Socio-Cultural Aspects Of Menstruation Hygiene

This PPT tells About Taboos Related to menstruation in india and the stratergy to combat the ill effects of these taboos related to it.very helpful for Research and Awareness about mentruation

1. Socio-cultural aspects of menstruation hygiene Submitted By: Preeti 2017BS27D

2. About Menstruation Menstruation is a phenomenon unique to girls. However, it has always been surrounded by taboos and myths that exclude women from many aspects of socio-cultural life. In India, the topic has been a taboo until date. Such taboos about menstruation present in many societies impact on girls’ and women's emotional state, mentality and lifestyle and most importantly, health. The challenge, of addressing the socio-cultural taboos and beliefs in menstruation, is further compounded by the low girls’ knowledge levels and understandings of puberty, menstruation, and reproductive health . Cultural norms and religious taboos on menstruation are often compounded by traditional associations with evil spirits, shame and embarrassment surrounding sexual reproduction.

3. Most striking is the restricted control which many women and girls have over their mobility and behavior due to their ‘impurity’ during menstruation, including the myths, misconceptions, superstitions and cultural and religious taboos concerning menstrual blood and menstrual hygiene (TEN 2007). The taboo of menstruation helps to inflict indignity upon millions of women and girls, but it also does worse: The grave lack of facilities and appropriate sanitary products can push menstruating girls out of school, temporarily and sometimes permanently. Stigma around menstruation and menstrual hygiene is a violation of several human rights, most importantly of the right to human dignity, but also the right to non-discrimination, equality, bodily integrity, health, privacy and the right to freedom from inhumane and degrading treatment from abuse and violence (WSSCC 2013 ). The current presentation aims to discuss menstruation related myths prevalent in India, their impact on women's life, relevance of addressing these issues in primary care and a brief description about various strategies to combat them.

4. REVIEW OF LITERATURE Mensch et al. (2001) observed that spaces between school and home being identified as particularly dangerous. Margaret recounted: ‘Our teacher told us that at that stage we should be careful with boys’ but didn’t elaborate on why or how they should be careful. Many girls said that they felt unable to discuss such topics or seek advice from family members so if problems arose, sought alternative solutions that led them into exploitative sexual relationships . El- Gilany et al. (2005) conducted a study among 664 Egyptian women and adolescent girls and revealed that two-thirds of the girls (66.8%) used sanitary pads, while 15.9% and 12% used re-usable cloths or old pieces of cloth thrown away after use, respectively. The use of sanitary pads was significantly higher among girls enrolled in general secondary schools, the younger girls and girls from urban areas and higher social classes, with parents working as professionals or semi-professionals, with highly educated parents and with mass media available at home . The majority disposed of used pads with the domestic refuses (96.7%) and stored unused pads with their clothes (81.9%). Only 6.7% changed sanitary pads at school. Lack of privacy at home and school was reported by 24.6% and 97% of girls, respectively.

5. Tiwari et al . (2006) conducted a study in the Anand district of Gujarat and found that around two-thirds of the 900 girls (62.7%) had been informed about menarche before its onset. The major source of information was the mother (60.7%) followed by older sisters (15.8%) . Asked if they felt they had been mentally prepared (yes/no), 48.2% of girls felt they were not mentally prepared for menarche. In this area of India, the custom of celebrating the event of menarche continues; 43.7% of respondents reported that a social ceremony is held in their houses for the first menarche. More than two-thirds of respondents (36.2%) reported that social restrictions are still observed in their family: the custom of not allowing them to hold prayers, go to the temple or enter the kitchen. Dasgupta and Sarkar (2006) conducted a descriptive, cross-sectional study among 160 adolescent girls of a secondary school situated in the field practice area of Rural Health Unit and Training Center, Singur, West Bengal.They revealed that out of 160 respondents, 108 (67.5%) girls were aware about menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in case of 60 (37.5%) girls .. Seventy-eight (48.75%) girls knew the use of sanitary pad during menstruation. Regarding practices, only 18 (11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156 (97.5%) girls used both soap and water. Regarding restrictions practiced, 136 (85%) girls practiced different restrictions during menstruation.

