Menstruation, a normal biological process in the female body, is often viewed as dirty and disgusting. Because of the negative perceptions and discussions on the topic of menstrual hygiene, especially with girls who have just begun menstruating. It is regarded as a taboo and hence there is little knowledge about menstrual hygiene practices. School girls do not have access to facilities for MHM. They fear humiliation because of leaking blood and body odour often resulting in absenteeism from school. If girls in schools are provided with adequate knowledge and resources, it can help them lead a safer and guilt-free life.
To address this gap, a baseline study was conducted by Healthy Aging India in 25 upper primary and secondary government schools in an aspirational district of Uttar Pradesh. The aim of the study was to explore respondents’ knowledge and the social and cultural practices regarding Menstrual Hygiene Management and then provide the rural girls with correct information about menstruation so that the right knowledge is passed on to the next generations. The study was carried out in Sharavasti district, an aspirational district in north-eastern Uttar Pradesh. The major concern was to provide the girls with biodegradable sanitary napkins which are user-, pocket- and environment friendly.
Key Words: Menstrual Hygiene Management, Taboo, Cultural and Economic Conditions.
Introduction and Literature Review
Menstruation is a normal biological process experienced by millions of women and girls around the world each month (Sebert et al, 2017). According to WHO and UNICEF Menstrual Hygiene Management is defined as “women and adolescent girls using a clean menstrual hygiene management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of the menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of the used menstrual management material.”MHM begins with delivering awareness and information about menstruation and good menstruation hygiene practices. Good menstrual hygiene is fundamental to the health, hygiene work, and wellbeing of women and girls (Keihas, 2013). It plays a significant role in the reproductive health and wellbeing of women and adolescent girls. Adolescence is the period of transition of an individual from childhood to adulthood. The transition is accompanied by dramatic physical, sexual, psychological, and social developmental changes. The changes, marked by the start of menstruation, are more obvious among girls because of which menstrual hygiene is a crucial health need for females.
MHM is a global concern and the aim of various interventions has been to narrow the gender gap in education and life opportunities by keeping girls in school after they start menstruating (Marnisommer, 2015). But MHM remains a big issue in low and middle-income countries (Eijk et al, 2016), particularly in rural areas. Economic considerations(i.e., affordability of sanitary napkins) and taboos in rural areas are the main reason for using inappropriate substitutes for sanitary napkins (Eijk, 2016; Kenney & Webster, 2016).For some girls and women in rural India, awareness of commercially manufactured sanitary products are virtually absent (Kuhlmann,2017).
The most used substitute for sanitary napkins is cloth rags but even their availability of the rugs is so scarce that many women are forced to reuse the same cloth after washing. Furthermore, inadequate water and sanitation facilities pose major difficulties in washing the rags with clean water (Sommer &Sahin, 2013). In addition, the washed cloth is usually dried in a damp place instead of under direct sunlight due to the shame women feel in exposing the clothes to public view (Sumpter &Torondel, 2013).Reusing an old cloth also increases the risk of urogenital infections (Kuhlmann, 2017). The problems associated with MHM arise because women are considered inferior to men in society and hence their needs are not considered as important.
There are also taboos associated with sanitary napkin use. For example, they are the cause of stomach and leg pain during menstruation, and that by burning used sanitary napkins, girls will never be able to have children. During her period, a woman is regarded as impure and therefore
cannot touch any object. Girls do not have enough information about menstruation and sometimes, even the information provided is not correct because their mothers have not been properly sensitized. Many girls, especially among those who are not aware of the duration of menstrual cycle, or feel that they bleed too much, take medicines to either reduce the flow of blood or stop their menstruation cycle for a month without knowing about the side effects of these drugs (Ejik et al, 2016).
The reason that such beliefs are still prevalent in our society is that rural people cannot afford MHM products and hence try to avoid creation of their demand altogether. The challenge faced by women is common across cultures: weak economic status, less or no availability of resources, local traditional and cultural beliefs. They often force women to use unhygienic methods during menstruation (Sumpter &Torondel, 2013). Poor menstrual hygiene practices put them at high risk of health issues that lead to a wide range of health and psychosocial outcomes (Eijk et al, 2016; Sumpter &Torondel, 2013), such as Reproductive Tract Infection (RTI), deadly disease like cancer, and psychological stress. Additionally, if the menstrual waste is not managed properly, it can affect the surrounding environment, resulting in other types of pollution as well.
