Menstrual health refers to complete physical, social and mental well-being with regard to the menstrual cycle. A significant part of menstrual health is menstrual hygiene. In addition to access to menstrual products like pads and tampons, it involves hygienic and accessible sanitation facilities with clean water and a supportive environment. Proper menstrual health allows menstruators to go about their lives comfortably while lowering the chances of vaginal infections.
Today, 500 million menstruators – almost a third of all menstruators across the world – don’t have access to any form of menstrual care. In many places all over the world, there is limited availability of menstrual products, forcing menstruators to resort to using dirty rags and torn washcloths instead. In other cases, even if menstrual products are available, they are not accessible, either due to high prices and taxation or because of the period-related stereotypes infiltrating society. A lack of education and awareness about menstruation has led to stigma and inaccurate assumptions, making it difficult for menstruators to ask for help. This negligence of hygiene causes many easily avoidable infections to spread undetected or, in some cases, to be diagnosed incorrectly and thus mistreated.
Bacterial Vaginosis (BV) is a common example of such infections, caused by prolonged contact with scratchy rags or tissue paper instead of menstrual products or by unprotected sex. It’s an illness in which the vagina undergoes inflammation due to the overgrowth of bacteria living inside it. In a study by the National Library of Medicine in 2013, menstruators with vaginosis reported feeling “embarrassed, self-conscious, and ashamed”. They admitted to feelings of disgust on smelling the foul “fishy” odour characteristic of BV. People with BV experience excessive discharge and vaginal itching, making them feel “dirty”. The impact it has on one’s self-esteem is staggering, and many are left grappling with not only an illness but also the self-loathing that comes with it. They halt daily activities like swimming and going to the gym, and are sometimes forced to forgo education altogether. Patients are repulsed by their symptoms and try to hide them for as long as they can, leading to the infection going undiagnosed for a long time. Additionally, as BV progresses to a later stage, there are chances of it being mistaken for a different illness, such as yeast infection or gonorrhoea, which leads to incorrect treatments that could adversely impact the patient’s health. Even after an accurate diagnosis, the cost of treatment reaches up to INR 22,500, which lower-income households – most of India’s population – find unfeasible. The general stigma surrounding menstruation compounds the problem, exacerbating the number of untreated BV cases and raising the chances of sexually transmitted infections and miscarriages.
Another illness that is worsened by a lack of sexual healthcare is cervical cancer. Poor menstrual hygiene is a decisive factor in the development of this disease, particularly when it comes to unprotected sex and not regularly cleaning the vaginal area. The first symptom of this cancer is vaginal bleeding between menstrual periods or after menopause. The widespread stigma around menstruation makes this an uncomfortable topic for most to discuss, and these first signs of cancer go ignored. The cancer, therefore, progresses to an advanced stage before being noticed. In its initial stage, the survival rate is 92%, but as it advances untreated, it drops to 59%.
It is also imperative to remember that cancer is one of the most frightening things anyone can be diagnosed with. The existence of a cure doesn’t always change its association with being a death sentence, especially when recovery is not guaranteed. Even if one survives the latter stage, recovery is a painful process, and survivors are left much weakened. They may be forced to quit their jobs, and future pregnancies are incredibly risky. This, of course, is about those who survive, who are outnumbered by those who don’t. In India alone, this amounts to a mortality rate of 34%.
Menstrual health is as much about mental health as it is about physical health. One of the most common disorders with regard to menstruation is premenstrual dysphoric disorder (PMDD). In India, there are over 10 million cases of PMDD every year. It can cause severe irritability, anxiety, depression, and suicidal ideation. Casey Clark, a menstruator suffering from PMDD, expressed the inclination to “lie motionless in bed all day” and “sit staring at the wall”, a response similar to premenstrual syndromes (PMS) which are far more common. The primary difference between PMS and PMDD is the latter’s severity and the influx of intrusive thoughts and suicidal feelings that come with it. According to Diana Samuel, a board-certified psychiatrist, “While people with PMS continue to function, someone with PMDD has emotional and behavioural symptoms that affect their daily functioning.”
Even so, a worrying number of people trim PMDD down to PMS. This dismissive attitude is prevalent with regard to almost all mental health problems associated with menstruation, which are often ignored entirely, pegged down to menstruators being too “hormonal” or “hysterical”. When nobody believes that their issue is a real one, their support system dwindles into nonexistence and they are left wrestling with it by themselves. Told continuously that their pain is a figment of their imagination, menstruators are forced to grapple alone with both the pain and the pervasive belief that it isn’t real at all.
One of the predominant causes of a lack of menstrual health is period poverty. On a global scale, people experiencing period poverty may be forced to lose economic opportunities because they are not able to leave their homes safely while menstruating. A study in the UK showed that out of a group of educated women, 44% of those who had experienced period poverty struggled to find employment. This figure was 20% higher than that of women who had always had access to menstrual products. This disparity perpetuates a vicious cycle of deprivation since less income may lead to period poverty in the future as well. Moreover, according to a study conducted in the US by BMC Women’s Health in 2021, over 68% of women who experienced period poverty reported symptoms consistent with moderate or severe depression. Despite such far-reaching impacts of period poverty, there is insufficient menstrual care infrastructure, and people experiencing this are left to fend for themselves.
Several initiatives across the world have risen to solve this problem of inadequate menstrual care provisions. In Ghana, sanitation facilities were constructed in more than 260 schools across the Greater Accra Metropolitan Area (GAMA). These facilities include separate toilets and changing rooms for girls along with handwashing facilities and safe spaces for the disposal of used sanitary products. In Bangladesh, a Rural Water, Sanitation and Hygiene (WASH) for Human Capital Development Project was set up, involving behaviour change sessions and training regarding the importance of menstrual hygiene and safely managed WASH facilities. It will finance 150 women entrepreneurs to help them sell soaps, disinfectants, and menstrual products at household doorsteps since many women are reluctant to purchase them in public spaces for fear of being seen as “impure” or “unclean”. Many countries around the world have also begun providing free menstrual products to anyone who needs them, including Scotland, New Zealand, Kenya, South Africa, and Uganda. While these initiatives are a strong beginning, they are usually “women-oriented” and leave out other groups of menstruators, rendering them the most vulnerable.
Besides the provision of menstrual care, the foremost strategy for combating problems related to menstrual health is to spread awareness about them and their implications in society. It is important to ensure that menstruators suffering from menstrual illnesses have their complaints taken seriously so that they can receive the support and attention they require. With regard to this, there is still a long way to go. However, while the steps being taken have their shortcomings and are not enough alone, they are making an impact all the same. The state of menstrual health is dire, but it is improving every day, with each new initiative and each “I understand.”
Article by Gia Arora from the REDefine Team
Featured Artwork by Sanvee Jatia
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