Menstruation is a Big Hurdle to Education and the Main Reason for School Dropouts and Absenteeism among Adolescents in Pakistan

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Dear Editor, Adolescence is a transitional process that involves physical, social, and psychological changes in an individual. The menstrual cycle is a highlighted aspect of adolescence.[1] According to the study, a Pakistani girl reaches her menarche at 12 to 14 years.[2] These processes are recognized in terms of beliefs, values, and cultural practices and intentionally implanted within the gender-superiority complex-based society of Pakistan.[3] It has become taboo in Pakistan that girls feel ashamed to share their menstrual problems with their parents and school teachers, causing severe difficulty in managing the initial stages of menarche.[2] About 78.7% of girls felt embarrassed in public to buy a menstrual pad.[4] Many mothers are not informed to convey basic information on menstruation management and its hygiene to their daughters, and when they do, they limit it to bleeding management.[3] This problem is more pronounced in villages because resources like segregated toilets or WASH facilities are limited or usually absent, especially at schools.[2] The menstrual pain and fear of stains on clothes have also increased school absenteeism and dropouts in Pakistan. According to the poll by UNICEF dated March 9, 2017, 28% of respondents in Pakistan missed school during their menstrual cycle because of the embarrassment of getting stains on their clothes or dysmenorrhea. Fifty percent of the students miss 1–5 days during menstruation.[5] Absenteeism from school can also be because of the culture of silence, not telling male members of the family about menarche. There is a stigma in Sindh society that menstruation is a symbol of getting married and getting a second period in the husband’s house. To prevent early marriages, mothers do not share the information with male members and forbid their daughters from going to school or being in the company of male members. This restriction of not going to school during menses becomes a crucial factor affecting the routine of school-going girls and eventually school dropouts.[3] The other reason for absenteeism and school dropout is the lack of WASH facilities in educational institutions. They have no separate washrooms for washing private parts and disposing of absorbent products. According to the UNICEF report, June 12, 2017, regarding menstruating girls, whenever they want to change pads, they have to ask permission from teachers to leave school and not return for hours because of the long distance from school to home.[3] This trend potentially impacts the girls’ education and is a stimulating factor in absenteeism and school dropout. Pakistan must take judicial actions to implement the Menstrual Equity Act, mandating WASH facilities, providing free sanitary pads, and imposing penalties on period-based discrimination. Pakistan should transform cultural standards by promoting the National Period Literacy program, in which parents and teachers should be trained about MHM, having public negotiations with religious leaders, and running a media campaign normalizing discussion on menarche. The government must take the initiative to provide education sponsored by the MHM agreement and establish a supportive partnership for viable sanitary pads and other products. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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