Menstrual health in India needs more than just the distribution of low-cost sanitary pads

Introduction

Menstruation is normal and a healthy part of life and yet girls and women in India go through extreme struggles to manage their period every month.

• According to Census 2011 population data, about 336 million girls and women in India are of reproductive age and menstruate for 2-7 days, every month, and yet the topic of menstruation is expected to be a hush affair and kept under wraps of the ‘black plastic bags’.
• National Family Health Survey 2015-2016 estimates that of the 336 million menstruating women in India about 121 million (roughly 36 percent) women are using sanitary napkins, locally or commercially produced. Only around, 36 Percent of Women Use Sanitary Pads In India.
• A 2016 study titled – ‘Menstrual hygiene management among adolescent girls in India’ involving nearly 100,000 girls in India found that almost 50,000 did not know about menstruation until the first time they got their period. The study further explains how many girls even think that they are dying or have caught a horrible disease, the first time they menstruate, due to the pain and blood. Despite a decade of policy-making and targeted schemes, the adoption of menstrual hygiene in India has a patchy record, a lot of which has to do with awareness levels.
• A 2014 UNICEF report pointed out that in Tamil Nadu, 79 per cent of girls and women were unaware of menstrual hygiene practices. The percentage was 66% in Uttar Pradesh, 56% in Rajasthan, and 51% in West Bengal.

By considering the Data available, we can say, It is not just about schemes or distributing sanitary pads. Much more needs to be done to make adolescent girls more aware of menstrual hygiene. Girls can't talk about this at home. In government schools, teachers don't spend time talking about the subject or clarifying doubts. Many girls have half-baked information. We need more openness about menstrual hygiene and awareness.

Menstrual Health and Hygiene (MHH)

Menstrual health and hygiene (MHH) encompass both MHM and the broader systemic factors that link menstruation with health, well-being, gender equality, education, equity, empowerment, and rights.

These systematic factors have been summarised by UNESCO as accurate and timely knowledge, available, safe, and affordable materials, informed and comfortable professionals, referral and access to health services, sanitation, and washing facilities, positive social norms, safe and hygienic disposal, and advocacy and policy.

How it is correlated with other aspects?

Menstruation and the Health

If a woman does not have access to menstrual hygiene products, the issue can increase a woman’s chances of contracting cervical cancer, Reproductive Tract Infections, Hepatitis B infection, various types of yeast infections, and Urinary Tract Infection, to name a few.

Menstruation and Impact on Education

Studies show that almost 23 million girls in India drop out of school annually, because of a lack of menstrual hygiene management facilities, including the availability of sanitary napkins and awareness about menstruation. The report suggests that the girls, who don’t drop out, usually miss up to 5 days of school every month.

Menstruation and the mental health

They go through mental suffering, in addition to the physical pain and discomfort, only add to their anxiety. The increased burden of household work and childcare, to dealing with emergencies at work, women in healthcare are at risk of developing complications with their menstrual cycles, with consequences for their reproductive health. 

Materials used during menstruation

Only around, 36 Percent of Women Use Sanitary Pads In India. The pattern of usage varies from state to state. In Bihar, around, 82 percent of women depended on cloth. In Uttar Pradesh, 81 percent used homemade alternatives like old cloth, rags, hay, sand, or ash.

Reasons behind the unhygienic practices

1. Cultural Taboos- Menstrual health in India is still largely governed by taboos and a lack of information. It needs to be addressed through social and behavioral change programs. A large chunk of the Indian population believes this natural cycle to be a ‘curse’, ‘impure’, and ‘dirty’ among other things, courtesy of the ancient myths surrounding menstruation in our country.
2. Lack of Awareness- Lack of awareness makes for a major problem in India’s menstrual hygiene scenario. Indian Council for Medical Research’s 2011-12 report stated that only 38 per cent of menstruating girls in India spoke to their mothers about menstruation. Schools were not very helpful either as schools in rural areas refrained from discussing menstrual hygiene. A 2015 survey by the Ministry of Education found that in 63% of schools in villages, teachers never discussed menstruation and how to deal with it hygienically.
3. Lack of Sanitary Napkins and Adequate Facilities-Most girls rely on home-grown or other readily available material, the latter often being unhygienic and unsanitary. Only 2 to 3 per cent of women in rural India are estimated to use sanitary napkins. This results in women resorting to unhygienic practices during their menstrual cycle.
4. Lack of health awareness- There is little knowledge about the health consequences of using unhygienic methods for menstrual management. The usage of cloth, which is a traditional method, in itself is not unhygienic and is also a sustainable option, but it requires washing and drying in the sun. Most women in India do not feel comfortable with the washing and drying because of prevailing taboos, apart from lack of access to water also proving to be a problem.
5. Lack of disposal facilities-Unavailability of disposal mechanisms for pads, poor water supply for washing or flushing, poor hygienic conditions of the toilets, lack of soap, washbasins, mugs for washing in the toilets, and no separate toilets for girls were major WASH challenges girls faced during menstruation. Broken locks/doors of the toilets were a matter of concern for the security of the girls in schools.
6. Higher costs-Limited supply and escalating prices keep sanitary pads out of reach of women, especially poorer women. And for those living in relief camps, shelters, and quarantine centers, access to food, water, and medicines are often deemed more important than pads, whereas they are equally

