Sarika Sharma
Menstruation, also known as a period or a monthly, is the normal vaginal bleeding that occurs in women as part of their monthly menstrual cycle. It occurs due to the increase and decrease in the amounts of hormones produced in the human body. Each month, a women’s body for a certain range of age (12-15 to 40-50 years) prepares for pregnancy and in case no pregnancy occurs, the uterus starts shedding its lining which leads to bleeding. The menstrual blood is partly blood and partly tissue and it passes out of the body through the vagina. The first period, called menarche, usually begins between 12-15 years of age, and stops with menopause (40-50 years of age). There are various issues related to menstruation like lack of proper periods, called amenorrhea, when either periods do not occur by a certain age or over a certain period. Other issues include painful periods and abnormal profuse bleeding or bleeding between periods. Majority of women report having premenstrual symptoms (both physical and emotional), like acne, bloating and sore breasts, lower back and abdominal pain, feeling enervated, irritability, mood swings etc., which in some cases leads to normal or severe premenstrual syndrome (this is particularly relevant to menarche). Women also experience a monthly change in body temperature in consonance with their menstrual cycle resulting in an increase in core temperature which averages 0.9°F (0.5°C) higher during the last half of the cycle. The average blood loss during a single menstrual period is 50 to 150 ml which poses a great menstrual hygiene management challenge along with other issues revolving around it.
The first menstrual experience of young girls has always been associated with a feeling of fear, shame, and embarrassment which represents partly lack of awareness on the part of young girls; but majorly ignorance and neglect of parents, education system, or society whereby information is not provided about menstruation as a normal biological phenomenon. This overall view has been plodding towards better awareness pretty slowly. Also, menstruation which biologically is a very important part of human existence, has always been surrounded by taboos and myths that preclude menstruating women and girls from various aspects of socio-cultural life. In India, it has always been a taboo and like many other societies it is having a pernicious impact on girls’ and women’s emotional state which in turn manifests itself in their outlook, lifestyle and most importantly health. The various restrictions/misconceptions which are associated with menstruation include things like not attending school, not playing sports, not attending religious functions/or entering temples, not allowed to cook, not washing body and so on. Thus, lack of gender equality, discriminatory societal norms, taboos and social stigmas, poverty and lack of basic services often result in a milieu where girls’ and women’s menstrual health and hygiene needs go unmet.
Another prominent issue is unhygienic practices associated with menstrual hygiene management (MHM) which basically is an ecosystem for the management of hygiene associated with the menstrual process. It has been found in a study that almost 77 percent menstruating girls and women in India use an old cloth (instead of sanitary napkins/pads), which is often reused. The number of women in India that resort to using ashes, newspapers, dried leaves, and husks to aid absorption stands at staggering 88 percent. According to Census 2011, 89 percent of rural population of India lacks toilet facilities presenting an uphill sanitation task and the effect, in turn, on Indian women rises disproportionally. These facilities have since improved markedly but the issue of MHM still looms large as India has not been able to provide WASH (water, sanitation, and hygiene) facilities to all its populace. There are risks associated with poor MHM like urine infections, rashes and itching, white discharge, etc.
The various MHM tips that women can follow are: taking a bath every day during menstruation, changing sanitary napkin/pads regularly, changing pads every 6-8 hours, during heavy menses changing pads after every 3-4 hours, using clean underwear and changing it every day, washing hands with water and soap after changing pads, clean the vaginal area using water regularly, always patting the vaginal area dry after every wash, keeping the area between the legs dry, always washing or wiping the genitals from front to back, and wearing lose and comfortable clothes. The things which girls and women should avoid are as follows: not using soap or vaginal hygiene products to wash the genital area, not flushing used sanitary pad and discarding them properly, not being sedentary and going out for a regular walk and doing light exercise and yoga, and avoiding white or light colored dresses.
The importance of sanitary napkins/pads in MHM is beyond doubt. These are easier to use and dispose of as compared to cloth, the absorbent material in it, provides a dry feeling, chances of infections decrease markedly, and helps in maintain usual daily routine. It has been found in a study that only 12 percent of Indian women can afford them. It is also estimated that the average woman throws away 125-150 kg of tampons, pads and applicators in her lifetime resulting in 433 million such products per month to be discarded in India. Majority of these products end up in landfills or sewage systems as waste pickers are avoid separating the soiled sanitary pads by hand and prepare them for burning as is required under the Indian Government’s Municipal Solid Waste Management and Handling Rules. SWACH, self-governing organization on waste management services, brought forth the issue of waste pickers’ exposure to infections and other health hazards due to handling feminine hygiene discards. The lack of disposable awareness and bags for used sanitary pad is making disposal hazardous to people and the environment. These sanitary napkins are often seen littering dry riverbeds, roadsides, and streets. On the one hand sanitary napkins are being promoted as hygienic products for holistic MHM but their use, on the other hand, has also created severe handling and disposal issues.
The National Family Health Survey-IV reported that 57.6 percent young women (15-24 years of age) use sanitary napkins. It has been estimated that India has 336 million menstruating women out of which 121 million uses 1 billion pads per month. This number is sure to go up in future as awareness about these pads and purchasing capacity of households in increasing day by day. Therefore, menstrual waste disposal is an integral part of MHM and the steps that girls and women can take for its efficient disposal are as follows: don’t left napkins in the open as it may lead to transmission of infections and will attract flies, animals, and insects, do not flush the napkins, instead put them in a bin, wrap them properly in a waste bag, newspaper or toilet paper (so that they do not open up) and then put them in a bin.
A latest survey by dasra.org reveals that due to the lockdown, the closure of education institutions and community organizations has severely impacted the supply chain of menstrual hygiene products thus affecting women disproportionally in lockdown as well. The survey reports that 62 percent respondents stated that access from regular channels for consumers has become very challenging and 22 percent organizations state that they have no access to menstrual hygiene products. This is happening despite Government announcing uninterrupted supply of essential products even during the lockdown phases which, in turn, is an indicator of lack of awareness and understanding on the part of suppliers and society at large regarding the health and hygiene needs of menstruating girls and women. There are many ways of providing awareness to an uninformed society about the components of MHM which, in turn, will help in capacity building in this regard. The awareness and capacity building steps are as follows: information dissemination via mass media like magazines/journals, radio/TV programmes, advertising, social media messaging and conversations, teacher training in knowledge and mentorship, parent training, menstruation and puberty classes targeting both girls and boys (to remove social stigmas), community health worker training, introduction of MHM in school curriculum etc.
In the end, it can be said that after God only women can create life and menstruation is an integral part of this life generation process. People should be aware of it and should cherish it instead of their revulsion towards it as unclean and impure. Both by expunging social stigmas and by awareness about MHM and its components can a society move towards gender equality and inclusive development of a society in its entirety.
(The author is working in School Education Department Govt of J&K)
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