Opinion: Inclusive Menstrual Health Education In India!

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Lack of education about menstruation is one of the drawbacks to achieving adequate menstrual hygiene worldwide. Schools offer an important chance to transform menstrual hygiene programs that will benefit young girls in the future.

According to the research, India is home to about 113 million young girls and around 54% of these girls are unaware of menstruation before they have their first period. Around 77% of people aren’t aware that the uterus is the source of the bleeding and only 45% consider that menstruation is normal and a vast majority of people observe religious, socio-cultural and food taboos during their menstruation. In total 70% of mothers consider menstruation to be polluting and dirty and around 63 million girls live in homes which lack bathroom facilities.

Research from 2011 also suggested that in the country 88% of women and girls were using unhygienic, unsafe menstrual absorbents. Later, some progress was seen.

In 2015-16, the latest National Family Health Survey 4, India’s DHS reported that about 42.4% of young women, aged between 15 and 24 are still using unhygienic protection methods during their period.

Lack of education leads to stigma

We can see a bright future for menstrual health education for all genders, but in the previous years when it wasn’t a priority, the adults needed to know about menstrual health later in their life.

Monica Karpinski, founder and editor of The Femedic stated “I know from my world and my research that there is a huge education gap around menstruation. Menstruation is the second most popular category on our site behind sexual health. You can see a real appetite for information which communicates that education is not there to fill that gap.”

This education gap can have contagion effects. Lack of education on menstruation health and hygiene is an important foundation that will maintain the stigma around periods and it will affect a certain group of population. Premenstrual stress is also a domain around periods in which women faced stigma. The health and education of young people who menstruate can also get impacted by facing shame-inducing stigma. Period poverty can also add difficulties and hamper the lives and education of people menstruating.

Mae Matauka, a founder of the Mino Period and a trustee of The Vagina Museum stated, “It is important to remember that period poverty is not confined to just access to menstrual products. It also includes having poor knowledge of menstruation. This goes to have a more open and frank conversation about menstruation and more information and resources that will help tackle the taboo, stigma and shame.”

If lack of education feeds stigma, you need to increase education around menstrual health and hygiene. Along with girls, including boys in these topics from a young age is great for creating a society free from period stigma and this will also improve scientific knowledge of how the body works.

Kapinski agreed that teaching about menstrual health among all genders is important. She said, “Ideally, if this was being taught in school, you’d teach it in an inclusive way, so it wouldn’t be about genders, it would be about ‘this is what happens in this body part.”

Making clear, accessible menstrual health education is an important key to tackling period stigma, which is an obstacle to gender equality, improving lives and building knowledge.

A vital chance to improve Menstrual Hygiene Management (MHM)

Schools play a crucial role to address MHM comprehensively. So what about young girls and MHM in Indian schools?

A systematic review on MHM in India stated that an estimated 60% of young girls are enrolled in about 1.4 million schools. Around 24% of school girls didn’t attend their school during periods and only 37% of girls changed their absorbents in school.

Schools can be vehicles for the girl to change but they also serve to continue discrimination and stigma regarding menstruation.

Modules for teachers and peer educators must be developed in school that will provide comprehensive information and essentials on menstruation and MHM.

Safe, hygienic and functional toilets and separate toilets for girls
Water in toilet units for girls to wash their parts and menstrual absorbents
Provisions in toilet unit to hang and store belongings such as shelves and hooks
Proper dustbin for safe disposal of menstrual waste
Private and safe changing room or space
Soaps or liquids to wash hands

Through special programs, we can address detrimental social norms, provide girls education on menstrual health and hygiene, and access to a vast range of safe and hygienic menstrual absorbents and options for treatment of menstrual waste and safe disposal. Reach out to girls who are enrolled but do not attend schools or discontinue their education due to lack of knowledge and transform the menstrual health and hygiene landscape in India for a better tomorrow.

This #MenstrualHygieneDay, #Infano along with #TheLogicalIndian, is addressing nuanced conversations on period centering on the well being of the menstruators as they power through every day. Share your thoughts about inclusive menstrual health education in the comments because your views can trigger an important aspect that we all need to know and talk about! #IBleedMyWay #MHD2022

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For many pregnant women, their blood sugar levels elevate during pregnancy causing gestational diabetes. This is diagnosed through blood sugar testing and those with Gestational Diabetes (GD) are at higher risk of developing type 2 diabetes later in life. Managing this condition can be quiet challenging because they have to be mindful of what they consume to make sure that their blood sugar does not increase and this can be difficult at a time when the nutritional needs of mother and baby are paramount but you have to make certain choices given an added condition of GD.

So how can you deal with this apart from the nutritional and medical aspect?

“Just being pregnant seems to invite advice or comments from well-meaning relatives to random strangers”, says Robyn Compton, a gestational diabetes dietitian. “Add in a diagnosis of GD & suddenly there are all these “experts” telling you what you should or shouldn’t be eating”.

