Every year since 2014, Menstrual Hygiene Day (May 28) has been celebrated in all countries under different themes. This year, the focus is on “Making menstruation a normal fact by 2030.” The theme itself explains how to make menstruation a normal fact of life and how to integrate it into all aspects of life. Menstrual hygiene management (MHM) is an important issue for the health and well-being of adolescent girls and women. It affects about a quarter of the world’s population, or about 1.8 billion women and girls of reproductive age (15-49 years). Most of these women and girls menstruate two to seven days a month and therefore need information and facilities for proper sanitary disposal. This is alarming because several studies have linked improper and unhygienic menstrual practises to reproductive tract infections, urinary tract infections (UTI), urogenital and other vaginal disorders, and poor psychosocial outcomes. Some of these infections are associated with adverse pregnancy outcomes, higher susceptibility to sexually transmitted diseases, infertility, low birth weight, pelvic inflammatory disease, and other conditions. Even more concerning, these reproductive tract infections are sometimes asymptomatic and the damage may have already been done long before the victim is aware of it.
Over the past decade, evidence has accumulated around the world about the many obstacles schoolgirls face when trying to menstruate safely, hygienically, and with dignity. Challenges include limited or non-existent pre-menstrual information, inadequate health education about menstruation and puberty, lack of social support from teachers and peers in managing menstruation at school and in the family, and inadequate access to water, sanitation, hygiene materials, and disposal infrastructure. These barriers contribute to a gender-discriminatory, physical school environment and widespread menstruation-related stigma that leads to behavioural constraints and feelings of shame, stress, and taboo. Researchers have also found associations with bullying or teasing about menstruation by boys in school. These gendered educational realities can lead to negative reproductive and psychosocial outcomes and diminished economic futures. This, in turn, can exacerbate gender inequalities worldwide.
The recent National Family and Health Survey 5 found that 89 percent of young Indian women (ages 15-24) use a hygienic method of protection (mostly sanitary napkins). This is a significant increase from the 12 percent who used sanitary napkins in 2010 (according to the Plan and AC Nielsen study). This is undoubtedly a result of the greater attention given to menstrual hygiene management (MHM) in India in recent years. Companies have expanded their product range and market reach. Several government and nongovernment programs have promoted menstrual hygiene through health education programs and free or subsidized distribution of sanitary napkins. Small sanitary pad production facilities have been supported to increase access to low-cost pads while generating income for women. And entrepreneurs who have concerns about traditional sanitary pads for quality, health or environmental reasons have developed a range of innovative menstrual products, including reusable cloth pads, menstrual cups and “eco-friendly” or compostable pads.
In recent years, sanitary napkins have become more widely available through various channels, but their quality, cost, and quantity vary widely. Although there is limited research on this topic, anecdotal evidence suggests that inferior sanitary napkins do not provide the promised absorbency, leakage protection, and hygiene standards. Furthermore, hygienic use is equated with the use of sanitary napkins, whereas there is much more to hygienic use, such as changing sanitary napkins regularly and personal hygiene practices. Informed choice is important in the context of women’s reproductive and sexual health and applies to menstrual hygiene as well. Informed choice means that women and girls are fully informed about the menstrual hygiene products available and are able to make a decision about their use, taking into account their needs and the socioeconomic environment in which they live and experience menstruation. Informed choice offers girls the opportunity to use other materials-for example, reusable cloth pads-in a safe and hygienic manner. Widespread promotion of sanitary napkins has ignored disposal. This problem is worrisome for two reasons. First, girls who do not have access to disposal facilities tend to use a hygiene/safety product in an unsanitary manner-often beyond the recommended time. Second, the discarding of sanitary napkins is concerning because we do not have viable and scalable solutions for the safe disposal of this waste, which impacts both girls and the environment.
Rural Development Institute (RDI), Himalayan Institute Hospital Trust (HIHT) in collaboration with Swami Rama Himalayan University and School Education Department of Uttarakhand has launched Menstrual Hygiene Management Program in Schools (SMHMP) on the occasion of Menstrual Hygiene Day on May 28, 2022. The main objective is to train all High school and Intermediate school teachers across the state through online webinars. Last year, a total of 42 webinars were organized, training 10234 teachers from 1872 schools across the state. Both male and female teachers participated in the training program. The trainings were held on Saturdays and teachers participated in blocks according to their respective schedules. The school menstrual hygiene management program is a comprehensive, integrated, and well-coordinated structural program. The weekly distribution of iron and folic acid and the deworming program of the existing health system are also linked to MHM activities so that girls and boys can receive education and care at the same time. Statistics show that 91% of male teachers participated in the program/training/orientation and discussions on menstrual hygiene for the first time. Many teachers pointed out that men are always curious and would like to learn more about the different aspects of menstruation and hygiene management, but no one provides them with such an opportunity.
The school menstrual hygiene program needs to focus more on comprehensive education and awareness of menstrual health and hygiene, availability and accessibility of quality sanitary pads including other options such as menstrual cups, Tampons and Saafkins, adequate mechanisms for disposal of menstrual materials, water supply, and provision of a private room where teachers and girls can change their pads during school hours. Both teachers and students need to be educated and sensitized on various aspects of menstrual hygiene. The school health and hygiene club of class representatives can implement the program more effectively under the guidance of trained teachers. Similarly, MHM activities should not be organized in isolation but should be part of all school events where the school can organize debates, essay writing, games, and other activities in which both boys and girls can participate. This inclusive approach to safe and dignified menstruation is essential to achieving the Sustainable Development Goals (SDGs) on gender equality, good health, quality education, and sustainable water and sanitation for all, as well as related human rights. In summary, geographic constraints, scattered settlement, and low population density in Uttarakhand make menstruation difficult and complicated for girls. A school-based menstrual hygiene program can play a critical role in disseminating quality information among adolescents and help adolescent girls manage good hygiene practices during their periods. It not only helps girls during their periods, but also improves their overall well-being.
Dr. Rajeev Bijalwan
