For most Indian girls life changes at adolescence, that is at the onset of menstruation. Even if you are from a very liberal family there is no way that you have not been told off from doing certain things during your periods, at least once in your life. Sadly even today, the conversation around menstrual health remains a taboo. Onset of menstruation continues to change a girl’s life overnight in many parts of the country. Have you ever wondered how much do these young girls known about this physiological process before they come face to face with it? How daunting is Menarche even today?

Madhulika Khanna through her research paper The Precocious Period: Impact of Early Menarche on Schooling in India explores how early onset of menstruation (menarche) affects schooling, and if girls are more likely to dropout of school after menarche. SheThePeople speaks to Madhulika who is pursuing her Ph.D. in the Department of Economics at Georgetown University and talk to her about her research, how if certain policies have helped adolescent girls to continue schooling, what are the factors which influence parents decision to discontinue schooling and why she decided to study Economics. Read on to know more.

The study says “Taken together, these results suggest that it is the onset of menstruation and not menstruation that affects schooling.” Can you elaborate?

This study uses data from the Young Lives Longitudinal Study, a multi-county survey that follows children throughout their childhood, adolescence, and adulthood. I use the part of the survey that interviewed children at ages eight, twelve, fifteen, nineteen, and twenty-two. The second round of the survey, during which children were about twelve years old, asked girls if they had started menstruating. While enrolment was universal for boys and girls at age eight, girls who had begun menstruating by twelve were much less likely to be in school than their peers at twelve. These patterns show that early onset of menstruation (menarche) affects schooling, and girls are more likely to dropout of school after menarche.

Now that girls are not in school at age twelve, what were they doing? Based on the information on how they spend time, I can see that girls who reached menarche before twelve, spent less time in school and on studying at home, and more time doing domestic chores. However, if I look at the sample of girls who are still in school, girls who are past menarche spend as much time in school as those are yet to reach menarche. Therefore, if a girl is still in school after menarche, perhaps, she is not missing school more than her classmates. These results show that while early menarche affects enrollment, menstruation per se may not be affecting on school attendance.

While enrolment was universal for boys and girls at age eight, girls who had begun menstruating by twelve were much less likely to be in school than their peers at twelve. These patterns show that early onset of menstruation (menarche) affects schooling, and girls are more likely to dropout of school after menarche.

A lot of studies have found a limited impact on providing menstrual hygiene management products like menstrual cups and sanitary napkins on school attendance (this and this, for instance). The two findings from my study described above – menarche affects enrollment but not the time spent at school – can be reconciled with this evidence since these studies might be looking at only those girls who are still in school after menarche. Importantly, an absence of documented effect of menstrual hygiene management products cannot be taken as evidence that menstruation does not affect young girls’ schooling experience.

Based on your experience, what kind of conversations did you come across regarding menstruation among prepubescent girls?

In this study, I drew on the existing literature to understand adolescent girls’ experiences as they reach and go through menarche. As young girls are taught to hide their menses, especially from male members of the family, often, a language of euphemisms around menstruation is used. Usually, girls know little about the physiological changes related to menstruation until they experience their first period.

My own experiences of growing up in India informed some of the narratives I tried to present in the study. In school, I attended a puberty education session that was organized by a leading sanitary napkin manufacturer. This session was meant for only girls, and when we came back to the classroom after this session, our male classmates would tease us. Admittedly, I was in school many years ago, and while I hope that things have changed since then when I talk to young girls, it seems that the change has been slow to come.

Madhulika Khanna

How bad are the menstruation-related exclusions you came across?

Menarche can be a daunting experience that changes a girl’s life dramatically, and cultural practices that associate menses with ritual impurity amplify these changes. The notion of ritual impurity of menstruation is best depicted by taboos and cultural practices that continue to define women’s daily activities. For instance, women are not supposed to enter the kitchen or the prayer room during their menses. Some dietary restrictions, such as the prohibition of sour food, are also followed during menstruation. It is widely held that touching pickles during menstruation would spoil it. In some communities, young girls are instructed to stay away from water sources during their menses since they might pollute it.

If better-nourished girls typically reach menarche earlier, do you think such a finding if discussed with the cohort can be counterproductive for the girls since there are so many taboos associated with menstruation?

Potentially, yes! In some of my conversations with stakeholders working in the menstrual hygiene sector, I came across stories that prepubescent girls eat sparingly so as to not start menstruating. While this is just an anecdote and may not be generalisable, but this is also something we all implicitly understand. Many a times a family member would remark that the girl has had a growth spurt and she might reach menarche soon. It is well known that early nutrition is also closely linked to pubertal timing among girls: better-nourished girls typically reach menarche earlier. In fact, this is nothing but an evolutionary response that the women’s body is ready for reproduction. Poor nutrition severely affects menstrual cycle in adulthood too, and may even cause periods to stop.

At the same time, long-run well-being is shaped by nutritional environment in childhood such that improvements in childhood nutrition enhance both the quantity and the quality of schooling. Taken in conjunction with the biological link between better nutrition and early menarche, these findings imply that the link between menarche and school enrolment that stems from local socio-cultural norms can undermine the gains from childhood nutrition for girls. An earlier onset of menarche, therefore, is another channel through which gender gaps in human development emerge.

“They pulled her out of school soon after menarche, and she was married at fourteen. Teenage girls also face greater restrictions on their mobility and their access to school for parents fear that socialization with boys brings them a bad name and adversely affects their prospects in the marriage markets.” How can this social stigma be controlled? Is it any different in a household where the mother is educated and earns a living?