6. Nagar and Aimol (2010) studied the awareness levels of menstruation and related aspects among adolescent girls. The study was conducted in Rongram block of West Garo Hills district of Meghalaya with 100 adolescent school going girls in the age group of 13 to 18 years. The results revealed that most of the girls were in the age group of 16 to 18 years and studying in tenth standard. The mean age at menarche was found to be 12.67 years. It was indicated from the results that the respondents had an average level of awareness of menstrual aspects. Thakre e t al. (2011) conducted a study on menstruation hygiene and reveals that only 36.95% of the girls were aware of menstruation before menarche. A majority of them had knowledge about the use of sanitary pads. The mean age of menarche in the study subjects was 12.85 ± 0.867 years; sanitary pads were used by 49.35% of the selected girls. The practice of the use of old clothes was reported in 45.74% of the subjects. Satisfactory cleaning of the external genitalia was practiced by 33.85% of the girls. Three fourth of the study girls practiced various restrictions during menstruation. Some menstrual hygiene indices have shown a significant difference in the rural and urban girls.

7. Shah et al. (2013) conducted a study in tribal Gujarat among 164 girls and found that almost half the girls had to sit separately during menses, 89% were restricted in what they could touch, and almost half experienced changes in the behavior of family members. Almost a third was not allowed to go outside the house alone during their periods. At baseline, 148 of the 164 girls were using old cloths, 15 were using falalin cloths and only one was using sanitary pads; 88 girls knew that falalin cloths were available in the market, while 76 did not, and 59 girls knew sanitary pads were available in the market, while 105 did not . Malusu and Zani (2014) studied about additional cultural taboos discourage menstruating women and girls from undertaking certain religious activities or even undertaking paid work. Although some of these restrictions relieve menstruating women from their everyday drudgery (Buckley and Gottlieb, 1988; Laws, 1990), they may simultaneously reproduce wider gender inequalities by restricting girls’ school attendance, income-earning potential and broader life chances.

8. Vidya and Rekha (2016) concluded that in a study in Karnataka , around 46.06% of the girls preferred old cloth pieces rather than sanitary pads as menstrual absorbent. The reasons cited by the participants for not using sanitary pad was high cost, shyness to buy, lack of knowledge and disposal problems. The reason cited for drying the cloth inside the house as menstruation is considered as impure and meant to be hidden which reflects the taboos found in the society. Chinyama et al (2019) conducted a study in Zambia and revealed that most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls’ school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. 

9. Menstruation and Religion All religions of the world have placed restrictions on menstruating women. Be it Judaism, Christianity, Islam, Hinduism or Buddhism. Sikhism is the only religion where the scriptures condemn sexism and don’t impose any restriction on menstruating women. This presentation discusses how a menstruating woman is treated and viewed in the major religions. We don't know what may have been the reason that forced the holy men to refer to menstruating women as 'unclean'. But all religions (excluding Sikhism) refer to menstruating woman as 'ritually unclean'. The society shies away from discussing menstruation . This leads to a lot of inconvenience for young girls . They aren't informed well, hence they tend to hold several misconceptions.

10. Judaism The Jewish code of law, Halakha , details strict rules governing every aspect of the daily lives of Jews, including their sexual lives. It prohibits literally any physical contact between males and females during the days of menstruation and for a week thereafter. The entire period of time, from the beginning of the menses to the end of seven clean days , when the women immerses herself in the ritual bath, is called the ‘ Niddah period’ . The Book of Leviticus is the third book of the Hebrew Bible and the third of five books of Torah. In the chapters on Unclean discharges , Sexual behavior and Grave Crimes 1 we find mention of the following : In Leviticus 15:19 and 24 we are told: “If a woman has an emission, and her emission in her flesh is blood, she shall be seven days in her (menstrual) separation, and anyone who touches her shall be tamei (interpreted as ritually unclean commonly by people) until evening ...And if any man lie with her at all and her (menstrual ) separation will be upon him, he will be tamei for seven days ….“

11. Leviticus 20:18 states: "And if a man lie with a menstruating woman both of them will be cut off from among their people. "There is also a mention of woman’s separation from other that occurs after giving birth: for a daughter, the mother is separated from others for fourteen days, and then is fully ‘clean’ after 66 days, she may then bring a sacrifice to the temple. For a son, she is separated for seven days, and then waits thirty-three days. According to a ritual, an Orthodox Jewish wife is responsible for immersing in the Mikvah , the ritual bath, and only then will she become ‘ritually clean’.

