According to World Health Organization, a person aged 10–19 years is considered as an adolescent. During this period, physical, psychological, and biological development of the child occurs.It is recognized as a special period in a girl’s life cycle which requires special attention. Menarche is an important biological milestone in a woman’s life as it marks the onset of the reproductive phase of her life.
The menstrual cycle has three phases, that is, follicular phase (proliferative), ovulation phase, and luteal phase (secretory).The uterine lining, or endometrium, gradually thickens and sheds off during menstruation, which results in bleeding that typically lasts for 3-5 days but can occasionally last up to 7 days.
Athoughmensturation is a physiological process, Previously it was regarded as Sin from god and had a tradional practice called Chaupadipratha –an custom in which women and girls are banished to isolated huts or sheds when they have their period, exposing them to life-threatening risks,particularly in the mid and far west of Nepal.Even in households with educated members and in metropolitan settings, there are other, less extreme types of Chauppadi that nevertheless prevent women from being fully empowered and participating fully in social and cultural life. Girls and women might not be allowed to touch other family members, see the sun, eat dairy products, or access certain sections of the house (such the kitchen or the worship space).
Chhaupadi was declared illegal in 2005, and menstruation-based exclusion and discrimination were made illegal in 2018. Despite this, many women cannot spend their period in the same house as the rest of the family.
Menstrual Health and Hygiene (MHH) is essential to the well-being and empowerment of women and adolescent girls
Cultural taboos, a lack of social support, facilities and services, and access to absorbent materials and supportive supplies are all variables that affect menstrual hygiene.
Poor menstruation hygiene can result in major health risks such as:
1. Reproductive tract infection(RTI) – soiled menstrual blood products serve as a breeding ground for bacteria such Salmonella, Staphylococcus, and E. coli. These bacteria can proliferate quickly in the reproductive system causing vaginitis and cervitis. Due to higher mucosal permeability these bacteria enter the circulation causing Sepsis and other complication.Not changing sanitary napkins on a regular basis can increase moisture retention and hasten the growth of hazardous bacteria.
2. Urinary tract infection(UTI)-inadequate cleaning of the external genitalia, washing the genitalia from back to front, and using unhygienic absorbents are the main causes that lead hazardous bacteria enter the urinary system which irritate the mucosal area and cause infection.
3. Yeast infection and Hepatitis B :Poor menstrual hygiene likefailing to wash your hands after changing your padcan lead to spread of infections like hepatitis B and candidiasis.As a result, it's crucial to thoroughly wash your hands with soap and water both before and after changing your sanitary pads.
4. Cervical cancer(rare):Cervical cancer is cancer of the cervix or uterine opening caused mostly by the Human Papillomavirus.It is diagnosed in Nepalese women each year.Although it is a rarity, unhygienic menstrual practices can lead to cervical cancer as increased incidence of UTIs and RTIs can make you susceptible to it.
The study discovered that some schools lacked toilet, separate toilet for girls, reliable water supplies, trash disposal facilities, locked doors, access to soap, and hygienic supplies including sanitary pads and painkillers. Most adolescent girls and women have trouble finding proper sanitary products because they are either unavailable or prohibitively expensive, especially in low-income and rural areas. The problem has been made worse by the economic difficulties brought on by the pandemic.Despite government financing for sanitary pad distribution to schools, reports indicate that access to pads has been difficult due to a number of issues, the most significant of which was the COVID19 lockdown at the time. Despite a grassroots push to abolish it, sanitary pads are still viewed as luxury goods and are therefore subject to a 13% value-added tax.
There is much that can be done. In Nepal, these actions should be considered to help girls and women, as well as transgender men and non-binary individuals who menstruate:
1. In order to promote better sensitivity and understanding, efforts to combat harmful associations and social practices surrounding menstrual hygiene management necessitate the involvement of mothers (who are frequently the primary providers of information for girls), elders, communities, and boys.
2. Schools are also an important source of information about menstruation for both girls and boys. More assistance for educators would help them communicate correct knowledge about sources, signs, and causes of menstruation in an intelligible way.
The timing of when (what grade and age) the classes on menstrual hygiene management and sexual and reproductive health should be revisited and taughting them in lower classes/grades is also crucial to ensure that the girls receive the information on menstrual management prior to the start of their menarche.
It isalso advised that schools collaborate with nearby healthcare institutions so that nurses can assist in giving classes to girls about menstrual management at the right age.
3.providing facilities like –sufficient water,restocking of supplies, including soap , sanitary items,as well as painkillers, and lastly making toilets accessible with enough privacy.
The aforementioned collaborative initiatives seek to provide secure, sanitary, private, and hygienic facilities in schools as an alternative to the shame and marginalization associated with menstruation.These facilities help girls attend school more consistently and increase their educational possibilitiesby reducing hygiene-related diseases, and thereby positively impacting learning achievements, and overall contributing to gender equality and fostering of social inclusion and individual self-respect.
-(Dr PratikshyaThapa, Medical officer at Kakarvitta, Jhapa).
