Shhh! It’s menses…!

I was done with the OPD and the receptionist let in a slew of medical rep. It was late afternoon and I was busy, simultaneously suppressing a yawn, checking my phone, posting updates on FB, surfing for some reference and in general trying not to pay attention to the rep’s sonorous sales talk. There’s hardly anything worth attention, in their routine, rote, monologue. All of a sudden one utterance caught my attention. He was pleading, ‘…it’s festival season sir, and a lot of women want to postpone their periods. Please prescribe my brand! The company has raised the target for this season sir, and I can achieve it only if you help.’ He left, daintily placing a sample of his product on my table. I was awestruck.

The pharma could readily afford to reach a small time, small town practitioner like me! The market to postpone cycles must have a huge profit margin indeed. I was aware that pharma companies go to any length in this dog eat dog race but never imagined they would do ‘this’. They had correctly sensed the Indian psyche and raised their sales pitch just at the right moment. I grew appreciative.

It’s such a routine request; it’s pooja, festival or pilgrimage; rarely though, its travel or exams. It’s all in a day’s work really, patients walk in, ask for postponement and a few questions later, reflexively, I scribble a prescription. I do get agitated but usually keep mum. ‘How stupid!’, I muse, ‘Their ideas of purity and impurity belong to the middle ages.’ If I have time to spare, which is but rare, I probe further,

‘What are you qualified as?’

‘x’ comes the reply. x can take a value ranging from illiteracy to post-doctoral studies.

‘Do you sincerely believe that menses are impure, that you should stay away from the rituals?’

‘Oh no! The function is in my own house…’, ‘Ours’s is an orthodox family…’, ‘We follow every tradition…’, ‘It’s my mother in law, you see…’ these are the usual replies; regardless of the value of x.

In my twenty years of practice no patient has ever told me that she does not agree with this idea but is being forced into it.

This impurity bias against menstruating women has deep roots. A natural, physiological, essential function has sprouted religious, personal, familial and economic shoots. Where do these ideas come from? They are ingrained right from childhood. Mother, elder sister, neighbors harbor them.  One just imbibes them, as a sponge, soaking up water.

Often as I talk to school girls about adolescence, they use the word ‘problem’ for menstruation. ‘I am having a problem…etc.’ I urge them not to use the word ‘problem’. ‘Not having your menses may mean that there is a grave problem!’ I quip. ‘Problem’ gives a negative connotation to a very essential, physiological process, doesn’t it? But this is a moot question. The word doesn’t cause the negativity, it only reflects what is already in the air. However, I still feel that such words should not be used. They darken the negativity and lend it an air of righteousness, a stamp of social approval.

The same misconstrued concept is reflected in other such words. The colloquial words for curettage are all on these lines. They talk of ‘washing’ or ‘cleaning’ the uterus (thaili dhona in Hindi, pishvi saaf karane in Marathi); as if it was an organ that gets soiled or defiled from time to time.

Once menstruation is labeled as a ‘problem’, rest follows automatically. It’s now easy to believe that menstruation is a process of discharging the month long ‘waste’. No wonder societies across the globe have linked menstruation to impurity. The vagina is between the urethra and the anus, which serve essentially excretory functions. Lack of insight in physiology led people to label menstruation as excretory.  In fact (most) bodily cells die and are regenerated all the time. Our skin is shed, hair fall, the RBCs live for 120 days; it’s something akin to this. The uterine lining can sustain gestation for a certain time and then it ceases to be of help. It has to be shed and a new lining generated to replace it. That’s cyclic menstruation. The point is menstruation is not a truly excretory function. But women (and men) often believe that it’s a monthly cleansing process.

Thus, a separate dwelling for a menstruating woman, separate food, staying away from rituals, temples and pooja, having a ritual bath on the fifth day; such traditions and taboos result from this basically faulty premise. Whatever your caste, whichever your religion; as for menstrual taboos all religions are equal.

There are people who justify this quarantine. ‘That’s her only chance to rest, have some peace…’, they argue. It simply means that the woman is made to slog it out at all other times. This is a concession made out of a sense of impurity, not out of respect or indebtedness. The family wants to absolve itself of the impurity and hence this compromise. It’s not out of respect towards the woman, nor in recognition of her contribution towards the family.  Women should refuse such ‘rest’. It’s no gift; it’s a tip. Women will do well to refuse such audacious benevolence.

With the how and why totally unknown menstruation must have been mindboggling for our ancestors. There’s the monthly bleed. So similar to the lunar phases! A divine, superhuman power must be at work for sure. It starts at adolescence, ceases with senility, ceases during pregnancy…! So odd, so mysterious it must have seemed. But we need not share the same awe and carry on the same ill-informed practices, need we?

We now understand menstrual physiology to the extent that we have medicines to alter its course. But we aren’t willing to use these with reason. We harness this knowhow to strengthen our traditional notions. Glory to our progress! Glory to our scientific outlook!!

Society has menstrual taboos. But why perpetuate those?  Who decided that natural menses is ill but postponing it with a pill is ok?  Should one not rethink and do away with such constrain?  Marathi Saint Poetess Soyarabai pointedly asks, ‘…if menstruation is natural how can any religion be defiled because of it? How can the species propagate without this?’

Argue on these lines and there are two counters. First, ‘it’s the patriarchy, women think with men’s brains’ and second, ‘what’s wrong with postponing menses, it does no harm, does it?’

The answer, let’s see this as the first step towards negating current social order.  It’s a simple step. If stated firmly anyone can be easily convinced. But it’s easy to be firm only if you are convinced. However, if you are unsure, you have lost it.

In response to, ‘What’s the harm?’ argument, I can say only this. Small tradeoffs ultimately weaken the cause. Aai (Mom) does it, so Tai (elder daughter) follows and since Tai does it the younger one follows; the ‘sanskar’ of meekly submitting to tradition and taboo is passed on automatically, effortlessly, unnoticed. This is enough of harm.

This should stop. Men and women should be able to perceive their bodily functions in a healthier and fairer manner. Someone somewhere should make a beginning.

Dr. Shantanu Abhyankar

(Dr. Shantanu Abhyankar is a Gynecologist based in Wai, Dist. Satara, Maharashtra. He is a well-known speaker, published writer and translator. He has also contributed chapters to books on rural obstetrics (Management of PIH in rural practice; tips & tricks in rural gynecology and obstetrics) and medical disorders in pregnancy (Management of thyroid disorders in pregnancy). He can be reached at shantanusabhyankar@hotmail.com)