Menstrual Problems of Women in Bangladesh

Abstract

Bangladeshi women suffer from menstrual problems such as dysmenorrhoea, menorrhagia, light and heavy bleeding during menstruation, and irregular period and are constantly worried if they menstrual flow is not a “normal” amount. They believe that a good menstrual flow is needed to stay healthy. If the flow decreases, they think that they’re must be “bad blood” trapped within their bodies, and if it stops altogether, they are concerned that they may have become infertile. Inability to conceive is viewed negatively in Bangladeshi society and women are subjected to psychological distress by society if they are perceived as infertile. Also, there are many social, cultural and religious taboos surrounding menstruation such as staying away from food such as fish, eggs, meat, sour fruits, etc during menstruation. Moreover, they are often advised to stay indoors as menstrual blood may attract evil spirits. Furthermore, these women also experience menstrual problems as side effects of contraceptives such as Norplant, IUD, and the pill, and sometimes discontinue its use as a result which may lead to unplanned pregnancies. Gynecological problems such as those related to menstruation are a major concern among Bangladeshi women, but social stigma and shame stand as a barrier against seeking proper healthcare. Often, they seek health advice from female relatives and unqualified health providers which in turn often leads to incorrect treatment and chronic menstrual related illnesses. Only a few studies have been carried out on menstrual problems in Bangladesh and most of them are either part of larger studies on side effects of contraceptives or a few small-scale exploratory studies. The aim of this literature review is to learn about local terminologies used to describe menstrual problems, to understand the practices and restrictions surrounding menstruation during adolescence, to learn about concerns surrounding infertility and its causes, to look at menstrual problems which result from use of contraceptives, and to examine patterns of health seeking behaviour of Bangladeshi women to treat their menstrual illnesses. This literature review was carried out by obtaining information from published reports, books and articles collected from local NGOs. Some information was also gathered from interviews with staff from local NGOs and gynaecologists from Bangladesh Railway Hospital. The review found that notions surrounding menstrual blood include perceptions that it is polluted and women should not serve food during this condition or touch anyone with an eye or skin infection as it may worsen their illness. Religious teaching also states that women are polluted during menstruation and cannot offer prayers in this state. Women tend to use local terminology to refer to menstrual problems such as kaler chut for dysmenorrhoea, humka batas for menorrhagia, and khum jhore if they get their periods twice or more a month. Perceived causes of menstrual related illnesses include evil spirits, lack of enough food, birth control pills, etc.

During adolescence, girls are taught about the various restrictions during menstruation such as not going outside and staying away from certain foods such as fish, eggs, meat, sour fruits. When they encounter menstrual problems, family members either take them to traditional and religious healers such as per, fakir and huzurs or their mothers send someone to buy medicine from the pharmacy. Bangladeshi women from lower socio economic backgrounds mostly use menstrual rags to absorb menstrual blood. These rags are often not washed well with soap. Also they are dried in dark places as it is considered embarrassing if others see these rags and it is believed that ghosts, fakirs, crows and flies can cause menstrual problems if they come in contact with these rags. These improper cleaning practices cause women to get illnesses such as RTIs from these rags. When menstrual flow is low or absent, women often perceive themselves to be infertile. Fertility is highly valued in Bangladeshi society and infertile women face many forms of social rejection and marginalization from their communities. In several studies, it was found that women blame evil spirits for their infertility. As Bangladeshi women equate a regular amount of menstrual flow with good health, contraceptive methods which alter this flow are causes for concern among these women. A study showed that use of Norplant implants cause dysmenorrhoea, intermenstrual bleeding or amenorrhea which the women dislike, yet they continue to use this method because of its effectiveness as a contraceptive. DMPA injectables were shown to cause spotting or amenorrhea among its users, but also had benefits of improving dysmenorrhoea with time. Oral contraceptives were shown to cause mainly intermenstrual bleeding but lowered menstrual pain, amount of menstrual flow and duration of menstruation. The intra uterine device (IUD) was said to cause excessive menstrual bleeding (22-24%), irregular menstruation (11-12%) and lower abdominal pain (11-13%) among 801 women in a study. About a quarter of the women reported pain during the last menstrual period and virtually all said they had no intermenstrual bleeding. Among the 198 who had discontinued use, 34.3 % had reported excessive bleeding, 17.2% reported complete expulsion, and 16.1% stated lower abdominal pain/white discharge as the causes for discontinuation. Other studies showed women to be concerned whether Norplant causes amenorrhoea because they feel impure blood is trapped within their bodies or when Norplant or IUD causes continuous bleeding because they cannot go near their husbands, pray or prepare food, as they are perceived to be in a polluted state. Despite the side effects some women may choose to continue use of Norplant as it protects them for 5 years from getting pregnant. Women in some studies also agonized when the pill or injectables brought about amenorrhoea because they believed the methods had dried out the uterus and had made them infertile. Women tend to ask other women for advice for their gynecological problems, especially women from their natal homes but rarely those who are their in laws according to a study. They also asked a traditional healer (kabiraj) from problems such as menorrhagia as they feel that these illnesses are caused by evil spirits which only traditional healers can cure. Herbal pills that cause severe bleeding are prescribed when menstrual blood is thought to be trapped within the womb by herbalists. Another method employed to remove this trapped blood is D&C (Dilation and Curettage) which “washes” out the perceived build up of fat.