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Social Stigma Centred around Menstruation: A Reflective Review

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Frontier Anthropology, 2022, 11: 51-58
ISSN 2319-5835
©Anthropological Society of Manipur
DOI-DS: 01.2023-14175947

Social Stigma Centred around Menstruation: A Reflective Review

P.S. Vaveine Pao1
ABSTRACT
Background: Menstruation is a monthly periodic bleeding cycle as a part of the female reproductive
system that indicates sexual maturity. However, abnormality in the natural cycle, i.e. menstrual disorders,
are a major concern for women as it stimulates numerous gynaecological morbidities affecting reproductive
health. Even if the disorder is multi-factorial, the social norms, taboos and stigma centred around menstruation
worldwide have intensely triggered the normal cycle leading to a swift rise in disorders affecting the
reproductive profile of a woman.
Materials and Methods: The present study is a reflective review based on the secondary data available on
the stigma and taboos centred around menstruation. The secondary data were compiled, analysed and
reviewed.
Findings: Many societies stigmatise menstruation and its disorders. Social stigmatisation leads to poor
knowledge and unhealthy attitudes that may directly or indirectly link to menstrual health and hygiene.
Raising awareness is one of the foremost strategies for improving menstrual health problems. Open
communication on menstrual issues needs to be encouraged to make adolescent girls accessible to the
parents, especially the mother and health care providers when they need help.
Conclusion: Every societal unit needs to cooperate to promote better reproductive health knowledge. A
strategic programme will be significant in dealing with this issue as it is a sensitive topic based on social
obligations and restrictions.
KEYWORDS Menstruation, menstrual disorders, morbidities, taboo, stigmatisation

INTRODUCTION
Menstruation is a normal phenomenon in worldwide perceive their monthly periodical
every women’s life, indicating a sign of being bleeding to exceed the normal limit (Goldrath
fertile and healthy. With first onset in adolescents, 1995). Irregular cycles or amenorrhoea (cessation
it is associated with the release of egg cells of menstruation) may be directly or indirectly
through the uterus and ovaries, suggesting linked with infertility, which has now become an
enough maturity for reproduction (Cronje and emerging concern of women, especially in
Krintzinger 1991; Howard 1996). However, the industrialised and urbanised societies (Inhorn
menstrual issue has recently become a common 1998).
reproductive health concern. It deteriorates the
In a hospital-based study, it was revealed that
health status of women by exposing them to
menstrual disorders (disorders of cycle length
several risks, likely leading to multiple
and flow) have the highest frequency of 62.6%,
gynaecological disorders affecting their
which causes infertility, followed by diseases
reproductive fitness. As per a WHO report, 18
(obesity, thyroid diseases, diabetes), 58.7%
million women in the age group of 30-55 years
1
Research Scholar, Department of Anthropology, Manipur University, Imphal – 795003.
Email: [email protected]
Pao, 2022 52

