Dr Sahil Dutta
According to the WHO/UNICEF Joint Monitoring Programme 2012, menstrual hygiene management is defined as: “Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.”
National Girl Child Day
Menstruation is a natural physiological process experienced by all adolescent girls and women. Menstrual Health and Hygiene is essential for women empowerment. The first menstruation (menarche) usually occurs between 11 and 15 years of age with a mean of 13 years. The onset of menstruation means a new phase in the lives of adolescent girls. Yet many face stigma, social exclusion and mental harassment during menstrual period. Gender inequality, cultural taboos, discriminatory social norms, poverty and lack of basic facilities such as toilets and sanitary products can all cause menstrual health and hygiene needs to go unfulfilled. This has far-reaching impacts on the lives of adolescent girls and women in reproductive group. It restricts their mobility, affects attendance in school and also impacts their participation in community life. Moreover it causes additional stress and anxiety.
Effective Menstrual health and hygiene interventions can help overcome these issues. In addition to fulfilling the unmet demand for menstrual hygiene products, they also build confidence, protect dignity and strengthen female reproductive health. In significant section of the society, menstruation is still regarded as something unclean or dirty due to several factors. Although menstruation is a natural biological process, it is linked with several misconceptions and practices, which sometimes result into adverse health outcomes. Women having better knowledge about menstrual health and hygiene and adopting safe practices are less vulnerable to Reproductive Tract Infections and its consequences. Therefore, correct knowledge about menstruation right from the childhood may inculcate desirable hygienic menstrual practices in women thus helping them lead a healthy and more productive life. To effectively manage their menstruation, adolescent girls and women require access to water, sanitation and hygiene (WASH) facilities. They also need affordable and appropriate menstrual hygiene materials, correct information, and a supportive environment.
Why does knowledge of menstruation matter? Knowledge regarding the physiological processes associated with menstruation has a pivotal role in determining sexual and reproductive health outcomes. Most girls don’t know their bodies are changing when they start menstruating, that menstruation is a biological process, or what they can do to regulate it. A 2014 report by an NGO, Dasra, said over 23 million girls drop out of school every year due to a lack of adequate MHM facilities, including sanitary napkins and proper knowledge of menstruation. Focused national policies and budgetary support for menstrual hygiene, with appropriate infrastructure, provisions of adequate pain relief, and sensitivity training for teachers vis-à-vis such socially controversial subjects could effectively help better implement menstrual-care measures in schools.
Importance of Menstrual Health Education: Just 20 days before celebrating menstrual hygiene day on 28 May 2023, India Today magazine reported a heart-wrenching incident in Thane district of Maharashtra, where a brother killed his 12-year-old sister after assuming her first-period blood stains were signs of her physical relationship with someone. The incident was a reality check about the importance of educating boys and men about menstruation. Menstrual health is not a ‘women’s subject’. Comprehensive and meaningful education on menstrual processes, supportive environments, encouraging participation, and honest conversations can help adolescent boys and men better understand MHH.
Effect of Schooling on menstrual hygiene : The fifth National Family Health Survey (2019-2021) revealed that around 90% of women with 12 or more years of schooling used safe period products (locally prepared napkins, sanitary napkins, tampons, and menstrual cups) in 17 states and Union territories. In Jammu and Kashmir this number is 83%. From the previous round of the survey, 20% more women aged 15-24 years used hygienic methods during menstruation.
NFHS-5 data on menstrual hygiene for the region of Jammu and Kashmir: Using a hygienic method of menstrual protection is important for women’s health and personal hygiene. In NFHS-5, young women age 15-24 were asked what method or methods they use for menstrual protection, if anything. In Jammu & Kashmir, 51 percent use sanitary napkins, 58 percent use cloth, 23 percent use locally prepared napkins, and 3 percent use tampons. Overall, 74 percent of women age 15-24 use a hygienic method of menstrual protection, up from 67 percent in NFHS-4. Notably, only 71 percent of rural women use a hygienic method of menstrual protection, compared with 86 percent of urban women.
