How Menstrual Hygiene Impacts Women’s Health and Rights

An insight into the community

As part of a university project, I conducted a research on the impact of menstrual hygiene management (MHM) on girls and women’s health and rights. Focusing on the case-study of the rehabilitated slum of Natwar Parekh Compound, where Myna Mahila is based, I had the opportunity to conduct surveys and focus-group discussions with girls and women from the community. If it was not easy at first due to my status of foreigner and the linguistic barrier, Suhani and Hasseena helped me throughout my primary research by translating and introducing me to the community. If I learned a lot through secondary research, books and academic articles about MHM in India, this is not comparable with the experience of discussing about menstrual hygiene directly with the girls and women from Govandi. I was so positively surprised and impressed by their warm welcome, their generosity and their capacity to open up. Indeed, talking about menstruation in India and most countries in the world- including France- is not an easy thing, especially with people you don’t know. I was expecting this feeling of uncomfort, shame and resistance to be particularly present in the context of this neighborhood because of the importance of the menstrual taboo and the lack of education. Yet, after conducting the first surveys, something quite unexpected happened: women and girls started to come and fill up the room, sitting together waiting for their turn to answer the questions. Meanwhile, they would start intervening, sharing their own stories and experiences regarding menstruation. It seemed that being in group made them feel more comfortable to speak up as they would realize that their stories were shared by many of them.

Lack of awareness

The most striking observations throughout the interviews and discussion were the lack of awareness about menstruation and the feeling of shame and impurity associated with it. Most of the interviewed girls and women reported not being aware of what menstruation was before they had their periods. Some women said that, as they started menstruated, they were only told “this will come every month but don‘t tell anyone about it”. A woman even shared that she thought “someone had split paan in her underwear” the first time she saw menstrual blood! Younger girls as well shared their experiences of menstruating at school and the shame and embarrassment they feel. Most of them told me they would never been taught about menstruation at school and would learn about it through their mothers or sisters: “At school, if it is a male professor, he does not teach about reproductive system and menstruation; if it is a female professor, she teaches boys and girls separately”. One girl also shared her experience of having her periods for the first time at school: she panicked and went to her teacher who wrapped her up in cloth and sent her home without any explanation.

Perception

When asked if they feel comfortable talking about periods, more than half of the women and girls replied no (53%) and their embarrassment was often perceptible during the surveys. While a majority of women (53%) would say that periods are “impure”, this opinion was most common in older age group than among young girls. When asked why, most of them would say that they do not know, that they were always told this in their families and that they felt “dirty” during their menstruations. Yet, the majority of the mothers (58%) reported talking about periods to their daughters, and even sons in some cases. Another issue revealed by the results was the difficulty to access sanitary pads because of the stigma around menstruation and the feeling of shame that the women and girls might face when purchasing their MHM products. When describing her customers, Suhani Jalota, founder of Myna Mahila, explained:
“ It’s those women who are unable to step out, A because of affordability –they just feel this is something too expensive, that they can’t buy every month- and B it could be because I feel so shy going to that chemist shop, with a male shopkeeper, which is always stuffed with lots and lots of men and I’ll be announcing to the world that I have my periods if I ask for a pad and then they’ll wrap it up in layers of newspaper, put it in a black plastic bag and then give that to me as if I was carrying a bomb.”
In fact, 36% of respondents reported not buying their sanitary pads themselves and 45% mentioned not feeling comfortable when buying pads.

Social restrictions and impact on work and education

Another major point of my work relates to the diverse types of restrictions girls and women may face when they are menstruating, regarding their social and professional lives for instance. In fact, 70% of women reported facing restrictions during their periods. However they would not necessary consider them as “restrictions”  per se but as normal customs or habits. The most common restrictions were related to religion: all respondents facing restrictions reported neither being able to pray during menstruation nor performing any religious rituals. 41% also said they could not visit religious institutions. Other restrictions reported were not being able to go outside of home during their menstruations, having to sleep separately, not being able to fast (for the Ramadan) or to make “holy food” such as  ladus for Hindu festivals.

Regarding access to work and education, almost all women and girls reported feeling uncomfortable having their periods at their workplace or at school. Despite having access to WASH (water, sanitation and hygiene) facilities, almost all respondents said they would not change their used absorbents at work and at school and therefore wait to be home to do so. Almost half of the women and girls reported missing a day or more at school or at work because of their menstruation. This could be either because of physical menstrual symptoms, as well as the feeling of discomfort and shame associated with menstruating.

Conclusion

The results confirmed that there exists a positive correlation between the level of education and having an adequate MHM, i.e. “using a clean menstrual management material to absorb or collect menstrual blood, having access to adequate WASH facilities, as well as understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.” (WHO and UNICEF).
The study revealed that younger (between 14 and 18 years old) and more educated respondents (secondary or above) were more likely to use pads, whereas respondents above 30 years old and less educated are more likely to use cloth. Regarding awareness, respondents who had heard about menstruation before menarche were all below 25 years old and had completed at least secondary education.
Thus, this research shed light on the importance of the remaining taboo and feeling of shame and discomfort around menstruation present among girls and women. It seems that culture, education and awareness play a determinant role in providing girls and women with a safe and adequate MHM. This points out the necessity to improve awareness and education about menstruation at the younger age, in order to free girls and women from the menstrual taboo and allow them to have an adequate MHM, with dignity. As S.Jalota stressed in the interview, improving MHM is a fundamental step on the path to women empowerment:
“The empowerment is more the impact side, so we see MHM more as an outcome to the things we are doing but the impact is really that these women who earlier were shivering at the word “pad” or “periods”, now these women are full time making, educating and talking about, marketing and selling pads. These women can now break that ice to talk about other things that menstruation is also taboo with. It could be domestic violence, it could be sexual assault, it could be a single question like asking your husband if you can go out now. So once you start feeling confident about your own body, it kind of gets you confident to talk about other things as well, and that’s where we link menstruation and women empowerment”. 

Indeed, the inability to manage menstruation properly in India is influenced by broader discriminatory cultural and social norms. Thus, addressing the menstrual taboo can be the opportunity to raise further issues related to sexual and reproductive health, which is critical to empower women and allow them to reclaim their rights over their bodies and sexuality.

 

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