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Menstruation related myths in India: Strategies for combating it

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Abstract

Menstruation is a phenomenon unique to girls. However, it has always been surrounded by taboos and myths that exclude women from many aspects of socio-cultural life. In India, the topic has been a taboo until date. Such taboos about menstruation present in many societies impact on girls' and women's emotional state, mentality and lifestyle and most importantly, health. The challenge, of addressing the socio-cultural taboos and beliefs in menstruation, is further compounded by the low girls' knowledge levels and understandings of puberty, menstruation, and reproductive health. Thus, there is the need to follow a strategic approach in combating these issues. The current paper aims to discuss menstruation related myths prevalent in India, their impact on women's life, relevance of addressing these issues in primary care and a brief description about various strategies to combat them.
Journal of Family Medicine and Primary Care 184 ApriI 2015 : Volume 4 : Issue 2
Introduction
Menstruation is the natural part of the reproductive cycle in
which blood from the uterus exits through the vagina.[1] It is a
naturalprocessthatrstoccursingirlsusuallybetweentheage
of 11 and 14 years and is one of the indicators of the onset
of puberty among them. Despite being a phenomenon unique
to girls, this has always been surrounded by secrecy and myths
in many societies. Taboos surrounding menstruation exclude
women and girls from many aspects of social and cultural life.
Some of these are helpful, but others have potentially harmful
implications.[2]
Myths Related to Menstruation in India
In India even mere mention of the topic has been a taboo in
thepastandeventothisdatetheculturalandsocialinuences
appear to be a hurdle for advancement of knowledge on the
subject.[3] Culturally in many parts of India, menstruation is
still considered to be dirty and impure. The origin of this myth
dates back to the Vedic times and is often been linked to Indra’s
slaying of Vritras. For, it has been declared in the Veda that
guilt, of killing a brahmana‑murder, appears every month as
menstrualowaswomenhadtakenuponthemselvesapartof 
Indra’s guilt.[4] Further, in the Hindu faith, women are prohibited
from participating in normal life while menstruating. She must
be“puried”beforesheisallowedtoreturntoherfamilyand
daytodaychoresof herlife.However,scienticallyitisknown
that the actual cause of menstruation is ovulation followed by
missed chance of pregnancy that results in bleeding from the
endometrial vessels and is followed by preparation of the next
cycle. Therefore, there seems no reason for this notion to persist
that menstruating women are “impure.”
Many girls and women are subject to restrictions in their daily
lives simply because they are menstruating. Not entering the
“puja” room is the major restriction among urban girls whereas,
not entering the kitchen is the main restriction among the rural
girls during menstruation.[5] Menstruating girls and women are
also restricted from offering prayers and touching holy books.[6]
The underlying basis for this myth is also the cultural beliefs of
impurity associated with menstruation. It is further believed that
menstruating women are unhygienic and unclean and hence the
food they prepare or handle can get contaminated. According to
study by Kumar and Srivastava[7] in 2011, participating women
also reported that during menstruation the body emits some
specic smell or ray, which turns preser ved food bad. And,
therefore, they are not allowed to touch sour foods like pickles.
Menstruation related myths in India: strategies for
combating it
Suneela Garg1, Tanu Anand1
1Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
Abs t r Ac t
Menstruation is a phenomenon unique to girls. However, it has always been surrounded by taboos and myths that exclude women
from many aspects of socio‑cultural life. In India, the topic has been a taboo until date. Such taboos about menstruation present in
many societies impact on girls’ and women’s emotional state, mentality and lifestyle and most importantly, health. The challenge,
of addressing the socio‑cultural taboos and beliefs in menstruation, is further compounded by the low girls’ knowledge levels
and understandings of puberty, menstruation, and reproductive health. Thus, there is the need to follow a strategic approach in
combating these issues. The current paper aims to discuss menstruation related myths prevalent in India, their impact on women’s
life, relevance of addressing these issues in primary care and a brief description about various strategies to combat them.
