Comprehensive Sexuality Education | Menstrual Health and Hygiene

  • 52% of female population, 26% of total population is of reproductive age , whereas talking about menstruation is considered a subject of shame and taboo.
  • 5-15% of women of reproductive age globally, have abnormal menstrual cycle globally.
  • 3 out of 10 girls are unaware of menstrual hygiene
  • 90% of girls miss 1-5 days of school on average every month due to their period.
  • 23% girls aged 11-18 drop out due to lack of sanitary supplies, fear of staining,

Menstruation, a natural process in women’s life needs special care from physical and psychological point of view. Negligence in menstrual hygiene can result in biological disorders for example different sorts of infections but unfortunately awareness concerning this area of life is not highlighted due to socio-cultural trends of our society. In present age menstrual hygiene needs more attention because of rapidly increasing active participation of females in different walks of life.
One of the main reasons behind the issue is that menstruation is considered in many societies including Pakistan a hidden and secret issue. It is not openly discussed between mother and daughter. In many cultures menstruation is being perceived as unclean and embarrassing and also believed that it must remain hidden in communication.
There is lack of adequate knowledge and proper facilities for menstrual waste management. Girls belonging to low income class and less educated families, don’t know how to dispose off  sanitary material properly especially in time of immediate need. The focus on menstrual hygiene management is an essential part of promoting hygiene and sanitation amongst adolescent girls and women who constitute approximately 45 per cent of the total female population.

Menstrual hygiene promotion will be an indirect support to gender equality, national development, high literacy rate and SDGs accomplishment.
Menstrual Health and Hygiene Management is critical to be taught to achieve the Sustainable Developmental Goals 3, 4 , 5 , 6 , 8 and 12 to ensure healthy lives, inclusive quality education, gender quality, sustained availability of sanitation, economic growth and sustained consumption and production respectively.

In Pakistan the social perception of topics like menstruation and menarche are forbidden to be discussed. The stigma is largely based on societal thinking that speaking of menstruation is somehow a sin and unethical. Before conducting our project we knew that we will have to tackle some hurdles. Adding to the hurdles is the problem that when girls share what they were taught in seminar to their mothers and females of their friends and family, it is not looked upon as a positive change. It is often mistaken as an endeavor to spoil the minds of young girls. This is because the mothers and elder women of girls attending these seminars are mostly illiterate and uneducated. They consider that topics like sexual health shouldn’t be taught in schools. They may even come to the authorities of respective institutes and complain that our girls are being exploited.

“Menstrual Health and Hygiene” project was conducted in high schools of 3 citites of Pakistan.

Girls of age 14-16 were given information on proper management of menstruation, various disorder, health and dietary reccomendations related to menstruation. They were guided on simple ways to ease the pain so they can actively participate in daily life activities. The topics of dangers of unsanitary habits and complete hygiene guideline were covered during the sessions. They were taught how to precisely measure the expected date of your next period to prevent accidents and emergencies.

Before starting the seminar we explicitly told the girls that we aren’t advising them that they need to speak of menstruation in front of every other person as something glorifying. Its just a normal physiological process. We explained the girls when they should seek help and speak up about their problems experienced during menstruation. We are here to guide them on how they themselves must care about their hygiene during menstruation. Our focus was on empowerment of these young girls rather than dependency on others. We wanted the girls to be more aware, so they know when to consult a doctor or a professional. We told them to share the hygiene manual and the valuable information we have taught them during the seminar to the females of their families. After a few weeks, I revisited the school and asked the authorities of any complains were received from parents and luckily there were none. We were successful in disseminating knowledge on menstrual health and hygiene in a positive manner.

We first did pre evaluation by asking the girls some basic questions related to hygienic measures taken during menstruation, and management of menstrual blood flow. The questions we asked weren’t scientific, rather quite mundane that gave us the information about their approach towards dealing with menstrual flow.The response wasn’t encouraging because there is so much taboo around this topic. The girls were hesitant to talk and discuss this openly.

So before beginning with formal presentation and training we first went around the topic at their level that how it’s necessary to bring this thing out in the open if we want to end issues related to menstrual health.
To encourage active involvement of participants of the seminar we conducted an activity called”  Let’s Break the Myths” in which we asked teenage girls to tell about they myths about menstruation the believed to be true. The activity was a learning tool as well as an ice breaker. We started by telling a few myths we had heard about menstruation from our mothers. We talked to the girls at the level of language they best understood and interacted in. After this, the girls felt comfortable and started to discuss openly the myths they had heard. We discussed each one of them individually to prove them wrong as per no scientific evidence.

We gave the girls 2 skills during our seminar:

1-They were taught how to precisely measure the expected date of your next period to prevent accidents and emergencies.

2-Demonstration of the proper way to discard the menstrual absorbents and pads.

At the end of the session the girls were distributed a “hygiene kit”.
The kit had mestrual flow absorbents, sanitary soaps and a hygiene manual.
The manual had complete healthcare and sanitary guideline required to maintain cleanliness and prevent infections during menstruation.

We went back to those schools after 2 months to evaluate the impact of our project. Quesstionnaires were filled out byt the girls which indicated that more than 87% of the audience benefited from the knowledge provided.

65% girls correctly knew they had to consult a doctor in case on painful menstruation, missed period for 3 months, excessive bleeding.

70% knew that food in vit. C and iron should be preffered over junk food during menstruation.

87% learnt that best way to deal with painful menstruation was brisk walk rather than laying in bed or avoiding food

74% said that they consider menstruation as positive and as a sign of good reproductive health

92 % said that the session greatly increased their knowledge on menstrual health and hygiene.Several misconceptions and taboos surrounding the topic were cleared. The girls who attended the seminar were advised to spread the useful knowledge to their female friends and relatives so the impact of our project would be increased.

The project also included a a promotional video to spread the awareness to medical students about the importance of discussing menstrual health and hygiene through Ifmsa – Pakistan pages. Medical Students from different colleges participated in the video and expressed their views on why talking about mentruation is critical for female health.
Link to video :

The project will be continued over the course of next 2 years covering schools of entire Pakistan, and by repeated follow ups to re inforce the knowledge on menstrual health.

Activity Coordinators :
Ayesha Siddiqua
Haniya Waseem
Tabeer Warraich .

Report by :
Ayesha Siddiqua


Lisa Schulte, Program Coordinator on Comprehensive Sexuality Education

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