A sight very common in India, especially in rural areas and among low-income communities, is the public celebration of the rite of passage at menarche, also known as the first occurrence of menstruation. The occasion is marked by rituals, and gifting of cash, gold and other precious ornaments is customary. The ceremony commemorates a girl’s transition into womanhood and thereby her marriageability. However, despite the loud celebration of this milestone, behind the scenes menstruation invites shame and seclusion from everyday routine.
The heart of this stigma begins with the secrecy attached to menstruation within the household. Young girls are taken by surprise when they first bleed and report experiencing fear, panic and confusion. A study conducted in two villages in Tamil Nadu finds that 84% of girls were unaware of what was happening to them at the time of menarche. Mothers usually do not talk to their daughters about menstruation and how to prepare for it. Similarly, 63% of schools in villages don’t educate girls on menstruation, thus perpetrating the secrecy around this natural phenomenon. This lack of awareness and information is attributable to the taboos associated with discussing menstruation at home and in schools.
When young girls from non-urban settings begin menstruating, they are driven into seclusion in a gaokar or hut in the outskirts of their village. This practice is common among rural and tribal communities across the states of Maharashtra, Chhattisgarh, Andhra Pradesh and Orissa. These customs are discriminatory towards women and subject them to shame, isolation, fear and danger. Furthermore, menstruating women are prohibited from entering places of worship, kitchens, or from touching food items and elders. One study records that such restrictive practices stem from the religious belief that women are unclean or “impure” during their menstruation. In some communities, people even believe that a menstruating woman’s body emits rays that can contaminate objects if she touches them. A common myth based on this belief argues that if a woman on her period touches a pickle jar, the pickles will rot sooner, or if she touches a cow, the animal will become infertile. Husbands also refrain from touching their wives or daughters during their menstrual period as it would make them “ritually impure.”
Misconceptions about menstruation and the stigma associated with menstruating women are rife in the Indian society. These myths are rooted in religious and traditional belief systems that have evolved over time to become severely discriminatory in nature. This article highlights how such practices and beliefs affect a woman’s physical and psychological health. Furthermore, this article also draws attention to the detrimental effects that such taboos and stigma have on female education, labor force participation and community life in rural India.
Impact on Women’s Health
The stigma surrounding menstruation in society has given rise to “menstrual etiquette”, where girls are directly or indirectly taught to keep their experience and evidence of menstruating, such as buying sanitary napkins and disposal of the waste, hidden from boys and men. The pressure to maintain a discreet profile during menses is one of several factors that contributes to inadequate menstrual hygiene management (MHM; defined by WHO and UNICEF as a practice of using clean absorbents, having the privacy of changing absorbent materials regularly and access to Water, Sanitation and Hygiene (WASH) facilities and disposal services).
According to the National Family Health Survey 2015-16 (NFHS-4), only 48.5% of women in rural India use sanitary napkins. Instead, using old cloth from sarees and pillow covers or left-over rags as absorbents during menstruation is a prevalent practice in rural India. This is largely due to the high cost of sanitary napkins, absence of low-cost alternatives and lack of awareness regarding clean absorbents. Social customs of untouchability and shame during menstruation force women to wash their cloth absorbents in the night and dry them indoors or under mattresses to avoid prying eyes. Women often wash these cotton cloths without using soap or clean water because proper sanitation facilities are unavailable. These practices have been found to increase the risk of urinary tract infections and reproductive tract infections.
Misconceptions about how to handle menstruation have augmented restrictive practices. For instance, a focus group study conducted in-depth interviews with 52 women in a slum settlement in Delhi found that, among the Muslim community it was a common fallacy that women should not bathe while menstruating as cold water would result in swelling of the fallopian tubes and result in abdominal pains. Similarly, many communities also believe that consuming cold foods like yogurt and milk, sour foods, or foods that produce gas or heat in the body, could lead to blood clotting during menstruation. Sexual intercourse is taboo due to the misconception that it can obstruct blood flow, spread poison and cause tuberculosis. Such stigma, misguided ideas and behavioral expectations lead women to experience shame, distress and low confidence which consequently impacts their psychological wellbeing.
Implications for Education Outcomes
Attaining menarche is more than just a rite of passage for a young woman. The stigma around menstruation also affects her education outcomes. A report found that adolescent girls miss nearly six days of school a month because of the lack of sanitation facilities and infrastructure to manage their menses. After attaining menarche, 23% of girls drop out of school. Another study found that more than one in four girls missed out on more than one day of school during menstruation, citing the primary reasons as a lack of infrastructure and hygiene, restrictions imposed by relatives or teachers and the fear of staining clothes due to improper absorbents. In Andhra Pradesh (now Telangana and Andhra Pradesh), research found that 12% of girls who reach menarche before the age of 12 drop out because of concerns over safety and other socio-restrictive norms. Such dropouts have adverse effects on the girls’ nutrition because they no longer get their midday meals at school. In the long term, this also widens the gender gap in human development. Socio-cultural constraints combined with the lack of sanitation facilities in schools are strongly linked to higher school absenteeism. An early onset of menarche also increases the likelihood of girls getting married younger. Thus, school absenteeism has a detrimental impact on the quality of a woman’s life, increasing the prospect of getting married and engaging in household duties, which makes her more dependent on the family patriarch. This eventually takes away from potential female labor force participation, increases the gender gap in education and income and deepens issues of female economic independence and agency.
What Does This Mean for Policy?
At the national level, ministries such as Human Resource Development, Women and Child Development, and Health and Family Welfare, have directly and indirectly addressed policy issues regarding menstrual hygiene management. Several programs provide guidelines to educate adolescent school girls on MHM practices and support schools with infrastructure by plugging the gaps in WASH facilities. However, some of these initiatives lacked effective implementation of program activities, monitoring and evaluation, opportunities for collaboration and investment in program scale-up.
Such interventions cannot overlook the widespread taboos, stigma and misconceptions towards menstruation in rural societies. There is an urgent need to dismantle such social constructs and simultaneously improve MHM. Training school teachers to educate and inform girls is a foundational step to fill in the gaps of awareness. It is also imperative to sensitize male teachers and boys to understand menstruation as a normal biological phenomenon. Village community health workers such as Accredited Social Health Activists (ASHA) and Anganwadi workers are important players in mobilizing social support against the practice of menstruation-related taboos and stigma. Nudging for a behavioral change at large will be a key driver towards improved health and education outcomes for women.
Photo by Nevil Zaveri via Flickr.
Very well expressed. This one subject that should have been addressed long back by leaders, has never been touched as it even taboo to talk about it.
K R A Narasiah