Menstruation is a natural biological process and a key sign of reproductive health in girls and women. However, till today, very little attention has been given to the provision of appropriate and adequate hygiene facilities and services for its management. In our culture menstruation is treated as something negative, shameful or dirty as well as very confidential. It is associated with many taboos and cultural restrictions, largely due to limited knowledge and access to information both at home and in schools. As a result, girls often do not know what to do when they begin menstruating. Many women and girls use to manage their menstruation in unhygienic and inappropriate ways. The problems are exacerbated by insufficient access to safe, private and hygienic toilets and unavailability of clean water and soap for personal hygiene, specifically at schools. As a result, many girls and women in our country face considerable physical and social challenges during their menstruation period. At the same time, taboos appear to have a large negative impact on girls’ freedom during their menstruation, as well as on their nutrition, health and wellbeing and empowerment.
Menstrual health and hygiene management situation
A baseline survey of RITU project (which is supported by the Embassy of Kingdom of the Netherlands) was conducted in February 2017 on menstrual hygiene. The survey was undertaken with 4046 girls from class 6 and 7 in 149 schools in Netrakona during January-February 2017. The baseline data show that –
• 75% of girls could not change their sanitary napkins in the school due to inadequacy of facilities like running water, soap, bin and enough light in the school toilets.
• 53% of surveyed girls reported that they miss school on an average of 3 days a month during menstruation. This implies that barriers such as fear of being recognized for menstruating at school, teasing by boys, and fear of staining clothing by leakage of menstrual blood, use to discourage girls from attending classes during menses. As a result, 80% of total girls are deprived of getting stipend because of low school attendance. This is an untold story behind the adverse impact of not having menstrual hygiene management (MHM)-friendly toilets and environment at school.
• 66% of surveyed girls did not know what menstruation was when it started. The girls lack an understanding of the biological reasons for menstruation and have rarely discussed issues of menstrual health with anyone, beyond getting basic instruction from their mothers and sisters.
• 59% of girls avoided white foods (such as banana, egg, milk etc.) and 53% of girls avoided sour foods such as (olive, tamarind).
• MHM is not adequately articulated in the national curriculum. Teaching and learning materials, developed by NGOs and other agencies, have been piloted in primary and secondary schools, health and youth clubs.
• Teachers are hindered by cultural barriers to adequately address MHM lessons within the school curriculum, especially in rural areas.
According to Bangladesh Education Statistics 2015, a total of 6,317,963 girl students are at secondary schools and madrasah in Bangladesh while about 25% of them do not go to school during menstruation.
According to the Bangladesh National Hygiene Baseline Survey 2014, overall there were 187 students per toilet; the majority of schools (84%) had a functional improved toilet for students however, in only 45% of schools were these unlocked. Additionally, running water, soap, bin and enough light are unavailable in all school toilets.
Available policy/laws/ relevance to menstrual health
Talking about girl’s and women’s access to information and access to appropriate service means to manage their cycle is thus inextricably linked to the human rights conferences that reaffirmed women’s sexual and reproductive rights, children’s rights, and the right to be free from non-discrimination on the ground of gender. These include: The article no: 19 (Protection from all forms of violence) of the Convention on the Rights of the Child (CRC-1991). The principle no.8,no.10,no.11of the International Conference on Population and Development (ICPD) (1994),The goal no.3 (ensure healthy lives and promote well-being for all at all ages), goal no.4 (Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all), goal no.5 (achieve gender equality and empower all women and girls), and the goal no.6 (ensure availability and sustainable management of water and sanitation for all) of the Sustainable Development Goal (SDG)and the United Nations Fourth World Conference on Women (1995).
Initiatives of government
The government of Bangladesh is committed to ensure safe environment by promoting personal hygiene in including menstrual hygiene, National Education Policy (2010) acknowledges that gender-separate school toilets can reduce dropout rates and child marriage. In this respect, last couple of years, NCTB has incorporated SRHR and menstrual hygiene issues in school textbooks. But it is not comprehensive: the language and wordings are not specific, and it is not being well-implemented. Most of the time, parents and teachers remain silent and act more on taboos, which are fed by customs and traditions, than on the need to protect their children’s health.
Another important issue is that teachers are not trained properly to impart SRHR and Menstrual Hygiene (MH) lessons and most of the teachers are not sensitive on MH and not friendly with their students. It is also observed that teachers avoid these chapters in class as they do not feel comfortable discussing the topics with students. Some of the guardians sometimes do not agree that these topics should be taught in the schools.
The Education Ministry also issued a circular (on 23 June 2015) to the secondary and higher secondary schools, madrasahs, vocational institutions to improve the toilet and sanitation facilities. In spite of these initiatives there are some gaps that need to be filled to improve hygiene including menstrual hygiene situation at school level.
Considering the current situation and context, BNPS, DORP, Red Orange, TNO and MHM Platform (35 development organisations including Unicef, BRAC, WaterAid, ICDDR’B, BNPS) are working together through ‘Ritu’ project led by Simavi, in support of the Embassy of the Kingdom of Netherlands, with the objective to include sexual and reproductive health, menstrual hygiene management and important life skills related topics in the national curriculum and textbooks as well as developing menstrual hygiene management system in educational institutions.
Intervention needed to improve menstrual health situation
It is clear to understand that proper sanitation and hygiene management are important for every school to ensure a safe environment for the students, and MHM is one of the paramount issues regarding creating safe environment in schools. It has a serious impact on the education, health and dignity of women and girls.
– To include and rearrange the SRHR, Gender and MH information in National Textbooks properly with sequences among different grades.
– Include SRHR, Gender and MH information in the teachers training curriculum of government teacher training institutions and arrange to improve and establish supportive environment for women and girl child to MH and access to MHM services. In addition some new methods should be associated in the teachers training to train the teachers on teaching these technical topics.
– Development of a manual and handbook for teachers on MH, SRHR and Gender topics to creating a safe school environment including to support girls stay in school even during menstruation.
– SRHR, Gender, menstrual health topic is not only for girls, it should be needed to know to boys also as a part of human body chapter of relevant books instead of Home Science book of girls. These subjects should be incorporated in any general book that all of the students can read it and know about it.
– Development of MHM friendly structures in EDIs as well as ensure proper monitoring for proper implementation of the MHM and toilet related circular the Education Ministry of 2015.
– To take necessary steps for improving student toilet ratio, 1 toilet for 50 students in place of 1 toilet for 187 students following Sector Development Plan 2011 – 2025.
As menstrual health is a part of sexual and reproductive health, family, society and state have to ensure a safe environment for girls where they will avail healthy menstruation management system and positive outlook regarding this.