Period Poverty in Rural Sri Lanka; Understanding Menstruation Hygiene and Related Health Issues to Empower Women

Abstract

Menstruation is a common bodily function for every reproductive age female. However, the methods used to manage their menstrual periods is highly influenced by social, cultural, economic, and educational backgrounds. Several studies conducted in Sri Lanka show that menstrual problems has been one of the commonest health issues as perceived by adolescent and young girls. Despite high literacy rates, exceptionally good maternal and child health care services and having one of the most appraised public health systems, menstrual problems are still mostly under-explored and considered a “taboo” even in most affluent settings in Sri Lanka. The “period poverty” - not having enough financial resources to manage bleeding and pain during menstruation - often attached with cultural shame is prevailing in Sri Lanka. This descriptive cross-sectional study was conducted in Anuradhapura district using modified WHO 30 cluster sampling technique. 539 participants with a mean age of 26.8 years a median age at menarche of 13 years were included. Regular menstruation was reported by 476(88.3%) participants. Median duration of bleeding was four days. Passing clots during menstruation was reported by 157(29.1%) females with majority (n=90,57.3%) passing clots only on a single day and another 53(33.8%) on two days. Only 79 has reported that they are passing clots in every cycle. Flooding was reported by 31(5.8%) participants. 137(25.4%) reported that they had perceived severe menstrual issues in the past. 68(12.6%) women sought medical care for menstrual issues, while others who has perceived that they had severe problem(s) didn’t seek medical care. Estimated menstrual blood loss was more than 80 mL among 139(25.7%) women: less than one fourth of them perceived it as a problem. For 98(18.2%) women, the available sanitary product during their lifetime was “old clothes” showing a very high level of period poverty. Age, ethnicity, education, employment and income were significantly associated with not having access to proper sanitary methods. Use of clothes was significantly higher among participants with an older age, from remote MOH areas, of moor ethnicity, having a low level of education and low monthly income. Poor health seeking for menstrual issues is consistent with several studies conducted around the globe. Period poverty and inability of management of their period often subordinate women in their life with many aspects. Proper reproductive health education to the adolescent girls/reproductive age women and reducing the economic burden on sanitary products is needed as the two main steps for overcoming this issue in Sri Lanka.