A Reality Check Of Menstruation In Rural India

 A REALITY CHECK OF MENSTURATION IN RURAL INDIA 

 SUBMITTED BY: CHESHTA LAMBA 

For many of us, menstruation is a normal process that occurs every month. While we might suffer from minor annoyances such as pain and discomfort, it doesn’t usually have impact our personal and professional development. For many girls in the world, this is not the case. Menstruation prevents them from going to school or to work, and sometimes from performing daily activities like cooking, praying, exercising or even being in their own homes. Widespread restrictions and negative perceptions around menstruation contribute to strong gender disparities in health, education and work participation. In India, which is ranked 125 out of 151 countries in the HDI Gender Inequality Index, menstruation is still a barrier to achieving gender equality. This is true for urban slums but even more so for women in rural areas. The statistics are in fact quite alarming if we take into account that the average years of schooling among girls is only 4.1 years versus 6.1 among their male counterparts.

Silence and Shame

In rural India, menstruation is embedded in myths and taboos. Due to cultural and religious beliefs, menstruation is perceived as dirty, impure and even unholy. Because of this, menstruation is surrounded by a culture of silence and shame. Menstruating women are often expected to follow a set of restrictions during their periods, such as not going to the temple or offering prayers, not entering the kitchen and not touching certain foods.

Menstruation is not openly talked about in families or at school. It is actually estimated that over half of girls don’t know about menstruation when they first get their periods. Their mothers are too ashamed to talk about it and frequently lack knowledge of the biological explanation of menstruation and of the adequate ways of managing periods. Schools tend not to fill this gap either. The issue is rarely discussed in classrooms and teachers themselves often find the topic embarrassing, perpetuating an environment of shame and secrecy around menstruation.

Furthermore, most rural women lack awareness or are too poor to buy sanitary napkins or tampons. In fact, it is estimated that only 12% of women in India use sanitary pads. The most common alternative is cloth, and while cloth is not unhygienic per se, without proper care its use increases the risk of infection and other diseases. Misinformation and stigma often leads women to use unsanitary methods to manage their menstruation like dirty rags, leaves, sand or ash. Moreover, taboos prevent them from washing their cloth publicly and more importantly from drying it in the sun, so they frequently use damp cloth which is unhygienic and hazardous to health. It has been reported that reproductive tract Infections are 70% more common in women who don’t use sanitary napkins. Other diseases like urinary tract infections, fungal infections and cervical cancer have a higher incidence among these women as well.

School Absenteeism and High Drop Out Rates

Besides having important consequences on health, the inappropriate management of menstruation has a negative impact on the education of girls. It is estimated that around 20% of girls drop out of school after reaching puberty, and many more are absent for the entire duration of their period. While this might sound insignificant, missing around five days of school per month can affect their academic performance and can lead them to drop out because they are lagging behind at school. The main reasons for missing school during menstruation are a lack of adequate private toilets at school, and a lack of access to proper sanitary materials that are discreet and absorbent enough. The fact that menstruation is seen as shameful further encourages period-related absenteeism. Female teachers are also affected by these issues and will often skip work during their periods. Absenteeism and school dropout have an extremely significant impact in a woman’s quality of life, making her more likely to get married early and have children while still in her teens, and affecting her economic independence and agency. Therefore, a gender gap in education and income will continue to exist unless serious efforts to fight these issues are undertaken.

 

What Needs to Be Done

Public policies and programs to ensure that all learning and working environments are gender-inclusive are urgently needed.  Building private and clean toilets in rural schools, ensuring the availability and accessibility of sanitary napkins and imposing mandatory menstrual health classes for both boys and girls are important measures that can potentially keep many girls from being absent or dropping out of school.

Furthermore, all women should be granted access to quality sanitary pads, tampons or other hygienic methods of protection. According to the WSSC, sanitary pads have the potential to improve girl’s attendance to school, since they prevent issues like staining and odor. They also significantly decrease the chances of infection and gynaecological disease. Self-help groups, NGOs and other actors are starting to produce low-cost pads for rural women, but many women in remote areas are yet to be reached. When combined with WASH (Water, Sanitation and Hygiene) and MHM (Menstrual Health Management) awareness campaigns, these initiatives can have a long-lasting impact on the health of women.

And even though sanitary napkins are recognized by most urban women as essential, they are still considered an unnecessary luxury for many. In fact, the government of India recently decided to impose a 12% luxury tax on sanitary napkins. In a country in which most women cannot afford such a basic product, the controversial measure was received with a lot of opposition. A campaign named #Taxfreewings was launched alongside a petition to remove the tax on sanitary napkins. You can read and sign this petition here.

Fortunately, menstruation is being talked about more openly in the public domain, and menstrual hygiene is slowly emerging as a human rights issue, but a lot of progress still has to be achieved. Ultimately, the goal is that every girl in every corner of the world has access to proper sanitation during their periods and is aware that menstruation is a normal bodily function and that nobody has the right to shame her for that.

