For the April 2025 episode of the International Gender Champions podcast, we are joined by Dominic O'Neill, Executive Director of the UN's Sanitation and Hygiene Fund, and Dr. Ally Zlatar, feminist artist, scholar, and activist, as well as one of IGC's 2024 Youth Champions. They discuss why menstrual health should be an integral part of the sustainable development agenda, break down myths, spotlight systemic gaps, and share how market-driven solutions and policy change can drive menstrual justice.
TRANSCRIPT
Hannah Reinl
Hello and welcome to a new episode of the IGC podcast. My name is Hannah Reinl, and I’m with the International Gender Champions Secretariat in Geneva. Today, we will be looking at the topic of menstrual health and it’s often overlooked, yet undeniable connection to the United Nations’ Sustainable Development Goals. And for that, it is my pleasure to welcome today’s guests - Dr. Ally Zlatar and Dominic O’Neill.
Dr. Ally Zlatar is an artist, scholar and activist. She is the founder of The Starving Artist, an artist initiative that utilises creative voices as a way to create advocacy and systemic reform. She also founded the Starving Artist Scholarship Fund, which helps people access inpatient mental health treatment. Ally uses her art as a tool to delve into the complexity of the human experience, focusing on vulnerability, and authenticity. Her work – which received numerous accolades - navigates the intersection of art and activism, aiming to spark dialogue and create societal impact. It draws from personal experiences and auto-ethnography to drive change. In 2024, Ally was selected as one of our ten IGC Youth Champions.
Ally, welcome to the IGC podcast!
Dr. Ally Zlatar
Thank you so much for having me. I'm very excited to be here.
Hannah Reinl
And our second guest is Dominic O’Neill, Executive Director of the UN's Sanitation and Hygiene Fund (SHF) since its inception in 2021. Dominic has a long-standing career spanning over three decades in international development and environmental health. This includes working for the Ministry of Health in Namibia in his early career, the UK Government as a senior civil servant in the Department for International Development serving as Country Director in Yemen, Sierra Leone, Nepal and as Head of UN funding in DFID, Upon leaving the UK Government, Dominic took up the role of COO for WWF International. He also served as an Executive Director on the Board of the African Development Bank representing the Governments of the Netherlands, the UK and Italy from 2013 to 2016. Deeply committed to inclusivity and gender equality, Dominic became a member of the International Gender Champions Network in 2024.
Dominic, thank you so much for joining us today!
Dominic O’Neill
Thank you and nice to meet you, Ally.
Hannah Reinl
Let’s start with a fundamental question: How does menstrual health connect to the Sustainable Development Goals (SDGs) and why is it so often overlooked in global development discussions?
Dominic O’Neill
It's incredulous, actually, that there is actually no mention to menstrual health and hygiene in the SDGs. There is a vague, passing reference to women's health and hygiene, but certainly not the words menstrual health and that's in SDG 6.2. The fact is, women and girls menstruate for roughly 35 years of their lives. And so it's an issue that actually permeates into every single aspect of human development, whether it's going to school, work, health, growth opportunities, personal and career opportunities, and a woman's ability to manage their menstrual health in a safe, hygienic and dignified way goes to the fundamentals of human development. So it actually is something that has been woefully overlooked and when I've had discussions about it with senior leaders, both senior men and women leaders in development, they've also have seen the light bulb moment as to how did we miss this? As we were putting together an SDG for education, for health, for economic participation, for gender equality, how did we not mention and address this fundamental issue? As of today, 600 million girls and women in low and middle income countries rely on non-purpose made materials. That is basically, we're talking about the use of rags, of paper, sometimes even leaves, to manage their menstrual health and their periods. That's not okay. This is a problem that we can solve, that should have been addressed long, long ago. And so we're putting it at the forefront of our approach at the SHF. And as a fundamental part of SDG 6 for water, but also the SDGs for health, gender equality, education and economic empowerment.
