Menstruation is a natural biological process – from menarche to menopause – experienced by adolescent girls, and women, worldwide. Data suggests that women will spend up to seven years of their lives menstruating, and on any given day, more than 800 million women aged 15 to 49 are menstruating globally. Despite the scale, menstruation remains a taboo subject, shrouded in silence and considered a ‘woman’s issue’, excluding boys, men, transgender men, non-binary persons, and sometimes even adolescent girls from the discourse, further crippling the dialogue on menstruation at the individual and community levels.

The Menstrual Challenge in India – Impact on Education

A staggering 71% of girls in India have never heard of menstruation before their first period, according to UNICEF. This inadequate health information about menstruation and puberty, coupled with social isolation, compounded by insufficient access to water, sanitation, hygienic materials, and disposal management at educational institutions, often leads to gender-discriminatory school environments. These pervasive feelings of shame, stress, and taboo further result in girls dropping out of school.

These gendered realities also result in adverse reproductive and psychosocial outcomes, diminishing future economic opportunities for girls, while reinforcing gender inequalities globally. Managing menstruation with dignity, safety, and comfort is essential to meeting the Sustainable Development Goals (SDGs) for gender equality, quality education, good health, sustainable water and sanitation for all; and related human rights.

But, addressing social barriers that prevent girls and women from managing healthy and safe periods is easier said than done. These barriers, spurred by social sanctions, deem menstruating women and girls as impure and unclean, often giving them mixed messages and creating paradoxes like – periods are normal biological events, but they must stay hidden. This stigma jeopardizes their access to available information or services, even if their health issue is related to periods.

Impact on Health and Wellbeing

Research indicates that 88% of menstruating women in India use home-grown alternatives like old fabric, rags, sand, newspapers, dried leaves, ash, and wood shavings due to the high cost of commercial products. This lack of consistent access to hygienic menstrual products leaves them susceptible to severe infections and grave reproductive issues.

The lack of information on ‘period-appropriate’ diets that fulfill the daily nutritional requirements of menstruating girls and women is another blind spot for communities. The National Family Health Survey 2019-2 suggests nearly 60% of women in India are anemic, while a recent study by the Indian Journal of Community Medicine found a significant association between anemia and poor menstrual hygiene management.

This cascading impact of improper menstrual health and hygiene on girls’ education, health, awareness, and well-being, keeps them trapped in an inter-generational multi-dimensional cycle of poverty.

The Global movement to address Menstrual Hygiene

From deeply uncomfortable silences and embarrassment around the issue, we all have come a long way over the last decade, openly and with pride celebrating May 28 each year as World Menstrual Hygiene Day. The Day advocates for ending period poverty, raising awareness, destigmatizing, busting myths, and improving access to information and commodities to manage menstruation better worldwide. This year’s theme – “Together for a #PeriodFriendlyWorld,” emphasizes creating a world where stigma and taboos surrounding menstruation are history and everyone can access the products, education, and infrastructure they need for menstrual health.

While the Government of India and NGOs like the American India Foundation (AIF) have made huge strides in addressing menstrual hygiene, more work is needed to normalize this physiological phenomenon.

AIF’s MANSI: A Beacon of Hope

India hosts about one-fifth of the world’s population of adolescent women. Unfortunately, most of them, particularly those in rural areas, encounter numerous restrictions that significantly limit their agency and autonomy. During menstruation, these restrictions become much more severe, preventing their participation in many aspects of social life including worshipping, bathing, cooking, etc.

This is where Maternal and Newborn Survival Initiative (MANSI) – AIF’s award-winning public health program – steps in!

Through a life-cycle approach, MANSI fosters health equity for adolescent girls, young mothers, pregnant and lactating women, infants, and children up to five years of age, tailoring care at all critical junctures.

The program’s foundation lies in reinforcing the capabilities and capacity of existing government frontline workers, such as Anganwadi Workers (AWW), Accredited Social Health Activists (ASHA), and Auxiliary Nurses and Midwives (ANM) so they can empower the communities to make informed health choices. Through behavior change communication and active government engagements, MANSI implements multitudinous interventions and programs, including those on healthy menstruation and nutrition.

Combating Period Poverty and Promoting Menstrual Equity

MANSI operates at the intersection of gender and poverty, providing essential resources, education, and healthcare services to adolescent girls. The program distributes sanitary products, offers comprehensive menstrual health education, and fosters supportive community networks, empowering young girls to manage their menstrual health with confidence.

Nutrition and Anemia Prevention

MANSI’s Poshan Sathi program focuses on the nutritional needs of menstruating girls and women. It conducts informative sessions on dietary requirements and promotes Nutri-Gardens at the household level to boost dietary diversity by providing micronutrients to meet the daily needs of menstruating girls and women.

Additionally, its Anemia Prevention Program, aligned with the Government of India’s Anemia Mukt Bharat Campaign, is designed to combat the high prevalence of anemia in adolescents and women. Heavy menstrual bleeding can lead to significant blood and iron loss, which may cause iron-deficiency anemia. The program delivers essential knowledge and promotes the distribution and uptake of IFA (Iron-Folic Acid) tablets provided by the government, to significantly enhance adolescents’ health and well-being.

Promoting Sustainable Menstrual Hygiene Solutions

Period poverty is manufactured! It puts women and girls who cannot afford to buy expensive commercial menstrual hygiene products at a further disadvantage. MANSI combats the problem by distributing sanitary pads in select geographies. These reusable pads last up to two years. This approach is cost-effective and environmentally sustainable, reducing waste on the planet and the financial burden on families. In a woman’s lifetime, it is estimated she’ll use between 12,000 and 15,000 pads and/or tampons, most of which end up in landfills where they can take between 500-800 years to biodegrade. The use of reusable pads helps mitigate this environmental impact while helping girls menstruate with dignity.

By promoting menstrual equity and breaking the silence around menstruation, MANSI improves physical health and promotes gender equality. Through workshops, school programs, and community engagement, MANSI creates a supportive environment where girls can stay in school and participate fully in their communities.

Together for a period-friendly world!

As we commemorate World Menstrual Hygiene Day each year, it’s crucial to recognize that the journey toward menstrual equity is ongoing. Empowering women and girls with knowledge, resources, and support is essential for their health, education, and overall well-being. By breaking the silence, challenging stigmas, and promoting informed discussions around menstrual health, we can create a world where menstruation is no longer a barrier to anyone’s potential.

Sources:

• UNICEF, Menstrual Hygiene Management in Schools (2014).
• Ministry of Health and Family Welfare, National Health Mission (2019).
• World Menstrual Hygiene Day, Menstrual Hygiene Day Report (2020).
• Anemia Mukt Bharat, Government of India (2018).
• The Guardian, Environmental Impact of Sanitary Products (2019).