When I was 11-years-old, I became convinced that I was pregnant -- a fear that I quietly held onto for three years, despite it being impossible.

At the time, I got my first period and was suddenly made to follow many restrictions, including not being part of any festivals or being allowed to enter the kitchen while menstruating. I did not have any idea what was happening to my body and why I was made to follow rules which make no sense. I was provided with sanitary pads but the only thing that was told to me was, “You are now a grown-up girl.”

I was scared and confused, so I asked one of my close friends about periods. She told me, “You now have the seed of the baby.” With no one to speak about what was happening and all the inaccurate information provided, I thought I had a baby in my stomach and lived every day for three years with the fear that the baby would pop out anytime.

Twenty years later, not much about how girls find out about their bodies has changed. Talking about periods is still a taboo in many communities in rural—and urban—India. Suman (name changed), who I met during the menstrual health workshops in rural Rajasthan, shared that she suffers quietly in excruciating pain during menstruation because she is not allowed to talk about it. Another young woman, Sugibai (name changed), shared her belief of considering menstruation as a punishment for the sins she has committed.

Components of a New Curriculum

The first step is to educate girls and women with a holistic and engaging curriculum. Instead of just focusing on menstrual hygiene, it should start by creating an understanding of the menstruation process and its role in reproduction. Girls and women should be made to understand that menstruation is a normal biological process that brings in both physical and emotional changes; there should be no shame attached to it. Hygiene is important, but girls need to understand what is happening in their bodies.

A core part of this curriculum should also address menstrual disorders, which are one of the most ignored health issues in low-income countries. A study found that there is a high prevalence of painful cramps, heavy menstrual bleeding and menstrual irregularity among young females. Because of poor understanding of these issues, many don’t receive timely diagnosis and relief, which affects working abilities, and leads to school dropouts and severe reproductive health outcomes, including infections and infertility.

Having this curriculum is the first step, but then we need to make sure it reaches to all girls and women. For that, we need to broaden our current policies and schemes such as the Menstrual Hygiene scheme under the Rashtriya Kishor Swasthya Karyakram, which are directed towards adolescent girls leaving behind women who are equally affected by deep-rooted cultural and social taboos.

Trained and Sensitized Grassroots Trainers

The other important aspect is that the curriculum needs to be delivered by well-trained facilitators. Unfortunately, in many rural schools, the girls have told me that despite being part of the biology course, the teachers either skip or are uncomfortable explaining topics related to menstrual and reproductive health. This was my experience in school as well.

For example, one of the community health workers strongly believed that women should sleep separately while menstruating and conveyed that to other women. There is an immediate need for investment by funders and implementing agencies in training a cadre of dynamic local health leaders who can challenge age-old menstrual practices and beliefs.

Long-term Engagement is Needed to Shift Cultural Norms

In recent years, there has been an increase in menstrual hygiene awareness sessions, which seems like a step in the right direction. Unfortunately, most of them are just one or two workshops in a school or a community that is not tailored to the specific needs of different rural communities.

This is critical because different communities have different stigmas or openness to conversations about menstruation and an occasional workshop is not going to change cultural norms and taboos. Funders should support initiatives that provide an opportunity for sharing of experiences, critical discussions, creation of peer educators and working with the communities to devise approaches for an attitude change on a large scale.

Some may argue that workshops are important but aren’t enough. They’re right and education needs to be complemented by facilities, such as menstrual friendly toilets. That includes ensuring toilets in schools and in communities have running water, handwashing space and a disposal system.

At the household level, the government should incentivize each family to build menstrual-friendly toilets or convert the existing toilets to similar standards. This is all in addition to the work to ensure that girls and women have access to various products for menstrual hygiene management, such as compostable disposable pads, cloth pads, tampons and menstrual cups so that they use products based on the needs and preferences.

India has been one of the leading countries to have put in place programs and schemes surrounding menstruation. However, we cannot overlook that even in the 21st century, discriminatory menstrual practices emerging from draconian thoughts and structural barriers are still preventing many girls from reaching their full potential.

The government and donor agencies must recognize the urgency of this issue and realize that the quick-fix solution is not enough.

Comprehensive solutions need to address menstrual health from three perspectives: a biological health perspective, a social and cultural perspective and as a matter of sexual and reproductive health rights. Our girls and women, like Suman and Sugibai, can only have an equal opportunity to excel and prosper if we remove the stigma from menstruation.

Monalisa Padhee, PhD, is a medical researcher and the head of Women Wellness Initiative and Enriche health at the Barefoot College working with women and girls in rural India. She is a 2019 Aspen New Voices Fellow.