Menstrual Hygiene

This editorial is based on “Menstrual hygiene: A challenging development issue” which was published in Down to Earth on 27/09/2019. It talks about the causes and impact of poor menstrual hygiene faced by Indian women.

Menstrual hygiene continues to be amongst the most challenging developmental issues that women face today, especially in the developing countries like India, the mindsets, customs and institutional biases prevent women from getting the menstrual health care they need.

Menstruation is a natural and healthy biological process for women, in spite of this, it is still considered a taboo in Indian society.

Even today, the cultural and social influences on people create a major hurdle in ensuring that the adolescent girls are educated about menstrual hygiene.

Reasons for societal taboo and lack of menstrual hygiene

• Menstruation is associated with the onset of puberty in girls and many times, it brings with it rules, restrictions, isolation and changed expectations from the girls by society.
  
  • During their menstruating days, women are prohibited from participating in day-to-day activities. For example prohibiting women to enter the kitchen or a temple.
• Prevalence of Hegemonic Patriarchy in Indian society perpetuates the restrictions, which are often reflected in religious texts like Manu Smriti or in the restriction on entry of women from menstruating age group in the religious places like Sabarimala temple.
  
  • Hegemonic patriarchy normalises the discrimination against women and not only men, even women become the agents to impose the notion of subjugation on other women.
• The main reasons for this taboo still being relevant in the Indian society are the high rate of illiteracy especially in girls, poverty and lack of awareness about menstrual health and hygiene.
• These deeply entrenched social norms about menstruation restrict girls’ freedom and affect their health.
• There are several governments and non-government programmes that have promoted menstrual hygiene through health awareness schemes and free or subsidized distribution of sanitary pads.
  
  • However, their quality varies greatly.
  • Apart from this, girls lack access to disposal facilities.
    • This leads to using a hygienic/safe product in an unhygienic manner, as women often extend its use beyond the recommended time (sometimes using a single pad for a whole day).
    • This places the girl at increased risk for infection and has critical health implications.

Impact of Neglect of Menstrual Hygiene

• According to a UNICEF study conducted in 2011:
  
  • Only 13% of girls in India are aware of menstruation before menarche.
  • 60% of girls missed school on account of menstruation,
  • 79% faces low confidence due to menstruation and 44% were embarrassed and humiliated over restrictions.
  • Thereby, Menstruation adversely impacts women's education, equality, maternal and child health.
• Not only in India but on a global level, at least 500 million women and girls lack adequate facilities for menstrual hygiene management.
• Lack of adequate information on sanitation and hygiene facilities, particularly in public places like schools, workplaces or health centres can pose a major obstacle to women and girls.
• The latest National Family and Health Survey found that 58% of young Indian women (15-24 years) use a hygienic method of protection (mostly sanitary pads), a significant increase from the 12% using pads in 2010. However, only less than 18% of Indian women use sanitary pads.
• This changed attitude towards girls such as restrictions on their self-expression, schooling, mobility and freedom has far-reaching consequences on the mindset of women.
• More than 77% of menstruating girls and women in India use old cloth, which is often reused, ashes, newspapers, dried leaves and husk sand during periods.

Way Forward

• Movies creating social awareness about such social issues can play an instrumental role in bringing behavioural change in society.
  
  • The film Pad Man played a pivotal role in spurring conversations around periods and positioning sanitary pads as the saviour.
  • Recently, the documentary: Period. End of Sentence, that explores the stigma surrounding menstruation in rural India, won the oscar award.
• The government must promote, small-scale sanitary pad manufacturing units to make low-cost pads more easily available, it will also help in generating income for women.
• The government needs to provide, efforts directed at awareness and education about menstruation and menstrual hygiene, and access to safe products, and responsive water, sanitation and hygiene (WASH) infrastructure.
• An informed choice is important in the context of women’s reproductive and sexual health and is applicable to menstrual hygiene as well.
  
  • Informed choice means that women and girls have comprehensive information about menstrual hygiene products available (including their advantages and disadvantages, hygienic use, and disposal), and are equipped to make a choice about what they want to use given their needs and the socio-economic contexts in which they live and experience menstruation.
• The government has launched Jan Aushadhi Suvidha Oxo-Biodegradable Sanitary Napkin, that seeks to provide biodegradable sanitary pads for only One Rupee per pad, efforts should be made to increase its accessibility and availability.
• However, menstrual health cannot be achieved only through governmental efforts without addressing it as a social issue, requiring interventions at societal, community and familial level.

Government Schemes To Promote Menstrual Hygiene Management in India

• The Right of Children to Free and Compulsory Education Act (RTE) (2009) includes standards for drinking water and gender-separated sanitation facilities in schools.
• Menstrual hygiene scheme launched by the Ministry of Health and Family Welfare
  
  • Government of India (GoI) for promotion of menstrual hygiene among adolescent girls (10-19 years) in rural areas of selected districts in 2011.
  • From 2014 onwards scheme extended to all districts under Rashtriya Kishore Swasthya Karyakram to enhance MH knowledge, improve hygiene practices, provide subsidised sanitary absorbents, and raise awareness of MHM at school.
• SABLA programme of Ministry of Women and Child Development focuses on nutrition, health, hygiene and reproductive and sexual health (linked to a rural mother and childcare centres).
• National Rural Livelihood Mission of the Ministry of Rural Development supports self-help groups and small manufacturers to produce sanitary pads.
• Swachh Bharat Mission and Swachh Bharat: Swachh Vidyalaya (SB:SV): Menstrual hygiene management is also an integral part of the Swachh Bharat Mission and the ‘Menstrual Hygiene Management Guideline’ issued by the Ministry of Drinking Water and Sanitation(MDWS) involves the support from state governments, district administrations, engineers and technical experts inline departments; and school headteachers and teachers for its implementation.
• Guidelines for Gender Issues in Sanitation (2017) have been evolved by MDWS to ensure gender equality and empowerment of women and girls with respect to sanitation.
  
  • Safe and effective MHM is a trigger for better and stronger development for adolescent girls and women. This requires that all state, district and local authorities, including schools, communities and families create an environment where menstrual hygiene management is seen as acceptable and normal.
• Menstrual Hygiene Day is an annual awareness day on May 28 to highlight the importance of good menstrual hygiene management.
  
  • It was initiated by the German-based NGO WASH United in 2014 and aims to benefit women and girls worldwide.
  • In 2018, 310 organizations educated 27.2 million girls across 134 countries, about menstrual hygiene.
• The National Guidelines on Menstrual Hygiene Management
  
  • It was released by the Ministry of Drinking Water and Sanitation in 2015.
  • It seeks to address every component of menstrual hygiene ranging from, raising awareness, addressing behaviour change, creating a demand for better hygiene products, capacity building of frontline community cadre, sensitization of key stakeholders, convergence needed for effective outreach and intervention, creation of WASH facilities including safe disposal options, etc.

Drishti Mains Question
Menstrual hygiene continues to be amongst the most challenging developmental issues that women face today, especially in the developing counties like India. Discuss.