Robyn Compton is a dietitian who has a private practice in Melbourne, Australia. She specializes in assisting and supporting women with Gestational Diabetes. More recently she has also worked as a research dietitian with adults with type 1 diabetes.

Getting evidence-based information for women with gestational diabetes is her goal. Follow her on Instagram at Gestationaldiabetes_Dietitian

It is stressful enough to deal with a diagnosis of GD. It’s a big learning curve in terms of understanding the condition, management & eating plan. Then there’s your own worries & feelings about GD, your pregnancy & having to change your diet. The last thing you need is someone commenting on your food choices or giving unsolicited, insensitive & often incorrect dietary advice. Every case of gestational diabetes is different & what works for one woman may not work for another. That fact in itself is often the easiest comeback to any unhelpful advice.

How should a mom-to-be react when they receive a GD diagnosis?

“Being diagnosed with Gestational Diabetes (GD) can come as quite a shock. It can be very upsetting. Many emotions arise. Initially, it can feel quite overwhelming. Guilt & shame are very commonly experienced by women. Unfortunately, diabetes stigma exists due to ignorance about the condition & why it occurs. It is important to know that GD is NOT your fault. You didn’t cause this condition. It is not because you ate too many sweets. The reasons are multi-factorial but mostly a result of hormonal, genetic & cultural influences which are out of your control. It’s normal to feel angry. It’s not how you imagined your pregnancy journey. Understanding more about the condition & its management can clarify questions”.

“Talking about it can help to lift that burden. Distress and anxiety about the impact of GD on your baby, pregnancy & your own health are very understandable. Talking with your doctor & health professionals who specialize in diabetes can answer many questions & offer basic support, as well as talking with supportive family or friends”.

What kind of awareness and support should they look out for?

“You may feel overwhelmed with how you need to manage GD. Being armed with the right GD education, advice & support makes a huge difference. Seeing a diabetes educator and/ or midwife initially is recommended to understand how to monitor your blood glucose levels (BGLS) & learn more about GD management. Seeing a dietitian specializing in GD can help to answer all the practical questions about food, types, amounts, meal planning, pregnancy nutrition & provide ongoing support. Generally, with this assistance, women with GD will manage well but it’s very normal to have good & bad days. It’s ok to acknowledge if you are struggling. For further support speak with your Diabetes Team or health care provider”.

What about women who are asked to take insulin?

“Remember that despite attention to diet & exercise, some women may need to take insulin to assist with optimizing blood glucose levels (BGLs). Genetics & hormones contribute to insulin resistance. This is not your fault. Some women may just need bedtime insulin (long-acting) to control elevated fasting levels. Others may need mealtime insulin (short-acting) at 1, 2, or all 3 meals. Or any combination of the above, based on individual BGLs”.

What kind of postpartum care would you suggest for women with GD?

“If you have just had your baby following a pregnancy with Gestational Diabetes ( GD). Congratulations!! It was a big job managing your GD during pregnancy. Well done to have got through that challenging journey. Now you are at home with your little one, life continues to be busy but in different ways. You are juggling many new roles, with usually much less sleep. Your energy levels need to be supported with adequate nutrition, rest, sleep & self-care. If you are breastfeeding, the energy demands are further increased”.

“However, women who have had GD have usually been advised about their increased risk of Type 2 diabetes in the future. Some women feel the pressure to lose any extra pregnancy weight quickly or feel that they need to follow a restrictive postpartum diet plan. This is what I suggest:

It is not a race. It’s a steady journey back to look after your future health.
Your body has just grown a baby and is nurturing a newborn. It is pretty amazing and should be celebrated & appreciated.
Don’t compare yourself with others. Women’s bodies recover at different rates in their own time. And women have very different experiences with how their baby’s feed and sleep too.
Just focus on you and your baby. Nurture your physical & emotional health with healthy sustainable lifestyle changes.
Hold onto any healthy eating habits which are in your control & you enjoy. Be active when your body is ready & you feel up to it. Take it day by day as you find your new path.
As time progresses, routines generally get more established for your baby, family & you. However, your energy levels still need to be respected.
Reach out for support whether it’s with feeding or sleeping issues for the baby or your own physical & mental health needs.
A healthy lifestyle continues to be important for future health of course but in your individualized realistic framework.
Seeking advice from your dietitian down the track can provide extra support if needed. Postnatal online lifestyle programs are another option some women find helpful when they are ready.

“BOTTOMLINE: Take the pressure off yourself to do everything at once. Enjoy your little one. Remember your self-care needs too”, adds Robyn.

Robyn Compton can be contacted at r ob.compton@bigpond.com

Also Read Why Do We Crave Some Foods During Pregnancy?