Menstruation is a natural physiological phenomenon, yet considered a stigmatized topic, particularly in low- and middle-income countries like Pakistan. It is seldom discussed openly, leading to flow of incorrect and incomplete knowledge. The common unhealthy practices like using dirty cloth, sand, mud, not only affect the health but causes psychosocial stress.1 Adolescent girls in Pakistan are often unaware or unprepared for the onset of menstruation (menarche) mostly due to a culture of silence surrounding women’s reproductive health issues of which menstruation is a part. This lack of preparation, knowledge and poor hygienic practices during menstruation presents negative impacts on girls’ self-esteem and personal development. It also affects their education – they often miss school because of shame or lack of adequate facilities to manage their menstrual period. In addition to schools lacking proper hygiene facilities, teachers are often not prepared to respond to girls’ inquiries about menstruation.² A reality check of menstruation in rural Pakistan: Women and girls in poor countries like Pakistan can’t afford sanitary pads or tampons, which would normally be changed around four times a day during menstruation. Instead, the vast majority of women and girls in Pakistan use rags. These are usually torn from old dupattas and known as ‘ganda kapra’. Rags are washed quickly inside the latrine and used several times. There is no private place to change and clean the rags and often no safe water and soap to wash them properly. Even in their homes, a culture of shame forces women to find hidden places to dry these rags. These places are often damp, and unhealthy. This practice is responsible for the various urinary and vaginal infections causing major health concerns among females.³

Causes of unhygienic practices among menstruating females:

1. Lack of drying areas due to social unacceptability
2. Sanitary pads are too expensive
3. Lack of knowledge regarding menstruation
4. Toilets are not designed appropriately to change or wash the pads
5. Women and adolescent girls don’t share the problems with others; in some cases, this culture of shame leads to serious reproductive health problems.

Figure 1: Reasons for not using tampons amongst general population and healthcare worker.¹

Preventive Measures: Awareness among females regarding menstrual hygiene:

Teachers and other educated females among the particular setting should be given the responsibility to discuss this issue in-depth with adolescent girls and women in the villages, slums and schools of various cities of Pakistan. Menstrual awareness program should teach the audience to avoid unhygienic practice (using cards with pictures to explain specific points) Elaborate negative impact on health due to unhygienic practice Teach hygienic practice: by showing how period cloth should be washed, dried and proper disposal of sanitary pads with demonstration (using a doll and picture cards); how to use pads etc. Counselling for overcoming cultural barriers, especially embarrassment.³

1. Arshad Ali S, Baloch M, Riaz L, et al. (August 20, 2020) Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus 12(8): e9894. doi:10.7759/cureus.9894
2. menstrual-hygiene-polls-Pakistan article: breaking the silence on menstrual hygiene, Amplifying youth voices to tackle myths and taboos surrounding menstrual hygiene.
3. Menstrual hygiene: Breaking the silence Rokeya Ahmed and Kabita Yesmin WaterAid Bangladesh 21