Menstruation is still considered a stigma in many parts of the world. In most countries, especially low-income nations, it is not a subject for public discourse. This makes it difficult, and near impossible, to include it in matters of national dialogue and policies. Yet, all women are expected to maintain strict adherence to menstrual hygiene, regardless of their socioeconomic status. As a result, there have been continuous calls by rights activists for the world to make sanitary pads and other items a right for women.
A UNICEF study shows that in India, inadequate awareness about menstrual hygiene compels 23% of girls to drop out of schools after they start menstruating. This is a stage where girls are often confused and scared as to how to go about their first period since knowledge on basic hygienic practices towards menstruation is often not well addressed.
As the world marks Menstrual Hygiene Day, the need to raise awareness on the right of every woman to sanitary pads becomes even more apparent. One can make a case that there are several sanitary items for menstrual hygiene, but considering underprivileged women to whom feeding is a luxury, one is forced to wonder what their fate is with sanitary items.
The stark reality
According to the National Health Survey Report, of the women in the age group of 15 to 24 years in India, 42% use sanitary napkins, 62% use cloth and 16% use locally prepared napkins. Overall, 58% of women in this age group use a hygienic method of menstrual protection.
In Assam, around 41% of rural women in the same age group use hygienic methods of protection during their menstrual period. Though the government of India had started the Menstrual Hygiene Scheme in 2011 to provide sanitary pads at subsidised prices, it failed to reach the target. Gynaecologist Dr Bibha Bordoloi notes that most women in rural areas do not use sanitary pads due to a lack of enough income or awareness, resulting in various diseases such as vaginal and urinary tract infections.
“There’s still much, much more we all need to do to end period poverty. As a doctor, I get to witness the ground reality that lies behind the period poverty headlines. And the reality is that, when it comes to education, young people are ill-informed about menstruation and their reproductive health. Girls and boys aren’t being taught how the menstrual cycle works, or about the emotional and social aspects of periods. They are also missing out on basic, vital information about how their bodies work – and the health implications are extensive. Many girls who experience menstrual symptoms that worry them, or that could indicate a health problem, have not consulted their doctor. And you would be surprised to know that their reasons for this are primarily embarrassment, not knowing what’s going on with their bodies, worrying that their doctor will be male or the belief that they are overthinking or exaggerating their symptoms,” she adds.
Obstetrician and gynaecologist Dr Sushil Barua says, “We also have to talk about health, about education, about women’s right to know their own bodies and how to keep themselves healthy, happy and safe. To do this, we need to address the huge gaps in education that are leaving young people feeling alienated from their bodies. We need healthcare systems that are aware of menstrual health problems, and that can support those experiencing them properly. And we need to start listening to girls, women and other menstruators, without telling them to just go away and get on with things in silence. I’ve seen many mothers dismissing cramps and other issues faced by their daughters as normal. School going girls often call me up to say that their mothers do not understand their emotional state of mind or their physical difficulties during periods. I feel just raising awareness about sanitary pads is not sufficient; one needs to understand the concept of periods as a whole.”
The good Samaritans: Breaking the barriers
“I used to be plagued by menstrual cramps,” says Runima Haloi, “and I thought there was no way to ease them. However, after joining a menstrual camp for adolescent girls, I learned how to manage my cramps through eating a proper diet and exercising. I am now aware of safe hygiene; instead of old clothes I use sanitary napkins and I can also track my cycle. This has brought a positive change into my life. I am much more confident and do not hesitate when I have to travel long distances anymore.”
Thankfully, there are a few individuals and organisations dedicated to ensuring access to sanitary pads becomes a right that even the most underprivileged women can enjoy.
Social worker, Mayuri Bhattacharjee is a philanthropist who is ardently pushing a campaign for a safe environment for menstruating women. Mayuri currently runs Dignity in Floods, which provides sanitary pads for women in flood shelters. Most of these flood shelters are completely lacking in proper sanitation and hygiene and pose a serious problem for young women who have just begun menstruating.
Mayuri highlights a particularly heart-moving instance where she encountered a 15-year-old girl in a relief camp who had just begun menstruating. “This girl, in particular, was bleeding seriously for hours and stained her skirt in the process in the congested relief centre. There was absolutely no time for her to grab sanitary pads and clean clothes while she was in a hurry to save herself.”
“I’ve been working on sanitation since 2014 and it’s upsetting to see how menstruation is a taboo even among men in the sector,” she adds.
Like Mayuri, Jafrin Akhtar is creating safe platforms to educate women around the world on their inevitable monthly cycle. Balipara-based Ahktar founded an intersectional feminist-youth-led run organisation called Spread Love and Peace (SLAP) in 2018, with the help of some of her friends.
