MHM — an unappreciated development challenge

Bill Gates once called the Bollywood movie Toilet one of the better adverts for sanitation and reproductive health than any other development intervention. Another movie Padman directly dealt with the taboo subject of menstrual hygiene management and changed people’s perception regarding reproductive health. The message gained is that Menstrual Hygiene Management (MHM) is not a personal issue, but a development economics issue as it significantly impacts women’s health, education and economic participation.

According to the World Bank, globally around 500 million females do not have access to basic sanitary products and hygienic bathrooms in their homes, schools or workplaces. According to Unicef, around 79% of females in Pakistan do not have access to safe sanitary products. Another study by WaterAid claims that only 17% of Pakistani women have access to sanitary napkins, with 66% using the cloth option that is rewashed and reused repeatedly.

Access to sanitary products in Pakistan is a challenge for many females due to various factors including poverty, cultural norms and lack of education. Menstruation is still considered taboo in many parts of the country, leading to a lack of awareness and discussion about menstrual hygiene. Additionally, the cost of sanitary products is often prohibitive for many women and girls to afford, leading them to resort to unhygienic alternatives such as cloth or leaves. It is bizarre to even have a ‘luxury tax’ of 12% imposed by the government on sanitary products in May 2022. Given that there are only two key players in the Pakistani Sanitary Napkin market — P&G which produces ‘Always’ and Santex which produces ‘Butterfly’ — the prices are restrictive for the underprivileged. The two brands combined account for roughly 84% of the market share. In a country where a significant number of women live below the poverty line, it is a luxury to be able to afford sanitary napkins. Mensuration usually begins at the age of 13 and ends around the age of 51, when a woman enters her menopausal stage. That is, roughly four decades for women to manage mensuration and by the current rates of sanitary products. This amounts to spending a large portion of household income on such products.

Periods have long been stigmatised, perpetuating silence, humiliation and prejudice. Pakistan, like the rest of the world, has taboos, misconceptions and negative beliefs regarding menstruation. Menstruators experience embarrassment or discomfort when discussing a natural bodily function due to the suppression of conversations about periods. The absence of education and awareness regarding menstruation exacerbates the stigma by allowing myths and false information to prevail. Unicef Pakistan commissioned a research study by the name of Learning, Acting, Learning (LAL) to identify MHM-related issues in girls’ public schools. Based on the study, menstruation was always referred to in extremely vague and undefined terms and was never discussed explicitly. This attitude discourages young girls from seeking assistance. It also prevents the females from receiving accurate information, forcing them to rely on antiquated beliefs. Existing national health, education, youth and sanitation policies do not address MHM in a holistic manner.

Survey after survey suggests that one of the major factors in girls dropping out of secondary schools is a lack of support around menstrual health. MHM and establishing a supportive environment for menstruating girls are crucial responsibilities of schools. However, in countries such as Pakistan, the lack of focus on MHM in schools contributes to the difficulties and obstacles that students face during their periods. One of the primary issues is the absence of proper facilities and infrastructure. According to the study conducted by Unicef, the students’ toilets were found to be extremely dirty with no soap and broken taps. The lack of availability of sanitary napkins and disposal facilities for used sanitary napkins was reported by nearly all of the students. Pain-killer tablets were unavailable, but in cases where the girls complained of severe pain, the teachers mostly sent them home or sometimes gave them their own painkillers. Most of the younger girls and the majority of the older girls reported that menstruation negatively impacts their education due to decreased attention and missed school days, primarily due to fear of staining their clothes.

This challenge of accessibility and unsafe MHM practices pose significant obstacles for women, especially in marginalised communities and settings with limited resources. Inaccessibility to sufficient resources, facilities and support perpetuates a cycle of discomfort, health risks and limited opportunities. Unsafe MHM practices contribute to health hazards in the form of urinary tract infections and reproductive tract infections. They are more prevalent in areas with limited access to clean water, soap and hygiene kits. Poor management of menstrual hygiene can have long-term effects on reproductive health and the overall well-being of women, as found by a study commissioned by GIZ and carried out by IMSciences, Peshawar in the context of vulnerable Afghan refugees and host communities in three districts of KP.

MHM is closely related to several Sustainable Development Goals (SDGs) and has a cross-cutting intersection with the attainment of other global goals such as quality education, gender equality, clean water and sanitation, responsible consumption and production and climate action. SDG Target 3.7 clearly mentions that “by 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information & education, and the integration of reproductive health into national strategies.”

MHM is crucial to promoting the wellbeing, health and empowerment of women. By breaking down societal barriers, promoting awareness, involving the local clerics, ensuring accessibility and affordability, inclusive educational institutions and aligning MHM efforts with the SDGs, we can create a society where mensuration can be managed with dignity and safety, and contributing to women being productive section of the society.

Published in The Express Tribune, June 28^th, 2023.

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