We need to step up efforts to address menstrual hygiene amongst adolescent girls
Just a few days before I had my first period, I lost an uncle to colon cancer. That was many years ago, and we did not know what colon cancer was. All we knew was that he died while having bloody discharge from his rectum.
I had my first period while I was at school. Bangla class was going on and I felt a sudden sharp pain in my lower abdomen. I went to the toilet and found that I was bleeding. I seriously thought I was dying. I was dying like my uncle.
I came out and went to the music teacher and she was my saviour. She told me I wasn’t dying with this bleeding, and explained everything, and gave me materials and medicines.
In 2019, at the 91st Academy Awards ceremony, while accepting an Oscar, the producer of “Period. End of Sentence,” Melissa Berton, ended her speech by saying, “A period should end a sentence -- not a girl’s education.” This single line encompasses so many emotions and also touches upon the far-reaching impact of menstrual hygiene management (MHM).
The Bangladesh Adolescent Health and Wellbeing Survey 2019-20 found that most female adolescents aged 15-19 years had no knowledge about menstruation prior to menarche. Only 23% of ever married and 30% of unmarried adolescents reported having prior knowledge.
This is not only the case of Bangladesh. Millions of girls around the world have no idea what menstruation is, let alone how to manage it safely and hygienically when they get their first period. This often leads to misconceptions, resulting in girls being stigmatized and excluded from normal familial and societal events.
The same survey found that 87% of ever-married female adolescents and 85% of unmarried female adolescents think that “menstrual blood is impure,” and since they are carrying this impure blood, the girls are restricted from going to places, touching any number of things, and performing many rituals.
Are these the only misconceptions that prevail? No. More than half of the girls think that “physical activities should be limited during menstruation.” With these widespread misconceptions, society -- and the girls themselves -- limits their potential to lead more fulfilling lives.
Around the world, women use a lot of things while they are bleeding. The choice of product usually depends on access to that product, social norms, and purchasing power. In Bangladesh, overall, 98% of adolescents use disposable products or reusable materials cleaned with water and soap or detergent.
Sanitary napkins are being used by around two-thirds of adolescents and more than half of adolescents use reusable cloth materials. However, international guidelines suggest changing used menstrual products or materials at least four times a day during menstruation.
Based on that guideline, if we look into the composite indicator of “hygienic menstrual practices,” it was found that, although the use of disposable products or clean reusable materials is quite high among adolescents, only one in 10 adolescent females practice appropriate menstrual hygiene.
Based on a 2018 article, around 70% of the reproductive infections in women from developing countries like Bangladesh are caused by poor menstrual hygiene. Contaminated products used to contain menstrual blood are breeding grounds for several bacteria like Salmonella, Staphylococcus, and E. coli. These bacteria can multiply rapidly in the reproductive tract, starting from the cervix and spreading upwards.
They can enter the bloodstream directly from the highly permeable mucosal membrane. This can lead to sepsis and related complications. The other most common form of infection present in women practicing poor menstrual hygiene is urinary tract infection (UTI). If left untreated, UTI can develop into a serious complication.
This low level of hygienic menstrual practice could mean many things -- girls may not have the knowledge of how many times they should change products, or they simply cannot change them because of limited access to products or changing facilities.
How many schools have running water, a proper waste disposal facility, and adequate privacy for changing? Though we do not have official numbers, anecdotal evidence suggests that the proportion is really low. Lack of period-friendly sanitation facilities in schools is a significant obstacle for millions of girls that attend.
The BAHWS 19-20 states that one in four adolescent female students miss at least one day of school during menstruation. The most common reasons cited for not attending school during menstruation were having menstrual cramps/pains, embarrassment, and high-flow bleeding. Having analgesic tablets at schools, period-friendly sanitation systems, and other students being more empathetic can solve the first two reasons very easily.
An empowered girl who is not limited in her activities during any time of the month is more likely to stay and excel in school, and thus, less likely to be the prey of early marriage and early pregnancy. Proper education will empower that girl to have better decision-making abilities to build a healthier family.
Therefore, it is high time we stepped up efforts to address this critical barrier to girls realizing their full potential for themselves, their families, and their communities.
Fortunately, the topic of menstrual hygiene is achieving increased attention, but a lot more effective action and proper investment is required to ensure that girls do not lose the opportunity to thrive just because they are bleeding.
Let a period end a sentence, not the window of opportunity for a young girl.
Shusmita Khan is Research Associate, Data for Impact (D4I), Carolina Population Center. To learn more, please email Shusmita Khan at [email protected]