Despite the University’s strategic commitment to equality and sustainability (University of Warwick, 2019), there remains no qualitative or quantitative research into the experiences of menstruating students on campus or their awareness of recent menstrual activism. In beginning to address this gap, this research contributes to the growing body of literature on menstrual equity, setting the scene for future research into student experiences, the effectiveness of menstrual activism, and potential policies to improve gender equality and student wellbeing at English university campuses. This highlights the essential role of intersectional academic research in informing appropriate and inclusive menstrual activism, and exposing ‘some of the fundamentally problematic aspects of misogyny, sexism, racism, homophobia, and classism’ that underpin current attitudes to menstruation (Bobel and Fahs, 2020: 1013).

Regarding language, which is crucial in shaping dominant discourses and gender relations (Briggs, 2021), throughout this research, I use the non-gendered language of ‘menstruators’, recognising that not all women menstruate, and some men and non-binary individuals do (Bobel and Fahs, 2020).

Literature review

Shame and stigma

Menstruation remains a deeply stigmatised phenomenon across the world, including the UK (Johnston-Robledo and Chrisler, 2013; Plan International UK, 2018; Sommer et al., 2021). Scholars have illustrated how this stigma manifests in varied ways, from secrecy and silence maintained through euphemisms (Gottlieb, 2020; Sang et al., 2021; Sommer et al., 2021) through societal pressure to follow a strict ‘menstrual etiquette’ (Briggs, 2021; Roberts, 2020) to common media portrayals of menstruating women as angry, irrational and emotional (Gottlieb, 2020; Johnston-Robledo and Chrisler, 2013; Roberts, 2020).

Johnston-Robledo and Chrisler (2013: 182) illustrate how menstruation fulfils Goffman’s (2009) conceptualisation of stigma, as ‘any stain or mark that sets some people apart from others […] that spoils their appearance or identity’. Menstruation is commonly portrayed as polluting or dirty, thanks to an ideology of ‘freshness’ and ‘cleanliness’ perpetuated through advertisements, media and conversation (Allen et al., 2011; Gottlieb, 2020; Jackson and Falmagne, 2013; Johnston-Robledo and Chrisler, 2013; Plan International UK, 2018). This is rooted in deeply engrained gender norms and discourses of ‘womanhood’ whereby menstruators are expected to meet unrealistic standards of femininity (Gottlieb, 2020; Jackson and Falmagne, 2013; Levitt and Barnack-Tavlaris, 2020; Roberts, 2020), so internalise the shame of experiencing a biological occurrence painted as impure or deviant (Briggs, 2021; Johnston-Robledo and Chrisler, 2013; Sang et al., 2021).

The impacts of stigma

Although there remains a lack of academic research into the experience of menstruation, thanks to ongoing marginalisation and stigma in male-dominated HE institutions (Munro et al., 2021; Sang et al., 2021), the mental and physical effects of living under stigma or period poverty are being increasingly documented (Briggs, 2021; Plan International UK, 2018). Discourses of shame and silence have placed a double burden upon menstruators, who must both manage and hide menstruation in the public and private spheres (Sang et al., 2021). This secrecy leads to disruption to daily life, anticipation of negative reactions and shaming, and increased physical and emotional labour (Plan International UK, 2018), which Sang et al. (2021: 1) conceptualise as ‘blood work’: ‘managing painful and leaky bodies, accessing adequate facilities, stigma, and managing workload’.

As well as negative consequences on physical and reproductive health (Allen et al., 2011; Bobel, 2020; Gottlieb, 2020; The Lancet Child & Adolescent Health, 2018), this ‘blood work’ has mental health implications including self-consciousness, lowered self-esteem, low mood, and social withdrawal (Briggs, 2021; Cardoso et al., 2021; Johnston-Robledo and Chrisler, 2013; Plan International UK, 2018). Within HE settings and the accompanying stress, anxiety and social pressures, such impacts have been found to hinder educational performance – for example, through increasing self-exclusion from educational and social activities – and place undue pressure on menstruating individuals to operate ‘as normal’ despite negative symptoms (Plan International UK, 2018; Briggs, 2021; Munro et al., 2021; Sang et al., 2021).