I will respond to the second question first. I find that the negative effect early menarche on school enrolment is weaker if the mothers are literate. Female education can be a vital tool to ensure equity in educational access for the next generation. Not only education, but women’s work also matters: the negative impact of menarche on the enrollment rate is attenuated in communities with relatively higher wages for teaching and nursing, which are typically female-dominated professions.

To understand how the social stigma around menstruation can be controlled, perhaps we need to understand the belief system that fosters restrictive gender norms. In some conservative communities, while families might personally reject restrictive norms, they incorrectly hold that other people accept them and continue to follow them. Fortunately, these perceived cultural norms are not immutable, and correcting false beliefs does alter behavior. Persuasion and discussion can also change gender attitudes: a social campaign that engaged children in discussions about gender equality shifted gender attitudes to be more progressive in Haryana. Interestingly, this social campaign changed the boys’ attitude more than the girls’. I think that this is hopeful because when these boys grow up and have their own families, they will traditionally have more of a say, and can foster an equitable environment for their sisters, wives, and daughters.

Over the years of the study if access to the internet has created more awareness about menstrual health?

I am not aware of any study that that explores the effect of access to internet in this context. Access to mobile phone in India is gendered in that women typically don’t have access to a private phone. In fact, adolescence marks the emergence of a gender gap in mobile usage. Research shows that parents worry that giving phones to adolescent girls would bring bad name to the family not only because they can access prohibited information but also because it can become a source of harassment. Of course, mobile phones would give young girls access to a support network and technologies can help address parents’ safety concerns. The most critical change has to be attitudinal such that families can see the benefits that access to internet would have for their daughters, and how that could outweigh all other costs, perceived or otherwise.

In some of my conversations with stakeholders working in the menstrual hygiene sector, I came across stories that prepubescent girls eat sparingly so as to not start menstruating. While this is just an anecdote and may not be generalizable, but this is also something we all implicitly understand.

What are the schools doing to tackle this dropout? The schools you came across are they equipped to make these girls safe? Do they have access to sanitary products and a facilitating school environment?

The Right to Education Act mandates that states will provide separate toilets for girls and boys on the school premises. A large scale toilet construction initiative had been launched even before this act under the Total Sanitation Campaign. We know that toilet construction was effective in stemming the dropout of pubescent girls, especially when separate-sex toilets were constructed in their schools. Another instance of a public policy that was effective in encouraging female enrolment was the Mukhyamantri Balika Cycle Yojana by the Government of Bihar. When girls cycle to school together, it reduces the safety cost of accessing education and reduces dropout among adolescent girls.

Kishori Shakti Yojana, a component of the integrated child services scheme, among other things, provides sanitary napkins to young girls. Recent evidence from the Delhi Government’s free sanitary napkin distribution scheme improved school attendance for adolescent girls. Along with allowing girls to manage their menses better, distributing sanitary napkins also fostered a more supportive environment where girls could talk about menstruation and help each other cope. Various other state governments have launched some versions of such a scheme.

Incidentally, the distribution of sanitary napkins has been disrupted during the efforts to control the spread of coronavirus. As an aside, while responding to the pandemic’s immense threat is critical, neglecting other public health services will also have welfare costs.

At present, there is considerable confusion around the institutional framework on policymaking for adolescent girls with six different ministries responsible for implementing various relevant schemes.

Tell us about yourself, why you decided to study economics and go into research.

Since my father worked with Indian Railways, we moved around a lot when I was in school. I have spent most of my life in Delhi, and it is now home. When I was younger, I thought that Economics meant studying macroeconomics and finance. My training at Shri Ram College of Commerce and Delhi School of Economics was critical in shaping my interests. I was fascinated by the toolkit that the discipline provides. In its most stripped-down version, the framework for thinking about any problem is the one where an individual (or many individuals) weighs her options and chooses the best one. With this framework, one can analyze diverse questions. The discipline gives me the freedom to study menstruation while forcing me to ground my arguments in credible evidence.

Over the past few years, my research agenda has evolved to have a strong gender focus. While this was not a deliberate choice, growing up in India, I was always conscious of the crucial role one’s gender identity plays. Of course, gendered constraints are not limited to India or the developing world for that matter. They are embedded in the social and cultural structure that reproduces itself and the deep-rooted gendered inequalities generation after generation. As the first step, through my research, I want to understand how this structure sustains gender gaps in both opportunities and outcomes for women.

Like art, while some research is essential as an end in itself, to me, the most attractive part of being a researcher is unpacking a question and putting together an answer to inform policy-relevant debates.

What prompted you to conduct this study?

Part of the inspiration to conduct this study came from my lived experiences of growing up in India. Despite growing up in relatively liberal upper-middle-class India, life did change in adolescence. I used to give hour by hour account of my whereabouts to my mother. Somehow, in the teenage years, girls in our neighbourhood would transition from playing games to walking in the evening. On a school trip, priests from a famous pilgrimage reminded our group that we should not enter the inner sanctum if we are menstruating. Our teachers dutifully confirmed with every girl that we were not menstruating before we were allowed to visit the temple.

The second and perhaps the more immediate reason to undertake this analysis was to understand if there is a causal link between the timing of menarche and schooling. While there is an important body of literature that argues that menarche affects education using case studies and careful qualitative data, to the best of my knowledge, this is the first study to explicitly establish this link using survey-based data.

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