Article by Anupama Rajesh, Associate Vice President- Medical Content at FINN Partners
Original article can be found at https://www.finnpartners.com/news-insights/normalize-menstrual-health-period/
When I got my first period at age 11, my mother told me I was a big girl now and that I should be careful around my father and other male relatives. She said that the blood was “dirty” and I was dirty too. Then, she listed several do’s and don’ts: don’t enter the kitchen or the temple, eat from a separate plate, wash your clothes separately and sleep on the floor in a room separate from the rest of the family. At that age, I felt isolated and humiliated as everyone seemed to believe I was “dirty.” At that very moment, I realized things would never be the same again. Many women similarly remember their first period and, for most who do, the shame and stigma attached to menstruation is an indelible experience.
Menstruation, like respiration or digestion, is a natural and normal process. Did you know that the cumulative days of this monthly cycle from menarche (first menstruation) to menopause add up to nearly seven years of a woman’s life? Globally, on any given day, over 800 million women (15-49 years) are menstruating.
Breaking the taboos about menstruation is a key need throughout the world and several organizations are working to change mindsets. With cultural and religious beliefs deeply intertwined with menstruation and the practices surrounding it, increasing awareness and facilitating open conversations are important steps toward driving change.
India has the largest adolescent population in the world with 116 million girls (10-19 years). Despite the universality of its occurrence, menstruation is often shrouded in mystery and considered shameful. Additionally, it is associated with several restrictions. Menstruating girls are not allowed to enter temples and kitchens or participate in religious ceremonies. In some regions, they are prohibited from watering plants, placed on a restricted diet, and socially isolated. These restrictive practices prevent them from accessing health services when problems related to menstruation arise. Moreover, for many, menstruation is associated with pain and mood swings as well as depression, anxiety, and stress, making tackling these issues difficult.
Cultural beliefs, knowledge, and practices all combine to make menstrual hygiene management key to ensuring a woman’s well-being. Though the Government of India has made significant inroads in this matter via its dedicated programs, an analysis of the National Family Health Survey-5 (2019-2021) showed that the use of a hygienic method of protection was much lower in adolescents (15-19 years) with less education, from poorer backgrounds and rural areas, and those who were married.
Combating the obstacles that directly impact women’s dignity and health require a multi-pronged approach. Increasing awareness, changing mindsets, promoting hygienic practices, and ensuring appropriate disposal of used menstrual products can help in moving the needle on this issue.
1. Raising awareness
Though breaking sociocultural barriers of “being impure and unclean” is not easy, raising awareness about the normalcy and importance of menstruation is necessary. A study conducted in South Asia showed that nearly three out of 10 school-going girls had not heard of menstruation before their menarche, and nine out of 10 girls were not aware of where menstrual blood comes. Even though mothers are the primary point of contact for advice on menstruation, nearly seven out of 10 mothers believe that menstruation is dirty, which further hinders open dialogue. Boys, girls, and all family members (especially mothers) must be sensitized towards menstruation and its impact on women. Along with awareness, social practices that communicate menstrual stigma, shame, and silence should also be addressed. One such step has been taken by Menstrupedia, which provides accurate information and normalizes menstruation through a comic book. A more concerted effort must be made to reach out to girls who do not attend schools, mothers, uneducated women, and those residing in rural areas and marginalized communities. Several NGOs are working at the grassroots level in this regard, but a strong approach is needed to offer accurate information in a culturally sensitive manner.
2. Building community leaders
Changing the belief system of communities is pertinent in combating deep-rooted social beliefs. It is important for men to have equal knowledge about menstruation so they can support their wives, daughters, mothers, students, employees, and peers. In some cases, community leaders who can influence mindsets can be leveraged to spread accurate information and combat restrictive practices. Women within the community can also be trained at the grassroots level to reach out to other women to ascertain their difficulties and offer solutions.
3. Getting the basics right
Access to affordable sanitary materials is an issue with nearly 88% of menstruating women in India using old fabric and rags to manage their monthly flow. The use of unhygienic materials has led to reproductive tract infections (RTIs) being 70% more common in these women. On the other hand, nearly 63 million adolescents do not have toilets at home whereas 40% of schools do not have a separate toilet for girls. Along with the use of menstrual products, there is an urgent need for a suitable environment which allows girls to clean, change, and dispose of menstrual waste. The lack of privacy often leads to unhygienic practices that aggravate the problem.
Building clean restrooms with continuous water supply in both schools and homes, providing spaces for drying reusable menstrual materials, and ensuring the accessibility and availability of sanitary napkins, even in emergency situations are steps in the right direction. Community organizations are engaging rural women in sanitary napkin-making units to boost their knowledge and provide a source of livelihood. This can be further expanded with the help of private players, potentially increasing affordability. If produced across multiple units, the subsidized sanitary products can overcome accessibility barriers too. These along with WASH (WAter, Sanitation, and Hygiene) and menstrual health management awareness campaigns, can collectively help improve menstrual health outcomes.
4. Appropriate disposal
Inappropriate disposal of sanitary napkins can be hazardous to health and the environment. Women need to be taught about the right ways to dispose of menstrual products (e.g. do not flush pads down the toilet). The development of natural (e.g. made from materials like banana fiber, bamboo fiber, etc.) yet affordable sanitary products needs to be prioritized.
A natural process like puberty profoundly affects every aspect of a woman’s life: her potential to study, work, and contribute to society. A simple thing that we often take for granted can change the way women think about themselves and their futures. From changing mindsets to making affordable and natural menstrual products widely available, an integrated and compassionate approach to menstrual health by various stakeholders is imperative for a woman’s personal hygiene which, in turn, empowers her and lends her dignity.