Menstrual hygiene management

Poor MHM may affect the reproductive tract, but the specific infections, the strength of effect, and the route of transmission remain unclear.[14] In India, a majority of girls are at risk for reproductive tract infections (RTI) because of poor MHM. RTI can lead to various disabilities if not treated early on[15] and are the cause of 30–50% of prenatal infection.[16] Due to prejudices surrounding the issue, some women in India do not eat or take showers during their menstruation.[17]

Girls' self-image may be negatively impacted by adverse attitudes towards menstruation.[18][19]

The onset of menstruation is challenging for school-aged girls in low-income settings. Impacts can include school absenteeism, missed class time, reduced participation, teasing, fear and shame, and risky adaptive behaviours.[20] Further challenges that menstruating school girls face are a lack of knowledge, communication, and practical guidance prior to menarche and during menstruation; inadequate water, sanitation, and hygiene (WASH) facilities; and ineffective or unavailable menstrual management materials.[20]

In many parts of sub-Saharan Africa, girls can miss up to 5 days of school a month or drop out entirely due to insufficient access to water, sanitation and hygiene (WASH) facilities and menstrual hygiene products.[21][22] Improving access to WASH facilities can actually increase girls' attendance at school. A program for school sanitation in Bangladesh increased girls' enrollment at school by 11%.[23]

Menstrual waste is largely ignored in schools in developing countries, despite it being a significant problem. Girls' access to water and sanitation at school is only available at 47% and 46% of all schools globally.[5] Often, school toilets for girls (if they even exist) are missing bins for menstrual waste collection with the result that pads may be spread all around the school compound area.[24] This pollutes the environment and also causes embarrassment for the school girls.

In the United States, among other countries, girls who are unable to afford feminine hygiene products may miss school in order "to avoid the embarrassment of staining their clothes".[25]

In low-income countries, girls’ choices of menstrual hygiene materials are often limited by the costs, availability and social norms.[26][27]

A lack of affordable hygiene products means inadequate, unhygienic alternatives are used, which can present a serious health risk.[28][29] Menstrual cups offer a long-term solution compared to some other feminine hygiene products because they do not need to be replaced monthly. The quality of the material also makes them a reliable and healthy menstrual hygiene solution, as long as there is access to clean water for washing them.

Girls and women in the workplace often miss work because they don't have access to sanitary materials and places of employment in some countries do not provide resources for women or even have "proper toilets".[19] Women in Bangladesh who work in factories have reported that due to the cost of sanitary products for menstruation which they could not afford, they have resorted to using "factory-floor rags in place of pads and tampons, leading to dangerous infections and missed work."[30]

Menstruation can be a barrier to education for many girls, as a lack of effective sanitary products restricts girls' involvement in educational and social activities.[31][32] Often they do not attend school due to fear of leaking, shame or embarrassment, period pain or inadequate sanitation facilities that do not allow them to wash or change in privacy.[33] This applies mainly to schoolgirls from low-income families, since disposable hygiene products are a monthly expense that many females simply cannot afford.[34]

Adequate sanitation facilities and access to menstrual hygiene products are just one part of the solution to menstrual taboos that impede women's progress in many developing countries. Knowledge is critical for girls to feel comfortable with menstruation and to gain a positive awareness of their bodies.[35]

Many low-income and/or homeless girls and women in the inner cities of the United States cannot afford sanitary supplies.[25][36] Food banks in New York report that feminine hygiene products are in high demand.[25] Homeless women in the United States may face the challenge of not being able to shower or use the communal toilet in homeless shelters as often as they need to in cases where there are restrictions on toilet usage.[36] In New York, proposals to help lower income women access menstrual sanitary supplies includes proposals to remove the sales tax on feminine hygiene products and "distributing free tampons in public schools."[25] Sales tax are levied on menstrual supplies in 36 states.[37] On May 1, 2018, the National Diaper Bank Network, which provides millions of diapers to poor and low income parents and advocates for policy change around basic needs, launched the Alliance for Period Supplies and began distributing free period products through allied organizations across the U.S.[38] Homeless women in other industrialized countries, such as the United Kingdom, face problems affording tampons and sanitary napkins.[39]

A review in 2018 found that disposal of menstrual waste is often neglected in sanitation systems. This leads to improper disposal and negative impacts on users, the sanitation systems and the environment.[40]

Despite the fact that menstruation is a healthy biological process, it is approached with hesitance and misinformation because of deeply-rooted cultural taboos surrounding menstruation.

Cultural, religious and traditional beliefs — particularly in developing countries — can lead to restrictions that women or girls face during their period. In some societies, women do not wash their bodies, shower or bathe during menstruation. They may not be allowed to use water sources during menstruation. Even if they have access to toilets, they might not use them because of the fear of staining the toilet bowls (in the case of dry toilets or flush toilets where the flush is not powerful).[34] This impairs the use of menstrual cups compared to pads as the cups are normally emptied into toilets.

Expanding the discussion to include consideration of waste management is part of the attempt to "normalize" conversations about menstruation.[3]