Menstrual hygiene in hill tracts

This is an op-ed authored by Joyee Chakma, Arusa I Rahim and Adnan Qader working at WaterAid.

Can you imagine using a dirty rag instead of a sanitary napkin or being isolated from your friends and families when you are having your period? Although this is hard to believe, there are still women in Bangladesh who often go through this audacity in our time.

Initiating a discussion regarding period in Bangladesh is still considered a taboo; some may go as far as to mark it as a stigma. Still a patriarchal society, communities are not comfortable to discuss the topic of menstrual health and hygiene, and this subject is often addressed as a secret of a woman’s life.

From metropolis to the remotest part of Bangladesh, like the households in the Chattogram Hill Tracts there is no difference regarding the issue surrounding periods. Girls and women feel shy to share their menstrual health status due to the decade old cultural constructs. Local women living in the CHT areas hold stronger practices of not disclosing or discussing periods publicly because of both religious and cultural norms. Over the years, from one generation to the next, women in the hills have passed on the struggle in silence about their period battles.

In Bangladesh, according to the International Work Group for Indigenous Affairs, there are about 54 different indigenous communities spreading across the country. Among them 11 indigenous communities live in the CHT and they are Chakma, Marma, Tripura, Tanchangya, Chak, Pangkhua, Mro, Bawm, Lushai, Khyang and Khumi. The people of these communities are often referred to as the ‘hill people’ or ‘jumma’ and are known to have their own unique languages, social structures, cultures, beliefs, and even economic activities which differs entirely from the rest of the country of Bangladesh. However, the culture of silence over menstruation is shared by all ethnic communities in Bangladesh.

It cannot be denied that women in these regions relentlessly contribute to building their families and communities. They equally donate their time to the community with productive work along with performing household and community roles. Nevertheless, being part of the patriarchal society, these women are often suppressing the need to highlight life threatening issues such as menstrual health. As per Menstrual Health Management platform, issues such as inadequate economic opportunities or having to live in extremely remote areas lead to scarcer access to sanitary protection products and it is a common problem related to menstrual health and management. Furthermore, living in remote and hilly areas these communities face difficulties accessing clean water, decent toilets, and opportunities to manage periods with dignity and safety. Some hill communities are often seen washing their disposable pads before the disposal and women and girls of the hill areas have stricter restrictions including social isolation during menstruation. There are also taboos in some communities of not touching women’s cloths and not allowing them to prepare food during their cycle. Some women are seen to wear double skits (often referred to as petticoat) and others go as far as using mud — carefully drying it and covering it with cloth to develop homemade pads. These methods are not hygienic or safe for the health of these women. Restrictions further include access to sanitary protection products and in hilly area there is always a possibility of water, sanitation, and hygiene resources scarcity in their homes, schools, and workplaces. Access to affordable sanitary products and functioning bathrooms are also limited in the area. Generations of girls and women have internalised taboos, secrecy, and shame about the natural processes of their bodies. In this context, information about menstruation either come too late (after menarche, a female’s first period), incompletely, inaccurately, or not at all.

Another common trend among them is that both men and women of the area view the monthly period cycle as an illness, and label menstruating women to be dirty and impure. In what follows, they do not reach out for information or medical advice while going through unpleasant or even painful menstrual experiences. This issue is accelerated further due to a lack of support available in this region.

For not having the adequate access to sanitary products the indigenous women often rely on regular clothes over and over again — a practice which is extremely unhygienic. Due to a lack of access to water in the CHT, the menstrual health management practice of washing, drying and disposal does not or cannot happen in a safe and convenient manner. During the menstrual cycle, women need water not only for external use, but also to stay hydrated. Without ample water intake, women could experience augmenting menstrual cramps and discomfort. This malpractice leads them to reproductive health issues as menstrual hygiene is often the cause of urinal and vaginal infections, urogenital diseases — a common issue among the women in the CHT.

There are not enough and specific interventions to educate indigenous women and promote a healthy menstrual cycle in the region. Due to inadequate access (such as lack of transportation, lack of roads) into these regions, NGO interventions in these communities are also low and not sustainable in the long run. With such lack of awareness and information around menstrual hygiene live indigenous women of all ages especially youth and adolescent girls, always in live-in risk and vulnerable. However, this needs to change.

There are some key areas of interventions that can be achieved through both public and private measures. The availability of clean water, decent toilets and good hygiene facilities and ensuring that these facilities are menstrual health management friendly in Chattogram Hill Tracts is a necessity. Both public and private organisations should consider developing key messages and relevant behavioural change strategies should be taken to address negative stigma around menstrual health management. Developing the willingness to support menstrual health management needs of indigenous women and girls including opinions from a religious perspective can build awareness that menstruation does not make a women or girl impure rather it indicates a woman’s health in all ways natural. Advocating against the harmful impact of menstrual taboos while maintaining the cultural and geographical aspects in different religious dialogues is also needed.

Menstruation should not be considered only as a ‘women’s business’, let alone limiting it to indigenous communities. As global attention to menstrual health management continues to increase, it is critically important to ensure that disparities in the CHT are considered and addressed. This is also vital for achieving the sustainable development goals. Ensuring menstrual health management would help us achieve multiple SDG provisions. To achieve SDG 3, we need to promote education on healthy lives which goes hand-in-hand with SDG 4, which includes inclusive education for all communities. Moreover, to ensure menstrual health management for all communities including our large workforce that includes women, a community-based change will have a huge impact on our goals for SDG 8. A combination of these goals can ensure our targets to achieve SDG 6 and SDG 5.

Menstrual stigma and taboos have far reaching implications across populations, yet the experiences of those facing inequities in the CHT have not yet been adequately heard or addressed. Developing initiatives that address menstruation from individual, familial, community, and societal levels will contribute to dismantling the barriers identified by researchers around the world. Further research is needed to understand the barriers to menstrual health management among Bangladeshi indigenous girls and women and to inform the development and evaluation of effective policy and practice.

Illustration: Social Story

Source: New Age