Keywords: Adolescent, attitudes, culture, female, genital diseases, health knowledge, health surveys humans, India,
menstruation, practice, puberty, reproductive health
Family Practice
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DOI:
10.4103/2249-4863.154627
Address for correspondence: Dr. Tanu Anand,
Department of Community Medicine, H‑1/7 Malviya Nagar,
New Delhi ‑ 110 002, India.
E‑mail: drtanu.anand@gmail.com
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Journal of Family Medicine and Primary Care 185 April 2015 : Volume 4 : Issue 2
Garg and Anand: Menstruation related myths
However, as long as general hygiene measures are taken into
account,noscientictesthasshownmenstruationasthereason
for spoilage of any food in making.
Cultural norms and religious taboos on menstruation are often
compounded by traditional associations with evil spirits, shame
and embarrassment surrounding sexual reproduction.[2] In some
cultures, women bury their cloths used during menstruation to
prevent them being used by evil spirits.[8] In Surinam, menstrual
blood is believed to be dangerous, and a malevolent person
can do harm to a menstruating woman or girl by using black
magic (“wisi”). It is also believed that a woman can use her
menstrual blood to impose her will on a man.[1,6] Interestingly, in
Asia including India, such beliefs are still practiced.[4] However,
thereseemstobenologicalorscienticexplanationforthis.
In some parts of India, some strict dietary restrictions are also
followed during menstruation such as sour food like curd,
tamarind, and pickles are usually avoided by menstruating girls.[5,7]
It is believed that such foods will disturb or stop the menstrual
o w. [9] As far as the exercise is concerned, many studies in India
and elsewhere have revealed that many adolescent girls believe
that doing exercise/physical activity during menses aggravate
the dysmenorrhea while in real exercise can help relieve the
menstruating women with symptoms of premenstrual syndrome
and dysmenorrhea and relieve bloating. Exercise also causes a
release of serotonin, making one feel much happier.[9‑11]
In some parts of India, perceptions of Hinduism center on
notions of purity and pollution. Bodily excretions are believed
to be polluting, as are the bodies when producing them. All
women, regardless of their social caste, incur pollution through
the bodily processes of menstruation and childbirth. Water is
considered to be themost common medium of  purication.
The protection of water sources from such pollution, which is
the physical manifestation of Hindu deities, is, therefore, a key
concern.[1,12] This highlights the possible reason why menstruating
womenare notallowedtotakeabath especially forrst few
days of their menstrual period. It is believed that if a girl or
women touches a cow while she is on her period, that the cow
will become infertile – leading girls to associate their own bodies
with curse and impurity.
Impact of Myths Related to Menstruation on
Women’s Life
Such taboos about menstruation present in many societies impact
on girls’ and women’s emotional state, mentality and lifestyle and
most importantly, health. Large numbers of girls in many less
economically developed countries drop out of school when they
begin menstruating. This includes over 23% of girls in India.[12]
In addition to this, the monthly menstruation period also creates
obstacles for female teachers.[2] Thus, the gender – unfriendly
school culture and infrastructure and the lack of adequate
menstrual protection alternatives and/or clean, safe and private
sanitation facilities for female teachers and girls undermine the
right of privacy.[2,6] There are health and hygiene issues also
to consider relating to girls and menstruation. Over 77% of 
menstruating girls and women in India use an old cloth, which
is often reused. Further, 88% of women in India sometimes
resort to using ashes, newspapers, dried leaves and husk sand
to aid absorption.[12] Poor protection and inadequate washing
facilities may increases susceptibility to infection, with the odor
of menstrual blood putting girls at risk of being stigmatized. The
lattermayhavesignicantimplicationsfortheirmentalhealth.[13]
The challenge, of addressing the socio‑cultural taboos and beliefs
in menstruation, is further compounded by the fact the girls’
knowledge levels and understandings of puberty, menstruation,
and reproductive health are very low.[3,9,13,14]
Relevance of Addressing Menstruation
Related Myths by Primary Care Physicians
Primary care physicians are the first point of contact for
diagnosis of common menstrual problems and other associated
reproductive morbidities among the populations in their
community. Many of the practices during menstruation have
direct implications on reproductive health. For instance, not
bathing during menstruation can lead to compromise in hygiene
of the girl and thus lead to the reproductive tract infections.
