“How can we leave the traditions of ourBaab Daada” socio‐cultural structures and values driving menstrual hygiene management challenges in schools in Pakistan

Abstract

Introduction: Despite the growing attention to the relationship between menstruation and girls schooling, there remain many challenges to addressing the issue. Current interventions, which mostly focus on developing WASH infrastructure and sanitary hygiene management products, while necessary, may not be sufficient. This paper aimed to identify the root causes of poorly maintained WASH infrastructure, and understand the deeply embedded socio-cultural values around menstrual hygiene management that need to be addressed in order to provide truly supportive school environments for menstruating girls. Methods: Qualitative data were collected in rural and urban sites in three provinces in Pakistan using participatory activities with 312 girls aged 16-19 years, observations of 7 School WASH facilities, 42 key informant interviews and a document review. Results: Three key themes emerged from our data: (1) a poorly maintained, girls-unfriendly School WASH infrastructure was a result of gender-insensitive design, a cultural devaluation of toilet cleaners and inadequate governing practices; (2) the design of WASH facilities did not align with traditionally-determined modes of disposal of rag-pads, the most common used absorbents;(3) traditional menstrual management practices situate girls in an 'alternate space' characterised by withdrawal from many daily routines. These three socio-culturally determined practices interacted in a complex manner, often leading to interrupted class engagement and attendance. Conclusions: To be truly effective, current menstrual hygiene management strategies need to address the root causes of poor WASH infrastructure and ensure facility design is sensitive to the gendered and deeply embedded local socio-cultural values and beliefs around menstrual hygiene management.

Adolescent Menstrual Health Literacy in Low, Middle and High-Income Countries: A Narrative Review

“…Effective menstrual practices by adolescents in schools are hindered by powerfully embedded cultural beliefs. Some cultures believe that menstrual blood is used by witches or Satanists to lure evil spirits into girls' bodies [71] or negatively impact fertility [21] and this can impact the use and disposal of period products due to fear that their blood may be obtained from these.…”

“…Given its association with reproduction, menstruation has been sexualized which has consequentially led to it being made a taboo topic with families avoiding discussions to maintain 'purity' or 'innocence' of their children [71]. When a girl was menstruating, some communities imposed restrictions on her participation in household chores such as cooking, cleaning [72] as well as worshipping Gods in the temples [45], since they were considered 'dirty' or 'polluting' during this time [71].…”

“…Given its association with reproduction, menstruation has been sexualized which has consequentially led to it being made a taboo topic with families avoiding discussions to maintain 'purity' or 'innocence' of their children [71]. When a girl was menstruating, some communities imposed restrictions on her participation in household chores such as cooking, cleaning [72] as well as worshipping Gods in the temples [45], since they were considered 'dirty' or 'polluting' during this time [71]. The practice of Chhaupadi in Nepal, wherein menstruating women and girls are considered impure and deemed untouchable and are forced to live in exile with bare necessities, thus barred from participation in household activities, is one of the primary examples of deep-rooted cultural taboos having hazardous consequences on adolescents' health [73].…”

Knowledge and practice of menstrual hygiene management among women living in a low-income neighbourhood, Karachi, Pakistan

“…4 the overall life of women in Pakistan. 5 However, we still face extreme lack of knowledge, poor perception of menstruation, and detrimental practices among Pakistani population.…”

Women’s Cognition and Attitude with Eco-Friendly Menstrual Products by Consumer Lifestyle

“…During menstruation, women use different menstrual products to absorb menstrual blood and prevent outflow. The use of menstrual products can be traced back to ancient times, when women used leaves, hay, and bark, which are easy to clean, to carry menstrual blood due to poor living conditions [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, women in different countries dealt with menstrual blood in different ways, including the use of wool, folded paper, and papyrus.…”