The situation is particularly difficult when a girl has her first period. Often, pre-pubescent girls are not given adequate guidance and material to prepare them for menstruation and hence the first period can be a traumatic experience. They get frightened and anxious. Preliminary studies by Healthy
Aging India reveal that almost every menstruating girl misses school during her menstruation cycle which, on average, means that 40 days of schooling are lost in an academic year.
Eventually, this affects the academic performance and learning outcomes of the girls. In turn, the risk of dropping out of school increases. The reason that girls do not attend school during their periods is that they do not have access to sanitary napkins at school or home. Restrictions on mobility and other activities, which are imposed during menstruation ads to the problem (Kenney & Webster, 2016). These aggravate an already stressful situation, making it difficult for a menstruating girl to cope.
A lack of proper infrastructure in schools forces the girls to stay at home during menstruation.The toilets are usually dirty and, often, water supply is erratic or altogether absent (Sommer&Sahin, 2013).Further, toilet doors are missing or do not close properly. In some places, toilets are even locked to prevent their ‘misuse’. The physical discomfort, pain, lack of water and
disposal facilities in the school toilets leave menstruating girls with no option but to stay at home (Eijk et al, 2016). In rural areas, pupils usually walk to school, which can cause severe discomfort and pain to menstruating girls (Kuhlmann, 2017).
Studies indicate that girls do not receive guidance prior to their menarche (Sommer et al, 2016) as their mothers themselves were also not sensitized properly in the first place. At school, the high percentage of male students (Sommer &Sahin, 2013; Sommer et al, 2016) who believe that menstruation is a women’s business and that should stay home, adds to the insensitivity in the school environment. This makes it difficult for the girls to articulate their problems and seek help and support. But menstruation should not be of concern for women and girls only. It is key to reproduction and hence should concern men equally.
Need for the intervention
Beliefs and wrong practices surrounding menstruation are common in rural India. Not talking about menstrual problems and non-use of sanitary napkins have led to poor health conditions of women and girls. Menstruating women and girls have little or no knowledge of the biological processes that cause their periods. Instead, their responses and actions are governed by superstitions and wrong notions which are passed to the next generation of women and girls.
Menstruation is not just a women’s concern alone; it is also an environmental one. Disposal of the used sanitary napkins is a considerable challenge. As sanitary napkin use increases, the amount of waste generated will also increase. Alternatives like reusable menstrual cups, re-useable pads, and other environmental-friendly options are still being explored and their
acceptance is likely to be slow. The aim is to change the menstrual practices in the school and improve MHM facilities.
A. Sample Characteristics
This study is based upon interviews conducted during the months of December 2019 and January 2020. The topic and purpose of the study are based on studies and reports of the struggles experienced by menstruating women. A qualitative approach was used in this study. A Clustered Sampling method was employed to select the sample from which data was collected. The sample consisted of 60 girls who had just started their periods. The average age of the girls in the sample was 13 years. Oral permission for interviewing the girls was taken from the principals of the schools they were studying in, as well as their teachers.
All 60 interviews were conducted in a face-to-face manner. Prior to the interviews, a workshop was conducted in the schools. The study area was conducted in Sharavasti district in northeastern side Uttar Pradesh.
Only those girls were selected for interview that has started with their menstruation. After taking written permission from the principal and/or respective teacher, oral permission was taken from the interviewee keeping in view the ethical guidelines of conducting research with human
C. Instruments Used
The survey instrument was a semi-structured questionnaire consisting of 12 questions. The questionnaire had two sections— A and B. The questions in both sections were answered by girls only.
Section A: comprised of three questions which sought information on the socio-demographics of the interviewees, including their names, the class they were studying in, and their age.
Section B: had nine questions.They pertained to the girl’s menstrual issues experienced by the girls.
D. Analysis of Data
Quantitative analysis of the data (responses to the questions) was done using MS Excel. Further, an assessment was also carried out of the toilets in each school.
Results and Findings
The average age of the interviewees was 13.78 years. The girls were studying in various grades— and their classes vary from 6th to 10th. The highest number of girls from the sixth to the tenth. The largest proportion of the respondent girls was studying in the sixth grade (17 out of 60) and
the smallest in the tenth (6 out of 60).Most of the girls in the study said that they were not aware of menstruation at their menarche. Most of them were told about the phenomenon by an elder sister at home or at school by teachers, friends, or mothers. The interviews revealed that the information provided to most girls was mostly incorrect or distorted. School was the only source of accurate and clear knowledge about the menstrual process.
Most girls living in villages use cloth to absorb the flow because they cannot afford sanitary napkins. They use sanitary napkins only when it is provided by the school. The study found that only a few girls buy sanitary napkins, but even they are not always able to afford them.
