High PCOS prevalence, nutritional deficits and stigma demand urgent action

World Menstrual Health Day, observed annually on May 28, serves as a global platform to highlight the importance of menstrual hygiene and to break the taboos surrounding menstruation. This day was first initiated by the German-based NGO WASH United in 2014 to advocate for better menstrual health and hygiene management (MHH) worldwide. India is the world’s largest democracy and home to 336 million menstruators out of which only 37% have access to proper menstrual products. While those living in rural areas and borders still use ash, leaves, hay, etc. Every year in India 23 million girls drop out of schools on the onset of menstruation. Every time a young person starts bleeding, this biological event is met with fear, trauma, silence and shame. These countless taboos and stigmas put restrictive behaviour on menstruators. All these factors together have made the life of females a bare complex interplay of their everyday gender-based experiences, their biology and their medical condition.
Unfortunately, in India, menstrual justice is a missing element. India’s policies fail because they do not recognize that marking women as impure menstruating bodies is the cause of women’s health inequities from birth to death. All these factors lead to uninformed choices as a result the menstruators may miss school or work, or struggle to participate and benefit fully in educational activities (SDG 4) or economic opportunities (SDG 8) due to menstruation, and achievement of gender equality (SDG 5). Menstrual health is important for the achievement of several SDGs and is both affected by and dependent on removing stigma, discrimination and taboos associated with menstruation that often restrict the participation of people who menstruate.
As we mark this significant day, it is crucial to turn our attention to Jammu & Kashmir, a region grappling with severe menstrual health challenges exacerbated by unique geographical, socio-political, and health factors.
The Crisis in Jammu & Kashmir
One of the most pressing issues in Jammu & Kashmir is the alarmingly high prevalence of Polycystic Ovary Syndrome (PCOS) among women, which exceeds 30%, the highest globally. PCOS is a complex hormonal disorder that not only affects menstrual health but also has long-term implications on women’s fertility, mental health, and overall well-being. The high incidence of PCOS in this region can be linked to several factors, including poor nutrition, lack of awareness, and limited access to health care. The menstrual health and mental health of females are deeply connected, any problems in the former directly affect the mental well-being of the females thereby limiting her participation in the family, society and most importantly her own life.
Geographically, Jammu & Kashmir’s rugged terrain and ongoing conflict create significant barriers to accessing education and healthcare. From 3.1 children per woman in 1991 to 1.4 in 2021, Kashmir is confronted with an above-average fall in the fertility rate. In many tribal and border areas, adolescent girls are particularly disadvantaged, with little exposure to menstrual health education and inadequate access to safe menstrual products. The stigma and silence surrounding menstruation further compound these challenges, leading to poor menstrual hygiene practices and adverse health outcomes like problems with childbearing which are also considered as a strong cause for increasing domestic violence in the UT.
Nutritional Deficits and Anemia
Nutrition plays a critical role in menstrual health, and the situation in Jammu & Kashmir is dire. According to the National Family Health Survey (NFHS) 2019-21, about 73% of children aged 6-59 months and 90% of women in the region are anaemic. Anaemia, often caused by iron deficiency, can lead to severe menstrual irregularities and exacerbate conditions like PCOS. This nutritional crisis underscores the urgent need for comprehensive interventions to improve the dietary intake of women and children in the region.
Menstrual Health and Human Rights
Menstrual health is intrinsically linked to the fulfilment of several human rights, including those related to health, education, work, adequate housing, and access to safe water and sanitation. These rights extend to all persons who menstruate, irrespective of age, religion, socio-economic background or context. Inadequate menstrual health management can impede girls’ educational attainment, limit women’s economic opportunities, and undermine their overall quality of life. Therefore, promoting menstrual health and hygiene is not merely a health issue but a critical component of gender equality and human rights.
The Role of Male Participation and Dialogic Interventions
Addressing menstrual health challenges in Jammu & Kashmir requires a multifaceted approach that includes male participation and dialogic interventions. Men and boys need to be educated about menstruation to dismantle the myths and stigmas that perpetuate gender inequality. Schools and community programs should incorporate comprehensive menstrual health education that engages both genders, fostering an environment of understanding and support.
Dialogic interventions, such as community discussions and awareness campaigns, can play a pivotal role in changing societal attitudes towards menstruation. By involving community leaders, providers, and educators, these interventions can promote a more inclusive dialogue about menstrual health, encourage the use of safe menstrual products, and advocate for better healthcare services.
Conclusion
On this World Menstrual Health Day, it is imperative to recognize the unique challenges faced by women and girls in Jammu & Kashmir. Addressing the high prevalence of PCOS, improving nutrition, enhancing access to education and healthcare, and fostering male participation in menstrual health discussions are crucial steps towards achieving menstrual equity. To inculcate these values and bring about behavioural changes in our future generations, we need to make females free from gender inequities, more planet sensible, and build a world where a process as natural as menstruation does not become a barrier in her life, setting examples right there in the communities through physical and behavioural changes. By prioritizing menstrual health, we can ensure that every woman and girl in Jammu & Kashmir can lead a healthy, dignified, and empowered life.
The writer can be reached at [email protected]

Sheezana Rasool