Dealing with Taboo Socio-cultural and Health Perspectives on Menstruation
As girls progress towards puberty, they experience physical, psychological and hormonal changes in the body. One of the physical changes is menarche. Menarche is the beginning of menstruation. Menstruation is the monthly discharge of blood throughout active reproductive life of females due to shedding of the uterine lining (Critchley as cited by Ali & Rizvi, 2010). But in majority cultures around the world, it is considered as a taboo instead of being considered as part of the normal physiological process.
It is evident from daily life examples that it is easier for a girl to buy a paracetamol packet from medical store than to buy a packet of sanitary napkins. If she buys sanitary napkins, firstly she suffers judgmental attitude by salesman and secondly, packet is wrapped in newspapers or brown bags which reveal social unacceptability associated with it. Unfortunately, in Pakistani culture, there exist diversified myths regarding menstruation.
The common myths about menstruation in Pakistan are: women are not allowed to take bath, to touch sour foods, to cook and to enter the kitchen (IRSP, 2013). The rationale for choosing this topic is that these myths have made a normal physiological process as shocking (44%), frightening (30%) and distressing (18%) for most of the females according to study conducted in Karachi (Ali, Azam, Waheed& Memon,2006). Therefore, it is necessary to identify causes of the menstruation taboo and its impact on women health in order to promote better women health and women empowerment.
Menstruation is a stigma in our society; it could be related with Goffman’s stigma theory. Goffman identified three conditions leading to stigmatization. The menstruation stigma fits well on all three conditions. Firstly, stigma could be due to source of disgust or hatred in body.
Many cultures consider menstruating blood as impure. However, people show more hatred towards menstrual blood as compared to breast milk or semen (Bramwell as Cited by Robledo & Chrisler, 2013). Secondly, stigma could arise due to mark on an individual’s character. These myths have portrayed menstruation as a stain on women’s character.
Therefore, during menstruation days women are hyper vigilant for menstrual blood leakage to avoid this stigma. Lastly, tribal characteristics could also lead to stigmatization. This includes sex, religion and ethnicity. As only females undergo menstruation, therefore they are more likely to be stigmatized (Robledo &Chrisler, 2013).
One of the major causes of menstruation taboo is that most religions have portrayed menstruating women as impure for religious activities. In Islam, menstruating women are not allowed to offer prayers, touch the holy Quran, visit shrines or fast during Ramadan. As highlighted in Quran:
And they will ask thee about women’s monthly courses. Say: it is a vulnerable condition. Keep, therefore, aloof from women during their monthly courses and do not draw near to them until they are cleansed; and when they are cleansed, go unto them as god has bidden you to do. (2:222 as cited by Joseph & Nagmabadi, 2006, p.27)
As stated above, menstruation is considered as “adha” (meaning vulnerable state in Arabic language); it isn’t something to be feared but during this state a woman’s personal space should be especially respected. However, multiple incorrect translations of the word “adha” as a contamination, disease or harm have created negative impressions in minds of people regarding menstruation (Joseph & Nagmabadi, 2006).
Another cause is less awareness about this natural process among general population. A study conducted among female adolescents in Karachi illustrated that around 50% of respondents lacked knowledge regarding source of menstrual blood (Ali & Rizvi, 2010). However, this could be attributed to communication gap between mothers and daughters, lack of combined education sessions for both sexes regarding physical pubertal changes. In patriarchal societies like Pakistan, women have always kept their menstruation undisclosed with fear of being stigmatized. This further resulted into scarce awareness, misconceptions regarding menstrual blood leading to oppression of women.
Furthermore, media has also played its role in augmenting misconceptions regarding menstruation. In television advertisements regarding efficiency of sanitary pads, they always symbolize menstrual blood with blue liquid instead of red one. In addition, for the marketing purpose of their product, they depict menstruating women suffering with pain, discomfort and low self-esteem. However, after using designed product, menstruating women experience better physical and psychological health.
These advertisements also illustrate menstruating women as socially less active, suffering restricted movement and professionally distressed. Thus, this magnification of issues faced by women during menstruation further strengthens the stigma in our society (Yagnik, 2012).
Menstruation has a great impact on a woman’s life. However, negative perception of this positive impact has led to many consequences. Many girls are pulled out of primary school by their parents with a perception of her readiness for marriage. As a result, this misconception leads to early marriages and illiteracy in our society.
In addition, myths related to hygiene practice such as not taking bath, unhygienic practices i.e. reusing soiled cloth and lack of access to clean water and toilets can impact health. A study conducted in India indicated positive correlation between unhygienic practices during menstruation and reproductive tract infections (Anand, Singh &Unisa, 2015).
In conclusion, we can implement the following strategies:
Firstly, at an individual level, teaching sessions could be carried out for girls on self-hygiene during menstruation, proper hygienic methods of usage and disposal of sanitary napkins. These sessions could be carried out in schools and community health centers. Secondly, nurses can teach mothers effective communication skills to discuss pubertal changes with their daughters. This again can be carried out at community health centers as well as individually from door to door. At community level, nurses can carry out counselling sessions for girls to make them feel that it is proud to be a girl.
Furthermore, in a patriarchal society, males should also be included in group teachings held on pubertal changes in both sexes. Also, community should be encouraged to allocate a portion of their monthly maintenance capital on construction of female friendly toilets. At the national level, we can look forward for integration of menstrual hygiene as a part of primary class curriculum. By practicing these strategies from simple to complex level, nurses would be able to minimize violation of human rights, promote better women’s health and facilitate fulfilment of millennium development goals.
About the Author: Mashal Shoukat is currently a fourth year nursing student at AKUSONAM, Pakistan. She can [email protected]
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