These impacts are especially severe for marginalised individuals, including non-binary, transgender, culturally diverse and disabled students, or menstruators from low socio-economic backgrounds, who continue to be neglected in research (Gottlieb, 2020; Medina-Perucha et al., 2020; Phillips-Howard, 2021). Current failures to include such intersections reflect ‘the complexity of menstrual experience as at once biological and sociocultural’ (Bobel and Fahs, 2020: 1013). Thus, stigma and its effects can widen existing gendered, classed and racialised health and educational inequalities, highlighting the importance of a critical and intersectional feminist lens to the topics of menstruation and period poverty (Briggs, 2021; Medina-Perucha et al., 2020; Munro et al., 2021; Sang et al., 2021; Sommer et al., 2021).

Menstrual activism and institutional interventions

Nonetheless, ongoing stigma has been increasingly challenged over recent years as menstrual activism gains greater media, corporate and political attention (Bobel, 2020; Bobel and Fahs, 2020; Plan International UK, 2018), and young people look to challenge gender norms and period poverty (Allen et al., 2011; Johnston-Robledo and Chrisler, 2013). Such engagement draws upon the diverse history of menstrual activism, which has shifted focus over the decades – from challenging taboos to emphasising affordability of products and the experiences of those with marginalised identities (Bobel and Fahs, 2020).

Yet interventions that focus on product provision alone have been criticised by activists for medicalising menstruation and failing to challenge social and cultural stigma, gender discrimination, marginalisation or inequality (McLaren and Padhee, 2021; Roberts, 2020). This overemphasis on product provision has been criticised as a neoliberal ‘solution’ to periods as a ‘problem’, which ‘betrays [menstrual activism’s] feminist roots’ (Bobel and Fahs, 2020: 1009), raising questions regarding the compatibility of product provision with feminist approaches to menstrual stigma. Here, a sexual-reproductive-rights approach to menstrual health has been advanced, focusing more broadly on sociocultural stigma, menstruators’ agency and the psychosocial experience of menstruation (Bobel and Fahs, 2020; McLaren and Padhee, 2021). Fighting for improved menstrual health as a right may be more effective in challenging structural inequalities than focusing on ‘fixing’ perceived deficiencies (Bobel and Fahs, 2020; Briggs, 2021; Hennegan, 2017; McLaren and Padhee, 2021). This involves systematically challenging the stigma surrounding menstruation to erode ‘culturally rooted taboos’ (Gottlieb, 2020: 152; Johnston-Robledo and Chrisler, 2013; Levitt and Barnack-Tavlaris, 2020).

In educational institutions, scholars and activists suggest implementing research-informed structural changes that support menstruators’ specific menstrual needs, including modifications to hygiene infrastructure and gender policies that currently disadvantage menstruating students (Munro et al., 2021; Plan International UK, 2018; Sang et al., 2021). However, as Munro et al. (2021: 22) point out, ‘further research is necessary to appropriately inform design and implementation of these interventions, particularly with students from culturally diverse backgrounds, and those identifying as non-binary or transgender’. Understanding menstruators’ diverse lived experiences and needs is essential to expose and act against patriarchal oppression, through research-led activism (Bobel, 2020). As Bobel illustrates:

a dearth of attention to a fundamental reality and indeed a vital sign is not only a profound knowledge gap, it is an exposure of the power of misogyny and stigma to suppress knowledge production. And when we lack knowledge, we cannot effectively act to effect change.

Methodology

The aim of this study was therefore to understand student experiences of menstrual stigma and discuss ideas of how to tackle this in a university context. Following my own campaign to provide free period products across the University of Warwick campus, I also wanted to see how effective students believe period product provision to be, following criticism that such an approach fails to adequately respond to ongoing stigma (Bobel and Fahs, 2020; McLaren and Padhee, 2021; Roberts, 2020).

A critical, intersectional feminist approach was taken throughout, to understand how menstruation ‘unites the personal and the political, the intimate and the public’ (Bobel, 2020: 3). This can provide an important insight into how gender politics and ongoing stigma in HE reflects and reproduces existing gender inequalities (Bobel and Fahs, 2020; Briggs, 2021). This feminist research methodology has been explained as:

An understanding that gender inequality exists, a commitment to political change through research, a concern with the subjective, lived experiences of participants, an emphasis on knowledge building as a relational process, which requires researcher reflexivity, and an acknowledgement of the positionality of the researcher and the power dynamics between researcher and the researched, all of which influence the knowledge produced.

