Expert Speak Health Express
Published on Aug 23, 2016
India needs to discuss menstruation. Period!

In December 2015, the Ministry of Drinking Water and Sanitation issued National Guidelines for Menstrual Health Management (MHM). It is indeed a welcome step that as a country with 355 million menstruating women, we finally at least have an official document that seeks to address the basic right of a healthy and dignified menstruation, an issue that has been completely ignored by the society and country thus far.

The guidelines aim for state, district, block and school level interventions and outline steps for all ministries involved — Health, Rural Development, Human Resource, Women and Child and Tribal Development. These recommendations are part of the Swachh Bharat Mission, thus, recognising that women and girls have special hygiene and sanitation needs due to menstruation.  It also lays down indicators of success as not primarily those related to provision of infrastructure such as toilets, pads and incinerators, but considers development of life skills for girls and women to be able to access this infrastructure as important indicators — having adequate knowledge, feeling supported, and development of abilities to experience a guilt and shame free period is an important component of the guidelines.

However, menstrual health cannot be achieved only through governmental efforts without addressing it as a social issue, requiring interventions at societal, community and familial level. Menstruation being a natural biological process, an average woman bleeds for about seven years of her life through out her reproductive life. Despite this, even in this so-called scientific age and time, society pretends that menstruation does not exist.

This culture of silence is made worse for women by myths, taboos and different stigmas around menstruation and its current association with impurity. Its quite unfortunate that we are less enlightened now than we were ancient times when it seems we gave more reverence to the female body and offered prayers to even bleeding goddesses as seen in Kamakhya temple in Assam and elsewhere. Many communities restrict women's entry into kitchens and temples during their period. Some tribal communities confine their women to separate living in menstrual homes or huts, which may be welcomed by these women as a respite from daily chores and hard work; some may however find it stigmatising. More studies and research is needed to understand menstruating women's attitudes towards such seclusion.

There is, however, enough research to show that most practices and beliefs that may have been reverent of women earlier have become taboos and stigmas in the present socio-economic milieu, impacting  their physical and mental health adversely. According to a UNICEF study conducted in 2011, on which the government guidelines rely, only 13 percent girls in our country are aware about menstruation before menarche. The same study indicates how disempowering and debilitating lack of menstrual hygiene is for these adolescent girls — 60 percent missed school on account of menstruation, 79 percent felt low confidence, 44 percent were embarrassed and humiliated over restrictions — thus menstrual mismanagement adds to gender discrimination by reducing the subjective and objective conditions of young women. It adversely impacts women's education, equality, maternal and child health — important goals for the country to achieve!

A study conducted by AC Nielsen showed that 23 percent of adolescent girls drop out from school after beginning their menstruation! Another study by the Institute of Development Studies (IDS) revealed that many adolescent girls face major hardships due to lack of proper infrastructure and sanitation facilities in their respective schools. The research further discovered that despite being a part of the curriculum, menstruation related topics were refrained from being discussed in schools.

The scale of the problem has made the government pay attention to the issue in recent years; in 2004, Tamil Nadu government became the first state to recognise the need of MHM and included it in its sanitation programme. The Ministry of Health and Family Welfare has also recently introduced a scheme that aims at spreading awareness of menstrual hygiene among adolescent girls (10-19 years) in rural areas. The objective of this scheme is to; increase menstrual hygiene awareness, increase access and to promote the use of high quality sanitary napkins, and to ensure that disposal of sanitary napkins are done in an environment friendly way. Under this scheme, sanitary napkins are also sold to adolescent girls at very low and affordable rates (₹6 for a pack of 6 napkins) by Accredited Social Health Activists (ASHA).

The United Nations Children's Fund (UNICEF), Wash United, and Water Supply and Sanitation Collaborative Council (WSSCC) are some entities working in the space currently with the government, but the scale to be achieved is humungous — for 112 million adolescent girls and future mothers need to be reached with information on menstrual hygiene and myths, and given appropriate sanitation facilities at schools and home.

MHM therefore needs strong championship from within and outside the government. It may require to be highlighted as an important component of Swachh Bharat, or it might boil down to individual efforts and initiatives of interested officers at district levels to take the MHM guidelines forward. Also, lack of effective coordination between various ministries might be a challenge and will need strong oversight and messaging.

It is therefore incumbent on society to see that we support, observe and engage with the Government on this issue, for it is not trivial. Corporates, thought leaders, feminists, social media activists all need to get involved to talk about it, especially in rural India beyond the digital divide. So far, corporates do precious little in the rural areas and are confined mostly to advocacy in urban areas. Sadly, the public conversation around menstruation remains negligible. Can we all do our bit and decide to include the period more and more in our public narrative? So that healthy, guilt free menstrual life will be considered as a basic health right of women in the near future. Period.

The author is an Indian Foreign Service officer and a trained medical doctor, currently based out of New Delhi.

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