Every month, 1.8 billion people across the world menstruate. Millions of these are unable to manage their menstrual cycle in a dignified, healthy way. Widely prevalent gender inequality, poverty, lack of access to toilets and sanitary products impacts menstrual health and hygiene. The lack of basic knowledge about menstruation may contribute to early and unwanted pregnancy; the stress and shame associated with menstruation can negatively affect mental health; and unhygienic sanitation products may make girls susceptible to reproductive tract infections. This has far-reaching consequences for millions of people

Many communities in India restricts menstruating women from doing various activities such as cooking, touching food, being with family members, attending religious ceremonies, and bathing. This leads to misconceptions and discrimination which hinders girls from treating it as the normal part of their childhood as it should be. It also hinders boys from understanding its importance.

Education about the menstrual cycle to everyone including boys and other family members and simultaneously dismantling stigma and taboo associated with it would help in achieving a complete state of menstrual health.

So, what is menstruation?

It is monthly shedding of lining of woman’s uterus(womb). Every month womb is prepared by hormones for a possible pregnancy. When it does not happen thickened lining along with blood comes out of vagina. Various chemicals (hormones) in the body are involved in this process. That is why when a woman is pregnant, she doesn’t get monthly cycle.  Bleeding usually lasts for 2-5 days.A girl can begin menstruating as early as 8 years of age or as late as 16. Woman stops menstruating commonly at around 45-50 years.

Along with vaginal bleeding woman also gets certain other symptoms such as pain in the breasts and lower abdomen, bloating, mood swings, lethargy and sometimes headache as well. These symptoms may require help from the teachers at school and support from family. Approachability and sensitivity of the teacher are also very important for the girls.

Menstruation is a normal and healthy part of every girl and woman’s life.Good menstrual hygiene management (MHM) plays a fundamental role in enabling women, girls, and other menstruators to reach their full potential.  

Various absorbents have been used during the menstruation.  The reusable absorbents are made up of cloth. They need to be washed and dried in sunlight prior to the next use. The nonreusable sanitary pads are made up of cellulose and plastic. They are user friendly. However, they are expensive and they are nonbiodegradable. Traditional sanitary protection is still the most widely used.However, tampons and other new menstrual hygiene products such as washable sanitary pads, menstrual cups, menstrual panties are also popular. Bamboo fibrepad, banana fibre pad, and water hyacinth pad are the biodegradable eco-friendly sanitary napkins. They are not readily available.

Tampons absorb blood from inside the vagina. It come in different sizes and absorbencies for heavier and lighter periods. There is no need for any deodorant in a tampon. It is very important to change tampons every 4-6 hours or if it is soaked completely. 

The adoption of menstrual cup requires a familiarisation phase over several menstrual cycle and peer support. Use of menstrual cup showed no adverse effects on the vaginal flora. Some women might experience allergies or rashes,vaginal pain, urinary tract infection and toxic shock syndrome. Other side effects noted are dislodgement of intrauterine device, professional assistance to aid removal. Overall, it is a safe option for menstruation management. The use of small cup should be encouraged to prevent toxic shock syndrome.

A key challenge in low resource countries is the inadequate and unreliable supply of menstrual products.

Many factors contribute to feminine hygiene practice. It includes personal preference and cultural influence. Routine washing of vulva is desirable. However, there has been a surge in intimate hygiene product for cleanliness and odour control but it may upset pH in the vulvovaginal areas which will affect the normal composition of vulvovaginal microbiota needed for protection against infection.

According to the WHO/UNICEF Joint Monitoring Programme 2012, menstrual hygiene management is defined as: 

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, 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. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.

Pillars of menstrual health hygiene based on a UNICEF are social support,knowledge and skills , facilities and service and materials.

Social support: It includes promotion of equitable gender norms, agency to seek support when needed; reduced stigma and taboos; access to emotional and practical support from trusted others; and reduced fear, stress and worry related to menstruation, including menstrual-related bullying. These elements are important before and after menarche and throughout the reproductive life course.

Knowledge and Skills: It includes that people understand the basic facts related to menstruation and reproductive health, as well as whether people who menstruate have the practical knowledge and skills to take care of their bodies during menstruation. Accurate and comprehensive information should be accessible before and after menarche and throughout the reproductive life course, including from knowledgeable and gender-sensitive professionals, such as those providing puberty or life skills education in schools or support and services in communities and health care facilities.

Facilities and services: The facilities and services pillar include facilities and services that allow for changing, washing, and/ or disposing of materials and clothing, and for handwashing and bathing when needed. These should be private, clean, have water and soap available, and be acceptable to users during menstruation. Facilities or mechanisms for drying and/or disposing of used materials should be discrete, hygienic, safe and environmentally friendly.

Materials: The materials pillar includes materials for absorbing or catching menstrual blood (such as sanitary pads, cloths, tampons or menstrual cups) and supportive supplies (such as underwear or laundry soap) that are hygienic/safe, acceptable (and appropriate), and accessible (physically and economically) to people who menstruate, including supplies for pain management.

The WHO (World Health Organization) and UNICEF (United Nations International Children’s Emergency Fund) advice WASH facilities at school, i.e., water, sanitation, and hygiene. In India, the Swachh Bharat: Swachh Vidyalaya campaign has been launched in every school  to provide WASH facilities, which includes soap and water for sanitation and private space for changing and disposal of menstrual absorbents. MHM has been made an integral part of the Swachh Bharath guidelines norms around menstruation leading to stigma, myths and taboos.

Efforts are being made to provide low-cost sanitary napkin vending machines and incinerators to dispose MHM products at schools. However, the extent to which all these guidelines percolate down to the ground level has yet to be seen.

We all along with UNICEF envisions a world where a period doesn’t create stress, shame or any unnecessary obstacle for girls. Information about menstrual hygiene doesn’t only safeguard girls’ health but also helps them reach their full potential.