Government launched a scheme for Promotion of Menstrual Hygiene which aims at ensuring

adequate knowledge and information about menstrual hygiene and the use of sanitary napkins
among adolescent girls. The scheme has been launched as part of the Adolescent Reproductive
and Sexual Health (ARSH) component under RCH II.The sanitary napkins are Provided under
NRFIM's brand, 'Freedays'. These napkins are being sold to adolescents girls at the rate of Rs. 6
per pack of six napkins by Accredited Social Health Activists (ASHAs).

From out of the sale proceeds, the ASHA gets an incentive amount of Re. 1 per pack, besides
getting a free pack of sanitary napkins per month and the balance Rs 5 is to be deposited in the
State/district treasury. The scheme has taken oil in 107 districts in the 17 States that are being
supplied sanitary napkins through Central procurement.The type of absorbent material used is of
primary concern since reusable material could be a cause for infection if improperly cleaned and
poorly stored.

Menstruation, the periodic vaginal bleeding that occurs with the shedding of the uterine mucosa
is one of the signs of puberty, and occurs one or two years following appearance of secondary
sexual characteristics. Menstruation is generally considered unclean in Indian society.

Various local agencies have taken up the production of sanitary napkins to provide safe sanitary
pads available and affordable to the community users. Jayaashree industries of Muruganandam,
V care product from Living Development Society, Indore, Cashpore —Healing foundation
supported unit at Buxar etc. are some of the local initiatives which have involved women in the
production and selling of sanitary napkins. It is perceived that this will raise awareness among
users and also provide economic independence to the women involved in the production unit.
 CHAPTER-2
LITERATURE REVIEW
What is puberty?

Girls between the ages of 8 and 13 and boys between the age of 10 and 15 undergo many
physical and emotional changes as they grow up from being a child to eventually becoming an
adult. This period of adolescence, with all the changes that happen during this time, is referred to
as puberty.

A few examples of such changes noticeable in girls are development of breasts, appearance of
pubic hair and the beginning of menstruation. With respect to boys, appearance of facial and
pubic hair, deepening of voice and development of muscles are examples of such changes.

It is important to remember that the time of onset of puberty and its completion varies at an
individual basis.

What is Adolescent?

Adolescence begins with the onset of physiologically normal puberty, and ends when an adult
identity and behaviour are accepted. This period of development corresponds roughly to the
period between the ages of 10 and 19 years, which is consistent with the World Health
Organization's definition of adolescence.

An introduction to female reproductive system

Pituitary gland

The pituitary gland (also called 'master gland') is a pea sized gland located at the base of the
brain. It secretes hormones that control the development and function of different organs in the
body. Hormones are chemical messengers that influence the functioning of their target organs.
One such hormone is the growth hormone 'G H' which causes the human body to grow. It results
in development of an infant into a child and the subsequent growth of the child to become an
adolescent and eventually an adult.
Pituitary

Uterus, which is also known as womb, is an inverted pear shaped female body organ located in
the lower abdomen. During pregnancy it holds and nourishes the baby.

When a girl reaches sexual maturity, her uterus develops a soft and thick lining on its interior
surface every month to provide a nourishing bed for a prospective baby. This lining is called
endometrium (pronounced: N-dow-met-ri-um) and is made of numerous blood vessels and soft
tissue. If a baby is not conceived during the month, the endometrium is shed and the uterus then
begins to develop a new lining for the forthcoming month.

Vagina

Vagina (pronounced: vaj-I-na), also known as birth canal, is a tube shaped female body organ
with one end leading to the uterus and the other end leading out of the body between the legs.
Cervix

Cervix (pronounced: ser-vix) is the lower end of the uterus that opens into the vagina. It secretes
mucus called cervical mucus. The function of cervical mucus is to moisten the walls of the
vagina and from time to time, it is expelled from the vagina.

During menstruation the cervix stretches open slightly to allow the enciometrium to be shed.

