Menstruation-A Culture of Silence

It is no wonder then that different societies across the world perceived it differently and have attached a lot of significance to menstruation. Modern Indian society is still not comfortable talking about it and there is a culture of silence around it. The topic of menstruation is often embroiled in controversies such as temple entry in the recent past. In our country menstruation and practices related to it are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls and women still unable to share their difficulties and problems related to menstrual management. Many of them remain ignorant of the scientific facts, essential hygiene aspects of menstrual management and also of the modern day options available. Poor Menstrual Hygiene often leads to reproductive tract infections and many other health conditions.

28th May is celebrated as world menstrual Hygiene day every year. There is a reason behind it. The menstrual cycle occurs every 28 days and lasts for 5 days every month in humans. Hence it is easy to remember 28th May which is the 5th month of the year.

Myths and taboos associated with Menstruation

The most prevalent and common myth about menstruation is that it is impure. Baseline data from a study conducted by UNICEF reveals that girls, teachers and Front line health workers found the religious restrictions to be ‘fair’. They did not burn their used sanitary napkin or clothes due to a common belief – ‘burning of menstrual clothes leads to the abrupt end of menstruation; inability to conceive; and miscarriage’. These findings also reveal that the process of menstruation and the physiological changes that occur are often an informational black hole – not only for adolescent girls but also for the influencers around them.

There is unanimous belief that the cloth should be disposed in a manner that nobody can see it, so that it is not embarrassing as well as to prevent the harm that can come from having the cloth exposed to black magic. Menstruation is perceived to be an impure process, and by extension the menstruating woman is impure as well. Shame and embarrassment with regard to menstruation

leads to a ‘culture of silence’. Menstruation marks the end of childhood for girls and is accompanied by restrictions – social, religious and educational which set a prescriptive behaviour accompanied with feelings of fear, frustration, guilt, privacy and secrecy.

Menstruation and School dropout rate

There is a direct correlation between menstruation and school dropout rate. Majority of adolescent girls miss school for a few days during their menstrual cycle due to pain or fear of staining. The fear and embarrassment felt during menstruation contributes to school absenteeism and dropouts. Those who do attend school during menstruation do not use the toilet facilities in the school for changing due to lack of water, dustbin to dispose the cloth or napkin etc. According to the National Family Health Survey (NFHS) IV 2015-16, around 62% of the young women aged between 15 and 24 still use cloth for menstrual protection. According to this report, an astonishing number of women in Bihar – 82% of them – still depend on cloth when they are on their period. The report finds that better and more hygienic methods of menstrual hygiene are directly linked to education and wealth. There is evidence that "women with 12 or more years of schooling are more than four times as likely to be using a hygienic method as women with no schooling at all. Similarly, women from the highest wealth quintile are more than four times as likely to use a hygienic method as women from the lowest wealth quintile".

Current Practice

According to NFHS IV(2015-16) Only 31% girls and women aged 15-25 in Bihar use any hygienic method of protection during their menstrual periods (Urban: 55.6% Rural: 27.3%). Cotton cloth is the preferred option for menstrual hygiene because it is believed to be more absorbent and comfortable to wear, and is sourced from old clothes and other material in the home. Many of the adolescent dispose of the cloth after each use; while others wash and re-use the cloth, throwing it away after the menstrual periods is finished. While drying in direct sunlight is preferable, many girls do not necessarily follow these prescriptions because they do not want anybody to see the cloth. The spaces where the clothes are washed are often hidden away as well, not very clean. Clothes are often buried, either in a place far away from home or in the fields that are used for defecation, or wrapped in a plastic bag and thrown where other rubbish is disposed off. Use of sanitary napkins is offset by high cost factor.

Factors that influence the adoption of sanitary napkins

 A family member who is more exposed and lives, or had lived; in a more urban area is often the avenue of introductions to sanitary napkins .The relatives’ endorsement of sanitary napkins seems to help overcome the fear of experimentation with respect to menstrual hygiene

 Mothers are often introduced to sanitary napkins at the primary health centre if and when they go in for institutional deliveries

 Easy access to markets or retail outlets for sanitary napkins (Medical Shop, Beauty Parlour)

Girls who used sanitary napkins preferred them over cloth because they believed that they were less hassle, didn’t need washing or drying , didn’t shift and were more comfortable

Purchase of sanitary napkins

 In 2010-11, merely 12% menstruating females in India were reported to be using hygienic menstrual absorbents[1]. This has increased to 58% of 15-24 year old girls and womenin India using a hygienic method of protection during menstruation in 2015-16[2]. This figure is still relatively low at 31% for Bihar (56% for urban and 27% for rural Bihar)[3].

Most of adolescent girls did not go and buy sanitary napkins for themselves, a male member or a child in the family is sent to get the pads from the store.

Many girls feel uncomfortable about buying from male retailer and try and avoid the visit to the store. Groups of girls go to the store on their way to or from school – and take some comfort in their numbers to get over the hesitation of asking for sanitary napkins. Even the store keeper feels uncomfortable selling them, hence he wraps  it in a paper and gives it to the purchaser.
Government Schemes on Menstrual Hygiene
Even though there are a plethora of schemes run by the Government of India and various State governments in 60:40 fund sharing basis, there is a need to converge all efforts by different stake holders and increase access to information and knowledge, access to low cost products and access to WASH facilities. Some of the programmes run on 60:40 basis are Government of India sponsored Rastriya Kishori Swasthya Karyakram (RKSK), for out of school girls, Swachh Bharat Mission (Gramin), Swach Bharat Swach Vidyalay Abhiyan, Scheme for adolescents girls (SAG) to spread awareness on health, hygiene, nutrition and life skills. Whereas the Government of Bihar provides Rs 300/ anum to school going girls for purchasing sanitary napkins under Mukhya Mantri Kishori Swasthya yojana (MMKSY) as a sub component of Mukhyamantri Kanya Uthhan Yojana.
Way Forward
Adolescents (10 – 19 years) in Bihar comprises of 22.47 percentage of its total population (Census 2011). Of the total adolescent population 59.50 percent belongs to the 10-14 years age group and about 40.50 percent are in the 15-19 years age group. Females comprise nearly 46 per cent and males 54 per cent of the total adolescent population. Hence it is important to have a policy on comprehensive adolescent health and well being. Convergence of efforts by all stakeholders, relevant departments, NGOs and International organizations is much required. Production of low cost sanitary napkins and social marketing by small enterprises and Jeevika groups should be the way forward. Sanitary napkins should be made available at the school premises itself so that girls can use the money under MKUY meaningfully. Increase access to information and knowledge through various IEC activities and involve parents and adolescents in the awareness campaigns. As the world is now going through Covid 19 pandemic it becomes all the more important to understand and pay attention to menstrual hygiene management.
Let us resolve and ensure better hygiene practices for all adolescent girls and women on this International day of Menstrual Hygiene management.
The author is a senior civil servant and views expressed are personal.