A primary care physician, is thus, required to be acquainted
with common myths related to menstruation prevalent
in his/her community and treat the individual holistically by
addressing them also. Else, the problem may be treated for a
while but it would continue to recur with increasing severity.
Strategies to Combat Menstruation Related
Myths
Based on the available evidence, it is pertinent to follow a strategic
approach for combating the myths and social taboos associated
with menstruation in order to improve the reproductive health
of adolescentgirlsandwomen.Therstandforemoststrategy
in this regard is raising the awareness among the adolescent
girls related to menstrual health and hygiene. Young girls often
grow up with limited knowledge of menstruation because their
mothers and other women shy away from discussing the issues
with them. Adult women may themselves not be aware of the
biological facts or good hygienic practices, instead passing on
cultural taboos and restrictions to be observed.[1] Community
based health education campaigns could prove worthwhile in
achieving this task. There is also need to spread awareness among
the school teachers regarding menstruation.
Empowerment of women through education and increasing
their role in decision‑making can also aid in this regard. Women
and girls are often excluded from decision‑making due to their
lower literacy levels per se. Increasing the education status of
women plays an important role in improving the health status of
the community at large and overcoming the cultural taboos, in
particular. Provision of sanitary napkins and adequate facilities
for sanitation and washing should be made available with the
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Journal of Family Medicine and Primary Care 186 April 2015 : Volume 4 : Issue 2
Garg and Anand: Menstruation related myths
gender perspective. In Delhi, there are an estimated 132 public
toilets for women, only 8% the number of the 1534 for men.[12]
Low cost sanitary napkins can be locally made and distributed
particularly in rural and slum areas as these are the areas where
accessto the productisdifcult.[7] Government of India has
approved a scheme to improve menstrual hygiene for 1.5 Crore
adolescent girls by distributing low cost sanitary napkins in
rural areas under the National Rural Health Mission since
2010.[15] However, the scheme is in the pilot phase, and a lot
more needs to achieve in this regard. Increasing the role of the
male partner and clearing the beliefs system of the male partner
is also pertinent in combating deep rooted social beliefs and
cultural taboos. Men and boys typically know even less, but it
is important for them to understand menstruation so they can
support their wives, daughters, mothers, students, employees,
and peers.[13] Sensitization of health workers, Accredited Social
Health Activists and Anganwadi workers regarding menstruation
biology must also be done so that they can further disseminate
this knowledge in the community and mobilize social support
against busting menstruation related myths. Adolescent Friendly
Health Services Clinics must also have trained manpower to
address these issues.
Thus, it is becoming clear that multi‑sectoral approaches are
needed. We need to link physical infrastructure and water
and sanitation projects to health education and reproductive
health programs and address the issue in more holistic
ways.[14] Menstruation is nothing but a very normal biological
phenomenon, and adolescent girls and women should understand
that they have the power of procreation only because of this
virtue.[9]
References
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15. Press Information Bureau, GoI. Government Approves
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How to cite this article: Garg S, Anand T. Menstruation related
myths in India: Strategies for combating it. J Fam Med Primary Care
2015;4:184-6.
Source of Support: Nil. Conict of Interest: None declared.
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(a). Situation faced: In India, there is a severe lack of access to menstrual education and health issues. Awareness of menstruation hygiene in rural or urban areas are just inadequate. Females especially in low-income areas face hygiene issues during menstruation, particularly in the beginning years of menstruation among young girls. Girls in rural and semi-urban settings suffer insufficient puberty education and unavailability of hygienic aids (absorbents), which leads to menstruation as an uncomfortable and shameful experience for them. Reports suggest that there is absenteeism of girls from schools due to fear of humiliation and body odor. Cultural taboos complement their snags and prevent them from seeking help, and it restricts their activities during this period. (b). Action taken: Lots of initiatives are taken by the government and social bodies to increase awareness and reduce taboos through various programs, focusing on ensuring dignity, privacy, and breaking the stigma. Efforts are being made to ensure absorbents accessible and affordable. (c). Lessons learned: We face extreme gender-related disparity for health awareness, availability of separate washrooms, cleaning materials, and safe disposal of solid waste. Disposal of these used items is also an area of concern. The efforts taken by a young entrepreneur in dealing with causes related to menstrual hygiene, illiteracy about the whole concept of menstruation, its myths, and taboos faced by young girls and women, use of sanitary pads, and their self-esteem. More social entrepreneur are welcomed to tackle this stigma.