12. Christianity The history of menstrual taboo has been a major reason to keep women from positions of authority in Christianity . Just like in Judaism it’s the belief of many Catholics that woman should not have sexual intercourse during her menses. In the Eastern Orthodox Christian Church, menstruation is considered unclean. Partaking of sacraments, especially communion , or touching holy items like Bible or religious icons are not allowed for menstruating women. This is not a universal practice, but it hasn’t gone away entirely. Russian Orthodox Christians believe in menstrual taboos. Menstruating women have to live in secluded huts during this time . They don’t attend church services, cannot have any contact with men, and may not touch raw or fresh food. A menstruating woman’s gaze is also thought to affect the weather negatively. While western Christian denominations are less extreme, some negative attitudes still remain.

13. Islam In the Quran, 2:222 reads, “They ask you about menstruation . Say, ‘It is an impurity, so keep away from women during it and do not approach them until they are cleansed ; when they are cleansed you may approach them as God has ordained …”. This clearly shows that Quran only stipulates one prohibition for menstruating women, which is abstinence from sexual activity. Some interpreters have expanded upon this concept to state that, menstruating women have to stay away from their male family members. Menstruating woman is not allowed to read the Arab Quran but can read from the translations in other languages .

14. I n Islam menstruating women aren’t supposed to touch the Quran, enter the mosque, offer the ritual prayer for seven full days. The woman is exempted from rituals such as daily prayers and fasting, although she is not given the option of performing these rituals , even if she wants to. Like Judaism the woman has to complete a ritual washing before she becomes clean again.

15. Buddhism From a Buddhist point of view menstruation is “a natural physical excretion that women have to go through on a monthly basis, nothing more or less.” However in practice this is not followed. It is because of the influence Hinduism has had on Buddhism. Many temples do not allow women to circumambulate around the Stupas. There is clear evidence of this rule in Thailand . During menstruation women are thought to lose Qi (commonly spelled as chi , is believed to be part of everything that exists, as in ‘life force’, or spiritual energy.) There’s a Buddhist belief that ghosts eat blood. A menstruating woman is then thought to attract ghosts, and is therefore a threat to herself and others. An example cited by the Buddha Dharma Education Association says, that while fermenting rice, menstruating women are not allowed near the area or the rice will be spoilt.

16. Sikhism Guru Nanak, the founder of Sikhism, condemned the practice of treating women as impure while menstruating. Menstruating women are allowed to visit Gurudwaras and offer prayer. There is no restriction to movement in the house or outside. Guru Granth Sahib (Sikh scripture) boldly rejects sexism. It affirms women’s creative and natural processes in the social fabric. It condemns the taboos surrounding menstruation and post-partum pollution. Rather, menstruation is regarded as an essential and natural process . Guru Nanak openly chides those who attribute pollution to women because of menstruation and asserts that pollution lies in the heart and mind of the person and not in the cosmic process of birth.

17. Hinduism In Hindu mythology it’s believed women got ‘ Rajaswala Dosha ’ (menstruation) when Lord Indra (the king of gods) severed the head of Vishwaroopacharya (the second teacher of the gods). Since Lord Indra killed a Brahmin he got ‘ Brahmahatya dosha ’ . He got rid of it by distributing it amongst the prithvy (land ), samudra (water ), vriksha ( tree )and stree ( women folk) . The women from that day on started menstruating every 28-30 days and got the ability to give birth. Hence it’s believed that menstruation is a dosha . During menstruation some women aren’t allowed to enter the kitchen and temples, sleep in the day-time, bathe, wear flowers, touch other males or females, talk loudly, and touch pickle.

