As I began my introduction to over 150 adolescents, both girls and boys, at a government school in rural Maharashtra, I noticed an immediate ripple of snickering, whispering, and shy glances permeating the hall. Before I could begin addressing the group, the teacher reviewed my talking points and requested, &quot;Could you please separate the boys when discussing periods? Provide a general health talk to both genders, but discussing periods together wouldn&#39;t be appropriate.&quot;&nbsp;

This initial encounter shocked me as it starkly highlighted the extent to which there is secrecy surrounding discussions about menstruation. Menstruation, a natural biological process experienced by nearly half of the global population, remains clouded with an attitude of taboo for women and men alike.

Stigma and misinformation

Picture Anita, a 13-year-old girl from rural Maharashtra. Anita begins menstruating around the age of 13, as is usual for girls from her family. She will experience approximately 480 menstrual cycles throughout her lifetime, with each cycle lasting between 5 and 7 days. This spans nearly 8 years of her life. Even though menstruation will form such a large chunk of her life, it is unlikely that Anita will have ever heard of periods before actually experiencing it. (<a href="https://bmjopen.bmj.com/content/6/3/e010290">A systematic review of 88 sources</a> found that only 48% of girls in India are aware of menstruation before menarche).&nbsp;

Once Anita starts menstruating, she will be asked to spend a week isolated from the others in a room separated from her house. She will then be bombarded with restrictions - &ldquo;You cannot enter the kitchen, the prayer room or sleep on the mattress&rdquo;, she will likely be told. She would be asked to hand wash her clothes and not touch the pickle jar, lest it go bad. &ldquo;But what is actually happening to my body?&rdquo; Anita might ask someday, to which, her mother would reply, &ldquo;I don&#39;t know, but you&#39;re a big girl now, so you cannot play with your brother and his friends anymore.&rdquo;

This is the reality that menstruators grapple with throughout India. The <a href="https://bmjopen.bmj.com/content/6/3/e010290">systematic analysis</a> also shows that only 23% of girls studied know that the uterus is the source of menstrual bleeding, and only 55% view menstruation as normal, indicating substantial gaps in menstrual education.&nbsp;

Behind closed doors of their home, girls navigate a complex series of menstrual taboos and restrictions that dictate their daily activities - none of them rooted in science. All the girls I talked to connected over the presence of restrictions related to menstrual activities, expressing discomfort with limitations such as attending social events, visiting religious places, attending school, eating certain foods, and managing bathing and sleeping arrangements.

The prevailing attitude tends not to be about helping the girl understand her body and make accommodations to help her when she has any distressing symptoms during her periods but about not letting her sully the purity of the household environment by menstruating.

This portrayal of a normal physiological phenomenon as a sign of impurity is not only cultural but also religious. The fact that they are impure and could contaminate things is reinforced again and again to young girls via these restrictions and that leads to not only stifling of the girl&rsquo;s autonomy but also causes a major impact on a girl&#39;s self-image, mental health and overall growth in society. <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-02894-7">Studies</a> have reported that girls often feel scared and confused during their first period. Many even thought they were <a href="https://fortuneonline.org/articles/myths-and-misconceptions-about-menstruation-a-study-of-adolescent-school-girls-of-delhi.html">seriously ill,</a> which caused them a lot of worry.

Do boys need to know about periods?

Let&#39;s talk about Anita again for a moment. Anita has two brothers but neither of them knows anything about periods. Anita&rsquo;s mother has told her that she must keep all her thoughts and issues about her period a secret from them. Anita won&#39;t be able to have an open conversation about menstruation with her father or her brothers. If Anita accidentally leaves her packet of menstrual pads somewhere where her father or brothers could see them, she will be scolded (or punished) for the same. This means that Anita probably won&#39;t be able to ask them to buy her menstrual hygiene products if she needs them.

&ldquo;They know about periods, not everything but they are aware.&rdquo; After much encouragement and questions about whether they think boys know about periods, one 15-year-old girl sheepishly tells me. &ldquo;They&rsquo;ll make jokes about it, I think they find it offensive. And consider this as something bad. They think because we get periods, we are weak and cannot do things better than them &ldquo;

When I spoke to boys aged 14-16 about periods, they recoiled, laughed and refused to engage. With some prompts, the responses were circling the half-baked information they have from ads, some biology classes and major refusal to address this topic. Some know about the bleeding aspect but without any knowledge of how, some had experiences of girls and women in families restricting certain activities once a month, which they considered as facts now and believed in the same practices. Research done on the perception of boys regarding periods using focused group discussions with 88 boys has revealed similar knowledge gaps and inconsistencies in their insights.

&ldquo;This is girls&rsquo; matter; I don&rsquo;t know much about it. we should not discuss it.&rdquo;&nbsp;

&ldquo;I know it causes discomfort and pain, they stay reserved, and it is awkward discussing it.&rdquo;

This gap in knowledge and stigma around it may even have more severe consequences, For example, <a href="https://www.indiatoday.in/crime/story/ulhasnagar-security-guard-kills-sister-after-suspicion-of-affair-2376852-2023-05-09">news stories</a> recounting the death of a young girl who was subjected to days of torture by her 30-year-old brother because he mistook her menstrual blood for evidence of sexual activity are distressingly familiar. This particular incident involved a 12-year-old girl from Ulhasnagar, Maharashtra, experiencing her first menstrual cycle. This incident shows us that without a doubt, men must be made a part of the menstruation conversation.

