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Anaemia Among Menstruators Is Easily Preventable And Treatable By Following These Steps

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This post is a part of Periodपाठ, a campaign by Youth Ki Awaaz in collaboration with WSSCC to highlight the need for better menstrual hygiene management in India. Click here to find out more.

What is anaemia?

Anaemia is an indicator of both poor nutrition and poor health. It is a condition of the blood that occurs when the number and size of red blood cells is insufficient. Red blood cells contain the iron-rich protein haemoglobin, which is necessary for transporting oxygen from the lungs to the cells and tissues. When your haemoglobin concentration falls, the oxygen-carrying capacity of the blood decreases, resulting in symptoms such as fatigue, reduced physical work capacity and shortness of breath, among others.

What is the most common form of anaemia?

Iron-related anaemia is the most widespread nutritional disorder in the world and causes about 50% of anaemia cases. Women are at a greater risk of becoming iron deficient because they have much lower iron stores than men and incur additional iron losses during menses. Adolescent girls or women who become pregnant have a significantly higher need for iron during pregnancy, which can substantially increase risk of iron deficiency anaemia.

What are the signs and symptoms of anaemia?

Anaemia can range from mild to severe with a range of signs and symptoms. Some common symptoms of anaemia include fatigue, weakness and difficulty in concentrating, brittle or spooned nails, pale skin, cracks at the sides of the mouth, coldness in the feet and hands, shortness of breath.

Iron and Folic Acid Supplementation programme in progress in school. Image has been provided by the author.

How does anaemia impact adolescents?

Anaemia reduces energy levels and can compromise the work potential of a person. As a result of anaemia, adolescents may face decreased school performance and loss of productivity. It can also have negative reproductive outcomes for an adolescent mother and her infant.

 What are the ways of preventing anaemia in adolescent girls?

In addition to taking weekly iron and folic acid supplementation (WIFAS), simple steps such as consuming iron-rich diets, adopting healthy eating practices, consuming staple foods which are fortified with iron, and being physically active, can all help in keeping anaemia at bay.

Clarifying Queries On Iron And Folic Acid Supplements

What are iron and folic acid supplements? 

Iron and folic acid supplements or IFAs are oral supplements recommended by the World Health Organisation as a preventative public health intervention for adolescent girls and menstruating women living in areas where the prevalence of anaemia in adolescent girls and women of reproductive age (WRA;15-49 years of age) is 20% or greater. Weekly iron and folic acid supplementation (WIFAS) is a strategy adopted to ensure regular and wide consumption of iron among those who are most vulnerable to anaemia.

 Why are WIFAS important for adolescent girls?

Adolescence is the period with the second highest rate of growth in a person’s life, second only to infancy. A human being has greater nutritional needs during puberty than any other period of life. One much-required nutrient is ‘iron’, which is needed for expanding blood volume, development of lean body mass, as well as counteracting menstrual blood loss in females. Through iron folic acid supplementation, adolescent girls can get their required quantities of iron, which can help prevent and reduce anaemia.

Is it safe to consume IFA by adolescents?

Yes, IFA are safe to take once a week.

Is it safe to consume weekly IFA over long time periods?

Yes, it is safe to consume weekly IFAs over long and/or multiple time periods. The current weekly formulation is well below the weekly upper limits set by the institutes of medicine.

Are there any side effects associated with WIFAS?

There are some side effects associated with WIFAS, which may include black stools, nausea, constipation, abdominal cramping and vomiting. However, these side effects are typically reported only in the first few weeks and normally decrease over time.

How can the side effects be managed?

Side effects have been most associated with taking the supplement on an empty stomach. Thus, to reduce the chances of side effects, it is best to take the supplement within two hours of consuming a meal.

Do WIFAS help regulate menstruation?

Girls who are underweight and gain weight may experience increased regularity in menstruation or return of menstruation if periods were absent. However, there is currently no evidence that links iron supplementation with improving or influencing menstruation.

Should we screen for anaemia before starting WIFAS?

Since WIFAS is a preventive strategy, adolescents need not be tested prior to receiving weekly supplements. However, it is advisable in case one presents signs and symptoms of anaemia, they should be referred to a local health centre for follow-up, to be assessed and given treatment as appropriate.

Is WIFAS for treating anaemia?

WIFAS is a public health strategy recommended by the World Health Organisation that has been adopted in many nations to prevent anaemia among adolescent girls and pregnant women. It is not a treatment procedure given to a person identified with symptoms of anaemia.

What happens if a girl does not take IFA?

Girls do not need to be or appear sick in order to take WIFAS, as it is not a treatment for anaemia and is only a preventive strategy. All girls without any specific medical conditions are recommended to take WIFAS as a preventive measure against anaemia and its negative consequences. While taking WIFAS is completely voluntary, if a girl chooses not to take the supplement, she may be at a higher risk of anaemia and its associated consequences.

What are the common myths associated with IFA tablets?

Some women and girls refrain from taking IFA tablets as they think they will get fat or have problems in conceiving. Many pregnant women also believe that consuming IFA during pregnancy will result in the birth of a dark-complexioned child. However, all these are myths and must not be believed.

Are IFAs a contraceptive?

No, IFA is not a contraceptive. The formulation contains iron and folic acid that are not contraceptive agents. A girl can still become pregnant while taking IFA supplements as it is neither a reproductive tool nor a family planning method.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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