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From Menstrual Hygiene to Menstrual Health

  • June 11th 2019

Monalisa Padhee, PhD, is a medical researcher and the head of Women Wellness Initiative and Enriche Health at Barefoot College working with women and girls in rural India. She was a 2019 Aspen New Voices Fellow, and spoke in the session Undaunted: Stories from the Frontlines.

This year has been truly groundbreaking for the issue of menstrual hygiene across the globe. From Period, End of Sentence, a movie on menstruation in India winning the Oscar for Best Short Documentary, to the United Kingdom pledging £2 million to end the lack of access to sanitary products and stigma surrounding menstruation around the world by 2030. In the United States, a comprehensive menstrual equity act was proposed to address various barriers for accessing menstrual hygiene products.

These are great initiatives which have not only provided safer ways of managing periods for millions of girls and women, but are also a great starting point for conversations on menstruation. However, these efforts just scratch the surface. These conversations have limited the entire menstruation conversation to being an issue of hygiene.

I have seen girls and women being victims of discrimination and unsafe practices, but the real issue is how menstruation is understood, not just the issue of hygiene. I met 13-year-old Juhi (name changed) at a workshop and she told me she locks herself away for five days every month when she menstruates because she has been told that she is impure. In some communities, the girls are made to sleep in the cowshed even in chilly winters.

Sadly, this is not the story of few girls; it’s the story of thousands of rural Indian girls and women. Many of them are made to feel like untouchables, stop going to schools, or are made to sleep in a separate room, which is often outside the house. This is despite the fact that many of the girls get a supply of sanitary pads either from the school or the government-appointed community health workers in villages. Even in the USA, the students from a Bronx middle school shared that 67 percent of girls were not comfortable discussing their periods. In the UK, one in five girls have experienced bullying over their periods, and as most of the teasing is reported to take place in schools, girls feel forced to miss school.

As a medical researcher working on menstrual health education, I can tell you that menstruation cannot be only a topic of hygiene. Supplying sanitary pads alone won’t fight the stigma associated with menstruation. If we want to ensure that the girls are not discriminated against, then we need to change the narrative from hygiene to health. From simply managing a period to understanding their bodies.

I’ve seen that tools like sanitary pads are only part of the solution in my work teaching semi-illiterate or illiterate girls and women of rural India about menstrual health. Through games, role-playing, storytelling using picture books and discussion, my colleagues and I help the girls and women get to know that menstruation is a normal biological process and an integral part of the transition phase of adolescence that brings in both physical and mental changes.

We discuss how period blood is not dirty, but in fact nourishes the developing embryo. For many, this is the first time they understand how their body works and why they menstruate. We introduce women to a range of menstrual hygiene products from reusable cloth pads, biodegradable disposable sanitary pads, tampons to menstrual cups and share instructions on how to use each of the products hygienically. We want girls and women to choose a product based on the comfort, affordability, and their ability to use it in a hygienic manner.

Equipped with this knowledge, the girls and women have a better chance of escaping old myths surrounding menstruation. Critically, it also helps them to understand when menstruation isn’t normal and they need to visit a gynecologist or doctor. I’ve seen many girls and women have severe reproductive tract infections because they did not know the difference between infectious and normal discharge and kept ignoring the signs. An approach that focuses on menstrual health rather than hygiene provides vital health information as well as confidence to dismantle the culture of silence surrounding menstruation and other bodily changes.

Creative approaches have been adopted by various other grassroots organizations throughout India. Sikun Relief works primarily in the flood prone region of Assam. Jatan Sansthan, in Rajasthan, employs a unique approach of involving men in training sessions and stitching of cloth pads. Menstrupedia is using comic books and TheaCare uses their online platform to foster healthy conversations on these topics.

Vitally, we need to have these conversations with not only adolescent girls but with women of all ages, including mothers and grandmothers. They are important to imparting correct information and supporting girls in shattering the taboos.

The movement in India on menstruation has come a long way and this year’s Oscar win brings it to the center of conversation. Now we all have the responsibility to direct the conversation to the right approach. This discussion should encourage government and donor agencies to address menstruation from biological, social, and gender lenses. Grassroots health leaders should be provided training to disseminate holistic information on menstruation.

The work that has been done to distribute sanitary pads has been a vital start, but now we need to have deliberate conversations around menstruation in order to help girls and women have stigma-free and healthy menstruation and lives.

The views and opinions of the author are her own and do not necessarily reflect those of the Aspen Institute.

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