Menstruation is a natural biological process and a critical indication of reproductive health. As per Census 2011, more than 31 crore women in India are of reproductive age (15–49 years).[i] Most women and adolescent girls menstruate each month for about two to seven days. Yet, as normal as it is, menstruation is stigmatized around the world and treated as a taboo in many societies, cloaked in a culture of silence and shame. Myths and misconceptions that menstruating women are “dirty,” “impure” and “polluting” abound, adversely affecting their health and social lives.
Ability to manage menstruation hygienically is fundamental to the dignity and well-being of women and girls and constitutes an integral component of basic hygiene, sanitation, and reproductive health services.[ii] Menstrual hygiene management (MHM) is gaining increased recognition in the water, sanitation, and hygiene (WASH) discourse globally. WHO and UNICEF (2014) have defined MHM as “Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials”.[iii] Since 2014, May 28 is observed as the Menstrual Hygiene Day worldwide to break the silence, raise awareness and change negative social norms around MHM and engage decision-makers to increase the political priority and catalyse action for MHM, at global, national and local levels.[iv]
While there is no specific goal or indicator for MHM in the UN Sustainable Development Goals (SDGs), it is well recognized that menstrual health and hygiene affects the initiatives and performances of the countries toward achieving the following SD Goals: 3. Good Health, 4. Quality Education, 5. Gender Equality, 6. Clean Water and Sanitation, 8. Good Jobs and Economic Growth and 12. Responsible Consumption.[v]
Government of India has incorporated MHM into national policies and programs as part of initiatives for improving health, well-being, and nutritional status of adolescent girls and women, as well as for reducing school absenteeism of adolescent girls.
In spite of the multitude of initiatives, many girls and women continue to face challenges with managing their periods safely. Few of the challenges and possible ways of addressing them are encapsulated below.
- Promoting Healthy Understanding about Menstruation
Societal censorship around menstruation coupled with inadequate access to information at home and in schools result in many women and girls lacking knowledge about what happens to their bodies during menstruation and how they can handle it. A study from UNICEF revealed that 1 out of 3 girls in South Asia knew nothing about menstruation prior to getting it, while 10% of girls in India believe that menstruation is a disease (WaterAid 2013, Menstrual Hygiene Matters).[vi] Moreover, MHM problems are aggravated by use of unhygienic products, inadequate access to private, safe and hygienic sanitation facilities and lack of clean water, soap for maintaining personal hygiene. This can lead to reproductive tract infections (RTIs) and other health conditions. Thus, it is important to integrate menstrual hygiene management into the sexual and reproductive health education programmes, especially for adolescents.
Through its various programs on the ground CCDT has been actively engaging with adolescents in the community and across its Residential care program enabling them to understand the physical and emotional changes during growing up and the reproductive systems. Focused sessions with the girls on menstruation help them to open up and clarify all their doubts as well as understand the importance of maintaining hygiene during these days.
- Addressing Taboos and Building Positive Social Norms around Menstruation
Taboos and myths related to menstruation often portray women and girls as inferior to men and boys and reinforce gender inequities and exclusion. Mothers and other women may themselves be unaware of the facts or good menstrual hygienic practices, instead enforce the patriarchal rules thus perpetuating the cultural taboos and restrictions. It is thus vital to address taboos and promote positive social norms around menstruation by engaging with women and girls and key decision-makers in their life. It is equally critical to educate boys, sensitize male and key cultural influencers (social and religious leaders) to build their understanding and foster supportive attitude in removing discriminatory practices and build a support system at societal level.
Grassroots health workers such as ASHAs, ANMs, Anganwadi Workers (AWW) are being capacitated on menstrual hygiene. They can play a key role in imparting accurate information in a timely manner on the biological and psychosocial aspects of puberty, menstruation, and its management tailored to the local context, thus strengthening the awareness programs and making it effective.
Many organizations are integrating WASH and menstrual awareness in schools and community. UNICEF-led WASH in Schools Partnership, WaterAid, Plan International, Save the Children, PATH and the United States Agency for International Development(USAID) are some examples.
- Increasing Access to Sanitation Facilities
Inadequate or lack of access to sanitation facilities that do not ensure privacy and hygiene, particularly affect women and girls. Girls tend to miss school an average of six days a month due to the lack of quality sanitation facilities at school. This eventually contributes to almost 23% of them dropping out of school on reaching puberty, which in turn, sharply degrades their potential as individuals and future workers.[vii] It is vital to ensure that all women and girls have access to water and sanitation facilities that are safe, hygienic, socially and culturally acceptable coupled with options for safe disposal of menstrual products. Menstruation should not limit a woman’s mobility, educational and work opportunities.
