-Manoj Paudel
Bleeding that occurs in every month from vegina is called menstruation. At this time the blood comes out from uterus. Menstruation is a biological process that occurs to every woman. To every healthy woman it starts from adolescence and automatically stops at their old age.
Menstruation is the symbol of the beginning of women’s reproductive age. Reproductive is the age where a woman is able to give a birth to child biologically. But it does not mean they are able to marry and have children; still women’s reproductive organs are not matured to have children. Also they are physically, psychologically, socially and mentally not fit to become a mother. Generally, women reproductive age is considered from 14 to 49. In a normal condition menstruation falls in between 26th to 30th days of the previous menstruated day. In average, menstruation falls in every 28 days. By their birth a baby girl has about four hundred and fifty thousand ovum but they are situated in a hidden position. Various types of hormones (major; estrogen and progesterone) produce in women’s body relating to their physical development women gradually move towards adolescences then the ovum also move towards maturity. Beginning of Menstruation symbolizes the maturity of ovum. In between the period of previous and coming up menstruation an ovum comes out from ovary. The process of ovum coming out from ovary continues every month. In one month ovum comes out from left ovary and from right in the next month. Menstruation process happens every month but it does not occur during pregnancy. For some month menstruation does not to those women who are feeding breast. From the day when ovum comes out from ovary body produces a kind of hormone a lot in the. By the effect of that hormone the internal part of the uterus is covered by a thin net. If pregnancy/fertilization occurs the embryo attaches with the same net and the development process of embryo begins. It could be also called the preparation of pregnancy. When there does not occur fertilization then the net developed in the internal part of the uterus seals the small blood vessels from where the blood passes. To those blood vessels blood is collected, those blood vessels split and bleeding occurs and the blood departs from vegina. During menstruation the small pieces of the net, other hormones contained in the uterus and the ovum comes out one after another. During menstruation generally bleeding occurs up to 4th to 6th day. During menstruation 30 ml blood goes out uselessly at once. During menstruation sometimes massive bleeding occurs and sometimes a little. Sometimes it occurs for 5-6 days and sometimes for 2-3 days. During menstruation the time and amount of bleeding depends on various aspects. For example:
- Health condition (sick or healthy, depressed or happy)
- Nutrition (fulfillment of the nutrients needed to the body or its lack)
- Daily life (normal in-home work, farm work, official work, laboring work)
- Relaxed or tired ( relaxed or tired situation)
- Age ( adolescence, adult, mid age)
- Quantity of hormones produced (due to variation in hormone production)
Before and after menstruation the following health related problems could be seen among women:
- Feeling hot, feeling uneasy, headache
- Back pain, pain in internal part of thigh, tiresome
- Feeling as if stomach is swelled, abdominal pain
- Breast pain
- Nausea , constipation or diarrhea
- Depression, feeling to live alone
During menstruation women are grounded and shy. Nepal is a male dominated society and most of the people do not pay attention to women. The main reasons behind it are blind faith, traditional mal-practices and lack of proper knowledge on menstruation. After 7-8 days of the menstruation women feel easy and relaxed. For example:
- Get salvation from the problems occurred before menstruation and feel delighted
- Relaxed, happy mood
- Feeling energetic
- Emergence of creativity and innovativeness
- Desire to involve in intimacy/sexual relation
Because of the prevalent traditional mal-practices and blind faith women have to bear the following problems during menstruation;
- Cloths used during menstruation are old and untidy
- There is no proper place to wash and dry such cloths
- Not allowed to touch taps, spring taps and well
- They don’t get sufficient water to wash and bath
- It is managed to stay and sleep apart, and sleeping cloths are not safe and clean.
- Compelled to live in cow-shed or separately built unhygienic house in MWDR and FWDR (highly practiced among Brahmins, Kshetries and Dalit communities)
Women should be well aware about personal hygiene during menstruation, but it is found less concerned about it because they do not get good environment for to maintain their personal hygiene. Due to lack of hygiene and sanitation practices there may occur vaginal infections and most of the women do not want to talk on these matters. Poor traditional conceptions and cultural malpractices on menstruation are the main causes for such behaviors done to the women. During menstruation blood departs from vegina so it is essential to use sanitary pad. If sanitary pad is not available then napkins or soft cotton cloths should be used. After using the sanitary pad and if the napkin or cloth becomes wet then it is essential to change another one. After the use of sanitary pad or napkin one should collect it in a dustbin and must dispose it later on. The napkin or the cotton cloths could be reused after washing it with soap and water and drying it in the sun. During menstruation vegina and the surrounding of the genital organ should be washed with soap and water time to time. Sanitary pad is made of soft cotton cloth filled with cotton and napkin is made of soft paper or soft and thin cotton cloth. There is thread inside the packet of sanitary pad which could be used by tying the rope on the waist. If the thread is not available then it could be used with support of underwear. During menstruation also one must use clean and tidy cloths.
School is a place where children get their basic academic education. The environment of the school should be favorable to the children. During school education a girl have to spend nearly 500 menstruated days in the school. Therefore there should be the provision of separate toilet for the girls and it should have the following facilities
- The provision of dustbin with cover to keep the used sanitary pad and the napkin and provision to clean the dustbin daily
- Provision to dispose those used sanitary pads and napkins
- It should maintain confidentiality of the girls with respect to change another sanitary pad or the napkin
- Availability of sufficient water and soap to wash the used napkin or the cotton cloth used during menstruation
The main reason behind lack in girls’ admission at school, absentee and dropout is the lack of the toilet having such facility. At least a class should be run related to sex education, reproductive education, menstruation and sanitation in a week to the students studying above grade 5. Girls should be advised to use sanitary pad, napkin or cotton cloths with respect to their hygiene and sanitation. To use the napkin or the cotton cloth during menstruation, one should consider the paper or the cloth should be soft and clean, and for the reuse of those napkin and cloths it should be washed with soap and water and dried in the sun. Each female student should possess knowledge on this. Each female student studying above grade 5 should be provided with the following knowledge:
- Why menstruation occurs and how it is related to human life?
- During first menstruation what type of physical changes occurs in a woman?
- During menstruation why should a woman be very sensitive about their personal hygiene?
Community should be provided with the knowledge that during menstruation one should use sanitary pad or napkin. And on the following subjects discussion should be done with the community
- Is there culture to use sanitary pad or napkin during menstruation?
- Is sanitary pad or napkin easily available in the market?
- How far the shops where they can get sanitary pads and napkin?
- Can economically disadvantaged group afford sanitary pad or napkin?
If they do not use the sanitary pad or napkin then they should be provided with the knowledge on:
- in turn of sanitary pad or napkin they can use a piece of soft cotton cloth
- After using once those pieces of cloths could be reused by washing with soap and water and drying in the sun.
To wipe out the negative effects that happen due to highly privileged blind faith, traditional malpractices and poor cultural behavior done to the women, each member of the society should be provided with the knowledge on the following factors:
- Why menstruation happens?
- How it happens?
- What sorts of things to be done during menstruation?
Every parent should know: what are facts about menstruation? What sorts of problems could be seen among women during menstruation and how such problems could be solved? For this it is essential to contact health workers or health volunteers
Every mother and grandmother should have practice to have discussion with their siblings (daughter or granddaughter) on menstruation related facts
During menstruation there should have the provision of comfortable living and sleeping place. The toilet should have the provision of dustbin with cover and it should be favorable to change the sanitary pads. The toilet should be hygienically clean.
One should also discuss in a family about the importance of the personal hygiene during menstruation. Parents should appeal to wipe out the highly rooted cultural malpractices with respect to menstruation.