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The study attempts to find out the existing social and cultural practices regarding menstruation, awareness levels, and the behavioral changes that come about in adolescent girls during menstruation, their perception about menarche, how do they treat it, and the various taboos, norms, and cultural practices associated with menarche. The study was conducted on 117 adolescent girls (age 11-20 years) and 41 mothers from various communities and classes in Ranchi comprising residential colonies and urban slums. The findings unfolds many practices: cultural and social restrictions associated with menstruation, myth, and misconception; the adaptability of the adolescent girls toward it; their reaction, reaction of the family; realization of the importance of menstruation; and the changes that have come in their life after menarche and their resistance to such changes. The article also suggests the strategies to improve menstrual health and hygiene among adolescent girls. The study concludes that cultural and social practices regarding menstruation depend on girls' education, attitude, family environment, culture, and belief.
Article
Menstrual practices are still shrouded by taboos and socio-cultural restrictions. Thus adolescent girls remain ignorant of the scientific facts and hygiene practices which sometimes result into adverse health consequences. This study was undertaken with the objective of eliciting the beliefs, perception and source of information regarding menstruation among the adolescent girl students and to find out the status of menstrual hygiene among adolescent girls. An exploratory and descriptive study has been conducted among 10th clas adolescent girl students of senior secondary schools in Amritsar City, Punjab. A pre-designed and pretested interview schedule has been during the interview. Data has been analyzed statistically by chi square test. Out of 300 respondents 184(61.3percent) adolescent girls are having awareness about menstruation prior to initiation of menarche. Mother was the first informant regarding menstruation in case of 160 (53.3 per cent) girls. 221 (73.7 per cent) girls believed it a normal physiological process. 207 (69.0 per cent) girls knew regarding use of sanitary ad during the menstruation. Regarding menstrual hygiene practices, 68.7 per cent girls used sanitary pads and 30 (10.0 per cent) respondents practicing any cloth or rag/ cotton during menstruation. For the purpose of cleaning external practiced by the family, 294 (98.0 per cent) girls practiced different types of family restrictions during menstruation.
Article
The aim of this study was to assess the level of knowledge, attitudes and health-taking behavior of female students ages 15-18 years old in regard to dysmenorrhea and menstrual hygiene in suburban districts of Tehran, the capital of Iran. The study applied a descriptive, cross-sectional method, in which 250 students were selected at random, using a cluster random sampling method. The data was collected by applying a 44-item questionnaire. The reliability of the questionnaire was checked by the Chronbach-Alpha method, showing a correlation of 90 percent. Seventy-seven percent of the subjects claimed that they had enough knowledge about dysmenorrhea, from which only 32% practiced the personal health taking behavior, such as taking a bath and using hygienic materials. About 33% of the students avoided any physical activity or even mild exercise during menstrual period. Over 67% of the girls reported to take palliative medicine for their menstrual pain without prescription by a doctor. Fifteen percent of them stated that dysmenorrhea has interfered with their daily life activities and caused them to be absent from school between one to seven days, similar to other relevant studies. The prevalence of dysmenorrhea in this study was 71%. The main point achieved in this study was the necessity of educating female students about the menstrual period health-taking behaviors, including: appropriate nutrition, exercise and physical activity, personal hygiene, and appropriate use of medication based on physician's prescription.
Menstruation and body awareness: linking girls' health with girls' education
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Tackling menstrual hygiene taboos Sanitation and Hygiene Case Study No. 10 Available from: http://www.unicef.org/wash/files
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