Hannah Reinl
Thank you, Dominic. And as you said, I know you and your team have been working really hard to bring this issue to the heart of the international discussion. Ally, what are your thoughts on this question?
Dr. Ally Zlatar
I mean he really highlighted a lot of the key points, but I also really want to touch on the fact that when we're looking menstrual health, it actually affects and is very intersectional in a lot of the different SDGs. So I'm thinking about SDG 4, for example, that's quality education. So when we think about the lack of menstrual hygiene facilities, whether it be in schools or workplaces, it actually increases dropout rates and then it even effects school attendance, academic performance. or other areas that we see directly within SDG 5, which is gender equity. And yet, as a very pivotal gender based issue, we don't necessarily talk about the fact that menstruation stigma is impacting both the economic opportunity, social participation, other issues such as body autonomy. All of these are fundamental to empower women and girls, and yet we're not ensuring the accessible resources and spaces to facilitate the exact goals we're looking for.
Hannah Reinl
So you both addressed menstrual health and period equity through your work. You're coming from very different angles and I'm looking forward to hearing more from each of you. What are the common misperceptions, the stigmas, the cultural taboos that you have encountered in doing this work?
Dr. Ally Zlatar
There's quite a few, but within what I try to do is use that as a space to kind of have the alternative discourse. So, when we think about menstruation it's often something that has to be done in secret and people don't want to admit if they're on their period or not, or else people will associate that with they're in a bad mood or they may be gross or unhygienic. This, again, is deeply stigmatising the topic. And when we're really trying to understand the different cultural taboos, there's so many different ones that I've personally encountered through some of the work. So when I was doing a project in Thailand and Taiwan, I actually learned about the concept of period huts, in which several countries, including Nepal, for example, Nepal is one of the largest that have this concept, in which young girls are sent off to these remote huts and they have to endure their period in isolation.
Photo 1: Installation view from "A Glimpse Behind The Blood", an exhibition of Ally Zlatar’s work at The Redhouse, Taiwan
And so while we do know that there's some very apparent cultural taboos, there's also just the lack of comprehensive data on what is this impact and what are the actual stigmas. I think also, menstrual health has kind of also been overlooked in the misconceptions about its impact. So we think about menstruation as perhaps like, oh, someone's on their period two or three days a month. Oh, no., it's going to be the time when they need to have ice cream. But in fact, there's such a wide range of menstruation issues such as endometriosis, which I believe affects one in every 5 to 10 women. This is something that affects women for their whole entire lives, and yet it's not covered in in any healthcare treatments, especially within the NHS. So again, we really get to see that there is this very limited understanding, but then also there's this lack of space to actually talk about these issues.
Hannah Reinl
What about you, Dominic?
Dominic O’Neill
I approach this subject with humility because I know I have no firsthand knowledge. What I can talk about is the dehumanising actions where women and girls are essentially sent to a cow hut. And there's been a lot of work to deal with that. Or even in in West Africa, where it isn't just the management of the hygiene aspects, but it's also the signal within society that actually a girl is becoming a woman, but she's still a girl and has a whole load of expectations put on her by society in terms of being ready to have babies. So there's a whole load of support that is needed, but let's also remember this is not just an issue of the Global South, this is an issue for the whole world. And some of the conversations I've had that I alluded to earlier with, for example, a former French minister, who I won't name, but I started talking about this issue as a man with the limited knowledge that I do have. I was there with three or four colleagues and we actually had a very fundamental discussion about their experience, their experience of their daughters. And actually as a man coming in to talk about this, it does tend to lift some of those taboos. That okay, well, we need to talk about this because I don't think anybody is talking about it. Because of the social taboos in the Global North, in the Global South, in different types of countries, societies and cultures. So I think it is time to talk about it. It's time to talk about the gender equality, the human rights issues around it. It's time to talk about the solutions. How do we get affordable, safe, sustainable products to the women and girls who need them in sufficient quantity? I think there's a lot of work to be done and we've come quite a long way, but there's a huge journey to go.
