Bengaluru: The coronavirus crisis has impacted the menstrual hygiene and health of women, globally. A lot of them do not even have access to menstrual supplies as the world is either getting into lockdown mode, quarantined, or getting out of it to contain the spread of the infection.

Although menstruation is a natural process it has never been discussed openly, through the ages. It has been associated in turn with witches, magic, shame and taboo.  And it is not surprising that even today most women in our country do not talk freely about it.
 
In some communities in India, women, during a period are not allowed to enter places of worship, cook food or participate in socio cultural activities. All this and more perpetrates the myth that menstruation is impure, and the body is cursed during this time, which is far from the truth.

Welcome to the world of over 355 million menstruating women in India!

Menstrual Hygiene Management (MHM)

The WHO and UNICEF put out a joint statement defining MHM:

“Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials”.

What did women do before the sanitary pad or the tampon was invented? It is believed that the Egyptians and Greeks used papyrus and lint wrapped around a stick to use as a tampon.  Some over time used “rags” and the rest just bled through their clothes and continued to wear the same dress for the length of their period!  So much for menstrual hygiene! 

The modern sanitary napkin was not invented until the late 19th century and the tampon came into being only in the early 20th century. But many women in the developing world continue to use cloth or rags as they cannot afford menstrual hygiene products.

Many of you probably do not know that 15 – 40% of girls in the developing world do not attend school during their periods.  This is due to lack of access to sanitary napkins, toilets, sanitation and adequate privacy. 

In rural schools, female teachers, during their periods, perform less efficiently for similar lack of infrastructure and tend to take leave or go home early. In recent times, there have been several NGOs involved in spreading awareness and helping women manage their periods with dignity.

Even in the cities and metros, access to clean toilets is a luxury.  Not all workplaces may be “period friendly” and stepping out of the comfort of one’s home during this time continues to be a challenge for most women. 

Inadequate Menstrual Hygiene

Some of the consequences of poor menstrual hygiene are listed below:

Table Source: Menstrual Hygiene Matters: a resource for improving menstrual hygiene around the world 1ed.: WaterAid.

On a Final Note

In many cultures the onset of the first period is announced and celebrated.  And yet it is the same period that condemns her to a life of impurity and isolation for those few days in some cultures across the world.

I would like to leave you with a few lines from Gloria Steinem’s – If men could menstruate:  “What would happen, for instance, if suddenly, magically, men could menstruate and women could not? The answer is clear—menstruation would become an enviable, boast-worthy, masculine event: Men would brag about how long and how much. Boys would mark the onset of menses, that longed-for proof of manhood, with religious ritual and stag parties. Congress would fund a National Institute of Dysmenorrhea to help stamp out monthly discomforts. Sanitary supplies would be federally funded and free. (Of course, some men would still pay for the prestige of commercial brands such as John Wayne Tampons, Muhammad Ali’s Rope-a-dope Pads, Joe Namath Jock Shields—“For Those Light Bachelor Days,” and Robert “Baretta” Blake Maxi-Pads.)”

There are also health issues to consider apart from the above-mentioned social issues. Poor protection and inadequate washing facilities may increase susceptibility to infection, with the odour of menstrual blood putting girls at risk of being stigmatised. In communities where female genital cutting is practiced, multiple health risks exist. Where the vaginal aperture is inadequate for menstrual flow, a blockage and build-up of blood clots is created behind the infibulated area. This can be a cause for protracted and painful period, increased odour, discomfort and the potential for additional infections (KIRK & SOMMER 2006).

It is assumed that the risk of infection (including sexually transmitted infection) is higher than normal during menstruation because the blood coming out of the body creates a pathway for bacteria to travel back into the uterus. Certain practices are more likely to increase the risk of infection (see figure below). Using unclean rags for example, especially if they are inserted into the vagina, can introduce or support the growth of unwanted bacteria that could lead to infection.

As an example, findings from Bangladesh, where 80% of factory workers are women, show that 60% of them were using rags from the factory floor for menstrual cloths. These are highly chemically charged and often freshly dyed. Infections are common, leading to 73% of women missing work for on average six days a month. Women had no safe place either to purchase cloth or pads or to change/dispose of them. When women are paid by piece, those six days away present a huge economic damage to them but also to the business supply chain (WSSCC 2013).

(Author - Dr Prathima Reddy, MBBS, MRCOG (London), FRCOG (London), FACOG (USA) is the director, senior obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)