Much has been assumed regarding the sanitary pad usage in rural india. The general perception is that, sanitary napkins are not available or affordable by rural women and girls. It will therefore come as a surprise to many that, even in the rural areas, the prevalence of disposable products for managing menstruation is much higher than the 12% number often quoted. The study was conducted by A. C. Neilsen and endorsed by Plan India in October 2010, which stated that only 12% Indian women use Sanitary Napkins, and the rest are using unsanitary methods of managing menstruation. However, this study titled “Sanitary Protection: Every Woman’s Health Right” is not available on any public domain. This was a 2010 study. Years later, most CSR programs, NGO interventions and even Government schemes are still based on this “12%”. What’s more, it is assumed that the rest 88%, that do not use sanitary napkins, must be using unsanitary means. According to National Family Health Survey, NFHS 2015-16, the numbers both in rural and urban India are far higher than this. The NFHS 2015-16 survey pegs the number for women using hygienic means of managing menstruation in India at 78% in urban areas, 48% in rural areas and 58% overall. Today, nearly 6 out of 10 women in India have access to disposable sanitary napkins. According to this survey, locally prepared napkins, sanitary napkins and tampons are considered as hygienic methods of protection. One can assume from the language used that single use disposables are considered hygienic. There are wide variations in usage of ‘hygienic products’ across different states, with Tamil Nadu, Kerala and Delhi as high as 90% and rural Bihar as low as 30%.
Government has been running free sanitary pad programmes in rural areas where a girl student receives a pack of pads on a regular basis. Scheme for promotion of menstrual hygiene has rolled out in 17 states in 1092 blocks through Central supply of ‘Free days’ sanitary napkins. Till August 2014, over 1.4 crore adolescent girls have been reached and 4.82 crore packs of ‘Free days’. However, recently published article in a leading daily, The Hindu shows that such government programmes are often marred by lack of funds, as ensuring a continuous supply of disposable single use pads is not a one-time expense. Not only are such programmes financially unsustainable for governments but are also inadequate as girls receive only about 5 or 6 pads per month. There also exists a large gap between the guidelines and the actual practices in these schemes in terms of execution and quality of pads distributed. A detailed report on one such scheme in Kerala touches upon these issues. The quality of pads handed out in most programs is sub-standard, says Kavya Menon, a Bio-Technology graduate from IIT Madras who has first-hand experience of reaching out to nearly 700 girls in 15 villages while working in Vedaranyam, a rural municipality in Nagapattinam district. To manage a normal period, 12-20 pads are required on average. Anything less than that means changing less often and leading to reduced hygiene. 5 pads are not sufficient anyway!
Government. NGO and CSR programs that distribute sanitary napkins are based on the assumption that adolescent girls drop out of school because of lack of sanitary products. Interestingly, there is no substantive research or data to back this assumption – that providing sanitary napkins free or subsidized to school going girls increased their attendance or performance. In the absence of supporting data, what is so simplistically reduced to access or lack of products, is actually a more complex situation. Shradha Shree Jaya, a menstrual hygiene advocate and educator at Sustainable Menstruation Kerala collective, who has worked in Assam, Odisha, Tamil Nadu and Kerala at various times, opines that the girls miss school during periods due to two main reasons – Period cramps and lack of private changing space and clean toilets. Ground situation is not very different in Rajasthan.

Lack of water in villages?

With anecdotal evidence gathered from many cloth pad users, most say that one needs 5-8 cloth pads per period to allow for drying and flow. Amount of water required to wash a cloth pad, hold your breath, is not significantly different from that required to wash underwear or clothing of similar size. Roughly, 3-4 mugs of water is needed to soak, soap-wash and rinse a cloth pad. Laura O’Connell from Ecofemme, a cloth pad marketing group based out of Auroville, opines: “We believe that most regions in rural India do have the resources to continue their traditional practice of using washable cloth for menstruation.” Most NGOs and educators working in rural India agree that menstrual cups are excellent solution for married women in rural areas with water shortage. But the idea of promoting menstrual cup in India has mixed takers mainly due to the cultural aspect and vague notions of virginity. Use of an internal device such as menstrual cup also requires more handholding for the user in terms of usage, maintenance and troubleshooting, without which the transition may not be successful. Interestingly, in the past, women did insert cloth like tampons to absorb menstrual flow, but we have not looked for documented research on this topic yet. In rural scenarios, the choice to promote menstrual cup varies depending on the educator and most take into account the cultural sensitivities around this topic. There have been instances of rural women embracing the menstrual cup. A behavioural experiment on 960 rural women from 60 villages in rural Bihar quotes reasonable success (30%) 

Attitudes are surely changing with times. But we have a long way to go when dealing with menstruation and women’s needs. Even today, there are communities who believe menstruation is a curse to girls and a health problem. Making products available is not doing much to this seldom talked about topic that affects 50% of the population. Good menstrual hygiene practices need to be talked about and discussed in the open for the sake of economic and environmental sustainability and health. There is need to involve men in menstruation. Many issues related to functioning toilets, access to safe private spaces and clean water need to be sorted, often times at the household level, to give the rural women a decent shot at having a healthy reproductive life and beyond. Lastly, in search of a readymade solution that fits all immediately, let’s not trade one evil for another. Lack of good menstrual hygiene practices and the silence surrounding menstruation cannot be replaced by a non-biodegradable disposable product with unnaturally long-life cycle. Eventually, what goes around, comes around.