The initiatives &ndash; are they enough?

Throughout history, though menstruation has often been disregarded, leading to negative impacts on girls, women, families, and the environment - several initiatives have been introduced to rectify the same.

India&#39;s Menstrual Hygiene Policy is in line with its commitment to achieving Sustainable Development Goals, particularly in health, education, gender equality, and sanitation. Various health programs and schemes have menstrual hygiene management as their core objectives. The Menstrual Hygiene Scheme initiated by the MOHFW in 2011 focused on providing affordable sanitary napkins through ASHAs. In 2014, menstrual hygiene management was integrated into the Swachh Bharat Mission - Gramin initiatives, and in 2015, the National Guidelines for Menstrual Hygiene Management (MHM) were introduced by the Ministry of Education and the Ministry of Jal Shakti. The Rashtriya Kishor Swasthya Karyakram (RKSK) and The School Health and Wellness Program included MHM awareness sessions in schools.&nbsp;

And according to the National Family Health Survey 5, there has been a significant increase in the percentage of women aged 15-24 using hygienic menstrual protection methods, with sanitary napkins being the most common at 64%, followed by cloth at 50%, and locally prepared napkins at 15%. Geographically, 73% of rural women and 90% of urban women use hygienic menstrual protection.&nbsp;

But the question that remains is- are the policies also helping in alleviating the stigma associated with menstruation? Because the victories we have accomplished by increasing access to hygienic menstrual products are one dimensional considering the fact that harmful menstrual beliefs and practices continue to have negative physical as well as psychological impacts on girls - affecting their health, education as well as social presence.

A <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000070">study</a> was conducted on public policies aiming at addressing menstrual stigma and promoting menstrual literacy. As a part of the study, 34 policy documents from countries like India, Kenya, Senegal, and the United States were examined and in-depth interviews were conducted with 85 policymakers and advocates. This study reveals that though policies sought to acknowledge and raise awareness about menstrual stigma, they often ended up reinforcing it by emphasising concealment and control. The educational initiatives too tend to prioritise bodily management over empowerment. Policymakers may subscribe to societal taboos, resulting in missed opportunities.To effectively combat stigma, there must be a deeper understanding of its pervasive influence and a concerted effort to challenge and redefine it across society.

The way forward

A conversation regarding Masikh Pakhwada being celebrated by Akshara Center, an organisation working for adolescent health in Mumbai with Urmila Salunkhe, lead youth action and fellowship sheds light on a major factor- how the onus is on all stakeholders not merely the mother to impart the correct and timely education to the teenage girls and boys.&nbsp;

&ldquo;Sometimes the mothers themselves have carried forward half-baked knowledge about periods physiology and impact on health. The taboos and societal stereotypes majorly govern the conversation and limit themselves. Health posts, schools, public health governing bodies and even social media should take equal responsibility to spread the correct message in the most easy and interesting medium for better and broader understanding among adolescents.&rdquo;

Addressing menstrual stigma requires a multifaceted approach that prioritises education, dialogue, and advocacy. Menstrual health education, inclusive of both girls and boys, is essential for dispelling myths, fostering empathy, and promoting gender equality. By providing accurate information about menstruation, including its biological processes, cultural practices, and social implications, adolescents can develop a deeper understanding and appreciation for this natural phenomenon.

Furthermore, creating safe spaces for open dialogue about menstruation is crucial for challenging existing taboos and promoting acceptance and support. Initiatives that encourage peer-to-peer discussions, mentorship programs, and community-based workshops can help break down barriers and empower adolescents to advocate for menstrual health within their communities. Policymakers must also employ experts on gender studies to ensure that the policies are designed in a way that they not only talk about dispelling menstrual stigma but walk the walk as well.

Addressing menstrual stigma is not just a matter of individual health but a human rights imperative. The existing shame and secrecy surrounding menstruation propagate gender inequalities, restrict girls&#39; access to education and opportunities, and undermine their overall well-being. By challenging existing taboos and promoting menstrual equity, we only create a more just and equitable society for all.

Edited by Christianez Ratna Kiruba.

Image by Janvi Bokoliya.

&nbsp;

India's policies on menstrual health have achieved a one dimensional victory - promoting menstrual hygiene without tackling the issue of menstrual stigma.

Period Positivity: Leaving Taboos and Stigma Behind

Dr. Sumana Mukhopadhyay, currently pursuing an MD in Community Medicine at Grant Government Medical College, Mumbai, has been actively engaged in community activities since her college days. What began as a creative outlet has evolved into her professional focus in public health. She is particularly interested in preventive psychiatry and adolescent health. Dr. Mukhopadhyay also loves reading and hoarding books, and she loves to consume and create storytelling in all its forms.

Dr. Sumana Mukhopadhyay, currently pursuing an MD in Community Medicine at Grant Government Medical College, Mumbai, has been actively engaged in community activities since her college days. What began as a creative outlet has evolved into her professional focus in public health. She is particularly interested in preventive psychiatry and adolescent health. Dr. Mukhopadhyay also loves reading and hoarding books, and she loves to consume and create storytelling in all its forms.

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Sumana Mukhopadhyay

Sumana Mukhopadhyay

Period Positivity: Leaving Taboos and Stigma Behind

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