Following these principles, and to generate a deeper understanding of participants’ experiences and ideas regarding potential interventions against menstrual stigma, qualitative research methodology was chosen, comprising of a focus group of six menstruators studying at the University of Warwick. This group provided a supportive and intimate environment where participants could build upon each other’s comments while yielding a manageable amount of data within the time and resource constraints of the project (Haenssgen, 2019). Due to health and logistical restrictions, the discussion took place online, and thus careful attention was paid to non-verbal cues that may be lost through online interactions. The sample was recruited from my own menstrual activist campaign and the Warwick Anti-Sexism Society, and included one non-binary participant, one post-graduate participant and one participant of colour. Thus, participants had a variety of experiences of menstruation and were aware of current menstrual interventions on campus. Pseudonymised names and demographics of participants can be seen in Figure 1.

The discussion followed a loose topic guide and set of questions (see Appendix A) generated from the literature review, but was mainly guided by participants. Following the ethical research procedures of my faculty, the discussion was recorded online, transcribed (to include hesitations, repetitions, or other notable non-verbal cues), and coded according to themes derived from the initial topic guide and several iterations of analysis (see Appendix B). These results have been analysed in relation to current literature below.

With awareness of my own position as a menstruating woman within the university, reflexivity and sensitivity were central to the data collection and analysis. Remaining conscious of my privilege as a white, cisgender woman who has not struggled severe effects of stigma or period poverty was important in being sensitive to the diverse experiences discussed, and to minimise uneven power relations (Briggs, 2021; Craddock, 2020).

Results

The results of the focus group demonstrate how the stigma surrounding menstruation is ever-present for University of Warwick students, with participants going beyond discussions of shame to express frustration at poor understanding of menstruation, the difficulty of dealing with its effects, and the perceived failures of current policies.

Understanding the complex experiences of menstruation

The group generally acknowledged that there is still a stigma surrounding menstruation, although they felt that this was more prevalent among different age groups and non-menstruators than between menstruators themselves. Participants’ comfort discussing their periods at university was linked to informal support systems (usually involving peers such as best friends and housemates, or wider networks including supportive members of staff or period product schemes) for both information and practical support. However, participants remained conscious of several groups they feel less comfortable discussing periods with, including family members, international students from different cultures, non-menstruators or people who may judge their gender identity. Pip stated that ‘it’s interesting from a trans perspective, there are certain people who I feel very comfortable talking about my period with […] and certain people who I’m just like, I don’t want you to know what’s going on’. This discomfort highlights how disclosure of menstruation can pose a risk to individuals with marginalised identities who may feel excluded or endangered (Levitt and Barnack-Tavlaris, 2020; Munro et al. 2021).

When discussing stigma, many participants focused on a lack of non-menstruators’ understanding and avoidance of the topic of menstruation. For example, Samira said, ‘I think it’s hard, from my personal experience, for men to understand the nuance behind it. It’s a lot of work to understand that there’s one thing we all go through, but everybody goes through it differently’. Non-menstruators were thought to perceive menstruation as ‘dirty’ or ‘gross’ (Samira), highlighting a prevalent narrative of menstruation as ‘unclean’ (Briggs, 2021; Gottlieb, 2020; Plan International UK, 2018; Roberts, 2020) and reinforcing the idea that ‘believing that menstruation is gross and should be kept hidden is a normal and acceptable male response’ (Allen et al., 2011: 152). Participants agreed that poor menstrual education has perpetuated this lack of understanding, with sex education in schools seen as ‘unsatisfactory’ and a reason that non-menstruators did not have ‘the right tools’ to support others (Samira). Here, some participants referenced how they had educated themselves, and while this mostly occurred before university, they were still in the process of learning about their own cycles. Allen et al. (2011) found that the segregation of menstrual education to women and private conversations was significant in many men believing menstruation was not something they needed to understand. Their findings about the importance of intimate relationships in educating non-menstruators chimes with Samira’s experiences: ‘unless they’ve had a long-term relationship with somebody who menstruates or has difficulty menstruating, so many boys or men don’t understand what that process is’.

