In Bengali, the national language of Bangladesh, menstruation is ‘Mashik’. However, old women particularly in the rural areas prefer to say ‘Shorir kharap’, which can be translated as health problem. I am sitting in Dhaka for my research, which includes the assessment of significant data. My research is concerned with the central question – ‘How does the approach of menstruation in a society influences the individual health behaviour of women?’ It brought me to Southeast Asia, where I developed a questionnaire in order to obtain input and more clarity on this topic. My intention is to prove that there is a need to raise awareness of this so called ‘health problem’. My first couple of weeks as a student of the North South University in Dhaka have passed but I am still in a position of observing people and their behaviours and, of course, also observing myself.
The girls, or to more precise, the young women at the university look in a sense very beautiful. Some of them wear high heels, most of them have red or pink lipstick, their eyes are black from the kohl, their nails are perfectly made and their salwar kameez (Bengali dress) allow them to all look like first ladies! So indeed there are a lot of things to talk about, including the newest fashion, the best shopping mall and so on, but when it comes to menstruation, which seems to me to be a natural topic to talk about – silence. Why is it important to raise awareness and to question how a society deals with the most natural phenomenon of womanhood?
My focus is now to understand this situation in Southeast Asia. The fast growing economy in countries like India or Bangladesh has been a determining factor to create a market for menstruation hygiene products. Sanitary pads are sold as ‘the’ solution and to a certain extent they have been an important contribution to raise awareness about hygiene. In urban and suburban areas, sanitary pads are ‘easily’ available, but to understand the issue with the pads I want to provide a whole picture of such a market and its consequences. One package costs around $1-2, which sounds cheap, but for the majority of low-income countries like Bangladesh, these monthly expenses are a huge financial burden and basically most of the women simply cannot afford it. Regardless of economic and social challenges, the use of sanitary pads causes severe environmental pollution, which requires thinking on a meta-level. Safe disposal will become a growing problem across India as more females turn to commercial pads, with the potential for up to 9000 tonnes of waste (for 432 million pads) annually. In most of the low-middle-income countries proper waste and disposal management is missing and burning or burying are the common practices. Indeed I have to question whether sanitary pads are ‘the’ solution. These have been a starting point to break the taboo but it is a long way to reach a sustainable, acceptable and hygienic solution. In 2011 the Government of Bangladesh conducted the National Baseline Survey and menstruation hygiene management has been one part of it. The result: 86% out of 2000 schoolgirls use old cloths or rags for the days of bleeding due to several reasons. Some have been mentioned above while additional challenges are the very poor conditions of toilet and washing facilities in schools – no separate toilets for girls, no water, no soap, no light in the toilet. These are good reasons to prefer staying at home during menstruation. The study shows a median of three days of absence of school every month, which amount to 36 days a year of missed education. To maintain a hygienic standard and avoid health risks the rags must be cleaned with soap and hot water and afterwards they are to be dried in the sun.
The study shows a median of three days of absence of school every month, which amount to 36 days a year of missed education.
This implicates a cultural discrimination women have to face. Predominantly in the rural areas, beliefs and myths are in existence that men will lose their eyesight when they see such rag. In this case the consequence is that the rags are dried while hidden in a dark place, which in countries with a tropical climate and high humidity, not to mention during the rainy season, is practically impossible. The rags remain damp and under this condition the risk of getting an infection is quite high as bacteria can develop very easily. The impact of poor menstruation management includes the financial aspect, religious restrictions, cultural harassment, social discrimination as well as additional challenges due to the climate of the country, health risks and the psycho-social burden of women.
After looking at the different determinants of menstruation management, it is important to question: Who can be a part of the change? Who can be a role model? How can the market of hygiene products react to the needs of women and match their resources at the same time? What is needed in daily life to develop a culture in a positive way and which policies are required on a governmental level to have this happen? I believe it is time that governments start implementing good menstruation management in health policies, so that girls as well as boys receive the right education. This would enable them to receive sufficient information, to develop skills and to establish well-behaviour regarding womanhood. Additionally it would allow religious leaders begin to respect women as equal to men and to create a positive mindset in society allowing women to finally find a peaceful way to their womanhood.
I believe it is time that governments start implementing good menstruation management in health policies, so that girls as well as boys receive the right education.
I do not want to reveal the results of my research as the work is currently in progress. In few weeks my journey continues and I will go to Bhutan to learn about their practices and culture. I hope that my thesis will be contribute to raise awareness in the global health community. I would like to send a special thank you to my supervisor, Dr. Armin Fidler in Austria, who leads me back to clarity when I am overwhelmed and lost with information, to my reproductive health teacher in Bangladesh, Dr. Nazneed Akther, to Mr. Sangay Khandu for his organization in Bhutan, to Sabarmatee Tiki for her hospitality and expertise in India and of course to my partner Dhiraj Kulkarni for his endless support to fulfil my purpose of empowering women.