Science & Tech

The link between menstrual hygiene and sexual and reproductive health

Maternal mortality rates remain high in low- and middle-income countries, accounting for 94% of all cases. In India, the maternal mortality rate is 113 per 100,000 live births; the government hopes to reduce the rate to less than 70 by 2030. Experts agree that one of the keys to addressing this massive challenge is to promote sexual and reproductive health (SRH). Achieving global SRH targets, in turn, is heavily reliant on a collective commitment to improving menstrual health and hygiene (MHH).

Menstrual Hygiene Obstacles

  • Insufficient access to information and services: The harsh reality is that menstruating women lack adequate access to SRH information and services and are unable to exercise their SRH rights throughout their life cycle. Poor economic and educational outcomes are among the causes of this lack of access.
  • For example, multiple studies in various developing countries have found that those with fewer schooling years are more likely to engage in early sexual initiation and early marriage, have higher fertility rates, and have poor maternal outcomes.
  • Multiple barriers to menstrual health and hygiene promotion exist, including socio-cultural norms that regard menstruation as taboo, as well as biological and medical issues such as urinary tract infections and abnormal urinary bleeding caused by fibroids.
  • The vicious circle of low SRH: These issues limit menstruating individuals’ agency in making decisions about sex, relationships, family planning, and contraception use. This reintroduces them into the vicious circle of poor SRH.
  • Inadequate privacy and dignity: Menstruation-related issues can be found in schools, workplaces, and communities where menstruating individuals are unable to manage their needs in a private and dignified manner.
  • Myths and taboos: In some communities, menstruating women are not allowed to pray, bathe, sleep in the same bed as others, or prepare food. In India, taboos and myths prevent the government’s more than 8,000 Adolescents-Friendly Health Clinics (AFHCs) from being used to their full potential.

Global Outlook

  • Menstrual health is frequently overlooked in SRH agendas: Despite strong evidence that menstrual health is an anchor of sexual and reproductive health, governments, policymakers, and non-governmental organisations (NGOs) rarely include menstrual health in their SRH agendas.
  • Although SRH was the focus of both World Population Day and the Gender Equality Forum in 2021, little, if any, attention had been paid to menstrual health.
  • Menstrual health, for example, was not taken into account during vaccination: Early research also suggests that during the production of COVID-19 vaccines, menstrual health was not taken into account when conducting pilot studies to determine the vaccine’s efficacy.
  • There is also a lack of education: Menstrual health received little attention in a study of education policy documents from 21 developing countries. In the last decade, the focus of those countries that appeared to have MHH on their health and education agenda was on the distribution of disposable sanitary pads, primarily for schoolgirls; they tended to ignore other issues related to menstrual health and hygiene, such as safety, disposal, the right to dignity, and providing choices to people who menstruate.

A Framework for Menstrual Health and Hygiene Integration in India

  • Menstrual Health and Hygiene Education Promotion: Conversations about menstruation should begin in schools and communities by incorporating menstrual health and hygiene into reproductive health sessions.
  • For example, the Indian government launched the Adolescent Education Program in 2007 to promote discussions about sexual education, but it was met with criticism from teachers and parents. Sociocultural issues are also important and should be addressed by stakeholders.
  • Understanding of the products they use: Programmes should be launched to distribute disposable sanitary pads to all women and girls, not just those in school. As the conversation about menstruation shifts towards sustainable menstruation, it is critical to arm menstruating women with information about the potential harm of the period products they use.
  • Sensitization workshops for gatekeepers such as teachers, healthcare workers, and women in local communities would go a long way towards assisting young people who menstruate. According to recent research, mothers, teachers, and healthcare workers are the first sources of information about menstruation for adolescent girls in India.
  • Creating supportive spaces: To create supportive spaces, adolescent boys and men must be included in the MHH conversation. These discussions will help them understand the significance of MHH and will prompt changes in societal norms, such as the removal of the stigma associated with menstruation.
  • Conversations about menstruation must include trans and non-binary people: Menstruation is a fluid concept, with many women not menstruating while transmen, non-binary people, and people with masculine gender identities do. Menstruation’s feminization has resulted in the exclusion of transgender and non-binary people from the conversation.
  • Improving MHH infrastructure and WASH infrastructure: Workplace policies for menstruating employees should be established, including the provision of adequate WASH facilities. There is a need to work with multi-sector stakeholders to improve MHH infrastructure and WASH facilities.

Way Forward

  • Raising menstrual cycle awareness should be a priority for communities and policymakers.
  • It is necessary to make SRH programming gender-transformative, beginning with recognising the link between MHH and SRH.
  • The task is urgent because of the economic case for sexual and reproductive health: promoting SRH helps a country’s economic, educational, and development outcomes.
  • The UN High-Level Meeting (UNHLM) Action Plan for 2023, which emphasises the need to “leave no one behind” in global goals for universal health care, must prioritise menstrual health and hygiene on the SRH agenda.
  • According to 2011 Census data, approximately 0.5 million people in India self-identify as third gender[b]. There is a need to engage communities and educate them about the LGBTQIA+ population, as well as improve their SRH knowledge, by examining the menstrual health discourse through the lens of inclusivity.

@the end

Sexual and reproductive health agendas at the global and national levels continue to pay little attention to its relationship with menstrual health. Integrated attention to the links between MHH and SRH can advance both sectors’ mutual goals while also improving the health and well-being of menstruating women throughout their entire life cycle.

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