Hannah Reinl
Thank you, Dominic. And I believe it was your colleague who coined the phrase to bring the topic from the bathroom to the boardroom, which really resonated with me at the time. So we will be hearing a bit more about SHF's work on that in a second. But Ally, if you can hear from you first - you have approached the topic of period equity through your feminist artwork and your activism. Can you tell us a bit more about that?
Dr. Ally Zlatar
Yeah, absolutely. So for me, and the starving artist, what we're really rooted in is using art as that catalyst for dialogue awareness, but then also really trying to ignite systemic change by understanding the lived-in experiences of those who menstruate. So not only is it trying to tackle some of those stigmas and taboos, but really trying to understand the communities that they're serving in order to make policy and infrastructure changes that are truly understanding the needs of those communities that they're trying to serve.
So one great example is a project that I've done called “Blood Stains Like Ink”. It's featuring over 30 international artists that are all sharing their experiences with menstruation equity. So each one kind of brings their own art voice and experience Say artists like Izzy Sneed, she does those very traditional, like embroidered textiles that look at different forms of like menstruation. Or another artist that we did work with was Madeline Kay and she really highlighted the fact that they don't know how much pain goes on behind the scenes, so it's not just the blood, but it's both the psychological and physiological experiences. We do this, again, not just through traditional exhibitions and art, although beautiful, it's not just the artwork on a gallery wall, but instead we also use art as a tool to help people understand their own experiences. So we do this through education and workshops so we do this by really opening up dialogue on how people are experiencing their own health and well-being and using art as that exploratory space.
"The Holy Period", Ally Zlatar, 2022. Acrylic on canvas
And then also I think that we do this through policy engagement. So again, not every person who menstruates is included in policy discussions. So what we try to do is bring those voices for the people who need to hear it. And sometimes it's also trying to highlight those who have been neglected from these conversations. So while there be language, financial, socioeconomic hurdles, we really try to bring those, say, people who not just come from Global South, as we mentioned, but say those who are trans and non-binary individuals who are menstruating, or those who are refuge seeking or come from low income backgrounds. Including especially those who are disabled- bodied, because we need to have more intersectional strategies that include the diversity of people that are experiencing these issues. I rant, but again, I'm just really passionate about it. So art for us is really just trying to break that silence and shift these attitudes to see more tangible change that that is really rooted in dignity and then also just genuinely understanding and caring about it. And for us, it's art that really allows us to do that conversation shift.
Hannah Reinl
And really approaching it through an intersectional lens, as you said, right, that is so important. Dominic, you and your colleagues at the SHF are promoting a market-based approach to mental health and initiative, which I know a number of our Gender Champions are supporting as well. What is your vision for accessible and affordable mental health and how do you go about implementing this vision?
Dominic O’Neill
If I can just address Ally’s super important point about the issues of diversity around this issue and there is a risk that people get excluded from the discussion, and that their needs aren't fully addressed. It's something that we need to keep close in mind and ensure that anybody who menstruates gets the adequate support that they need.
Our vision is that every woman, girl, menstruator anywhere is able to walk into a nearby store, find a safe quality and affordable menstrual product of their choice and that they need in order to manage their period for the entirety of its duration. A lot of the advocacy and social mobilisation that needs to go into that other organisations are doing that. That is a prerequisite for our work. Our work does not happen unless there has been that education, the mobilisation and the advocacy.
What we found was that that was a niche that was missing. You know, people being made aware of the need, of the opportunities, but the products weren't being made available. So to do this, we are working with governments, with business, with investors to create the conditions so that what we call the menstrual health marketplace can grow and thrive.
This includes quality standards so that women and girls can know and trust the products that are there on the shelf. It includes international trading codes, which may seem obscure, but actually we just don't have the information about the flow of goods across borders to know what is being purchased, what's moving around and where does investment need to happen. We're looking at taxes and tariffs and levies, so in order to lower the costs for users and providing the support to businesses who want to get involved in providing MH products, but they may need some start up financing, some initial investment to get started.