18. According to mythology a pickle touched by a menstruating woman rots away. The basil plant is considered to be holy in Hinduism; hence menstruating girls aren’t allowed to touch it. In some extreme cases they aren’t allowed to let even their shadow fall on it or it’s believed the plant will die . In Hindu culture, women aren’t allowed to visit temples while menstruating. The boards outside the temples read : ‘Ladies in monthly period are not allowed’. In ‘Sabrimala ’ temple, Kerala(India), women from the age-bracket of 10-50 years are not allowed to enter the temple. Hence we see that women are considered ‘ ritually unclean’ while menstruating and aren’t allowed to visit temples or pray to deities.

19. In certain parts of India women aren’t allowed to live in the residence with other family members . In many parts of India women during their menses had to stay in a separate section of the house, built at the back exclusively for this. They weren’t allowed to go out of the house, but when there was a compulsion to go out (going to school etc.) ,there was a separate door for them to use. This is a very common practice in Hindu households. They also had to cook their food themselves and eat separately.

20. Knowledge of girls about menstruation  In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places . L ittle , inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Indian Council for Medical Research’s 2011-12 report stated that only 38 per cent menstruating girls in India spoke to their mothers about menstruation. Unfortunately, due to lack of knowledge on menstruation preparedness and management or due to shyness and embarrassment the situation becomes worse for girls  . A 2015 survey by the Ministry of Education found that in 63% schools in villages, teachers never discussed menstruation and how to deal with it in a hygienic manner .

21. Absorbents used The preference of sanitary protection material is based on personal choice, cultural acceptability, economic status, and availability in local market. Along with basic sanitation facilities, one should be also provided with soap and menstrual absorbents to manage menstruation hygiene. The choice of absorbents varies among rural and urban women and girls. In rural areas, the most preferred absorbents are reusable cloth pads and in urban areas women prefer to use commercial sanitary pads . In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again.

22. Some of the commonly used absorbents 1. Reusable and Washable Cloth Pads 2. Commercial Sanitary Pads 3. Tampons 4. Reusable Tampons 5. Menstrual Cups 6. Bamboo Fibre Pads 7. Banana Fibre Pads 8 . Water Hyacinth Pads

23. Disposal of used Absorbent M ost of the women dispose of their sanitary pads or other menstrual articles into domestic solid wastes or garbage bins that ultimately become a part of solid wastes. Toilet facilities in India lack bins for the disposal of sanitary pads and hand washing facilities for menstruating women to handle menstrual hygiene . In urban areas , where modern disposable menstrual products are used, they dispose of them by F lushing in toilets and T hrowing in dustbins or T hrough solid waste management. I n rural areas , there are many options for disposing menstrual waste such as by B urying Burning T hrowing in garbage or in pits.

24. In rural areas, mostly women use reusable and non-commercial sanitary materials like reusable pads or cloths. Thus, they generate lesser amount of menstrual waste as compared to women in urban areas who rely on commercial disposable pads. The menstrual material was disposed of according to the type of product used, cultural beliefs, and location of disposal. In slum areas , women dispose their menstrual waste into pits as burning and burial were difficult due to limited privacy space.

25. T here should be a need to educate and make women aware about the environmental pollution and health hazards associated with them . Implementation of modern techniques like incineration can help to reduce the waste. A wareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fiber, bamboo fiber, sea sponges, water hyacinth, and so on. Needs and requirements

26. Environment-friendly chemicals should be used by manufacturers of sanitary products to stop soil and water pollution and to fasten the decomposition process . Government should introduce new rules for the safe disposal and treatment of menstrual wastes as they have made for solid or biomedical wastes. Appropriate policy and legal framework is necessary for the management of menstrual wastes.