An important result of this poor understanding was the assumptions participants felt were made of them because of having periods, including that they were hormonal, emotional or irrational, which made them feel invalidated, ignored and frustrated. As found in previous research, this resulted in hyper-consciousness and individuals altering their behaviour (Roberts, 2020), highlighting the stigmatisation of the psychological symptoms of menstruation (Sang et al., 2021). Pip also emphasised the gendering effect of menstruation, and how this felt like it was sometimes weaponised to attack their identity: ‘it has a weird gender invalidating sense because people equate periods with womanhood’. Menstruation is indeed ‘deeply gendered and coded as women’s experience’ (Bobel and Fahs, 2020: 1009), intensifying menstruators’ gendered experiences and linking strongly to discourses of femininity (Briggs, 2021; Gottlieb, 2020; Johnston-Robledo and Chrisler, 2013; Roberts, 2020).

Sometimes, participants’ own lack of understanding was seen as a barrier to discussing menstruation with people from other cultural backgrounds or gender identities as they did not want to ‘offend anyone’ or ‘make a mistake’ (Samira). This reflects the challenge to university students ‘when navigating their cultural expectations of menstruation’, which has important implications for supporting culturally diverse and trans students (Munro et al., 2021: 21).

Dealing with the difficulties of menstruation

Participants felt that a lack of understanding regarding menstruation has led to a mainstream perception of ‘normality’ as an ‘emotionless, mood-less ideal where you’re just kind of neutral’ (Phoebe), which is unachievable and used to dismiss the impacts of menstruation. Participants described the pressure to work ‘as normal’ during their period, despite fearing that this could negatively affect their academic or sporting performances. For Sabine, this means ‘a lot of the time, I’m just really stressed and scared that my period is gonna end up falling at a time where I really need to be fully concentrated and fully there’, which Phoebe linked to university sports, saying ‘we’re not thinking about playing the game. We’re not thinking about anything else [other than managing our periods].’ The discussion emphasised previous findings into the burden of calculation and anticipation around menstrual management (Briggs, 2021; Jackson and Falmagne, 2013; Sang et al., 2021), including worrying about taking time out during sport matches and choosing certain study spaces for their toilet facilities. As Claire said, ‘people who don’t have periods don’t think it’s that bad because it looks like we’re operating as normal, but we’re only operating as normal because we’re having to think so much about it.’ Thus, participants demonstrated an understanding of the risk that menstruation could pose to their attendance, concentration and performance, and were frustrated that this was not being addressed at the University (Munro et al., 2021; Sang et al., 2021).

With pain brought up repeatedly and often described as ‘debilitating’ (Nicole, Sabine, Samira), participants discussed how the failure of universities and workplaces to consider ‘the potential suffering that menstruators can go through’ (Nicole) is frustrating and illustrates the injustice of current systems. Samira linked this to sexist attitudes that endure in the workplace, asking ‘why would they still be making women or menstruators who really struggle work through such immense pain? Like, if someone got smacked in the head with a baseball bat, you wouldn’t tell them to work through it’. Evidently, the gendered expectations for menstruators experiencing painful periods to keep working without rest or supportive structures, such as appropriate sports facilities or flexible deadlines, negatively impacts their confidence, wellbeing, and agency (Johnston-Robledo and Chrisler, 2013, Munro et al., 2021; Plan International UK, 2018; Sang et al., 2021).

Participants also highlighted cost as an aspect of menstrual inequality, seen as an aggravating factor to previously discussed difficulties. Phoebe encapsulated this frustration, stating ‘access to period products should be a basic right, and it’s disgusting it isn’t’. This highlights the importance of a sexual-reproductive-health approach to menstruation that recognises supportive menstrual policies as a human right (Hennegan, 2017; McLaren and Padhee, 2021).

Expressing anger at perceived injustices

Relating discussion of wider menstrual stigma back to their immediate environment, participants expressed disappointment and frustration towards the perceived lack of support from the University of Warwick. This was linked to other perceived failures on gendered issues such as sexual assault, which Samira described as ‘worrying’, ‘disappointing’ and something that means ‘you just feel really let down when this is supposed to be a hub of fantastic people and fantastic ideas’.

Here, participants connected their own experiences to wider systems of inequality that ignore, invalidate and inconvenience menstruators. Claims that menstruation ‘doesn’t get taken seriously’ (Sabine) and ‘isn’t really taken into account’ (Nicole) resonate with continued dismissal of menstrual activism, research, and experiences in academia and the workplace (Bobel, 2020; Bobel and Fahs, 2020). Referencing patriarchy and capitalism, participants felt that they were being made to pay to manage and experience a normal bodily function, which Levitt and Barnack-Tavlaris (2020: 569) describe as ‘the medicalisation of menstruation [that] objectifies the female body through commodifying it through capitalist maintenance and care’. Samira described how mainstream discourse around menstrual management ‘feels like it enforces such a patriarchal narrative, of, you’ve got to prepare yourself, and if you’re not prepared, it’s your fault things have gone wrong’ – a responsibility she called ‘oppressive’. This reflects the individualisation of menstrual management and how ‘menstruation has been used to marginalize and oppress women and other menstruators through the process of objectification and the ideology of sexism’ (Levitt and Barnack-Tavlaris, 2020: 565).