A lot of these ideas are happening, there's some excellent ideas and examples around the world. We need to go to scale now because these are good, but there is nothing that is yet operating at the necessary scale, in particular, our focus on the 600 million women and girls in lower and middle income countries who have that urgent need today. We need governments to work together and so we're working closely with the community here in Geneva, with the World Customs Organisation, the World Trade Organisation, International Trade Centre, all of those multi-country and multi-government partnerships, who can all take the actions necessary to create a much more conducive environment. We're talking to investors to make them aware of the social impact as well as the investment opportunity within menstrual health. Ultimately, as you mentioned, to take menstrual health from the bathroom into the boardroom, so we can combine, you know, social needs, social goods, with impact investment and actions taken by government to free up whatever investment is required so that the products are available.
Hannah Reinl
Thank you for sharing that, Dominic. So let's make 2025 a year to scale up impact and elevate ambition.
So I have one last question for both of you. How do you think decision-makers such as our International Gender Champions- can use their sphere of influence to promote menstrual health and menstrual justice?
Dominic O’Neill
It starts with conversations like this - starting to break down the taboos as Ally described and does in such a wonderful way to get people talking about understanding the issues that and the fundamental needs in order to do this. We need to show this as an investment opportunity, at least we can have viable business models where employment opportunities can be created. But it all starts with cooperation, with an empathy for the needs of those people who are not given the current support. And looking at this as a fundamental part of our approach to development and not looking at it as a niche issue around gender equality. It is health. It is gender equality. It is education. It's economic empowerment. It's all of those. And quite frankly, we should have done this twenty, thirty, forty years ago. It's incredulous that we're only dealing with it today in the way that we are.
Hannah Reinl
Any parting words from you, Ally?
Dr. Ally Zlatar
My gosh, I mean, Dominic touched on so many good points, but I'm just going to try to reiterate the importance of both policy and legislative action. So I spent a lot of time in Scotland teaching at the University of Glasgow and Scotland is one of the very few that have groundbreaking policies such as the Period Products Act, in which there's free menstrual products within schools, workplaces, even prisons in in some regions.
But realistically, if we can start with tax exemptions or reducing- there's something called the pink tax in which often female goods that are essential for health are taxed heavily because it’s female-oriented.
Other ways that we can do this is really through education and awareness. So both through campaigning, so artists, activists, educators, in whatever forms can work together with different platforms or media presence to really help amplify some of these issues.
The other thing that we've also highlighted on this brief chat is the need for more research and data collection. Because menstrual health has been neglected from SDG progress reports, for example, we don't really have a lot of spaces at the global forum level that really address the menstrual health as a fundamental human right and as one of the core development issues.
In brief, I think what we should do is look at different ways that we can have multi-sector collaboration to create holistic solutions and ones that are really centred around engaging, let's just say, all the strengths of each institution. So governments, healthcare, education, even the private sector like Dominic mentioned to really address the support that women need.
I think one great quote to kind of summarise all this was by Judy Grahn and I may butcher it, but from what I remember, she says that menstrual blood is the only kind of blood that is not traumatically induced. And yet in modern society it's the most hidden blood. So it's the one that's never really spoken of and almost never seen, except for privately by women. And that's exactly why it's been neglected from our global conversations for far too long. So I think, real change takes time, and if it was easy, it would already be done. But we do need this call to action to help everyone bring their strengths to really address one of these most pivotal but under-talked about issues at the global level. Very, very big call to action, but again, it's really important, so I do also appreciate the time and space from both of you guys and hopefully our audience now feels the same passion that we all do.
Hannah Reinl
We do love to end with a good call to action. Ally, Dominic, thank you so much for joining us today and for sharing your important work with us.
Learn more about the SHF's work on menstrual health markets: https://www.shfund.org/what-we-do/menstrual-health-market