National and regional policies, initiatives, and programs addressing menstrual health and hygiene There has been an uptick in the last few years in the focus on menstrual health and hygiene (MHH) worldwide. In India, MHH gained its rightful place in the public health discourse when the National Health Mission 2011 promoted a menstrual hygiene scheme among adolescent girls in rural areas. Menstrual hygiene management (MHM) is an integral part of the ‘Swachh Bharat Mission’ guidelines; the Union Ministry of Drinking Water and Sanitation also issued MHM guidelines for schools in 2015. Initiatives in other states and UTs MHH has a crucial part in achieving the U.N. Sustainable Development Goals. Different states have their own schemes, but the primary focus of service delivery remains on the distribution of sanitary napkins. Maharashtra’s ‘Asmita Yojana’, Rajasthan’s ‘Udaan’, Andhra Pradesh’s ‘Swechcha’, Kerala’s ‘She Pad’, Odisha’s ‘Khusi’, Chhattisgarh’s ‘Suchita’, and Sikkim’s ‘Bahini’ all have provisions to distribute subsidized or free sanitary napkins to adolescent girls. Kerala and Karnataka governments have been distributing menstrual cups as a sustainable alternative to sanitary napkins. These initiatives have helped promote MHM countrywide but there are important challenges to equity.
Suggestions:
Health Education and awareness: One of the key reasons for gap in menstrual health and hygiene is lack of awareness. Transmitting vital message of correct menstrual hygiene to adolescent girls is of paramount importance. In our healthcare set up in J&K, the area is divided into Health Blocks each headed by a Block Medical Officer (BMO). At PHC level, we have Medical Officers (MO) as supervising authorities. Focussed plan should be made where every Saturday is celebrated as School Health Day. A team headed by Medical Officer from Primary Health Center (PHC) and accompanied by Adolescent Reproductive and Sexual Health (ARSH) counsellor should visit all the schools in their jurisdiction on rotation basis. The staff from health department and education department should work in coordinated manner for imparting menstrual education. The team should also distribute sanitary napkins among female students who need them.
Motivated School Teachers (preferably females) should be made representatives from their schools for coordinating with Health Teams celebrating School Health Day.
Sanitary Napkin Vending machines should be installed in all Government High and Higher Secondary Schools where adolescent female students may fulfill their emergency menstrual napkin requirements. This would improve attendance of female students in school and also help in reducing school dropouts.
Incinerator should also be installed along with vending machines to ensure proper disposal of sanitary napkins at the school premises.
Satisfactory quality of separate bathroom for girls along with 24X7 water supply is essential for safe menstrual assistance at schools. Saturation must be ensured under Swachh BharatAbhiyan.
Mother is often the first informant in case of menstrual health. So it is important to provide correct health education to mothers. Here role of Health and Wellness Centers (HWC) is significant. Health Staff should educate mothers about importance of hygienic menstrual practices in Village Meetings. This should also extend to Aanganwadi Centers during Immunization Days (Wednesday).
ASHA workers are the grassroot workers and a critical link between healthcare system and society. They become an important bridge between health educators and non school going adolescent girls and other menstruating women. ASHAs should be provided monthly packs of 6 napkins @ Re 1 per napkin as per the population. ASHA can distribute the sanitary napkins going door to door. The record should be maintained and ASHA Should be paid incentive for distribution along with a pack free for her own use.
Tribal women need special attention as depicted by NFHS-5 data. A special focused approach should be devised by coordinating Departments of Tribal Affairs, Social Welfare and Health& Family Welfare.
Educational Social Media campaign along with ICT activities should be carried at grass-root level to increase the level of awareness about menstrual health and hygiene. For example 28th May is celebrated as World Menstrual Hygiene Day. How many of our schools celebrated it? This should be made compulsory and Higher Education/ School Education Departments should issue a circular in this regard.
(The author belongs to J&K Accounts Service and was a former Medical Officer)
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