Responding to ongoing stigma

As found in recent studies (Jackson and Falmagne, 2013; Sang et al., 2021), a few participants referenced actively trying to challenge menstrual stigma through being open and ‘unapologetic’ (Claire). Phoebe referred to the role of privilege in this, stating ‘I shouldn’t feel any shame or embarrassment asking [for products], so I’m just gonna do it, because why not? I’m in a position where I’m comfortable enough to do that’. This suggests that some menstruators are indeed subverting cultural discourses about invisibility or secrecy (Bobel, 2020; Levitt and Barnack-Tavlaris, 2020). Stigma is therefore being challenged in certain circles, with some menstruators no longer ‘going to a great deal of effort to conceal [menstruation]’ (Johnston-Robledo and Chrisler, 2013: 184), instead emphasising the role of wider society in addressing stigma and inequalities.

Nonetheless, although discretion and silence were being challenged by some participants, sometimes it was seen as necessary, such as for trans students’ comfort and safety, with disclosure of menstruation potentially having harmful social consequences (Sang et al., 2021). Here, participants expressed an awareness of other people’s boundaries when discussing menstruation, with Claire recognising that ‘even if I don’t find this taboo, someone else might and that might make them feel uncomfortable’.

Participants agreed that the University should be taking the initiative to educate students and support the diverse experiences of menstruators. Suggestions included academic interventions such as introducing extensions on deadlines or alternative exam arrangements for menstruating students, and practical arrangements such as widespread product provision, awareness training for sports clubs, and more accessible facilities across campus. Free product provision was seen as a ‘really basic thing’ that the University could do to tackle current inaccessibility (Phoebe), with participants frustrated that this currently relies on individual student activism – seen as filling an important gap in provision, but short-term and burdensome for students. However, Phoebe acknowledged that products alone may be inadequate to tackle stigma, ‘because it would just be menstruators accessing and seeing and using those products, so in the broader consciousness of society it wouldn’t change much’.

Instead, education was emphasised, including the University leading or funding creative and informative events with expert advice on menstrual health topics. While participants emphasised the need for better education at a younger age, the University was still seen as an important site of learning. This supports previous findings into the importance of targeted education to challenge assumptions, myths and stigma around menstruation (Allen et al., 2011; McLaren and Padhee, 2021; Medina-Perucha et al., 2020; Plan International UK, 2018).

Discussion and implications

Throughout this focus group, participants’ discussion of perceived injustices – including poor menstrual education, stigmatising assumptions and difficulties with pain and accessibility – reveals the ongoing burden of menstruation at the University of Warwick. However, it also highlights how students are responding to and challenging these difficulties.

Silence and shame were less prominent discourses than found in previous research; for example, participants placed less emphasis on the pressure to ‘discursively and practically render menstruation invisible’ or fear of shame (Sang et al., 2021: 4), instead emphasising frustration at the lack of accommodation to their needs (Gottlieb, 2020; Sommer et al., 2021). Although non-menstruators were frequently cited as a barrier to open discussion about menstrual taboo, there were few references to policing, objectification or shaming behaviour, except in isolated incidents before university (Roberts, 2020). This suggests that it is the labour of managing the painful body, workload and access to facilities that are the most important aspects of these participants’ ‘blood work’, rather than managing stigma and remaining silent (Sang et al., 2021). Confidence and wellbeing appeared more affected by a lack of supportive structures than shameful experiences, embarrassment, or pressure to maintain a strict ‘menstrual etiquette’ (Briggs, 2021; Roberts, 2020).