impaired ovulation (hormonal disorders, oligo- polluted, and unhygienic; hence, social restriction
ovulation and anovulation) 50.3%, uterine causes has been imposed, causing uninformed, poor
16.7%, tubal factor 15.4%, and cervical causes knowledge and inadequate hygienic management.
7.9% (Masoumi et al. 2015). Menstrual The socio-cultural perception of menstruation and
irregularity and associated estrogen deficiency its disorders across the globe and their impacts
are well-proven risk factors for other on reproductive health suggest that evaluation and
complications, including osteoporosis (Alzubaidi treatment of menstrual complaints should be given
et al. 2002). Menstrual bleeding affects women’s higher priority. In the present review, an attempt
quality of life, and often excessive bleeding makes has been made to document the stigmatisation of
women prone to anaemia (Lentz 2007; Kadir et menstruation globally through secondary
al. 2010). A study found that 20% of the students literature available. Further, the review is expected
have family members suffering from to propose a few points that may highlight the
endometriosis and suggested that reflective thinking that could curtail the barriers
Dysmenorrhoea (painful menstruation) could be embarked upon by society.
an early sign of endometriosis (Aref et al. 2015). PERCEPTIONS AND BARRIERS OF
It is further reported that endometriosis is highly MENSTRUATION IN DIFFERENT
prevalent among adolescent girls with severe REGIONS
menstrual pain or pelvic pain (Reese et al. 1996;
Laufer et al. 1997). Menstrual problems are one All over the world, there are different social
of the most common gynaecological problems in outlooks centred on menstruation. Even in some
India (Kumar et al. 2016). Dysmenorrhoea and countries, menstrual women and girls are imposed
Pre-menstrual Syndrome are the most common on their mobility and behaviour with the notion
menstrual problems experienced by many of being impure during the menstrual bleeding.
adolescent girls in India (Khanna et al. 2005; Social restrictions and taboos are often associated
Sharma et al. 2008; Dasgupta and Sarkar 2008; with menstruation, leading to an open secret
Patil et al. 2009; Mudey et al. 2010). stigma of impure, uncleanliness etc. These social
perceptions may vary regionally, culturally or
Poor and inadequate menstrual hygiene can ethnically, but more or less, the notion of being
be one of the common practices that may lead to impure, unhygienic, and uncleanliness remained
such menstrual issues. A USAID report states that the same. These perceptions, along with the
there are more than 355 million menstruating experience faced, influence the women’s own
women and girls (Kiawah Trust and USAID view on body image, gender identity, self-
2014), and millions of these women are even acceptance, symptoms attribution and health
exempted from proper menstrual hygiene behaviour (Rempel and Baumgartner 2003;
management (MHM). 71% of Indian girls didn’t Houston et al. 2006; Rembeck et al. 2007).
know about menstrual bleeding till they
experienced it themselves. These adolescent girls Moreover, attitudes and experiences
felt shock (25%), fear (30%), anxiety (69%), associated with menstrual life are shaped through
guilt (22%), and frustration (22%) for the first varied social locations (Chrisler and Zittel 1998;
time when it came (Gupta and Gupta 2001). Marván and Trujillo 2009). Robledo and Chrisler
Moreover, 70% of Indian women could not afford (2011), in a review study based on attitudes and
sanitary pads (Sinha, 2011). Social stigma and experiences of American girls and women, noted
restrictions associated with menstruation could that the social stigma of menstrual women affects
be an important concern related to poor and their health, sexuality, and well-being. Laws
inadequate menstrual health management. (1990) suggested that women would normalise
each other’s pain, discomfort, etc., by discussing
In almost every society, there are certain it though it is considered embarrassing or taboo.
social obligations associated with menstruation. Seear (2009) observed that women were
The menstrual blood is regarded as impure,
53 Social Stigma and Menstruation

unwilling to open menstrual problems and knowledge of menstrual disorders among the
irregularities; it might be due to the notion that respondents. The study attempted to understand
menstruation is considered a discrediting attribute, Islamic rulings on menstrual disorders.
and such revelation would often result in disgrace. Comparatively, fewer males (26.8%) had good
She mentioned a case study of Ainsley in her knowledge of menstrual disorders than 73.2%
article, where Ainsley was misjudged as being of females. The study further revealed that men
malingering by her colleagues as she shared her generally had significantly lower knowledge
menstrual problems. At some point, such a scores on the causes of menstrual disorders and
revelation of menstrual disorders would bring off Islamic ruling on menstrual disorders than their
direct challenges or threats (Seear 2009). female counterparts. Male learnt about
Consequently, to avoid stigmatisation, women do menstruation either through friends and books,
not disclose menstruation and its related problems. while females learnt through their mothers or
Almost all studies accepted that young girls personal experiences, which somehow reflects
got information about menstruation from their the social behaviour of Malaysian society.
mothers, even before it came. But White (2013) FAWE (Foundation for African Women
observed that few mothers are uncomfortable Educationalists), a pan-African NGO, reported a
talking about menstruation to their daughters, feel culture of silence regarding menstruation in rural
unprepared for these conversations and often Uganda, ignoring menstrual-related discussions
convey negative attitudes that reinforce the in families, schools, and communities (Kirk and
menstrual taboos. Similarly, many menstrual Sommer 2006). As there is no supportive school
education materials reinforce these taboos staff and family members with whom the
(Erchull et al. 2002). Another social identity that menstrual issues can be discussed, Kenyan girls
may be associated with menstrual attitudes and face problems seeking puberty and menstrual-
experiences is religious affiliation. In almost every related information (McMahon et al. 2011; Mason
religion, menstruating women are considered et al. 2013). Such a gap and inattention approach
impure and polluted; and certain social restrictions to menstrual issues could be due to certain
are associated with it (Guterman et al. 2008). cultural sensitivity or taboos associated with
Under Islamic teachings, certain restrictions are menstruation (Laws 1990; Houppert 1999),
imposed on menstrual women, such as not being which worsened because of poor environmental
allowed to offer prayers or hold Ramadan fast sanitation (Black and Fawcett 2010). These
during the period days, and even sexual inattention approaches delayed the developmental
relationships between husband and wife are not initiatives and research to promote menstrual
allowed. Asyikin et al. (2015) reported that disorders and other related health issues (George
menstrual issues were not openly discussed, 2011; Jewitt 2011). A study of Nigerian school
especially in front of males in the Malay culture, girls revealed the prevalence of population-wise
as it is regarded as women-centric. This could variation of menstrual disorders in different
result in women confining the problems within proportions owing to varied socio-cultural and
themselves and even being reluctant to ask for regional characteristics (Uzochukwu et al. 2009).
help from their spouses and other male family Adinma and Adinma (2008), in another study
members. Another probable reason for not sharing from Nigeria, opined that misconception or poor
such menstrual-related symptoms or disorders knowledge of menstruation led to defective
could be the belief in the personal matter; hence, practices which deteriorate menstrual health,
certain women keep the matter private and prefer such as dysmenorrhea, reproductive tract
self-medication to seek (Cronje and Krintzinger infections etc. Esimai and Esan (2010) studied
1991; Domoney et al. 2003). Nor et al. (2015) menstrual abnormalities among college students
did a cross-sectional study among 430 premarital in Nigeria and found a lack of information
Malaysian men and women and found low seeking. They further urged the need to educate
Pao, 2022 54