27. School Drop-out Of girls In India, over 20 percent of girls drop out of school completely after reaching puberty.  Lack of access to private toilets and clean water also hinder school participation.  Yet a recent survey by National Sample Survey Office/Census (2012 ) found that in 14,724 government schools only 53% had a separate and usable girl’s toilet . “Girls…lack access to clean, safe private toilets. There is no clean water within or near the toilets, which means there is nowhere to clean up and discreetly dispose of used menstrual products,” said Plan International USA’s Director of Water, Sanitation and Health Darren Saywell. 

28. Facilities that should be provided by school for MHM Every school is required to have basic water and sanitation infrastructure so that girls and female staff can privately manage menstruation hygienically and with dignity. Essential facilities are: Separate toilets for girls and boys and ideally also for male and female teachers . Water supply (based on approximately 500 liters water storage capacity for 100 children), soap availability for hand washing and space for washing laundering menstrual absorbent. Availability of sanitary napkins to girls Facilities for safe disposal of used menstrual absorbents

29. It is therefore the responsibility of those with influence – including government officials and teachers, to find appropriate ways to talk about the issue and take necessary actions. Menstrual hygiene management is an integral part of the Swachh Bharat Mission Guidelines (SBM-G). The Menstrual Hygiene Management Guideline is issued by the Ministry of Drinking Water and Sanitation to support all adolescent girls and women. It outlines what needs to be done by state governments, district administrations, engineers and technical experts in line departments ; and school head teachers and teachers.

30. Who should be oriented and trained in MHM

31. Menstrual hygiene management framework

32. Menstrual hygiene management in the Swachh Bharat (G) guideline Funds available under the IEC component may be used for IEC in this matter and to raise awareness and skills on Menstrual Hygiene Management in all places and specifically amongst adolescent girls in schools. IEC plans should include this component for raising awareness among all stakeholders. Issues relating to women’s personal hygiene namely menstrual hygiene are to be focused under the SBM (G). Girls and women have hygiene and sanitation needs linked to their menstrual cycle. Women suffer in the absence of knowledge about safe practices on MHM ..

33. iii. There are several examples where CSOs and SHGs have worked with the community, informed them about menstrual hygiene practices and also developed economic models to meet the demand for sanitary napkins. This is one area where CSOs and SHGs can play a key role. *IEC- Information Education and Communication *CSOs - Civil Society Organizations *SHG - Self-Help Group

34. General guidelines for better MHM Every adolescent girl and woman, and their families, including men and adolescent boys, must have awareness, knowledge and information so that menstruation is understood and can be managed safely with confidence and dignity . Every adolescent girl and woman must have easy access to sufficient, affordable and hygienic menstrual absorbents during menstruation . Every adolescent school girl must have access to a separate toilet with private space for cleaning, washing. This includes access to adequate and sustained water supply and soap. Every adolescent girl must have access to infrastructure for disposal of used menstrual absorbant , and should know how to use it.

35. Role of Education ,Men and Boys Women and girls are often excluded from decision-making due to their lower literacy levels  per se . Increasing the education status of women plays an important role in improving the health status of the community at large and overcoming the cultural taboos, in particular. Men and boys can support women and girls to manage menstruation effectively across different social domains including household, community, school, and work.

36. Men and boys influence women’s and girls’ experiences of menstrual hygiene management (MHM) through many roles, including as husbands, fathers, brothers, students, peers, teachers, community leaders, entrepreneurs, employers, development and humanitarian practitioners, and policymakers . Sensitization of health workers, Accredited Social Health Activists and Anganwadi workers regarding menstruation biology must also be done so that they can further disseminate this knowledge in the community and mobilize social support against busting menstruation related myths .

37. C onclusion Conditions for menstruating women in India can only improve when awareness on menstrual hygiene is spread. IEC on menstrual hygiene, under Swachh Bharat Abhiyan or any other state scheme must educate women across all ages on what menstruation is and why the taboos surrounding it do tremendous harm. Simultaneously, sanitary napkins must be provided to menstruating women to ensure that they do not fall prey to age old unhygienic traditions of using cloth, soil or sand. Making sanitary napkins available to over 300 million women and ensuring that they do use these will be a herculean task, and can only be achieved with due cooperation all stakeholders and proper coordination between them to improve the status menstrual hygiene in India.

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