Menstrual health care: It’s time to break the taboo and talk about it

On 28 May every year, Menstrual Hygiene Day is observed. The day is aimed to enable women and girls around the world to achieve their full potential without menstruation becoming a problem. It aims to spread awareness about menstrual hygiene and curb taboos associated with menstruation. The theme of this day for 2021 – "More action and investment in menstrual health  hygiene now!

Menstruation is the process in which the uterus sheds blood and tissue through the vagina. This is a natural and biological process for girls and women of reproductive age. 

In Western communities, this is often called "Period." It typically lasts for 2 to 5 days, but this varies from person to person. A lack of fact-based information about menstruation leads to develop misconceptions and discrimination and can cause girls to miss normal childhood experiences and activities. Stigma, taboos and myths prevent adolescent girls from the opportunity to learn about menstruation and develop healthy habits.

Menstrual health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, concerning the menstrual cycle. This definition of menstrual health aligns with the WHO definition of health and attends to mental and social, as well as physical well-being. 

There is growing recognition regarding the importance of improving menstrual health to improve the quality of life and well-being of people who menstruate. Yet collective initiatives have not been met with the corresponding increase in the investment needed to address menstrual health for all. The Global Menstrual Collective was established in 2019 to bring together the multi-sectoral stakeholders and coalitions working on menstrual health to support coordination and bolster collective, evidence-based advocacy to drive investment. 

Achieving menstrual health implies that women, girls, and all other people who experience a menstrual cycle, throughout their life-course, with the inclusion of the followings:

Access to accurate, timely, age-appropriate information about the menstrual cycle, menstruation can change experience throughout the life-course, as well as menstruation-related self-care and hygiene practices.

Care for their bodies during menstruation such that their preferences, hygiene, comfort, privacy, and safety are supported. This includes accessing and using effective and affordable menstrual materials and having supportive facilities and services, including water, sanitation and hygiene services, for washing the body and hands, changing menstrual materials, and cleaning and/or disposing of used materials. 

Access to timely diagnosis, treatment and care for menstrual cycle-related discomforts and disorders, including access to appropriate health services and resources, pain relief and strategies for self-care. Experience a positive and respectful environment concerning the menstrual cycle, free from stigma and psychological distress, including the resources and support they need to confidently take care of their bodies and make informed decisions about self-care throughout their menstrual cycle.

Decide whether and how to participate in activities encompassing all spheres of life, including civil, cultural, economic, social, and political, during all phases of the menstrual cycle, free from menstrual exclusion, restriction, discrimination, coercion, and/or violence. We intentionally link menstrual health to the menstrual cycle. This acknowledges that menstrual-related discomforts and disorders, consequences for mental well-being and social exclusion are not restricted to the menstrual period. Whilst the majority of those who experience a menstrual cycle are women and girls, this approach also communicates the relevance of menstrual health for all those who experience a menstrual cycle. Further, it recognises that many who experience a menstrual cycle may not experience regular bleeding and the absence of menstruation can be a source of anxiety and distress.

Illustration: TBS

The Ritu programme (Development and Research Initiative for Menstrual Health) aimed to improve the menstrual health of girls between 10 and 15 years old in Bangladesh. The programme combined a set of direct interventions in schools and communities in the Netrokona district of Bangladesh, with national-level advocacy and (social) media campaigns. Reaching a total of 25,844 girls, the direct interventions had a positive impact on their menstrual health. Girls reported feeling less ashamed of and more confident about their menstruation and having the skills, knowledge, support, and necessary products and service to perform menstrual practices. 

The Ritu programme is a collaboration between Simavi, TNO, RedOrange, BNPS and DORP. A study was conducted in collaboration between Simavi, Dhaka University and BNPS and was funded through a small grant from Share-Net International. With the support of these organisations and grants we conducted a qualitative study in 6 schools that were part of the Ritu programme. 

It is important to note that the schools' academic activities are closed on account of lock-down for that reason the programme ended in March 2020, which strongly affected the sustainability of the programme and the research itself. However, we were still able to draw some conclusions, and we believe it is also worth drawing attention to the disrupting impact that Covid-19 had on the intended continuation of activities.

Summing up, They come to the following recommendations for NGOs working in schools to increase the likelihood that programme activities on menstrual health will be sustained: 1) dare to prioritise and select a small number of impactful activities to be sustained after the programme 2) engage stakeholders in the selection of these activities and in designing the strategies to sustain them 3) include time within the programme to test the feasibility and sustainability plan. Whilst acknowledging the limited scope of this study and paper, it touches on a need for a better understanding of the sustainability of development programmes. We, therefore, call for an increased focus on and (budget for) research on this topic and encourage others to share their successes and lessons learned.

Based on the study findings, they published a policy incentive letter on behalf of the concerned organisation, in which they reviewed the existing situation and made several recommendations, focusing on two issues at the policy-making level.

Menstrual Health Education 

Provide formal training and support to teachers on sexual and reproductive health and rights and menstruation to ensure menstrual health education in schools, compulsory teaching of menstrual health in schools, included the menstrual health-related questions in school examination question papers, and ensure regular and effective monitoring on above issues. 

MH Friendly Toilets Establishment of menstrual-friendly toilets in schools, adequate allocation in the government budget for repair and maintenance of useless toilets, simplification of access to allocated assistance for schools, and ensuring implementation of departmental monitoring as per circulated guidelines of the education department.

It's another positive development that with the financial aid from the European Union (EU), extensive work is being carried out by Simavi Netherlands and Bangladesh Nari Pragati Sangha (BNPS), in collaboration with 10 local development organizations (CSOs) in the Chittagong Hill Tracts of Bangladesh since 2019. `Our Lives, Our Health, Our Futures' (OurLHF) Programme initiative is working to support and empower unprivileged adolescent girls and young women in these three hill districts of Chittagong Hill tracts to manage their menstruation with dignity and hygienically.

The Covid-19 pandemic poses a threat to improved investment in menstrual health and hygiene progress made in recent years to halt or reverse hard-earned momentum. Managing menstruation during the pandemic has proven difficult as Covid-19 related restrictions have made it hard for some to access safe and affordable menstrual hygiene materials, clean and private sanitation and hygiene facilities and services providing support, information and health advice and treatment. 

After all, menstruation is a very important part of the overall well-being of a woman's life. Therefore, there is no substitute for ensuring the infrastructure, information and knowledge, materials of menstrual management, necessary support and supportive environment, because these are the key influencing factors for menstrual health management. We imagine a world where every girl and woman can learn, play, and safeguard her health without suffering stress, shame, or unnecessary barriers to information or materials during menstruation. 

Sumit Banik is a Public Health Activist and Trainer. E-mail: sumit.bnps@gmail.com 

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.