Debunking menstrual hygiene myths one school at a time

Bahawalpur, Punjab - May 2017: “Don’t take a bath, don’t touch or drink cold water, don’t eat spicy food!” these are just some of the many myths adolescent girls in many parts of Pakistan believe to be the normal practice during menstruation. Studies have suggested that girls in Pakistan have very limited knowledge on menstruation and related hygiene practices. Teachers are often reluctant to discuss the subject leaving mothers and elder sisters as the primary source of information for girls. Unfortunately this information is only shared after the girls have had their first period. As a result, most girls start their periods uninformed and unprepared to deal with it.

Such was the case for girls at the Government Girls Elementary School 19 Fordwah, in Bahawalpur district, South of Punjab province. Students reported not having had prior knowledge about menstruation, some even recalling it being a traumatic experience when it first happened. The school’s head teacher, Ms Ruqia Murtaza says, “Before we started having awareness sessions (about menstrual hygiene) at the school both students and teachers stayed at home during their periods. Absteentism was very high with at least 75% of the girls staying home during that time of the month.” 13 year old Iman Fatima, a student in the 7^th class explains why, “I was worried about the bleeding staining my dress so it was better for me to stay at home,” she says.

Ms Murtaza recalls one of the girls in the 8th class reading about cancer and thinking the bleeding she was experiencing during her periods meant she had cancer. Many of the girls attending the school come from neighbouring villages, some travelling up to 4kms to attend school. Not having their menstrual hygiene management (MHM) needs properly addressed at the school due to inadequate hygienic and private places for washing and changing of sanitary napkins resulted in a new type of deprivation for the girls.

Unhygienic practices: 

Ms Murtaza says some girls’ hygiene practices during menstruation were a cause for concern. “They cut cotton pieces from their dresses and used them as sanitary napkins which they would then wash and re-use,” she says. She explains that some girls would even share the same cloth with their sisters making them vulnerable to a myriad of hygiene related problems. Some mothers didn’t allow their girls to use commercial sanitary napkins because they believed they were laced with chemicals. While some of the girls could afford the commercial sanitary napkins, they were not using them properly and would leave them on for too long, again putting themselves at risk of infection.

Dispelling myths about menstruation: 

UNICEF, through its partner the Lodhran Pilot Project (LPP), provided the school with MHM kits consisting of supplies to help girls manage their periods while at school. Teachers were trained to conduct awareness sessions on MHM with girls aged between nine and nineteen. Ms Saba Rashid a teacher at the school and the water, sanitation and hygiene (WASH) club supervisor says, “We never talked about puberty or any related subjects before. Now we conduct weekly awareness raising sessions where we explain to the girls that what is happening to them is normal. We’ve shown the girls how to safely use sanitary napkins (if they can afford them) without keeping them on too long.”  For the ones that cannot afford commercial pads the school has taught them how to make low cost substitutes using clean materials with padding that they could easily make at home. 

“We have also taught them that it’s alright for them to eat what they want and most importantly that they need to take care of themselves and bath when menstruating,” she says. The school now keeps a stock of napkins for girls to use when they have an emergency at school, which the students and teachers contribute to replenish. “Thanks to the awareness sessions, girls have the knowledge and tools to better manage their menstruation even before their first period, ensuring that they experience it with less trauma,” she says.

13 year old Aila, who got her first period after the sessions in the school had started recalls her experience, “I stood up during class to talk to the teacher when my friend Sonia told me that my dress was stained. I knew what to do because we had learnt it in class. Sonia got me pads and a scarf from the teacher to cover myself,” she says. “We are lucky we have learnt about this in school because it has helped us tell others in the community who are not aware that this is normal,” she adds.

Generating evidence on barriers to girls’ proper management of menstruation:

Research conducted by Real Medicine Foundation (RMF), Columbia and Alberta universities in 2016, on girls’ perceptions about MHM in Pakistan, indicates that there are multiple contributing factors leading to poor management of menstrual hygiene in schools. Findings showed that girls’ knowledge of puberty and menstrual practices is rooted in local, cultural theories. However, some girls are sceptical of this knowledge and question it. The research further showed that prior knowledge of menstruation normalized the process, leading to positive experiences of the first menstrual period. According to Ms. Afshan Bhatti, National Research Manager at RMF, “Lack of access to affordable sanitary napkins, facilities for proper disposal of used sanitary napkins, and inadequate WASH facilities in schools are major contributing factors to the barriers girls face while dealing with their menstruation at schools,” she says.

Using technology to voice girls’ views:

To generate further insights on girls’ need for information on the subject, UNICEF conducted an SMS poll via its U-Report PakAvaz platform targeting almost 4,000 females aged between 10 and 35 from across the country. About 700 young girls and women from all over the country responded free of cost to questions on their perspectives of menstrual hygiene. The results indicated that 49% had no knowledge of menstruation prior to their first period. The poll further revealed that 44% of the girls do not have access to basic menstrual hygiene facilities at home, their workplace or school. An additional 28 % of respondents said they missed school or work while on their period mainly because they were ashamed of getting stains on their clothes/uniform. The information has been vital in assisting UNICEF plan awareness and advocacy campaigns to address it.

28th May is Global Menstrual Hygiene Day, dedicated to create a united voice for women and girls around the world, helping to break the silence around menstrual hygiene management. This year’s theme is aptly titled, “Education about Menstruation.” While the assistance on MHM offered at schools gives a sliver of good news to girls, a lot still needs to be done to increase awareness, ensure girls have access to basic yet necessary facilities like segregated toilets, and that polices are enacted to allow girls their right to manage their menstruation with dignity.