Menstrual health matters

When sixth grader Runa got her first period, she told her mother, who suggested she use rags as napkins. However, Runa did not receive any other information on the dos and don'ts of menstrual hygiene. In fact, due to the use of unhygienic menstrual rags, she constantly felt discomfort, her clothes got stained, and her school attendance was affected. Early on, she was given the impression that having a period was a matter of shame; so, if ever her uniform was stained, she tried to hide it by saying it was "red ink".

Moreover, Runa's mother asked her not to share any menstruation-related information with anybody, especially with boys—not even with her father and brother. She said it was a shameful event women must endure every month and girls should keep it secret. Runa received a similar understanding from one of her elder sisters. She was no longer allowed to go out of the house, even for evening games with her fellow friends. Her world suddenly turned colourless.

Does this story sound familiar? It is in fact what most adolescent girls and women face across the country during their menstruation. But menstrual hygiene is critical to women's journey of growth and development. How far have we reached in terms of its management? While 49 percent of the total population of Bangladesh are women (81.3 million) and menstrual hygiene management (MHM) is their basic health right, it is still a taboo subject in this country. Directly linked with both SDG 3 (ensure healthy lives and promote well-being for all at all ages) and SDG 6 (ensure availability and sustainable management of water and sanitation for all), MHM is a crucial factor behind the country's progress towards attainment of the sustainable development goals.

In Bangladesh, menstruation is a hush-hush topic which is avoided through a culture of silence. According to the Bangladesh National Hygiene Baseline Survey (BNHBS) 2014, only six percent of girls received any education session related to menstrual hygiene at school. The study also indicates that only 36 percent heard about MHM before their first period (menarche). Around 94 percent do not know why girls menstruate. Many teachers do not discuss the topic in front of the boys in class. Even mothers are uncomfortable talking about it to their daughters.

Moreover, parents do not feel the need to inform their daughters about menarche and menstrual hygiene. Besides, menstruating females are often prohibited from eating fish, meat, eggs, bananas, sour fruits and vegetables, which is illogical and hampers their nutrition. The clothes that they use are dried in the remotest corners of the house, from where it can't be seen by others.

The stigma and silence surrounding menstruation means proper knowledge is not being disseminated. Some myths like dietary restrictions are creating long-term health concerns, where women remain undernourished, leading to poor pregnancy and undernourished children. The stigma centred around menstruation also perpetuates low self-esteem among girls and hampers their growth.

It is essential for us at this point to understand how poorly managed menstrual hygiene is linked to issues like sexuality, education, sexual and reproductive health and rights (SRHR), child marriage, gender equality, and above all, women empowerment and the confidence of adolescent women. Neglecting MHM means allowing a development paradigm that does not echo gender equality and empowerment. To ensure inclusive and sustainable development, ensuring MHM is imperative.

Sadly, the situation in Bangladesh is still depressing. According to the Ritu Baseline Report 2017, the toilet to student ratio is 1:187 whilst the standard according to the World Health Organization (WHO) is one toilet for 25 girls. The BNHBS 2014 stated that disposable pads were used by about only one-tenth of adolescents in households. Around 40 percent of surveyed girls reported that they miss school during menstruation and 31 percent thought that menstrual problems affect their school performance. Additionally, females who are differently abled are the worst sufferers. Public restrooms are neither MHM-friendly nor disabled-friendly. Indeed, MHM for differently abled girls is something that is hugely absent in mainstream discussions. Furthermore, male involvement, which is necessary in improving MHM, is alarmingly low and culturally discouraged. Then there are situations like Covid-19, floods and refugee crises, which only intensify the problems girls and women face during menstruation.

Besides creating long-term health concerns along with severe gynaecological problems—which include reproductive tract infections (RTIs) such as bacterial vaginosis, urinary tract infections (UTIs), major complications such as pelvic inflammatory disease, toxic shock syndrome, increased risk of contracting blood-borne diseases like HIV or Hepatitis B, postpartum infections, complications after abortion or C-section, etc—poor MHM has broader socioeconomic impacts and is a threat to gender equality. To combat these challenges, NGOs and development agencies are working hand-in-hand with the government. For example, Share-Net Bangladesh is currently developing a resource document that could be used by local organisations to receive more funds for MHM interventions. Its host organisation, RedOrange Media and Communications, is currently running a project named "Alor Jatra" to ensure an MH-inclusive environment at schools for girls with disabilities by raising and creating awareness on MHM.

Thus, all efforts have to be made from all levels, in a coordinated manner. Immediate focus must be given on certain issues, including male participation, involvement of parents and schools, focus on the policy level, inclusive planning for differently-abled people, prevention of child marriage, and so on. Especially for effective male involvement, we should concentrate on certain issues, such as gender sensitisation, community-based counselling and training, proper utilisation of TV and other mediums of mass communication, training of the teachers at schools as well as parents, provision of comprehensive sexual education, etc. While nationwide policies and strategies are focusing on reaping population dividends in the demographic shift the country is experiencing, MHM should be considered as one of the core services in need of being mainstreamed everywhere. This message must reach more people, irrespective of gender, so that they can be encouraged to accept menstruation as a natural biological process, not a matter of impurity.

The Government of Bangladesh is planning on unveiling a National Menstrual Hygiene Management Strategy soon. We welcome the noteworthy initiative and believe that the strategy will focus on scientific implementations of MHM, and will also guide the relevant authorities to subsidise MHM products so that women of all economic classes have access to menstrual hygiene and their basic health rights.

Farah Nusrat is Communications Associate for research at RedOrange Media and Communications, which is hosting the Share-Net Bangladesh project—the Bangladesh hub of Share-Net International. Masuma Billah is the Senior Programme Manager, SRHR and Gender at RedOrange Media and Communication, and Share-Net Bangladesh.