Menstruation is one of the most crucial biological processes of the reproductive cycle that is surprisingly surrounded by myths and taboo, so much so that it is not considered to be suitable for open discussion. India’s 113 million adolescent girls are particularly vulnerable at the onset of periods. This is when they need a safe environment that offers protection and guidance to ensure their basic health, well-being and education.
The lack of a separate and usable girls toilet in schools and a toilet at home leave adolescent girls and women to face the indignity of open defecation. However, safe and effective menstrual hygiene management, or MHM, is a trigger for better and stronger development for adolescent girls and women.
Menstruation continues to be a subject of gender disparity in India. Myths about menstruation are largely prevalent, forcing many girls to drop out of school early or be ostracised for the duration of their menstrual cycle every month. In some cultures, women and girls are told that during their menstrual cycle they should not bathe or they will become infertile, look in a mirror regularly or it will lose its brightness, or touch a plant else it will die, or touching some food item or it will perish!
There is no scientific evidence behind these beliefs but these have been inculcated in the minds of the young girls to the extent that they believe these to be right. They even believe in the concept of ‘impurity’ during the time they menstruate and so refrain from entering religious places.
According to a UNICEF report, in 2014, Tamil Nadu had 79% girls and women who were unaware of menstrual hygiene practices. The percentage was 66% in Uttar Pradesh, 56% in Rajasthan 51% in West Bengal. This explains why when girls attain puberty, especially in rural India, they drop out from school that highly affects their future. This is further paired with lack of adequate menstrual hygiene that comprises of availability of disposable sanitary napkin and menstrual health care.
Further lack of awareness makes this even more complicated. In most of the cases, the mothers are themselves unclear about what menstruation is, how it is to be explained to a teenager and what practices could be considered as menstrual hygiene management. Schools in rural area have not been not very helpful as they refrained from discussing menstrual hygiene. Although the cities have now taken initiative in creating awareness, it has been observed that the teachers do not find it comfortable to discuss this in class openly, especially in co-ed schools. A 2015 survey by the Ministry of Education found that in 63% schools in villages, teachers never discussed menstruation and how to deal with it in a hygienic manner.
All these points make us realise that discussing and attaining proper menstrual health care is absolutely indispensable for the development of women. This can be discussed in various steps like the health concerns, cleanliness and sanitisation and a healthy sexual and reproductive life.
It is very important to understand that the process of menstruation, though common, takes the body through major hormonal changes. The continuous bleeding for 4-5 days induces substantial pelvic pain and discomfort, sometimes leading to complete lack of activity. Not only does it tire the body but also the mind. Sometimes, it gives a feeling of helplessness and not being able to concentrate on anything else. This is what needs to addressed properly.
The pain is real and it will get better with rest. If time and schedules do not allow for it, that then it is important to be hydrated and eat nutritious food to counter it. A hot water bag or a heating pad is a good way to relieve the pain. Here, it becomes extremely important that those who do not menstruate be sensitive towards the entire process.
Certain practices like usage of cloth pads that are not properly clean, not changing sanitary pads frequently, improper usage of tampons, not washing hands properly before and after changing pads may lead to grave ailments. Other problems associated with menstrual hygiene are anaemia, prolonged or short periods, infections of reproductive tracts, as well as psychological problems such as anxiety, embarrassment and shame. Hence, it is essential to ensure the following is fulfilled for proper menstrual hygiene:
1) Access to sanitary napkins,
2) Access to period medication,
3) Water sanitisation and responsible disposal,
4) Information and knowledge of the menstrual process in schools and communities,
5) Family and social awareness, and
6) Support policies and guiltiness by the government.
If each of these simple steps are followed diligently, it would instill a sense of dignity and confidence for women.
The next important aspect in menstrual health and hygiene management is cleanliness and proper sanitisation. In the present scenario, wherein the environment has been grossly affected by non-biodegradable materials, sanitary napkins too contribute towards this. However, banning disposable pads is not the solution unless an equally effective substitute comes up.
Also, it is really surprising to note that out of 355 million menstruating women in India, only 42.6 million have access to sanitary napkins, which is a measly 12%! Recently, the idea of menstrual cups has been popular with the urban population with some of its promising features like being reusable, secure and bio-degradable attracting many towards using it. However, it is still not suitable for younger girls because it needs to be inserted in the vagina and if not done properly, may lead to injury. Tampons are easier to but comes with a huge risk of infection. Hence, sanitary napkins still remain the best option for many.
Next, it is important to understand that menstrual cycles inflict a series of stress and anxiety accompanied by pre-menstrual syndrome in a number of cases. It becomes really demotivating to deal with all of these and hence, the role of men here is crucial. It is not ‘a tough job to deal with the mental state’ of a menstruating person with care and patience. Additionally, sexual awareness in this case needs to taken care of specifically. Sometimes, sexual intercourse during periods can lead to the infection of the urinary as well as the reproductive tract. While the urban population may be well aware of such issues, it must be addressed with the non-urban belt as well.
Adequate menstrual hygiene instills health, confidence, self-esteem and a sense of empowerment in women. The government’s role in supporting innovative and sustainable solutions to manufacture and distribute low-cost, yet high-quality sanitary pads and addressing the problem of disposing menstrual waste in an environmentally safe manner has to be major. Ensuring menstrual hygiene for girls and women should be one of the developmental priorities which calls for urgent and intensive action from all relevant stakeholders to change the scenario of menstrual hygiene in India.
There is also an emerging need for development of indicators under Swachch Bharat Mission Guidelines to measure the extent of achievement in MHM in India. Setting up realistic targets to indicate successful implementation of existing policy and programs would be a welcome move for providing basic hygiene and reproductive facilities to girls and women.