Ovaries

Ovaries (pronounced: 0-va-rees) are a pair of female body organs, each about the size and shape
of an almond, located on either side of the uterus. Since a girl's birth, her ovaries contain
thousands of immature egg cells. Once she reaches sexual maturity, one egg from either of her
ovaries develops and is released into the uterus every month. This process is called ovulation
(pronounced: O-vyu-la-shun).
Fallopian tubes

Fallopian (pronounced: fa-lo-P-an) tubes are a pair of narrow tubes stretching from the ovaries to
the uterus. Each of the tubes has one of their ends leading into the uterus while the other end lies
close to the ovaries. The ends of the fallopian tubes close to the ovaries are covered with finger
like projections called fimbriae. Each of these fimbriae are covered with tiny hair like projections
called cilia.

When an egg cell is released from the ovary, it is swept into the fallopian tube by the cilia of the
fimbriae. Once inside, the egg cell travels through the fallopian tube towards the uterus. It is
inside the fallopian tube that an egg is generally fertilized. Fertilization is the process by which
the male reproductive cell (a sperm) unites with an egg cell.

What is menstruation?

Every month a sexually mature female's ovary releases an egg cell that travels towards the uterus
through the Fallopian tube. The uterus prepares for a possible pregnancy by
developing a uterine lining made of tissue and blood vessels. This lining is called endometrium.

If the egg is not fertilized and pregnancy does not occur, the uterine lining is shed and it exits the
body through the vagina as a mixture of blood and tissue over a course of 3 to 7 clays. This is
called menstruation (pronounced: mens-troo-A-shun) or a period. The cycle stares over again
with an egg that begins to mature in one of the ovaries. This cycle is called menstrual cycle and
is generally 25 to 35 days long.

Phases of Menstrual cycle

The clay count for menstrual cycle begins on the first day of menstruation when blood starts to
come out of the vagina. In this section, the length of menstrual cycle has been assumed to be 28
clays (which is the average among women). The entire duration of a Menstrual cycle can be
divided into four main phases:

1. Menstrual phase (From day 1 to 5)

2. Follicular phase (From day 1 to 13)
3. Ovulation phase (Day 14)
4. Luteal phase (From day 15 to 28)
Menstrual phase (day 1-5)

Menstrual phase begins on the first day of menstruation and lasts till the 5th day of the menstrual
cycle. The following events occur during this phase:

 The uterus sheds its inner lining of soft tissue and blood vessels which exits the body from
the vagina in the form of menstrual fluid.
 Blood loss of 10 ml to 80 ml is considered normal.
 You may experience abdominal cramps. These cramps are caused by the contraction of the
uterine and the abdominal muscles to expel the menstrual fluid.
Follicular phase (day 1-13)

This phase also begins on the first day of menstruation, but it lasts till the 13th clay of the
menstrual cycle. The following events occur during this phase:

 The pituitary gland secretes a hormone that stimulates the egg cells in the ovaries to grow.
 One of these egg cells begins to mature in a sac-like-structure called follicle. It takes 13 clays
for the egg cell to reach maturity.
 While the egg cell matures, its follicle secretes a hormone that stimulates the uterus to
develop a lining of blood vessels and soft tissue called endometrium.

Ovulation phase (day 14)

On the 14th clay of the cycle, the pituitary gland secretes a hormone that causes the ovary to
release the matured egg cell. The released egg cell is swept into the fallopian tube by the cilia of
the fimbriae. Fimbriae are finger like projections located at the end of the fallopian tube close to
the ovaries and cilia are slender hair like projections on each Fimbria.
Luteal phase (day 15-28)

This phase begins on the 15th day and lasts till the end of the cycle. The following events occur
during this phase:

 The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours.
 If a sperm cell does not impregnate the egg cell within that time, the egg cell disintegrates.
 The hormone that causes the uterus to retain its endometrium gets used up by the end of the
menstrual cycle. This causes the menstrual phase of the next cycle to begin.

What are the different ways to manage menstrual flow?

During menstruation the menstrual fluid needs to be absorbed and disposed off in the right
manner. This can be done using any of the following products:

1. Disposable sanitary pad: This is an absorbent pad worn between the vulva and the
underwear.
2. Reusable cloth pad: This is a sanitary pad made of cloth that can be washed and reused.
3. Tampon: This is a mass of absorbent material that is inserted in the vagina to absorb
menstrual fluid.
4. Menstrual cup: This is a bell shaped cup usually made of silicone that is inserted in the
vagina to collect the menstrual fluid to dispose it later. Menstrual cups can be washed and
reused.