In sixth grade, at the age of eleven, I received The Care and Keeping of You from my mom. Ever the shy bookworm, I furtively read this puberty guidebook with intrigue and awe. With colorful illustrations, it explained the bodily changes that were on the horizon for me: hair, breasts, pimples, periods, and more. I remember reading this book and feeling mystified at the concept of puberty, as if studying for a test I knew was coming at an unknown date in the future.
But when I got my period a year later, I was not surprised, scared, or embarrassed. I told my mom when it happened, and she simply made sure I was feeling okay, reminded me that women all over the world get periods, and gave me sanitary pads. Soon after, I put on my soccer uniform and headed off to a match with my team, resuming my normal twelve-year-old activities.
Unfortunately, this is not the case for many girls in developing countries. They start their periods uninformed, unprepared, scared, and ashamed, according to a new literature review, published in Reproductive Health. The study maps the gaps in knowledge and understanding of menstruation and menstrual hygiene experienced by adolescent girls in lower resource settings.
Researchers found that girls in developing countries enter puberty with little knowledge of menstruation, and misconceptions are common. Many girls fail to correctly identify the uterus as the source of menstrual blood. In Nepal, India, and Uganda menstruation is viewed by some as a curse, disease, or a representation of sin.
Mothers were found to be the main source of information and advice about menstruation for girls, followed by sisters and friends, and less frequently, teachers and healthcare professionals. Some girls get information from mass media and the internet. Across developing countries, the information girls receive about menstruation is insufficient, inaccurate, and not timely. Adults, including teachers, have their own misconceptions and feel uncomfortable discussing menstruation, sexuality, and reproduction. Often they frame their discussions negatively, reinforcing taboos that are rooted in gender discrimination.
Adolescent girls experience myriad negative physical and emotional health effects from menstruation. Their daily lives are disrupted when they are restricted from parts of the home, or have to skip school and social or religious activities because of pain, embarrassment, or lack of hygiene products and sanitation facilities. Menstruating girls in rural and poor urban communities are particularly impacted. Overall, few girls—sometimes fewer than 1 out of 5—will consult a health professional for menstrual problems. As a result, girls experience great anxiety and sadness as they try to navigate the shame associated with menstruation and the practical challenges that come with trying to manage it.
It’s clear that girls need more support in understanding and handling menstruation, and there are several exciting cross-sector initiatives that show promise. One of IWHC’s partners in Kenya, Kisumu Medical and Education Trust (KMET), learned that adolescent girls from poorer families in the western part of the country were missing school when they had their periods. They were embarrassed and unable to afford sanitary napkins. In addition to teaching girls about their bodies, KMET started to manufacture reusable and affordable sanitary pads, enabling girls to better manage their menstruation and to stay in school with dignity and confidence. Such interventions have shown positive results in the short-term, including improving knowledge of menstruation and hygiene practices. But, more evaluation is needed to assess the long-term impacts.
Enhancing access to high-quality comprehensive sexuality education could go a long way in expanding girls’ knowledge of menstruation and their capacity to deal with it. Sexuality education that includes discussions of puberty and menstruation and that tackles gender issues would help bring about what adolescent girls need: to grow up in an environment where menstruation is seen as healthy and normal.
Thanks to Sheila Patel and Iliana Lang for their contributions to this piece.