Sang et al. (2021: 9) have suggested that the fear of stigma is a ‘by-product of the male-dominated nature of universities’ – however, this dynamic is not reflected in these participants’ female-dominated social circles, which may have allowed these individuals greater freedom in discussing menstruation than academics working in male-dominated spaces. Such gendered dynamics require further investigation, as informal circles represent an important source of learning about menstruation, with the resulting discussions forming a basis from which stigma may be challenged (Levitt and Barnack-Tavlaris, 2020; Plan International UK, 2018). Here, scholars have emphasised the importance of normalising menstruation through conversation to create more positive attitudes and challenge misconceptions (Bobel and Fahs, 2020; Gottlieb, 2020; Johnston-Robledo and Chrisler, 2013). While Johnston-Robledo and Chrisler (2013) suggest that menstruators themselves have the responsibility to challenge negative attitudes, the way that these participants used their informal circles for knowledge-sharing and resistance implies that the challenge is to widen the conversation beyond menstruators to truly challenge menstrual stigma (Bobel and Fahs, 2020; Levitt and Barnack-Tavlaris, 2020; McLaren and Padhee, 2021). In our conversation, many participants expressed the desire to share their experiences and for non-menstruators to actively find out how to support them. The role of non-menstruators in challenging menstrual stigma is therefore important, suggesting that future research could build upon existing work into non-menstruators’ knowledge gaps and willingness to know more (Medina-Perucha et al., 2020). For example, Plan International UK (2018: 41) found that ‘boys were accepting of the fact that their knowledge was flawed in regard to menstruation, but were willing to learn more to become more supportive of their female peers’.

As well as facilitating greater discussion through educational events, participants called for the University to take initiative to address the needs of menstruating students through academic and practical interventions. Free period product provision, although seen as inadequate alone, was still acknowledged as an essential part of a wider approach to challenge stigma (Bobel and Fahs, 2020; McLaren and Padhee, 2021). Implementing further measures to support students requires looking into current provision and the potential feasibility of suggested interventions, accounting for participants’ anxieties – which included the fear of disclosing menstruation or of having to ‘prove’ levels of pain – and ensuring these do not inadvertently exacerbate existing inequalities (Levitt and Barnack-Tavlaris, 2020; Munro et al., 2021; Plan International UK, 2018). Tackling stigma requires disseminating accurate, accessible information that encourages discussion to counter the feminisation, privatisation and individualisation of menstruation (Allen et al., 2011; Plan International UK, 2018; Sang et al., 2021).

Essentially, this research highlighted how the different experiences of shame and stigma between transgender and cisgender participants must be considered (Munro et al., 2021). Future research should look specifically at the feelings and experiences of marginalised students, accounting for the intersections of culture, language, disability, class, and so on, and how their needs and coping strategies may differ to the unapologetic empowerment discourses circulating among some cisgender students (Bobel and Fahs, 2020, Munro et al., 2021; Phillips-Howard, 2021).

In this way, this paper does have its limitations; the small and self-selected sample cannot reflect the diverse menstrual experiences of the whole student body, affected by a wider range of intersecting factors than could be included within this research (Gottlieb, 2020). The participants were also part of a similar feminist social circle, potentially over-emphasising the themes of activism and frustration over silence and stigma. Furthermore, the group reflects interacting forms of privilege – primarily, white, educated and engaged students who did not have first-hand experience of period poverty. Such dynamics may have limited the disclosure of more intimate details such as feelings of shame. This emphasises the need for larger and deliberately diverse samples in future research, centring marginalised voices and considering how qualitative and quantitative data, or individual and group discussions, can be combined to enhance our understanding of menstrual stigma and potential institutional interventions.

Conclusion

Overall, this paper contributes to the growing field of literature regarding menstrual health, addressing an important gap in understanding the experiences of menstrual stigma among university students, especially in my immediate context of the University of Warwick. The research has found that students are increasingly expressing frustration towards an ongoing lack of understanding or support for the difficulties of menstruation, demanding greater support from the University itself. This suggests that discourses are moving beyond shame and stigma to highlight current institutional failures – although the ability to challenge negative assumptions and take an unapologetic attitude remains somewhat limited to privileged groups, such as cisgender students – a dynamic that requires further research.

Educational institutions must implement proactive measures to improve menstrual education, counter stigmatising assumptions and help menstruators mitigate the impact of menstruation on their wellbeing and academic performance. This research has highlighted how inclusive and considerate university policy is important for student wellbeing, performance and equality, and can help act against patriarchal gender norms and generations of silence and shame surrounding menstruation (Bobel and Fahs, 2020; Johnston-Robledo and Chrisler, 2013). Menstrual activism should constantly expand upon its rich and radical history, which means ‘thinking deeply about the root structures of menstrual negativity and taboo, and working to link the inequalities that surround menstruation to deeper stories about power and identity’ (Bobel and Fahs, 2020: 1014).

