POOR MENSTRUAL HYGIENE MANAGEMENT AND ITS CONSEQUENCES FOR PAKISTANI SCHOOLGIRLS: Policy Analysis

Abstract 

“Culture of silence” around a woman’s menstrual cycle, which is pertinent in certain cultures, exists in most countries around the world. Although campaigns in order to abolish the luxury tax on feminine hygiene products have worked to destigmatize this topic in the west to some extent, it remains a big taboo in Pakistan. Women are scared to seek help regarding this issue which, in some cases, can pose a great danger to their health. This has also adverse consequences for girls’ education in several ways, especially for those coming from low and medium-income households. Despite the fact that the United Nations has considered Menstrual Hygiene Management (MHM) a global public health and human rights issue, at present, there are no policies in place to ensure proper MHM conditions in Pakistan. Even if girls try to break out of this stigma, the society never fails to police them and mostly it is fellow women who show these reactions confirming the deep-rooted internalized misogyny present in the society. In this context, this policy brief aims to critically review the problem stream, policy stream and political stream regarding the issue of poor menstrual hygiene management and its consequences for Pakistani schoolgirls. To serve this purpose, data was collected through interviews and survey questionnaires. Subsequently, various policy alternatives were proposed and evaluated using Policy Delphi rankings and certain assessment criteria such as equity, effectiveness, cost, political feasibility and social acceptability in order to ensure the provision of proper menstrual hygiene conditions and disposal facilities for girls in Pakistan. 

Key findings

The findings conferred significant negative impacts of neglecting the issue of menstrual hygiene in Pakistan including poor menstrual hygiene management as statistics revealed that 79% of Pakistani women do not have access to the required facilities (i.e. proper products, proper sanitation and/or disposal facilities) to manage their menstrual cycle hygienically, dropouts and absenteeism during menstruation as Pakistani girls reported a number of reasons for this including fear of staining their clothes, fear that boys would find out, or due to pain, reduced performance at schools and psycho-social wellbeing since feelings of shame, embarrassment and insecurity due to lack of comfortable sanitary material can affect girls’ participation, including hesitance when answering questions, fear of being teased by their classmates for staining their clothes or smelling unpleasant and/or being distracted from their work due to pain and discomfort, vulnerability to diseases as 97% of gynecologists reported that chances of reproductive tract infections are 70% higher among women adopting unhygienic sanitary practices. Similarly, such women were found at higher risk of urinary tract infections (UTIs), fungal infections, urinogenital infections, yeast infections, rashes, bacterial vaginosis, cervical cancer, adverse pregnancy outcomes like preterm birth, infertility, acquisition of sexually transmitted infections and development of pelvic inflammatory disease (PID). Further analysis identified major causes responsible for the poor menstrual hygiene conditions in Pakistan, including inadequate materials and facilities since only 17% of Pakistani girls reported having access to sanitary napkins, with 66% using cloth while 49% of whom rewash and reuse that cloth. Additionally, no organization or company in Pakistan was found producing affordable feminine hygiene products at a mass-scale for the lower-income brackets of Pakistan, lack of proper disposal mechanisms that further acts as a barrier, culture of silence around menstruation since menstruation is considered as taboo in Pakistan due to the strong patriarchal culture, religious implications and beliefs adopted from the Hindu culture, lack of information on menstrual hygiene since schools are reluctant to talk about this issue with their students so no official education on sexual and menstrual health has been included in the Pakistani curriculum due to the associated shame and social taboo surrounding the topic of menstruation, recent recognition as a policy problem since this issue was previously considered as a private problem meant to be dealt by the individual girl or her family rather than tackled by policymakers and experts, and lack of funds as other issues in the domain of health, education and sanitation tend to be prioritized over MHM since they have higher public demand, therefore, there is less pressure on the government to introduce reforms in this regard. In addition to that, certain policy actors were also highlighted that could influence the policy process as being directly or indirectly involved with menstrual hygiene management (MHM) in Pakistan including academics, charity organizations and NGOs, social enterprises (i.e. Her Ground), international organizations such as UNICEF, Integrated Regional Support Program (IRSP) and Real Medicine Foundation (RMF) Pakistan, private sector firms such as Procter and Gamble (P&G) and government authorities such as education and health ministries or officials. Besides this, the study proposed significant policy alternatives for reforming the menstrual hygiene conditions for school going girls in Pakistan which included incorporating education on menstrual health, proper sanitation, and disposal facilities at school, supporting social enterprises, improving access to sanitary products and collaboration with charity and nonprofit organizations. Since criteria-based assessment exposed certain trade-offs between different alternatives, therefore, the decision was made considering what society would value more and what would be administratively feasible for the government to do. Similarly, for any policy plan to work, it was found substantial that the stigma and shame surrounding this topic must be removed. Therefore, introducing this topic as a part of the curriculum for girls was found to be the most viable solution. Moreover, given that the cost of this policy option would be relatively low, it would be easier to gain political support for the approval of such programs. However, it was found that if nothing would be done by the government, social services in this area would continue to be provided by NGOs, international humanitarian organizations and a few organizations in the private sector as part of their CSR programs. Moreover, there would be a chance that with the growth of start-ups all over the world tackling this problem in different innovative ways, similar ventures like Her Ground might also gain popularity in Pakistan.

Implications

The study suggests that an integrated approach must be adopted where the initial step of the action plan could include information on menstrual hygiene in the curriculum for all girls’ schools. However, in co-education schools, this information can be provided to girls separately, including knowledge on the science behind the menstrual cycle, parts of the reproductive system involved, how to hygienically manage periods in terms of products that should be used as well as how frequently these should be cleaned/replaced, changes to diet needed to maintain health in this period and enforcing that this is a natural biological process that must not hinder their daily activities. Moreover, a pamphlet containing the relevant information can be provided to all students and their mothers can also be welcomed to attend these sessions. Similarly, in order to assess the effectiveness of this initiative, surveys can be taken from the same students a year later asking questions regarding knowledge of menstrual hygiene as well as assessing any change in their hygiene practices in terms of product usage. In addition to that, legislation regarding menstrual facilities in school toilets needs to be enforced, allocating a portion for this in the budget of every school. These toilets should be strictly inaccessible for males and equipped with adequate disposal facilities. Assessment criteria for this policy action can be the number of female students per toilet stall, the number of disposal units available and whether these toilets are gender segregated or not. However, the next phase of the program could involve making cheap sanitary products available through setting up as well as supporting social enterprises that produce these products locally. Furthermore, the government can improve girl’s access to these low-cost sanitary products either through direct provision in schools at subsidized rates or with the help of lady health workers. This action plan can be monitored by assessing if usage of these products brings any change in the academic performance, absenteeism, and dropout rates of female students. Moreover, NGOs should be brought on board to improve the delivery of all these policy solutions since they can help in conducting information sessions as well as in setting up social enterprises and improving the supply chain of these products.