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Context

• Maternal mortality rates remain high in low- and middle-income countries, where 94 percent of all cases are recorded. In India, maternal mortality ratio stands at 113 per 100,000 live births; the government is aiming to reduce the incidence to below 70 by 2030. Experts agree that the promotion of sexual and reproductive health (SRH) is among the keys to addressing this massive challenge. Achieving global targets on SRH, in turn, greatly depends on a collective commitment to improve menstrual health and hygiene (MHH).

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Challenges for Menstrual hygiene

• Lack adequate access to information and service: The stark reality is that individuals who menstruate lack adequate access to information and services around SRH and are unable to exercise their SRH rights throughout their life cycle. Among the factors for this lack of access are poor economic and educational outcomes.
• For instance: Multiple studies in different developing countries have shown that those with fewer number of schooling years tend to experience early sexual initiation and early marriage, have higher fertility rates, and suffer poor maternal outcomes.
• Multiple barriers hinder the promotion of menstrual health and hygiene: Barriers that include socio-cultural norms that regard menstruation as taboo, and biological and medical issues such as urinary tract infections, and abnormal urinary bleeding that can be caused by fibroids.
• Vicious circle of poor SRH: These issues diminish the agency of menstruating individuals in making decisions related to sex, relationships, family planning, and contraceptive use. This sets them back into the vicious circle of poor SRH.
• Lack of privacy and dignity: Menstruation-related challenges are seen in schools, work places, and communities where menstruating individuals cannot safely manage their needs with privacy and dignity.
• Taboos and myths: In certain communities, restrictive social norms do not allow menstruating individuals to pray, bathe, sleep in the same bed as others, or make food. In India, taboos and myths hinder the optimal use of the more than 8,000 Adolescents-Friendly Health Clinics (AFHCs) set up by the government across the country.

Global Outlook

• Menstrual health is often neglected in SRH agendas: Despite strong evidence that one of the anchors of sexual and reproductive health is menstrual health, governments, policymakers, and NGOs rarely include menstrual health in their SRH agendas.
• Little attention had been paid: Although SRH was the focus of both the World Population Day and Gender Equality Forum in 2021, little attention has been paid, if at all, to menstrual health.
• For example during the vaccination, menstrual health was not taken into account: Early studies also suggest that during the production of COVID-19 vaccines, menstrual health was not taken into account while conducting the pilot studies on understanding the efficacy of the vaccine.
• The education aspect is also lacking: A study of education policy documents across 21 developing countries found little attention to menstrual health. Of those countries that appeared to have MHH in their health and education agenda in the last decade, the focus was on the distribution of disposable sanitary pads, largely for schoolgirls; they tended to ignore the other issues related to menstrual health and hygiene including safety, disposal, right to dignity and providing choices to people who menstruate.

A Framework for mainstreaming menstrual health and hygiene in India

• Promoting Menstrual Health and Hygiene Education: Conversations around menstruation should be started in schools and local communities by including menstrual health and hygiene in sessions on reproductive health.
• For instance: In 2007, the Indian government introduced the Adolescent Education Program to promote discussions around sexual education, but it received backlash from teachers and parents. Sociocultural issues are equally important and should be given attention by stakeholders.
• Knowledge about the products they use: Programmes should be initiated that will focus on distributing disposable sanitary pads to girls and women, and not only those who are in school. As the discourse on menstruation is now shifting toward sustainable menstruation, it is crucial to equip individuals who menstruate with knowledge about the potential harm of the period products they use.
• Sensitizing gatekeepers: Organising sensitisation workshops for gatekeepers such as teachers, healthcare workers, and women in local communities would go a long way in helping young people who menstruate. Recent studies, suggest that mothers, teachers, and healthcare workers are the first sources of information for adolescent girls about menstruation in India.
• Creating supportive space: Adolescent boys, and men, need to be involved in the conversation around MHH to create supportive spaces. These conversations will help them understand the importance of MHH and prompt changes in societal norms, including removing the stigma around menstruation.
• Conversations around menstruation need to include trans and non-binary individuals: Menstruation is a variable concept, such that many women do not menstruate, while some transmen, non-binary individuals, and people with masculine gender identities do. The feminisation of menstruation has led to the exclusion of transgender and non-binary people from the discourse.
• Improving MHH infrastructure and WASH facilities: Workplace policies for individuals who menstruate should be laid out, including the provision of adequate WASH facilities. There need to engage with the multi-sector stakeholders who can work in improving MHH infrastructure and WASH facilities.

Way ahead

• Raising awareness about the menstrual cycle should be among the priorities of communities and policymakers.
• There is a need to make SRH programming gender-transformative, first by recognising the link between MHH and SRH.
• The task is urgent, given the economic case to sexual and reproductive health: i.e., promoting SRH helps improve a country’s economic, educational and development outcomes.
• The UN High-Level Meeting (UNHLM), 2023 Action Plan, which underlines the need to “leave no one behind” in global goals on universal health care, must bring menstrual health and hygiene to the forefront of the SRH agenda.
• As per 2011 Census data, around 0.5 million individuals self-identify as third gender[b] in India. There is a need to engage communities and educate them about the LGBTQIA+ population and enhance their SRH knowledge by looking at the menstrual health discourse with the core principle of inclusivity.

Conclusion

• Global and national agendas on sexual and reproductive health continue to give little attention to its link with menstrual health. Integrated attention to the links between MHH and SRH can advance the mutual goals of both sectors, and improve the health and well-being of individuals who menstruate, throughout their entire life cycle.

Mains question

Q. The link between Menstrual health and hygiene with sexual reproductive health is often neglected in policymaking. Highlight the challenges for promoting menstrual health and give suggestions.

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