Menstruation. Periods. That time of the month. Aunt Flo. Menstruation has long been a taboo topic. But in the past year, mainstream media has been breaking that taboo, with stories about new menstrual products,astronauts dealing with menstruation, and diminished shame about periods. And May 28th is Menstrual Hygiene Day, a day to speak out about and celebrate menstruation.
Still there is at least one place where we would expect to hear about menstruation, but are not: within the community working on sexual and reproductive health services and reproductive rights.
Work on menstruation, known as menstrual hygiene management, grew out of the education sector. That is because in many developing countries, girls miss classes and may drop out of school when they have their periods. Sanitary pads or other resources are cost-prohibitive or otherwise unavailable; schools may not have safe, clean or private toilets where girls can manage their periods; and girls are scared that classmates will notice that they are menstruating. The water, sanitation and hygiene sector also has a strong focus on menstrual hygiene management, working with schools and communities to build safe, clean toilets and promote hygiene in all its forms. The goal of menstrual hygiene management is to ensure that women and girls can manage their periods in a way that is not only healthy, but that enables their full participation in school, work, and other activities.
The field of sexual and reproductive health and rights has not embraced menstrual hygiene management. It is not included in common descriptions of sexual and reproductive health issues. And with few exceptions, it is not included in the work of groups that provide sexual and reproductive health services, which encompass a breadth of activities such as family planning, sexually transmitted infections, gender-based violence, reproductive cancers, and female genital mutilation/cutting. Why not menstrual hygiene management
Menstrual hygiene management should be part of an expanded definition and agenda for sexual and reproductive health services. Because at its essence, menstruation is about reproduction. Menstruation is the biological indicator that pregnancy has not occurred. When a woman gets her period, it means that the egg that was released from her ovary was not successfully fertilized and implanted in the uterus, and the uterine lining is being shed from the body.
Puberty and menarche, or the onset of menstruation, provide a window of opportunity to not only teach young adolescent girls and boys about the changes occurring in their body, but also about fertility, contraception, and other aspects of sexual and reproductive health. This type of program can be an avenue for reducing early pregnancy and child marriage and the risk of HIV and sexually transmitted infections, and can also help keep girls in school.
Poor menstrual hygiene can negatively affect women’s health. When women and girls cannot afford or access absorbent sanitary products, they may use improvised materials such as improperly cleaned or scavenged cloth or other material such as newspaper or even grass. This may cause reproductive tract infections, such as bacterial vaginosis or vulvovaginal candidiasis, which in turn can increase susceptibility to HIV infection.
There are other menstrual disorders and menstrual-related symptoms that affect a woman’s health and her ability to engage in daily activities. For instance, anemia, a major contributor to maternal morbidity, is associated with menorrhagia, or heavy periods. Endometriosis, a menstrual disorder, contributes to infertility. And women with dysmenorrhea, or painful menses, may miss one or more days of school or work each month.
There are also direct links between family planning use and menstruation. One of the most common side effects of hormonal and intrauterine contraception is changes in menstrual bleeding patterns. Some methods, like the hormonal IUD, may lead to reduced menstruation or even amenorrhea, when a women has no period. The copper IUD may increase monthly bleeding. The contraceptive implant and injectable DMPA disrupt bleeding patterns. But when women are counseled on and offered family planning methods, providers do not typically offer practical advice and resources to manage menstruation and menstrual changes related to contraceptive use.
As a community, those of us who work in sexual and reproductive health and rights need to break our own taboos about menstruation and embrace the work of menstrual hygiene management. Please join the Menstrual Hygiene Day celebrations by visiting www.menstrualhygieneday.org and adding your voice.
By Lucy Wilson and Sarah Fry