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The Hindu
29-05-2025
- Health
- The Hindu
How menstrual hygiene issues and period stigma keep schoolgirls out of classrooms in India
Taboos and stigma around menstruation abound in the Indian subcontinent, and, despite progress, practices such as getting young women married after they hit puberty or restricting them from praying, cooking, or sometimes even sleeping inside home or using their bed continue, all attributed to the 'impurity' menstruation This culture of silence around menstruation and restrictions around open conversations have a huge impact on the health and education of adolescent girls -- not only does it lead to the spread of misinformation and unhygienic practices, it also keeps girls out of school one in four girls in India miss school due to menstruation, says a 2024 study by Shafique Ahmed et al, in the Journal of Family Medicine and Primary Care . Issues faced by schoolgirls during menstruation Experts who work in the field say that a lack of proper washrooms, insufficient water supply, menstrual cramp management and sanitary pad disposal are some of the major problems faced by school-going girls across India. 'I have come across students taking leave from school during their periods. Parents start thinking about their marriage and many get married soon after puberty. Many of the girls in my school are already married,' said Dimple Singh, a teacher at a government school in Meerut, Uttar Pradesh. Medical professionals say that the onset of the menstruation is looked upon as the 'start of fertility,' and that is where the desire to 'look for a groom to marry the girl off', stems from. 'Across many rural parts of India, mothers play a central role in making choices post menstruation – and often make decisions for the girl to stay at home – whatever the reasons are. This furthers absenteeism, and can also create a gap between girls and boys attending the same schools,' said Divyang Waghela, head – Water, Sanitation, and Hygiene, Tata Trust. Multiple field workers report that girls feel shy speaking about their own menstruation cycles and face backlash at home even if they want to open up about the topic. Many have reported during closed-door conversations that they do not understand why they have experience abdominal pain, and talking about this at home or at the doctor's has fallen deaf ears. . 'During one of our community events, 'Khullam Khulla Baat Karenge', silence spoke louder than those who actually spoke. 14-year-old Khushi confessed that she kept mum at the event because she was too shy to speak about periods in public. Stakeholders say that this issue is very 'personal' and must not be made public. This mindset reflects the widespread attitude that menstruators must silently endure discriminatory practices,' said Shalini Jha, founder, Alharh, a menstrual awareness and equity campaign. Lack of access to sanitary products Research also sheds light on the fact that many schools do not have supplies of sanitary napkins or clean restrooms for women to take care of their period needs. In 2022, when a girl in Bihar had asked for free sanitary pads at her school, senior IAS official Harjot Kaur Bhamra shamed her and said, 'Tomorrow, you attain the age of family planning and you would expect government to provide Nirodh (condom) too.' According to a 2022 study in BMC Public Health in 2022, only 42% adolescent women in rural India can access hygienic sanitary products. Even though the department of school education and literacy of the Education Ministry has recognised the challenges faced by the girls due to limited access to sanitary products and menstrual hygiene facilities during examinations in June 2024, there is no nationwide mandate on making sanitary products available, much less for for free, in India. 'I grew up in a household where there was a big ceremony and celebration when girls attained puberty, but the month after, when we got our periods, we became 'impure' and were placed in isolation, with separate clothing, vessels, etc., I have had to unlearn all of these myths and allow myself to experience the process of menstruation without any guilt, but it took years to dispel the shame,' Revathy B. from Tirunelveli, Tamil Nadu told The Hindu. Ms Revathy spoke about how, even after having a child, and now as an older woman she has not been able to free herself from the shame of period blood stains. She remembers missing school during her periods due to the lack of clean restrooms and said that would pray that her periods started on a weekend or holiday, so she did not have to miss out on her classes. No doors in school washrooms Nayna Mondal, a field worker of the Rangeen Khidki Foundation from Kolkata said that during intervention in schools and communities they learnt that many of the school washrooms did not even have doors. 'The schools lack resources. Hundreds of students use one or two washrooms, and they aren't even cleaned once in seven days. The conditions are very unhygienic,' Sanjina Gupta, founder of Rangeen Khidki, said. She also highlighted that many of the girls who have gained awareness about menstruation through their awareness drives face problems at home when they try to speak freely about the issue. Experts say that older men and women of the house refuse to accept scientific explanations and sometimes even years of rapport building and de-stigmatisation does not help. Ms. Gupta also said that in their initial days of work they faced backlash from men in the neighbourhoods they worked in. Their posters were torn down, they were criticised for speaking about a 'dirty' topic, but with time and repeated counselling, people have become more accepting of their work. Call for better healthfocused policies and interventions Last year, on July 8, the Supreme Court of India directed the Central government to frame a model policy on menstrual leave for female employees; this was a landmark moment in bringing about policy-level change and making menstrual issue a part of open conversations. Even though ground-level implementation is yet to be seen, this move is a step forward in the process of destigmatisation of menstruation, experts said. But even after years of field work and intervention, Ms. Jha pointed out, 'the voices from the ground remain dishearteningly similar: a tale of shame and stigma that represents clear violations of fundamental rights.' 'The path ahead should be centered around fundamentally reframing the conversation around menstruation – inviting more households to recognise it as an indicator of health instead of a marker or sexual maturity,' Mr. Waghela said.