Swachh Bharat Mission has incorporated MHM as an integral part in its guidelines. “Swachh Bharat: Swachh Vidyalaya” campaign launched by the Government is working towards ensuring that every school in India has functional, well-maintained WASH facilities including soap, adequate water for washing, private space for changing, and disposal facilities for used menstrual absorbents.[viii] Ministry of Drinking Water and Sanitation has published operational guidelines to be implemented by state governments, district-level officials, engineers, and school teachers for improved MHM in the country.[ix]
- Improving Access to Safe and Affordable Menstrual Management Material
It is increasing understood that women and girls’ ability to manage their menstruation is affected by factors including access to safe and affordable menstrual hygiene management material to absorb or collect blood and safe disposal options; a lack of which leads to ineffective, unhygienic and uncomfortable menstrual management. In some contexts, natural materials such as mud, leaves, dung or animal skins (UNESCO 2013, Puberty Education and Menstrual Hygiene Management) or old rags, cloths or other unhygienic materials are used to manage the menstrual flow. Government has launched 100% oxy-biodegradable sanitary napkins “Suvidha” in packs of four priced at Rs. 10. In spite of such government initiatives to provide subsidised disposable sanitary pads, requirement for safe MHM products far outweigh their availability and accessibility.
Production of low-cost, safe sanitary napkins by community-based organizations/self-help groups has been supported to match the requirement. Arunachalam Muruganantham, the Menstrual Man, took the initiative and developed a low-cost method to produce pads using pulverized wood fiber and built the model machine to make them, simple enough to be operated and maintained in India’s remote villages. This has empowered rural women in India through sanitary pad production, delivery, and education schemes. [x]
Entrepreneurs as well as Organisations, driven by quality, health or environmental concerns over regular sanitary pads, have innovated with a range of menstrual products introducing reusable cloth pads, menstrual cups, and “eco-friendly” or compostable sanitary pads.[xi] One such initiative is “Flo”, a portable device that allows girls to carry, clean and dry reusable pads discretely and safely. It comprises of two bowls lined with a basket casing, a string and a sealable carrying. The bowls are used to wash the reusable pads and the basket casing converts into a hanging rack that can be covered with a piece of cloth so that the pads can be hung discretely outside while drying.[xii] Another initiative is PeriodPanty and FlexiPad, by BeGirl.These two reusable options for girls made from soft comfortable, strain-free material with a leak-proof lining that can be filled with safe and absorbent material, washed, and then dried indoors in less than 60 minutes.[xiii]
Moreover, encouraging policies and quality standards that promote safe and affordable menstrual products available at subsidized costs that are sustainable, environmentally friendly is the need of the hour.
Sanitation and menstrual hygiene are key issues for women and girls, consistent with their need for privacy, dignity and self-respect and is linked to gender equality and basic human rights. Challenges are multiple and calls for resolute multi-stakeholder interventions to break the social taboos, myths, and foster positive social norms around menstruation; increase access to water and sanitation facilities; support innovative sustainable and eco friendly solutions that are low-cost, yet high-quality to manage menstruation; and safe and environmental friendly disposal of menstrual waste materials. Developmental agenda needs to prioritise the issue of menstrual hygiene management for women and girls and call for immediate and concerted action from all relevant stakeholders to build a positive scenario of menstrual hygiene in India.
[i] Census of India, 2011 Census, Table C-13, Single Year Age Returns By Residence and Sex. Available from: http://www.censusindia.gov.in/2011census/C-series/C-13.html [Last accessed on 2019 May 24].
[ii] WaterAid 2012, Menstrual Hygiene Matters. A resource for improving menstrual hygiene around the world. Available from: https://washmatters.wateraid.org/sites/g/files/jkxoof256/files/Menstrual%20hygiene%20matters%20low%20resolution.pdf [Last accessed on 2019 May 24].
[iii] Resources on MHM; Menstrual Hygiene Management (MHM). Available from: https://menstrualhygieneday.org/about/why-menstruationmatters/ [Last accessed on 2019 May 29].
[iv] Resources on MHM; About Menstrual Hygiene Day. Available from: http://www.menstrualhygieneday.org/about/about-mhday/. [Last accessed on 2019 May 29].
[v] Infographic MHM and SDGs – Menstrual Hygiene Day. Available from: https://menstrualhygieneday.org/wp-content/uploads/2017/05/MHDay_MHM-SDGs_2017_RGB_fin.pdf [Last accessed on 2019 May 24].
[vi] http://www.wash-united.org/our-work/issues/menstrual-hygiene-management [Last accessed on 2019 May 30].
[vii] Dasra 2015, Dignity For Her. Empowering India’s adolescent girls through improved sanitation and hygiene.
[viii] Ministry of Human Resource Development, Government of India. Swachh Bharat Swachh Vidyalaya: A National Mission. Available from: http://www.swachhvidyalaya.com/Swachch-Bharat-Swachch-Vidhalaya.pdf. [Last accessed on 2019 June 10].
[ix] Ministry of Drinking Water and Sanitation, Government of India. Menstrual Hygiene Management-National Guidelines; 2015. Available from: http://www.mdws.gov.in/sites/default/files/Menstrual%20Hygiene%20Management%20-%20Guidelines.pdf. [Last accessed on 2019 June 10].
[xi] Menstrual hygiene management in India: Still a long way to go. Available from: https://www.downtoearth.org.in/blog/india/menstrual-hygiene-management-in-india-still-a-long-way-to-go-63606 [Last accessed on 2019 May 30].