on menstrual health issues and health-seeking 2005), as it continues to influence the social
behaviour. It is most likely that women who have attitude towards menstruation (Bramwell and Zeb
negative perceptions of menstruation tend to 2006). In a study among young women in
experience its related problems (Woods et al. Mumbai, Thakur et al. (2014) reported that very
1982; Yeung et al. 2005). This could be due to few women receive information before the onset
poor knowledge of menstruation, thereby of menstruation, though the information was not
affecting safety and hygienic practices. authentic. Poor knowledge of menstruation leads
MENSTRUAL MYTHS AND TABOO IN to unhygienic practices, further deteriorating their
INDIA health status.

In India, there are also myths about REFLECTIVE THINKING APPROACH

menstruation as impure and polluted (Patil et al. In totality, this collection of articles
2011). In Hindu societies, menstruating women illuminates that social contexts shape the multiple
are restricted from participating in daily activities ways of menstrual experiences and attitudes.
such as worshipping, cooking etc. Restriction Raising awareness is one of the foremost
from worshipping is more common in urban strategies for improving menstrual health
areas, while restriction to the kitchen is more in problems. Poor knowledge about menstrual
rural (Puri and Kapoor, 2006). They are not even healthcare among the elders makes them
allowed to touch holy books. As they are incompetent in imparting sexual and reproductive
considered unhygienic and polluted, there is a education to their children. Alongside this, the
belief that even the food they prepare would get inadequate information among young women
contaminated (Kumar and Srivastava 2011). encourages unhygienic practices deteriorating
Cultural obligations and restrictions on their health. The social restrictions on
menstruation are often weighed by traditional menstruation make the needy inaccessible in
beliefs of being associated with shame and seeking information and asking for help, which
embarrassment surrounding sexual entities was ignored or unattended. It is essential to
(Kaiser 2008). In some societies, women bury provide the correct information to young women
their bleeding clothes as they believe it might to avoid misconceptions about menstruation; it
attract evil spirits (UNICEF 2008). will enable the women to take care of associated
The custom of celebrating the first menarche health problems through safe and hygienic
and thereby observing the ritual of social practices. Comprehending the weightiness of the
restrictions is still practised (Goel and Kundan problems, the policymakers need to intervene to
2011). Menstruating women are generally formulate proper health policy dealing with
restricted in religious and social activities (Khanna menstruation, focusing on the mass education of
et al. 2005), as they are considered unhygienic, both parents and girls. It should be accepted that,
impure and untouchable (Khanna et al. 2005; under menstruation, women have the capability
Singh 2006). It makes them confined at home of procreation.
(Garg et al. 2001), far from her normal daily The social obligations and restrictions keep
activities, including worship (Singh 2006) or even the issue out of the common room discussion,
from basic physical exercises (Reirdan and Rise where the pubertal change and physiology of the
1995). Socio-cultural obligations around menstrual cycle are poorly informed to the girls.
menstruation in a society are determined by As these girls are avoided in such situations, they
women’s educational status, attitude, family feel reluctant to approach if any emergency arises.
environment, culture, and beliefs (Kumar and Sometimes, this whole process: avoidance and
Srivastava 2011). Generally, religion is the main reluctance, to a girl, make the periodic cycle a
entity that outgrows the social taboos associated traumatic experience. It is high time to break the
with menarche and menstruation (Bhatt and Bhatt silence and cover the social restrictions. Free and
 55 Social Stigma and Menstruation

frank discussion is important to end the trauma as it would not be possible without his guidance.
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Manuscript Timeline:
Submitted: July 27, 2022
Accepted: Januray 18, 2023
Published: January 31, 2023