New Indian Express
28-05-2025
- Health
- New Indian Express
Addressing anaemia next critical step to sustaining maternal health
Recently, in her address to the Lok Sabha, Union Minister of State for Health, Anupriya Patel, highlighted India's progress in reducing maternal mortality– an achievement that certainly is cause for celebration. Our maternal mortality ratio fell dramatically, from 384 to 103 deaths per 100,000 live births between 2000 and 2020. Improved access to antenatal care and greater numbers of institutional births have played an enormous role in safeguarding the health of mothers and their babies. What this milestone also emphasises, however, is the need to keep this momentum up by taking a closer look at more complex challenges that pregnant women continue to face. Of these, one of the most persistent threats to progress is maternal anaemia. More than half of our pregnant women suffer from anaemia and without immediate, holistic interventions and better health-seeking behaviours we risk undoing decades of hard-won gains. Women are disproportionately affected by nutritional deficits that impact their health and limit their ability to become equal social and economic contributors. Low haemoglobin in pregnant women not only heightens the risk of postpartum hemorrhage, a leading cause of maternal death, but also contributes to extreme fatigue, breathlessness, and a cascade of complications that affect both mother and child. Pregnancy demands a nearly 50% increase in blood volume, creating an 'iron sink' that depletes maternal iron stores. With over 57% of women between the ages of 15 and 49 being found to be anaemic, according to the latest NFHS-5 data, we must address this silent epidemic with the same urgency as we did in reducing maternal mortality. Recent evidence underscores that iron deficiency is the predominant cause of anaemia in pregnancy, with studies indicating that approximately 80% of moderate anaemia cases and 90% of severe anaemia cases in pregnant women are attributable to iron deficiency. This finding, published in the Journal of Family Medicine and Primary Care, highlights the critical importance of targeted iron supplementation interventions – both oral and intravenous– to address the root cause of most anaemia cases. The repercussions of maternal anaemia extend beyond the mother. Infants born to anaemic mothers face a higher likelihood of iron deficiency. This can impair cognitive development and limit children's future potential. Severe anaemia in children of anaemic mothers is nearly four times higher (5.9%) compared to children of non-anaemic mothers (1.5%), according to NFHS-5. Breaking this cycle requires proactive measures to ensure women enter pregnancy with sufficient iron stores and receive timely treatment when needed. For this, a multi-pronged approach is necessary, with the administration of iron and folic acid (IFA) supplementation during pregnancy and even pre-conception taking centre stage. Intravenous iron formulations, such as Ferric Carboxymaltose (FCM), may be prescribed to those women in whom IFA supplements are found to make low improvements to their haemoglobin levels. The use of IV iron, including FCM, has been encouraged by the Government of India, in a Guidance Note on The Use of Intravenous Iron Among Pregnant Women, released last year. This single-dose treatment has been found to significantly reduce the risks associated with maternal anaemia. Routine screening, especially through digital diagnostic devices,which can guarantee quick and reliable results, is also critical. Detecting anaemia, in both pregnant and non-pregnant women, early on can also help health workers initiate treatment early. Overall, significant focus must be placed on ensuring that IFA supplements, intravenous iron and digital screening tools, such as digital haemoglobinometers (DgH), reach the last mile, that health workers are adequately trained and, most importantly, that women and their families are educated about the severity of anaemia's implications during pregnancy. Strengthening adherence through robust Information, Education, and Communication (IEC) efforts is a key pillar of the AMB strategy. Empowering women with knowledge about their nutritional needs is essential for sustainable change. Community-based programs that proactively reach out to expectant mothers and their families, sharing practical information about incorporating iron-rich foodsinto their diets can have long-term impact. Educational campaigns must emphasise the importance of eating leafy green vegetables, legumes, and fortified cereals, as well as vitamin C-rich foods to boost iron absorption and proper meal planning to overcome dietary deficiencies. Improving awareness on the need for early antenatal care checkups and the availability of supplementation and IV iron in local health centres is also critical to ensuring the uptake of government services. By integrating nutritional counseling into routine antenatal-care we can ensure that women not only receive supplements but also adopt healthier eating habits that support improved maternal and fetal outcomes. Our commitment must be to a future where maternal anaemia is no longer a silent crisis undermining the gains we've made in maternal health. Embracing a comprehensive strategy, one that couples robust oral and intravenous supplementation and early detection, with targeted nutrition education and community empowerment, is vital. Our collective efforts, whether through improved patient care or increased messaging around the urgency for anaemia reduction, are key to ensuring women receive the support they need to overcome anaemia. By directly addressing anaemia, we take a crucial step toward healthier mothers, brighter futures for children, and stronger communities, making the vision of an anaemia-free India a reality. (The authors are Director, National Institute of Nutrition (NIN), at ICMR, Hyderabad, and Scientist E, Reproductive, Child Health and Nutrition, at ICMR, Delhi, respectively)
