The Many Gaps in Menstrual Hygiene Awareness in Rural India

“The government may be placing sanitary napkins in schools, but there are no toilets or clean water.”

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The majority of menstruating individuals in the county are still struggling for the very basic, and fighting the taboos that make any further progress unattainable.
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Over the last few decades, conversations around menstruation have slowly crawled out our bedroom walls and entered mainstream discussions in the media and elsewhere - with more awareness on the subject than there ever was before.

But these small leaps and successes are still only an urban reality - and a tiny bit of it at that. The situation may be better today, but it is far from ideal - as is evident by ignorant statements made repetitively by those in power, or the dismal fact that sanitary pads weren’t considered ‘essential’ enough to make it to the COVID-19 lockdown list in the beginning.

Despite the multiple signs of progress, the harsh truth is that only about 30% of women have access to sanitary napkins in India. This means that the majority of menstruating people in the county are still struggling for the very basic, and fighting the taboos that make any further progress seem unattainable.

As we observe Sexual and Reproductive Health Awareness Day, FIT interviews Pratibha Patel, a health specialist at ChildFund India with over 16 years of experience in maternal and child health, nutrition, reproductive and sexual health rights and social development.

She reflects on the present state of menstrual hygiene management in rural areas, and what measures and initiatives can help fill the implementation gaps. Read the QnA below:

What does menstrual hygiene awareness encompass?

Menstruation hygiene management is a big term, and access to sanitary napkins is only one aspect of it. There are other equally significant parts which need to be addressed - starting from having accurate and scientific information about the menstrual cycle.

So, the first step is knowledge of what is menstruation, how it is just a normal physiological process, and why it is important. This can be done by educating girls, women and families through peers, schools and other awareness programs.

The next step is access to hygienic materials, reusable sanitary pads, homemade cotton pads, or even cotton clothes. This also includes knowledge of how these should be worn, washed, dried and sundried, and how women should clean their own private parts and adopt the right hygienic practices.

What’s the need for menstrual awareness initiatives in rural areas?

The need for such initiatives is extremely high.

Only 36% of adolescent girls and women know what menstrual hygiene means and merely 26% use sanitary napkins. The majority of women still do not have access to the right facilities. Besides that, there are many taboos and stigma surrounding menstruation - which act as a barrier in letting the required information reach the community.

Where do we begin to improve the situation?

First and foremost is working with adolescent girls by taking the most suitable approach. From our experiences, we have seen that educating the peers is a good strategy of making the right knowledge reach the girls. They tend to be more comfortable with their peers, so involving both girls and boys would be of help.

It is also as important to teach families what menstruation is and that there is nothing to hide or stigmatize about it. Interacting with mothers and fathers helps address the intergenerational gap - because many of the myths and much of the wrong information is passed down from the previous generations. These taboos, in some cases, lead to isolating menstruating girls, making them live in separate headquarters and treating them as ‘impure’.

The lack of knowledge also leads to the dismissal of abnormal pain or menstrual disorders, or misdiagnosis of such disorders. For instance, the community members are often unaware of the fact that a period cycle can range from anywhere between 24 to 35 days, and would instantly jump to the conclusion that something is wrong if a girl doesn’t bleed every 28 days.

Plus, of course, access to hygienic materials during menstruation has to be a major part of these initiatives.

In the several years you have worked with rural communities, have you observed any progress in terms of menstrual awareness?

Access to sanitary napkins has certainly increased. More women and girls know about it now and are able to challenge the stigma associated with menstruation. But this is still only a small segment of the population.

The improvements are visible. For example, ten years back when I was visiting villages, I found women using ash, lead and dirty clothes in place of hygienic materials. Now many of them have shifted to clean clothes, but the taboos are still there. They are still segregated and treated unfairly. The general level of awareness is still miniscule - some don’t even take baths for 3-4 days - not realizing the problems that could lead to.

So yes, the situation is better than before, but it is far from ideal. A lot of work needs to be done.

What role do schools play in imparting this knowledge?

In 1992, Adolescent Reproductive and Sexual Health program (ARSH) was recommended at the national level, but eight states have still not included it.

School health programs, national schemes, and the announcement of the sanitary napkin brand by the Prime Minister this year have slowly made a difference - yet the implementation gap is huge for multiple reasons.

Schools are the primary distribution centres for girls and adolescents and with these shut, many girls are left without alternatives.

The government may be placing the sanitary napkins in the schools, but the toilets are not there. If the toilets are there, there is no clean water. So only one component is being addressed. No separate toilets or water facilities are made available..

Moreover, teachers don’t know about the schemes and health plans, and are unable to educate the students about the same. The chapters on sexual and reproductive health are not taught properly, which hampers basic awareness around menstruation.

How did the COVID-19 pandemic impact the level of awareness and access to sexual and reproductive health services?

As we are all well aware, sanitary napkins were not included as essential products when the lockdown was first announced. It was only after an uproar by NGOs and activists that union minister Smriti Irani clarified their inclusion. This announcement came after a gap of around 21-30 days, and there still continued to be an irregular supply of sanitary napkins for more than 2.5 months - even longer in rural areas.

Anganwadi centers get their supply from Primary Health Centres (PHCs) or ICGS headquarters, but the lockdown confined women to their homes and obstructed their movement. Girls and women who were having menstrual disorders were unable to go to PHCs or to the chemist shops. The shops and centers were either closed, or prioritizing other health issues.

So yes, the pandemic most certainly aggravated the situation for menstruating people.

(FIT had earlier spoken to Poonam Muttreja, Executive Director of the Population Foundation of India to see how the pandemic has impacted those who menstruate. Watch the video here.)

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