Acknowledgements

My thanks to my academic supervisor Marta Guerriero for her support throughout the module ‘Inequalities and Sustainable Development’ and feedback on this paper and accompanying presentation. I also thank the two anonymous reviewers of this paper, whose comments have been very helpful, and the editorial team of Reinvention for their feedback. I am grateful to my participants for their time and invaluable insights, to the Warwick Anti-Sexism Society and #EndPeriodPoverty campaign for their support, and to the Warwick Inclusion Conference and British Conference of Undergraduate Research for providing the opportunity to disseminate my results more widely.

Appendix A – Focus group discussion guide

Goals

• Understand students’ experiences of menstruation and their perception of the taboo surrounding it.
• Discuss ideas of how to tackle this stigma.
• See what students perceive the role of the institution in tackling this.
• Consider what actions do they believe will be the most effective? Is period product provision enough?

Introductions

• Firstly I would just like to confirm that you are all happy with me recording this session? Your data will be kept confidential.
• My name is Naomi, I am a second year GSD student conducting this research as part of a module I study about inequalities.
• The objective of this project is to investigate how students who menstruate at the University of Warwick perceive the role of the University and Student Union in responding to the ongoing stigma surrounding menstruation.
• Please reflect on the questions asked and the contributions of other members of the discussion, and feel free to ask your own questions as and when you think of them. You are not obliged to answer any questions, and if you feel the need to leave at any point you are welcome to do so with no adverse effect. You may also withdraw your data from this study for up to 1 week after this discussion, and if you wish to do so please contact me via my email or phone number.
• I would like to make this environment as safe as possible, so please be mindful of what you say, especially any sensitive topics such as stories of shame or stigma.
• Before we begin any questions, feel free to introduce yourselves to each other to facilitate the discussion.

Questions

• Firstly, can you give me three words that come to mind when you think about periods.

Existence of stigma

• Do you think there is still a stigma surrounding periods and period products?
• Can you see any links to broader systems of oppression or inequality? For example, how do you think attitudes to periods are linked to patriarchy (inc. the male gaze), gender norms (such as standards of femininity), racism, transphobia, classism, etc.
• What sort of positive attitudes to periods have you seen/heard? [in the media, amongst your peers, with your family, at university]
• What sort of negative attitudes to periods have you seen/heard? [in the media, amongst your peers, with your family, at university]

The university environment

• What do you find challenging or difficult about having your period? Do you avoid anything when you’re on your period and why?
• What do you do about these issues? What systems do you have to support you?
• Do you find the university to be a supportive environment?
• Do you have any thoughts or experiences regarding the shame and stigma that surrounds periods or period products, especially from your time at university?

Products

• What products do you feel comfortable using?
• Are there any that you feel uncomfortable using?
• Are there any that you would like to use but don’t currently?
• Has there ever been a time when you didn’t have a period product? What did you use? What happened? Why didn’t you have one?
• Where would you get a period product from if you needed? Who would you ask?

Response to stigma

• What would you like to see in terms of the culture and attitudes around periods?
• Do you know of anything the university is doing to address the stigma?
• Do you think the university is doing enough to address this?
• Do you think the provision of free period products is useful in tackling the stigma of periods? Does action need to go further?
• What do you think would be useful action from the university?

Conclusion

Thank you very much for participating in this discussion, I really appreciate it.

If any of the topics brought up have been sensitive or cause any distress, I would urge you to reach out to the University Wellbeing Services or your personal tutor.

I would like to remind you that you can still withdraw your data for up to one week after this discussion.

Appendix B – Framework for analysis derived from thematic coding of focus group transcript

To cite this paper please use the following details: Carter, N. (2024), 'Period Pain: Student Perceptions of the Ongoing Stigma Surrounding Menstruation at the University of Warwick and Potential Interventions to Counter Such Stigma', Reinvention: an International Journal of Undergraduate Research, Volume 17, Issue 1, https://reinventionjournal.org/article/view/1291. Date accessed [insert date]. If you cite this article or use it in any teaching or other related activities please let us know by e-mailing us at Reinventionjournal@warwick.ac.uk.