In all conversations around menstruation, the one topic that should have been at the forefront, and yet is hardly even touched upon, is menstrual health. Health is a very measurable entity. Numbers, diagnosis and medical expertise can easily point to exactly where we stand with respect to menstrual health. Yet, there is utter silence. In a recent trend, menstrual researchers such as those who gather on platforms like 바카라Menstrual Health Hub바카라 have begun to state that there is a need to gather eviÂdence-based research. This is a relief, especially after years of blindly pushing for sanitary napkins, saying these could save women from dangerous repÂroductive health issues.
But is it really the case that there isn바카라t enough data, or simply that we are not comfortable talking about what the existing data revÂeal? Let바카라s take a deep dive into this and look at what exactly is making the modern researcher uncomfortable when it comes to hard data on menstrual health.
Do developing countries reaÂlly have a greater Âprevalence of menstrual disorders? The vast majority of work on menstrual health and hygiene is happening in developing countries like India, Kenya, Nigeria, Brazil, Nepal, Bangladesh, etc. However, the discourse and agenda is largely set by entities from developed countries such as the US, UK and Australia. If we look at the data from comparative studies such as the WHO바카라s multiÂ-country study (Omran et al., 1981), we find that they usually compare data from devÂeloping countries, with hardly a mention of the prevalence of menstrual disorders in developed countries.
The assumption that devÂeloping nations have a higher prevalence of menstrual disorders is generally not contested. The reasons cited are often poor socio-economic status, illiteracy and simply the fact that a country is 바카라devÂeloping바카라. Let바카라s revÂisit this assumption by looking at comparative data on two of the most prevalent menstrual disorders바카라menorrhagia (heavy menstrual bleeding) and dysmenorrhoea (painful perÂiod)바카라among adult women and adolescent girls in India, other developing countries and developed countries.
Heavy menstrual bleeding/Menorrhagia: India: Studies from different regions in India indicate that among adult women, the prevalence of heavy menstrual bleeding is betÂween 1.6 per cent in ThiruvananÂthapuram, Kerala (Abraham et al. 2014) to 18.7 per cent in Tiruchirapalli, Tamil Nadu (Kavitha et al. 2015). And among adolescent girls, it was found to be between 0.8 per cent in rural Haryana (Singh M.M. et al. 1999) to 23 per cent in urban West Bengal (Subha et al. 2010).
Developing countries: Studies from different developing nations (other than India) indicate the prevalence of heavy menstrual bleeding among adult women to be between one per cent in south-western Nigeria (Esimai et al. 2010) to 35.3 per cent in Brazil (I.S. Santos et al. 2011). And among adolescent girls, it was between 3.6 per cent in Enugu, Nigeria (Theophilus et al. 2010) to 38 per cent in Assiut city, Egypt (Mohamed et al. 2012).
Developed countries: In comparison, the data from developed countries indicate a higher prevalence of heavy menstrual bleeding among adult women바카라between 22 per cent in the Netherlands (Fraser et al. 2015) to 52 per cent in England (Santer et al. 2005). Further, a study of elite athletes in London repÂorted that 54 per cent of women experienced heavy menstrual bleeding (Bruinvels et al. 2016).
Among adolescent girls, it was found to be 8.6 per cent in Washington DC (A.M. Houston et al. 2006) to 63.6 per cent in Japan (Nohara et al. 2011). Further, in the UK, 20 per cent of all women, and 30 per cent in the US, have a hysterectomy before the age of 60바카라and menorrhagia is the main presenting problem in at least 50바카라70 per cent (Hemaidi et al. 2007).
Menstrual pain/Dysmenorrhoea: India: Studies from different regÂions in India indÂicate that among adult women, the prevalence of dysmenorrhoea is between 11.3 per cent in ThiruvananÂthapuram, Kerala (Abraham et al. 2014) to 68.6 per cent in Tiruchirapalli, Tamil Nadu (Kavitha et al. 2015). And among adolescent girls, it was found to be between 15 per cent in urban West Bengal (Subha et al. 2010) to 72.6 per cent in urban Nagpur (Thakre et al. 2012).
Developing countries: Studies from different developing nations (other than India) indicate the prevalence of dysmenorrhoea among adult women to be between 14 per cent in rural Gambia (Walraven et al. 2002) to 89.1 per cent in Iran (Habibi et al. 2015). And among adolescent girls, it was found to be between 25 per cent in Enugu, Nigeria (Theophilus et al. 2010) to 84.9 per cent in Turkey (M. Seven et al. 2014).
