Navigating the Intersectionality of Menstrual Health and Mental Well-being

The Menstrual Health x Mental Health Roundtable at the national conclave, “Re-envisioning Menstrual Health: Shaping India’s Narrative” on 23rd & 24th November 2023 in Delhi, brought together diverse voices to explore the intersectionality of menstrual health and mental well-being by generating evidence, identifying best practices, designing solutions, and deploying them at scale through a collaborative approach. Spanning various life stages, including Pre-Menarche Adolescents, Adult Menstruators, and Menopausal Transitioners, the discussions revealed nuanced challenges and opportunities. This article aims to provide a comprehensive synthesis of findings, articulate actionable insights, and identify collaborative opportunities to enhance the intersectionality of mental health and menstrual health.

Beyond the physiological, the integration of menstrual health and mental health signifies a paradigm shift in healthcare’s holistic approach. Traditionally confined to separate policy spheres and funding structures, these integral components of well-being are often viewed through isolated lenses. The silos artificially constructed around menstrual health (often seen through a gender or WASH lens) and mental health (positioned within public health) have left critical intersections unexplored.

This separation, administratively convenient as it may be, has given rise to unaddressed challenges. The experience of navigating menstruation extends beyond the physical, intertwining with mental and emotional well-being. Hormonal fluctuations impact emotional health, societal stigmas fuel shame and embarrassment, and the emotional toll often goes unnoticed. It is this awareness gap that the menstrual health and mental health initiative strives to bridge, recognizing the intertwined emotional and psychological dimensions of menstruation.

“I really don’t feel like doing anything when I’m on my periods. I feel lazy, fatigued and unable to do things that I regularly do.”

The urgency for this shift lies at the heart of the Menstrual Health and Mental Health initiative — a collective effort to break down silos, generate evidence, and unlock opportunities where menstrual and mental health converge. Recognizing their interdependence is pivotal for comprehensive healthcare, paving the way for effective and inclusive solutions

National Policy Roundtable

Led by Uninhibited and supported by Dalberg, the Menstrual Health & Mental Health Roundtable focused on acknowledging the psychological distress and emotional well-being in menstrual health. With over 60 experts in attendance, the participants collectively recognized the importance of making mental and emotional well-being a mainstream agenda. As a follow-up, a working group is in the process of being established to exchange best practices, advocate for adoption, and raise awareness on this critical topic.

For Pre-Menarche Adolescents

Insights: The discussions highlighted a concerning communication gap surrounding menstruation, particularly in rural areas, where the subject remains taboo. This lack of dialogue contributes to an environment where adolescents feel compelled to keep their struggles hidden, adversely affecting their emotional well-being. While some initiatives have been taken in educational institutions, these fall short of delivering comprehensive information, necessitating teacher sensitization and the development of credible content. Adolescents in urban areas witness fragmented knowledge acquisition through social media and peer interactions, underscoring progress but revealing its inadequacy. The onset of menstruation, coupled with an information gap, significantly impacts self-esteem, leaving young adolescents feeling isolated. Moreover, the discussion shed light on the oversight of best practices for menstrual health and coping mechanisms for emotional support.

Action Items & Next Steps: To address these challenges, the roundtable emphasized the importance of creating equitable spaces that normalize discourse around menstrual health. This involves prioritizing menstrual health in schools and households and fostering open conversations. Formalizing information as part of the curriculum in educational institutions emerged as a key strategy to encourage information-seeking behaviors among young women. Additionally, active collaboration with policymakers, civil society organizations (CSOs), and corporate social responsibility (CSR) initiatives, coupled with government monitoring, was deemed essential.

Opportunities identified include:

1. Enabling conversations within households around menstrual health and mental health
2. Building a comprehensive menstrual health and mental health ecosystem through collaborative action between different stakeholders
3. Streamlining educational institutes to be comprehensive ecosystems for menstrual health and mental health.
4. Include voices of young adolescents in decision-making processes surrounding menstruation to create an equitable space.

“I don’t talk about periods, they’re dirty, it stains and it stinks. It is embarrassing and a personal matter, why should one go around discussing it?”

For Adult Menstruators

Insights: Adult Menstruators face challenges related to inadequate support systems, insufficient awareness, and affordability concerns impacting menstrual hygiene practices. Privacy issues within households and healthcare setups, especially for working-class women, present significant safety worries. Affordability becomes a substantial barrier in semi-urban and rural areas, where family budgeting directly influences menstrual hygiene practices, often leading to compromised choices and safety concerns.

Action Items & Next Steps: To address these challenges, the roundtable highlighted the need to destigmatize menstrual health through education, developing a clear vocabulary, and establishing definitions. Recognizing the vital role of family support, especially from men, emerged as an imperative strategy to normalize seeking help and unburden menstruators. Additionally, there was a consensus on the urgency to fill the research gap in rural areas, requiring sufficient budget allocations and addressing existing shortcomings.

Opportunities identified include:

1. Standardizing the acknowledgment of menstrual hygiene within our conversations around adolescent healthcare across the country
2. Inculcating safe menstrual hygiene practices within families
3. Leveraging existing National Family Health Survey (NFHS) data for policy action
4. Incorporating perspectives from rural communities during policy reforms and implementation

“I’m not allowed to enter the kitchen, pray or attend festivals. It is a little sad when I have to sit in a corner and don’t get to enjoy with others.”

For Menopausal Transitioners

Insights: The discussions underscored a significant knowledge gap surrounding menopause, contributing to a lack of support and understanding. Limited access to services (within families and institutions) and the perpetuation of stigma added layers of complexity, causing psychological stress during this crucial life stage.

Action Items & Next Steps: To address these challenges, the roundtable stressed the need to sensitize and train doctors and healthcare practitioners to provide both physical and psychological support. Opening dialogue surrounding menopause was identified as a critical step to dispel stigma, increase support networks, and provide sufficient knowledge. Establishing support groups was deemed imperative to foster an environment where individuals can navigate this natural transition with knowledge and support.

Opportunities identified include:

1. Enabling the environment to normalize conversations around menopause
2. Leveraging social media for increased awareness and access to knowledge
3. Tapping into existing channels to address menopausal transitioners, and offering support services.

“As a mother, I’m responsible for my daughter. But the pain (during menstruation) is very common, one just has to deal with it. ”

In conclusion, the discussions revealed intricate challenges and promising opportunities at the intersection of menstrual health and mental well-being. We aspire for this article to serve as a catalyst, prompting readers to contemplate this intersection and providing essential information for those already engaged or who wish to engage in these vital spaces. It also encourages collaborative efforts, urging readers to join in creating a more inclusive and supportive environment for menstruators, thereby fostering improved outcomes in both menstrual and mental health.

If you would like to actively contribute to our working group, please reach out to us at priyanka@uninhibited.org.in, and we would be delighted to connect with you.

Written By

Team Uninhibited & Dalberg

#NaCoMH #menstrualhealthpolicyinindia #menstrualhealth