Covid impact on menstrual cycles? Young girls 'relapsing' back to unhygienic old-cloth rags

By Dr Sudeshna Roy* 
Covid-19 pandemic has gripped the world in health and economic shock. Combating this public health crisis has diverted development resources earmarked for adolescents and the youth. India; having world’s second largest population; 1.38 crores as per UN mid-year 2020 estimation, also shelters the largest adolescents and young adult population, which at 243 million constitute 20% of the world’s 1.2 billion adolescent population.
Adolescence is the critical juncture in an individual’s lifespan; marking the transition from childhood to youth conspicuous by physical-psychological changes. It is imperative to delve into the health challenges emerging in the post-Covid-19 world that are affecting this population cohort; which the slated demographic dividend that is envisaged to be realized till year 2055 would tend to implicate. With the debate on Uttar Pradesh Population Control Bill, 2021 simmering, the adolescent girls are suspected to be further marginalized.
The enormity of the physical health needs gaps can be gauged from that Covid-19 led economic shutdown has resulted in accelerated unemployment rates, unbridled pay-cuts and poverty which has severely compromised the dietary and sexual and reproductive health (SRH) needs of the adolescent girls. The unemployment rate in India in 2017-18 was a 45 year high at 6.1%, while in March 2020, it rose to 8.8%.

Sexual and reproductive health (SRH) and nutrition

One of the most neglected facets of public health is the SRH needs among the adolescents in India. Discussion on sexuality and gender identity, bodily changes, menstruation and protected sexual relationship are tabooed subject in Indian society.
There lies a wide gap in the demand for information on these stigmatized discourses and how they are addressed among the adolescents. Furthermore, drop-out and from school consequently also results in inaccessibility to mid-day meals, sanitary napkin distribution and iron and folic acid consumption thus hampering uptake of nutrition and menstrual health needs.
Anemia, malnourishment, underweight and stunting is schools in Delhi-NCR catering to economically weaker section (EWS) children dispense sanitary napkins for free every month, which has seen a setback since the first-wave lockdown. It is a big tradeoff for poor households between buying napkins against food.
With drastic reduction in household income coupled with production shortages and delays in supply logistics of menstrual hygiene products due to lockdown and containment zonation it is feared that young girls have relapsed back using unhygienic old-cloth, saw-dust/ash, rags, leaves, during monthly menstrual cycles; severely putting their reproductive health at high risk; given that anemia, cervical cancer, reproductive tract infections are associated with poor menstrual health management (MHM).
About 71% of adolescent Indian girls are unaware about menstruation until they start bleeding themselves. There is an utter lack of preparedness even on the part of parents who avoid conversations on such topics, culminating into panic and anxiety among the young children. Moreover, spurt in child marriages will have severe health repercussions on adolescents and young girls as they are victims to forced early multiple pregnancies, intimate partner violence (IPV) and premature maternal deaths.
NFHS-4 (2018) estimates reveal that teenage pregnancy situation in India is quiet distressing; 1 in 3 adolescents who are married off become mothers before becoming adults. Almost 27% of these girls have babies by age 17 and 31% by age 18 years; with Goa (64%), Mizoram (61%) and Meghalaya (53%) being the states with highest rates.
Covid-19 has exposed the dearth of healthcare services pertaining to antenatal care (ANC), abortion and family planning among the young married and unmarried people. Regular ANC checkups and in-person consultations being scrapped, have adversely affected the young uninitiated pregnant women.
According to the directives by Adolescent Health Program of India, provision of counselors is mandatory at district and sub-district levels but tighter monitoring and evaluation is required to see how they have coped up during this pandemic. A study from Foundation for Reproductive Health Services (FRHS) reveals that, 2.95 million unintended pregnancies and 1.04 million unsafe abortions could have happened due to lockdown in India.

Mental health

Estimated, 9.8 million adolescents in age-group (13–17) years suffer from serious mental illness, damaging self-esteem and peer relationships, impairing learning, thus reducing their quality of life. Further the problems of poly-cystic ovary syndrome (PCOD) and other hormonal imbalances during teen years are not been addressed with adequate medical care. Studies have substantiated the inter-linkages between mental health issues such as erratic mood swings, restlessness, impulsive disorders and anxiety with hormonal changes.
Adolescent population has higher likelihood of being mired by incidences of eating disorders, body shaming, obesity which they are finding it increasingly difficult to cope up with post-Covid-19. Lack of outdoor sports and exercises, no physical contact with friends, long hours in front of digital screens, confinement and isolation at homes has disturbed sleep schedules and routine living which is bound to impact the health regimes of the adolescent population.

One of the most neglected facets of public health is sexual and reproductive needs of adolescent girls, a tabooed subject in Indian society

According to a report, isolation, lack of interaction, non-connectivity with peers and deprivation in emotional health needs can have long term effects on cognitive development of adolescents. Further the mental illness and mental health issues in India being highly stigmatized and mental healthcare facilities being grossly inadequate and incompetent, aggravates the disease burden of the country.

Many studies have emphasized how family relationship dynamics influence the mental health of adolescents during their growing up years. Thus, participatory approach in positive parenting with trusted and open communication between the parents and children are encouraged especially during the delicate adolescence life course and amidst these uncertain pandemic times. Parents are advised to be present and engage in their wards’ life allowing the latter’s opinion in decision making such as in career choices, family matters.

Domestic violence (DV)

Incidences of DV has witnessed mammoth spike with National Commission of Women (NCW) reporting a 48.2% rise in complaints immediately following first lockdown in 2020. Childline 1098 had also received a flood of complaints (a 50% rise in calls and 30% related to child abuse) from this age group.
But it must be remembered that most adolescent and young adult victims of DV are out of reach from help-seeking owing to inaccessibility, immobility and lack of privacy from their abusers. Intermittent lockdowns have forced vulnerable adolescents to be locked up with their perpetrators and to silently bear the aggression from male household members.
They are blatantly victimized to witness physical abuse to their mothers and women family members. 1 out of 3 women face DV in their lifetime. This will have intense, spiraling and cumulative impact on emotional health of the young adults. Anxiety, fear, stigma and numerous mental health problems will arise from such fragile domestic environment and dysfunctions in familial relationship.
The impact of violence perpetuates throughout the adolescent and adult life by submitting to, normalizing and internalizing the acts. Rates of suicide and self-harm among adolescents in India are thus one of the highest in the world is feared to accentuate.

Policy reforms

Frontline stakeholders (health workers, teachers, activists, institutional functionaries) require to upgrade capacity to tackle issues of MHM, psycho-emotional health and continuation of schooling at community level. Accessibility to robust tele-counseling services and dispersal of educational and healthcare toolkits is essential as pandemic trauma incidences are bound to exacerbate among the adolescents.
Strengthening of WASH and nutrition initiatives, regularizing social auditing of child protection and safeguarding schemes, augmenting governmental departments and NGOs accountability and mobilization of adolescents for participation in interactive peer-led collectives across India as stakeholders and not beneficiaries only, especially among the tribal, religious minorities must be made underway.

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* Ph.D from JNU, independent researcher, and writes on gender, health, livelihoods and marginalized people