Why talk about menstrual health management

Amit Banik

Amit Banik

Menstrual health management is a natural and normal process of reproductive life for women and adolescents around the world. Menstruation in teenage girls is a normal physiological process. But Bangladesh being a developing country, period and seasonal practices still face many social, cultural, and religious prejudices and constraints, which are a major obstacle in the way of proper menstrual health management. 

There are about 54 million menstruating women in Bangladesh and a large number of them are school going girls. According to the Bangladesh National Hygiene Survey-2018 conducted by the Bangladesh Bureau of Statistics (BBS), about 50 percent of adolescent girls use unsanitary old clothes instead of sanitary napkins. Many teenage girls in the country do not go to school or even appear for field tests during periods. 

Most educational institutions in the country do not have seasonal health management-friendly toilets. Toilets do not have access to emergency sanitary napkins and there is no hygienic disposal of used napkins. Whereas an average student spends 7-8 hours in school during a period, schools need to have access to emergency sanitary napkins and a hygienic disposal system. 

According to gynecologists, napkins need to be changed every six hours; otherwise, there is a risk of bacterial infection and various diseases can occur. According to the data from the Bangladesh National Hygiene Survey 2018, the rate of use of sanitary napkins among schoolgirls is 62% and the remaining 38% are still Do not use sanitary napkins. That is, 1 out of 3 girls may not be able to afford sanitary napkins or they are not readily available to them. 

The survey also revealed that 'in most schools in the country, 30 percent of girls are absent from school every month during the menstrual period due to a lack of separate and accessible toilets for girls'. As a result, on the one hand, they fall behind in the class, and on the other hand, the test results are also bad. Separate toilets are not being installed due to a lack of adequate investment, which is a lack of management, especially the indifference of the concerned institutions engaged in the responsibility, or a lack of participation in solving the problem. 

Two issues stand out so far, a lack of open discussion on seasonal health management and the availability of napkins is a major challenge. Second, lack of attention, budget allocation and monitoring of school and school water sanitation-related institutions. The main issue is that toilets or adequate MHM Friendly toilets are not being renovated or installed due to inadequate budget allocation and lack of specific guidelines in this regard by the concerned institutions, including schools. 

Creating a sensitive environment regarding water, sanitation and hygiene in schools without practicing cleanliness among the service providers and stakeholders not possible. Bangladesh, like other countries, is committed to achieving the Sustainable Development Goals by 2030. But among the 17 Sustainable Development Goals, seasonal health management is not specifically addressed. 

Sustainable Development Goal-4 (Ensure inclusive and equitable quality education for all and create opportunities for lifelong learning) mentions separate toilets in schools but does not specify this MHM issue. Also, integrity (transparency, accountability and participation) between service providers and receivers in educational institutions. There is a shortage. The school WASH Circular- 2015 issued by the Ministry of Education in 2015 stated in the 11 guidelines stated the stark reality that the ratio of students to toilets is 187:1. Although in the Sector Development Plan (SDP) 2011-2025 a desired ratio of students to toilets was set at 50:1. But this is far from reality. 

The government's Eighth Five Year Plan recognizes emphasis on ensuring adequate provision of sanitary napkins for girls with a seasonal health management corner and inclusive separate toilet facilities with cleaning materials along with school-based awareness raising programs through first level health workers and appropriate NGO workers. The emphasis is placed on inducing positive behavioral change in adolescents' guardians (parents, guardians, teachers, religious leaders, peers, etc.) on adolescent reproductive health issues. 

It is difficult to change the situation without government initiatives, attention and support from various departments. Specific guidelines should be incorporated into seasonal health management strategies such that, where consistent with the Sustainable Development Goals, roles and responsibilities of participants are specified, budget allocations and monitoring authorities are linked to strategy implementation. Revised menstrual health management strategies should be analyzed through a gender lens to ensure that adolescent girls who fall below the poverty line and girls with disabilities are not left behind. Girls need to be provided with low-cost sanitary napkins during periods in educational institutions so that they can continue to attend school regularly. 

The role of mass media is crucial in promoting communication and wide-scale implementation planning strategies for social and behavioral change. The school management board, upazila education officer, health engineering directorate, and upazila and union parishad need to formulate and follow guidelines for managing seasonal health management strategies in schools.  

Amit Banik,MBS,MDS(JU), Freelance journalist, Dhaka, Cell: 01793286343