Let’s talk menstruation!

Here’s why. India is home to around 120 million adolescent girls— that’s roughly 10% of the population. A girl menstruates on an average for five days a month, 12 months a year, and the cycle carries on till she reaches menopause in 30–40 years. Periods are normal and healthy, yet many girls across rural and urban India struggle to manage this monthly occurrence. The statistics are stark and dismal: 88% of girls and women who menstruate use unsafe materials; 66% of girls are unware of menstruation before their first period; 70% mothers think periods are dirty; 66% girls and women manage periods without toilets. Handling a normal physiological event is hugely complex, influenced by socio-cultural norms and the larger political environment that shape how girls experience their periods, what they can do while menstruating, what they can use to absorb menstrual blood and how they dispose the material, whether and from whom they can seek information and help, and even whether they stay in school or not. When a girl faces obstacles in managing her menses in a healthy way, she is at risk for infection, her self-esteem and self-confidence suffer, she may remain absent from school during her period, or worse still, drop out of school altogether upon reaching puberty. Over time, these negative effects add up, preventing a young girl from achieving her full potential and having a healthy, productive life. So what are we, as professionals, doing to help girls have healthy and safe periods?

Let us break down what it takes for a girl to manage her periods in a healthy way that respects and upholds her dignity, and privacy. We need “hardware”, “software”, and a conducive environment that supports these elements while empowering girls. Software includes information about, favourable social norms and healthy attitudes towards menstruation. A girl need to know why she has periods and what is happening to her body when she menstruates. She needs to be aware about the range of safe and hygienic menstrual absorbents available — both reusable and disposable. Negative and harmful menstruation related social norms and taboos can perpetrate a culture of silence and negative attitudes, and should be addressed to ease long term repercussions. The hardware includes adequate water, sanitation, and hygiene (WASH) facilities (including disposal systems), and safe and hygienic materials to absorb menstrual blood. When girls have access to adequate hardware they can use clean menstrual absorbents, and can wash up with clean water, and change the  cloth or pad as many times as required in a safe and private space. A supportive environment is essential if girls are to use and benefit from the software and hardware available to them. This enabling environment is complex, encompassing a multitude of influencers who affect the girl directly and indirectly. Menstruation is private, but most girls are constantly negotiating societal norms and public policy that impinge on them. Parents, siblings, community members, including men and boys, have a strong impact on how girls perceive and manage their periods. Teachers, health care providers, and others who come in contact with girls through schools, health centres also shape her experiences. These influencers come from the same communities as an adolescent girl, experience similar sets of constraints related to periods, and play a pivotal role in perpetrating a culture of silence and shame around this issue.  At a slightly removed, though no less critical level, are government/policy makers, NGOs, and donor agencies. Their decisions on policies and programs impacts whether girls will have access to and can afford the information, materials, facilities, and support needed for healthy periods. For instance, Prime Minister Narendra Modi’s clarion call for all schools to have girls’ toilets has led to intensive efforts across the country to equip schools with such facilities.

So far, the WASH sector has taken the lead on MHM. More recently, entrepreneurs have been innovating menstrual products, and the education sector has come on board as schools are a great platform to reach girls. These efforts are commendable, bringing attention to a much ignored issue. Action however, has centred to a great extent on hardware, which though necessary, is by itself insufficient to promote MHM. Girls will continue to struggle with menstruation till they lack information, and deep set, harmful social norms remain unaddressed. The health and women empowerment sectors can play a critical role in addressing these aspects and enabling girls to make informed decisions.

Menstruation matters to our girls, and it should matter to everyone, everywhere. We experience it and we shape its experience. As influencers, development professionals, and policy makers, we must take action now. Period.

Arundati Muralidharan is Manager - Policy (WASH in Health & Nutrition, WASH in Schools) at WaterAid India. She Tweets as @arundati_md