Earlier disposal methods.
Studies show that the inappropriate disposal of sanitary waste is widespread (Eijk et al, 2016). The girls who participated in the study admitted that they used to throw used pads in the forest, burn them, throw them in a pot, bury them in a pit or drop them in the dustbin. The girls who use cloth
said that it is usually washed and reused. When the cloth could not be reused anymore, it is thrown away as garbage — either in the bin or by other means. Haphazard disposal of used pads or cloth is unhygienic and a potential health risk which can result in diseases and soil pollution. The
smell of blood on used pads attracts feral animals like dogs and cats that tear them expecting to find something to eat. Furthermore, sanitary pads have a significant plastic component which takes a very long time to degrade.
Therefore, it is imperative that menstrual waste is disposed of in an environmentally friendly manner (Sinha & Paul, 2018). The present methods used for disposal are burning menstrual waste, throwing it away in the open or in the pot, burying in pits or discarding them in the dustbin are not sustainable.
The study also found that girls who did not use sanitary napkins did not know how to use them.They experience several problems, both at home and school. At home, there are several restrictions in their movements and contact with other family members. Often, they are forced to
isolate themselves and are barred from the area where the deities and religious symbols are kept.In school, there is no proper infrastructure and support for menstruating girls.
The problems faced by menstruating girls are across castes and socio economic backgrounds. Restrictions, often justified on cultural grounds, only aggravate their difficulties. Our study showed that although the schools had toilets, the toilets were deficient in on or the other way. For example, in a few schools the toilets were locked to limit their use by teachers only. In others, they were not clean or had doors that did not close properly; or they were not properly lit, or did not have enough water.
Limitations of this study
1. The study covered only girls who were enrolled. No information is available about girls who have reached puberty and do not attend school.
2. At the request of the teachers and the principals, the girls were interviewed in a separate room where the boys were not allowed. After the completion of the session, in most cases, the boys were curious to know what the girls were asked. This made the girls uncomfortable for the girls.
3. The girls’ mothers were not part of the study
4. In rural areas, even today, girls do not have enough freedom to speak for themselves. The teachers in the schools did not want to share the facilities, such as clean toilets or disposal of menstrual waste, with the girls. They were requested to install sanitary napkin vending machines in the staff rooms. Another problem was that even when sanitary napkins are
provided free by the government, the supplies are irregular.
5. No school had access to incinerators. In fact many schools did not have an electricity. Connection and thus installing electric incinerators was not feasible in these schools.
6. A key challenge in low resource areas is the inadequate and unreliable supply of products for helping girls manage their periods in a safe and hygienic manner. Poor quality products or inappropriate methods are the cause of ineffective absorption, leakage and stained clothes. Menstruation has a significant impact on social life, family life, education, work, and the general well being of females.
Conclusions and Recommendations
For a long term, the subject of menstruation has been a topic of shame in the society. Though our lives are connected with the menstrual process, the belief persists that it is a woman’s problem that should remain hidden. This mindset needs to change both boys and girls must be educated about menstruation. Our study found that many schools did not even have a single female teacher or even a female staff who could provide some assistance to the girls. In such conditions, such schools should be encouraged to seek help nearby schools which have female teachers. Even non-profit organizations can be approached to fill this gap.
Girls will feel encouraged to come to school only when there is proper infrastructure. Although there are toilets in school, they are often unclean and have a bad odour. Many remain locked to prevent vandalism or to prevent outsiders from using them after school are over. As mentioned previously also,many schools do not have sufficient water.
Prevailing taboos, especially in the rural areas, are at the root of many unhealthy practices. These practices can end only when there is sufficient awareness in society that menstruation is a normal biological process, and not a crime or a disease. Thus there is the need to educate rural women,
both about menstruation and the need to maintain hygiene in the absence of which, the risk of disease is high.
Female teachers should be tasked with imparting students above a certain age, the knowledge of biological processes in women’s bodies and the changes that take place when they reach puberty. The use of sanitary napkins should be promoted and the alternatives should be discouraged. Under article 21 of our constitution, it is the fundamental right of every Indian to clean toilets and proper sanitation.
Thus, the provision of basic necessities like clean toilets, water, doors, etc. is non-negotiable. However, providing adequate facilities in school alone is not enough; changing the mindset and attitudes are equally crucial ensuring proper menstrual hygiene management.
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Shubhangi Rawat is a post graduate of National Institute of Technology, Rourkela.