Menstrual health awareness entails the dissemination of essential information about a natural, biological process - but it is plagued with stigma and misconception. Ananya Bhardwaj takes us back to school to understand the reasons for this problem, and tells us how to actively fight against it. Reachout & Beyond will be delving into this issue in more detail - this article serves as an informative primer!

This Independence Day, Narendra Modi laid emphasis on on the government giving away sanitary napkins at Re. 1, a statement for which he was widely celebrated. Is the bar set so low that a mere mention of a pad is something we cheer this loud for? Let us not forget that until just a few years ago, this fundamental healthcare product was taxed as a luxury item for over 355 million persons menstruating in India.

The challenges plaguing menstrual health awareness are manifold – access to sanitary products, the absence of clean water and sanitation facilities, lack of toilets, or private spaces for disposal options, among others. The taboo associated with menstruation and the lack of attention to women’s safety and health can also be attributed to insufficient menstrual health awareness, which should ideally be generated by schools.

Schools and Menstrual Health Awareness

In a 2014 report by Dasra, it was seen that over 23 million girls drop out of school every year because of the lack of appropriate facilities to combat menstrual health management. In a country plagued with female infanticide, these numbers only increase the disparity between the opportunities available to girls and boys. Owing to ignorance and deep-rooted prejudices about menstruation, girls are often isolated from the daily routine and use hay or old cloth to combat the blood flow. Many girls are often unaware of ‘menses’ till they get their first period.

In educated and privileged cities where schools have separate, well-constructed toilets (a facility that should be a necessity but is considered a luxury in the rural landscape), a different worry plagues the youth – lack of proper menstrual health awareness. Almost every menstruating person reading this can recall the time in school (at around age 11 or 12) that they were led to a separate room, away from their male peers. They were then hurriedly explained the basics of the female reproductive system and handed a free sanitary napkin like it were a secret operation. Shriya, a 24-year-old working professional (name changed), hopes for a time when she can ask for sanitary napkins and be handed it normally as if she had asked for a stick of gum. “What would it be like to casually put this brightly colored package in my bag, or hold it while I am walking back home...instead of having to hide it in an old newspaper or tuck it into a black bag?” she asks.

In biology, the syllabus surrounding menstruation is often rushed through. This furthers the stigma associated with menstruation; children are taught that a biological phenomenon they will go through in their lives is not ‘normal’ or ‘okay’ to talk about. It is absurd to consider that the first time students are educated about menstruation (without being segregated according to their gender) - as a part of their curriculum - is as late as the 8th or 9th grade because, by that age, many would have already started their menses. What can make up for the years of having to hide a normal biological phenomenon, or being forced to quietly deal with sanitation problems in schools with poor infrastructure?

We have heroes like Bhavana Ganu (Bindii: the Red Dot Revolution) and Aditi Gupta (Menstrupedia), or organizations like Goonj (Not Just A Piece of Cloth) that involve themselves at the grassroots. Alongside these voluntary initiatives, there are projects undertaken by UNICEF (MAHIMA: Menstrual Health and Hygiene Management for Adolescents Girls Project in Jharkhand), GARIMA group in Uttar Pradesh, and women's self-help groups in Gujarat. In Himachal Pradesh, three government departments – health, education, and rural development – have collaborated in the past for state-wide implementation of a menstrual hygiene program. However, it is evident that the existing curriculum and educational methods under the government and schools' purview are insufficient.

Beyond Curriculum: The Real World

The absence of effective educational initiatives leads to poor awareness of complications in reproductive health, a growing worry considering that one in every five Indian women suffers from Polycystic Ovary Syndrome (PCOS). This only leads to the conversation around menstrual health continuing to remain taboo. It takes some reading to learn about typical menstrual problems like cramps that are as severe as heart attacks, fluid retention and joint pain, and nausea; an already long list, without even addressing the markers of PCOS or endometriosis.

Young girls are not educated about the biology of their bodies during a phase that is confusing and painful to go through. Further, the task of educating those who grew up without learning about the female reproductive system or took no efforts to go beyond the half-baked information absorbed from the internet, more often than not, falls solely on women. A lack of understanding about menstruation causes problems like accidental pregnancies, stigma around abortions, prevalence of birth control pills – all of which further impact a woman’s health.

Overlap of Environment and Menstrual Health

Menstruating persons should be educated about the options at their disposal from a young age so that they may try all and settle with what works best for them. It is estimated that a healthy, menstruating person will go through approximately 16,000 pads in their lifetime, each of which takes 500-800 years to decompose – a huge number for single-use plastic products that do not disintegrate or have systems for proper disposal.

Today, the youth are more aware of their environmental footprint and are invested in adopting eco-friendly practices for sustainable living. These conversations will ensure greater access to menstrual cups and reusable pads, reducing our carbon footprint. One of the main contentions against menstruating persons using cups is the myth surrounding the ‘intactness’ of the hymen. Due to improper menstrual health awareness, these biased and ignorant views continue to further alienate menstruating persons from hygienic and safe methods.

How Do We Become Better?

The way out is by talking to families about menstrual health management and educating parents on preparing their child for her menses. Another way would be to spread awareness from a younger age about alternative products for menstruation - like cups or reusable cloth pads - many of which can be locally sourced and are a long-term investment towards protecting the environment and the reproductive system. Creating an atmosphere in schools where menstruation is not a taboo subject that is avoided can ensure that girls feel more comfortable.

Increased state support for NGOs that run established awareness programs or initiatives can ensure that menstrual knowledge is imparted down to the grassroots level and beyond the privileged. Funds should be directed towards production units for sustainable menstrual health products. This will encourage local businesses that have the resources to supply necessary materials and make it far more accessible for menstruators. The only way forward is a multi-pronged approach because without all fronts up and running, imparting menstrual health awareness in schools will remain a gargantuan task.

Edited by: Susheela Menon