Developed countries: In comparison, data from developed countries indicate a higher prevalence of dysmenorrhoea among adult women바카라from 23 per cent in Boston (Abenhaim et al. 2005) to 77.6 per cent in Japan (H. Ju et al. 2014). And among adolescent girls, the numbers are still higher in developed countries. Dysmenorrhoea among adolescent girls was found to be 56 per cent in Italy (Rigon et al. 2010), 58 per cent in New York (K. O바카라Connell et al. 2006), 65 per cent in Washington DC (Houston et al. 2006), 74.5 per cent in South Korea (Jeon et al. 2014), (Yamamoto et al. 2009), 83.2 per cent in Singapore (Agarwal et al. 2009), 85 per cent in Houston, Texas (Bankiram et al. 2000), 80 per cent in Perth, Australia (Grbavac et al. 1999) and an exceedingly high 94 per cent as per an MDOT study of adolescent girls across Australia (Parker et al. 2006).
Menstrual Products and their impact on menstrual health: The undisputed trend of menstrual discourses in developing Ânations has been the promotion of menstrual products, especially sanitary napkins, under the guise of Menstrual Hygiene Management (MHM). The idea is to emulate women from developed countries who have access to such products. However, the menstrual health data above raises serious questions about why the focus has been on developing nations, when in fact developed countries have a greater prevalence of menstrual disorders, in spite of them following WASH United바카라s much-touted menstrual hygiene formula, of using declared hygienic products such as sanitary napkins and having access to good sanitation.
Which brings us to the next question: do menstrual products have any impact on menstrual or reproductive health disorders? A study by the London School of Hygiene and Tropical Medicine ((Torondel et al. 2013), which looked at 14 articles to understand possible correlations between menstrual health management and reproductive tract infection (RTI), found that there was no association betÂween confirmed bacterial vaginosis (typically characterised by excessive white discharge) and MHM. It also says: 바카라The body of eviÂdence to support the link between poor MHM and other health outcomes (secondary infertility, urinary tract infections and anaemia) is weak and contradictory.바카라 The study concludes: 바카라It is plausible that MHM can affect the reproductive tract, but the specific infections, the strength of effect and the route of transmission remain unclear.바카라
Strangely, it has occurred to very few that menstrual disorders have little to do with hygiene or the product used (except in the proven case of tampons causing Toxic Shock Syndrome among some women). The most common menstrual disorders such as dysmenorrhoea (period pain), Âmenorrhagia (heavy bleeding), amenorrhoea (no bleeding) and oligomenorrhoea (menstrual cycles > 35 days) have no association with what product is used or how hygiene is maintained. The more serious disorders like endometriosis or PCOS are even more cut off from hygÂiene correlations. Some write-ups go to the extent of associating poor menstrual hygiene with cervical cancer, for which there is even less evidence.
Should we let MHM Âevangelists teach us?: MenstÂruation is as old an occÂurrence as women themselves. Our ancestors were never taught MHM. They simply knew what to do, and passed on the knowledge from generation to generation. Woven into their culture were various practices that served to prevent menstrual disorders. Practices that allow women to take the needed rest during menstruation and avoid physical exeÂrtion, along with specific diet restrictions; these are not tabÂoos, but the means by which women in ancient socÂieties took care of their health바카라by intelligently weaving science into Âculture and religion, so that large masses of women are benefited.
Whether it is India바카라s Ayurveda, China바카라s Acupuncture (Armour et al. 2016) or the indigenous science of the Caribbean islÂands (Flores et al. 2014, Tinde et al. 2014), there is a far deeper understanding of the menstrual cycle than we have cared to investigate. This undÂerstanding shows in the menstrual health of women from these countries. This is the area where research could go if we choose wellbeing instead of treatment and surgery, not to mention the effect prevention will have on health budgets. But first, we should be willing to accÂept that the supposedly deficient targets of MHM 바카라benevolence바카라바카라that is, women from developing countries바카라might in fact be the ones who still hold ansÂwers on how to prevent menstrual disorders.
Here바카라s an honest question. How comfortable would menstrual researchers and NGOs that fight for poor girls and women in developing countries be if they had to state that, as of 2018, it is not India, Gambia, Nigeria, Brazil or Nepal that have the most menstrual disorders, but nations like the US, the UK and Australia바카라countries that are leading the menstrual hygiene movement to help developing countries. Yes, it is a lot easier to state that there still isn바카라t 바카라enough바카라 evidence-based research on menstrual health.
(The writer is a women바카라s health activist, menstrual Âeducator and co-founder of Mythri Speaks Trust)