New Indian Express
28-05-2025
- Health
- New Indian Express
View: Addressing anaemia is next critical step to sustaining maternal health
Recently, in her address to the Lok Sabha, Union Minister of State for Health, Anupriya Patel, highlighted India's progress in reducing maternal mortality– an achievement that certainly is cause for celebration. Our maternal mortality ratio fell dramatically, from 384 to 103 deaths per 100,000 live births between 2000 and 2020. Improved access to antenatal care and greater numbers of institutional births have played an enormous role in safeguarding the health of mothers and their babies. What this milestone also emphasises, however, is the need to keep this momentum up by taking a closer look at more complex challenges that pregnant women continue to face. Of these, one of the most persistent threats to progress is maternal anaemia. More than half of our pregnant women suffer from anaemia and without immediate, holistic interventions and better health-seeking behaviours we risk undoing decades of hard-won gains. Women are disproportionately affected by nutritional deficits that impact their health and limit their ability to become equal social and economic contributors. Low haemoglobin in pregnant women not only heightens the risk of postpartum hemorrhage, a leading cause of maternal death, but also contributes to extreme fatigue, breathlessness, and a cascade of complications that affect both mother and child. Pregnancy demands a nearly 50% increase in blood volume, creating an 'iron sink' that depletes maternal iron stores. With over 57% of women between the ages of 15 and 49 being found to be anaemic, according to the latest NFHS-5 data, we must address this silent epidemic with the same urgency as we did in reducing maternal mortality. Recent evidence underscores that iron deficiency is the predominant cause of anaemia in pregnancy, with studies indicating that approximately 80% of moderate anaemia cases and 90% of severe anaemia cases in pregnant women are attributable to iron deficiency. This finding, published in the Journal of Family Medicine and Primary Care, highlights the critical importance of targeted iron supplementation interventions – both oral and intravenous– to address the root cause of most anaemia cases. The repercussions of maternal anaemia extend beyond the mother. Infants born to anaemic mothers face a higher likelihood of iron deficiency. This can impair cognitive development and limit children's future potential. Severe anaemia in children of anaemic mothers is nearly four times higher (5.9%) compared to children of non-anaemic mothers (1.5%), according to NFHS-5. Breaking this cycle requires proactive measures to ensure women enter pregnancy with sufficient iron stores and receive timely treatment when needed. For this, a multi-pronged approach is necessary, with the administration of iron and folic acid (IFA) supplementation during pregnancy and even pre-conception taking centre stage. Intravenous iron formulations, such as Ferric Carboxymaltose (FCM), may be prescribed to those women in whom IFA supplements are found to make low improvements to their haemoglobin levels. The use of IV iron, including FCM, has been encouraged by the Government of India, in a Guidance Note on The Use of Intravenous Iron Among Pregnant Women, released last year. This single-dose treatment has been found to significantly reduce the risks associated with maternal anaemia. Routine screening, especially through digital diagnostic devices,which can guarantee quick and reliable results, is also critical. Detecting anaemia, in both pregnant and non-pregnant women, early on can also help health workers initiate treatment early. Overall, significant focus must be placed on ensuring that IFA supplements, intravenous iron and digital screening tools, such as digital haemoglobinometers (DgH), reach the last mile, that health workers are adequately trained and, most importantly, that women and their families are educated about the severity of anaemia's implications during pregnancy. Strengthening adherence through robust Information, Education, and Communication (IEC) efforts is a key pillar of the AMB strategy. Empowering women with knowledge about their nutritional needs is essential for sustainable change. Community-based programs that proactively reach out to expectant mothers and their families, sharing practical information about incorporating iron-rich foodsinto their diets can have long-term impact. Educational campaigns must emphasise the importance of eating leafy green vegetables, legumes, and fortified cereals, as well as vitamin C-rich foods to boost iron absorption and proper meal planning to overcome dietary deficiencies. Improving awareness on the need for early antenatal care checkups and the availability of supplementation and IV iron in local health centres is also critical to ensuring the uptake of government services. By integrating nutritional counseling into routine antenatal-care we can ensure that women not only receive supplements but also adopt healthier eating habits that support improved maternal and fetal outcomes. Our commitment must be to a future where maternal anaemia is no longer a silent crisis undermining the gains we've made in maternal health. Embracing a comprehensive strategy, one that couples robust oral and intravenous supplementation and early detection, with targeted nutrition education and community empowerment, is vital. Our collective efforts, whether through improved patient care or increased messaging around the urgency for anaemia reduction, are key to ensuring women receive the support they need to overcome anaemia. By directly addressing anaemia, we take a crucial step toward healthier mothers, brighter futures for children, and stronger communities, making the vision of an anaemia-free India a reality. (The authors are Director, National Institute of Nutrition (NIN), at ICMR, Hyderabad, and Scientist E, Reproductive, Child Health and Nutrition, at ICMR, Delhi, respectively)
