Girls in distress: Menstrual hygiene issues

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com)

In India, menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions for girls and women. Though menstruation is a natural biological process, most people in the Indian villages and a large section of the urban society, even women, hesitate to talk about it. Menstrual hygiene is an issue that every female has to deal with in her life, but surprisingly, there is a lack of awareness regarding menstrual hygiene management (MHM) in India.

As per the fifth National Family Health Survey (NFHS-5) 2019-21, only 77.3 per cent of Indian girls and women aged between 15 and 24 years use hygienic methods of protection during their periods. The figure is 89.4 per cent in urban areas and 72.3 per cent in rural areas. The NFHS-5, 2019-21, also states that the respective figures are 66.3 per cent, 82.9 per cent and 63.8 per cent in Assam, respectively. The rest use unsanitary old cloth pieces, papers, dried leaves, grasses, etc. These unhygienic practices lead to fungal infections, urinary tract infections, reproductive tract infections, etc., which further can cause infertility and even death.

As issues associated with menstruation and MHM are less discussed, most Indian adolescent girls are ignorant about menstrual hygiene-related practices that they should be adopting and the adverse health impacts of unhygienic menstrual practices on them. Most of them have no idea about what material to use to absorb the period flow. Menstrual hygiene is crucial in the reproductive life of every female. Therefore, every adolescent girl should have sound knowledge on menstruation and menstrual hygiene-related practices (using sanitary napkins, washing of external genitalia and taking baths during menstruation, etc.), and ideally, a mother should be the main informant at this tender age.

In India, about 255 million girls struggle every month to go to schools and colleges because of their periods. Sanitary napkins come at a price beyond their means. Barely 20 per cent of rural female students can afford costly, disposable sanitary napkins. The rest 80 per cent can’t afford sanitary protection during their periods.   Further, over 40 million schoolgirls have no place to urinate, as 40 per cent of the government schools lack toilets for girls. They need to go home to urinate during school hours and more so during their periods. Most government schools in India lack private space for changing sanitary napkins, soap and adequate water to wash themselves and their cloths during their period, and safe disposal facilities for soiled sanitary napkins. Limited access to safe sanitary products and facilities during their periods forces them to miss five days of school every month (about 20 per cent of the school year). The regular monthly absenteeism in schools often serves as a trigger for school dropouts. As a result, one in five girl students in India are forced to drop out of schools because of menstruation.

The lack of MHM in schools and colleges is a major reason for a majority of Indian girls skipping schools and colleges during their periods and eventually dropping out at an early age and missing out on their education. This is a matter of grave concern, as it can be detrimental to the country’s image and economic progress. Steps should be taken to support girls during their menstruation so that they do not miss schools and colleges. There is a strong need for encouraging menstrual hygienic practices among the girl students, and MHM training needs to be imparted to them. They should be taught MHM by female teachers, female health workers and female members of NGOs in a sensitive and supportive manner. MHM involves menstrual hygiene education sessions at schools, colleges and girls hostels, along with steps to ensure that girls have separate toilets and sanitation blocks located at a safe place to assure privacy, based on a ratio of one toilet for every 40 girls (and/or one urinal for every 20 girls). The sanitation blocks should be equipped with well-positioned mirrors so that girls can check for stains on their clothes, private bathing or changing units to change their clothes/sanitary napkins and to wash themselves, including a place with a shelf, hooks or a niche to keep clothing; provision of sanitary napkin vending machines; and incinerators or dustbins for safe disposal of soiled sanitary napkins and cloths. Other than these, education officials and teachers need to undergo compulsory MHM training workshops in all districts so that girl students get maximum information related to menstrual hygiene.

Moreover, girls can establish ‘Girls’ Hygiene Clubs’ to ensure peer-to-peer learning and sharing of menstrual hygiene information. Apart from MHM training for girl students, there is a need to talk to boy students, male teachers and parents about MHM in the context of girls’ access to education and school completion. These will not only boost the confidence of girl students but also improve their attendance in schools during their periods.

There is a need to mobilize the girl students to use sanitary napkins. India should aspire to become a 100 per cent sanitary napkin-using girl students’ country. The government and other associated agencies should launch a major publicity campaign to make girl students understand the importance of sanitary napkins. Commercial sanitary napkins are not cheap. For most Indian girl students, the luxury of affording sanitary napkins is a far-fetched dream. The need of the hour is to improve the quality of life of these distressed girls by providing them free or highly subsidized and easily accessible sanitary napkins, which will give them freedom and protection from their monthly dilemma and discomfort.

Though there are few government schemes to distribute such sanitary napkins for rural areas and free sanitary napkins to girl students, their reach remains limited. The government should either upgrade the existing schemes or introduce new ones so as to reach out to all girl students. Providing free sanitary napkins to all the girl students will be a massive health booster for girl students, will reduce their absenteeism in schools and colleges during their periods, greatly enhance their academic and personal development and safeguard their dignity and lead to greater empowerment of women.