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.
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
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