Initiatives taken to spread hygiene and awareness

• Menstrual Hygiene Day (MH Day) is a global advocacy platform to promote good menstrual hygiene management (MHM) for all women and girls. It was initiated by a German non-profit organization called WASH United in 2013.
• The initiative of Menstrual Health Alliance India was started.
• In 2019, AbMeriBaari(It's my turn now), a campaign launched by the 10to19 Adolescents Collaborative, helped girl champions to present a charter of ten bold recommendations to government representatives, frontline health workers, community leaders, non-profit organizations, and peers to improve adolescent health and wellbeing.
• In 2015, another milestone was achieved when the Ministry of Drinking Water and Sanitation published guidelines on MHM
• The World Health Organization proposed the concept of Health Promoting Schools (HPS) in

The available alternatives

• Alternative menstrual hygiene products such as reusable pads made of various textiles, menstrual cups are available in the market
• Menstrual cups also offer another affordable and environment-friendly alternative. She Cups, Boondh, Soch, and Stonesoup Wings are examples of brands of menstrual cups marketed by Indian retailers. But given taboos related to vaginal insertion and an uninformed linkage with virginity in several low and middle-income countries.
• More research is also needed to identify the information, guidance, and supportive eco-system that would be needed to ensure hygienic use of menstrual cups. Unhygienic practices may lead to a higher risk of reproductive tract infections as the product is vaginally inserted.

What has changed over time?

• There has been a marked improvement in awareness. A report by the National Institute of Public Cooperation and Child Development found that the awareness of adolescent girls about menstruation till its onset had gone up from 29.4 percent in 2007 to 72.6 percent in 2012, while knowledge on washing and reusing cloth had gone up from 57.6 to 82.5 percent. 

What is required for an India with Menstrual Hygiene?

• Breaking the taboos- The myths and taboos surrounding menstruation need to be broken down effectively before schemes and incentives make their way to make life better for menstruating women. In rural India, the biggest challenge continues to be lifting the silence over menstruation, addressing period poverty, and tackling the shame that still surrounds this natural process. Progress is being made, slowly.
• Awareness generation-Conditions for menstruating women in India can only improve when awareness of menstrual hygiene is spread. For example, there is a need to reiterate messages around the importance of drying reusable pads in sunlight after washing them with soap and water.
• Safe and hygienic material- Sanitary napkins must be provided to menstruating women to ensure that they do not fall prey to age-old unhygienic traditions of using cloth, soil, or sand.
• Inclusion in the educational curriculum- A national educational curriculum that focuses on practical and biological aspects of menstruation and personal hygiene should be included to spread awareness. The report quoting various studies in 2015 and 2016 said that girls typically miss 1-2 days of school per month.
• Sanitation practices-Hand-washing facilities with soap, sanitary products/disposal mechanisms, and hygiene education can be strengthened in many schools. A critical window of opportunity is available to provide girls and women across India with clean water, decent toilets, and good hygiene, and ensure that these facilities are responsive to their monthly menstrual needs.
• Implementation of schemes- The implementation of the government's schemes is a big issue. A major problem arises when field workers do not have a full understanding of menstrual hygiene, and its dos and don'ts.
• Frontline workers-There are not enough front line workers who have finished school. The accredited social health activists (ASHAs), the backbone of India's primary health-care system who are tasked to promote menstrual health and hygiene, are already overburdened.
• Sanitation facilities at the workplace and home-The installation of sanitary pad vending machines in toilets, action on safe and responsive water, sanitation and hygiene facilities to enable girls and women to practice hygiene in schools, homes, and workplaces.
• Safe disposal-One big emerging challenge is the safe disposal of sanitary napkins. Most sanitary pads sold in India are made of non-biodegradable ingredients and are environmentally hazardous.
• PPP-Access to essential menstrual products must be eased through private and public sector channels.Large scale manufacturers must facilitate supply to shops and medical stores, equitably across geographies, and ensure that retail prices are well within MRP limits.
• Decentralization- State governments can aggregate and release product stocks through district administrations. District officials can facilitate access at the last mile through frontline workers (ANMs, ASHAs, Anganwadi workers), SHGs, community volunteers and groups, and NGOs working with communities. 

Conclusion

 A woman’s menstrual health is crucial to her well-being and also to the well-being of her family and community. But too often mindsets, customs, and institutional biases prevent women from getting the menstrual health care they need. Menstrual hygiene continues to be amongst the most challenging development issues today. A comprehensive approach is required to fulfill the gap that exists in the requirement process and the supply side.