Akhtar has pioneered several campaigns like the #MyFirstPeriod which is a result of the challenges she also experienced with regards to her sexuality and menstruation. She also began the digital campaign called #DOT, where she convinced artists to lend their powerful voices to create awareness for menstrual health across the country. She was able to raise over Rs 30,000 to buy sanitary products for menstruation, which she shared in the rural parts of Assam. The health worker has gone on to work voluntarily for organisations like We are Young Foundation, Khoon, Fridays for Future, Child-Friendly Guwahati, and Sauhard, among many others. She recently got a chance to take part in a national workshop conducted by Youth Ki Awaaz to further amplify her campaign.
Additionally, several campaigns promoting menstrual hygiene and proper sanitation have also been launched in Assam. One of them is Samanway Foundation’s Red Badge, a campaign launched in collaboration with the Assam Branch of Indian Tea Association (ABITA) in which over 6,000 adolescent females in over 60 tea gardens in districts all over Assam are being reached. Gaurav Agarwalla, the founder, describes their mission in simple terms. “Our campaign was targeted to end period poverty and make menstrual hygiene an important health concern amongst the tea tribe community who are one of the underserved communities in Assam,” he says.
As the years roll by and enlightenment campaigns yield results, it is a joy to see more men play their role in raising awareness about menstrual hygiene. Arth Art for Humanity portrayed this by launching a unique performance art with the trendy hashtag #MenForPads. They launched this piece at the Jeevan River Kite Festival during the 2021 Menstrual Health & Awareness Week. To showcase his solidarity for the cause, artist and co-founder Rittyz Kashyap dressed as a sanitary pad. Rittyz also clearly stated that all proceeds from the performance would be used in purchasing eco-friendly sanitary pads for young menstruating women.
While the struggle continues, the success stories have been heartwarming. In Pamohi village, a lot of adolescents are now bold enough to speak out about issues concerning their periods and menstrual health. This revolution was partly the result of the work of Uttam Teron and Aimoni Tumung of Parijat Academy. The academy is a haven for discussing health, hygiene and issues concerning menstruation. In July 2017, when Dollean Perkins and a few volunteers from Florida working on the Days for Girls campaign visited Parijat Academy, they helped them make reusable sanitary pads with cotton cloths. The pads have two parts – a shield and a liner. The girls stitch three pieces of cotton and flannel cloth into shape and add two plastic buttons to clip it to the undergarment, besides the leak-proof polyurethane laminate fabric that is tucked inside. The team has priced the large and small ones at Rs 110 and Rs 80 per pad respectively. And the best part – the pads could be used for three years. They have also distributed these reusable sanitary pads to underprivileged women in their community for free.
Many individuals like the founder of The Eco Hub, Nelson Deb has also been very instrumental to the growing awareness of menstrual health management in India and beyond. As a staunch advocate of menstrual hygiene, Nelson has been able to reach out to people in the remotest corners of Assam, the government & private schools, tea tribes, hill tribes and teachers to provide education on menstrual health management holistically.
“We have created different modules for government schools and private schools, colleges, urban and rural communities, working professionals, and for males as well. I truly feel that menstruation is not just a women’s concern but men play an important role too. All menstruators who menstruate are not always women. Hence, irrespective of gender, one needs to be educated on this biological process. Through our modules which are very engaging and interactive, we try to create safe spaces for women and girls to participate. We screen short movies on period followed by open discussions. We have participatory games that engage all participants and that way they slowly open up and talk about periods. We also work on building functional toilets at schools, colleges, workspaces etc because it is essential that a woman/girl finds water, soap, pads, incinerator while using a toilet during her periods. We try to make biodegradable sanitary pads available and accessible to women through pad vending machines and then we make sure that they have proper disposable mechanisms, so we provide them with incinerator,” he says.
With the help of his team, and using his startup as a platform, he has been able to reach hundreds of women and instigate that much-needed revolution in the health sector. One notable campaign worth mentioning is The Hygiene Bucket Challenge, just like the Ice Bucket Challenge, which ran for quite some time and had become very popular. Here one could challenge 5 friends/family to take up the hygiene bucket challenge, The challenge was that he/she had to gift a hygiene bucket worth Rs 500 or 1000 that contained a year’s or half and a year’s supply of sanitary pads to an underprivileged girl. It was like a chain, once an individual participates, s/he would need to challenge five more people in their circle. This created a lot of awareness on menstrual health. This was done on social media via Facebook.
Other campaigns by The Eco Hub include the fundraiser campaign for Assam floods every year. With the fund raised they distribute hygiene kits to flood-affected victims (women and girls) and their kit contains disposable pads, reusable pads, hand sanitiser, mask, bathing soap, detergent powder, phenyl, bleaching powder, a pair of underwear and mosquito repellent. During the Baghjan oil well blast, the team had distributed hygiene kits. “Basic hygiene needs are not taken care of most of the time during disasters, so we try to fill in the gap in our capacity,” he says.
Speaking on menstrual cups and his preference on the most effective items to use in menstrual management in uncommon scenarios, Nelson says, “I personally think that menstrual cups are one of the most sustainable menstrual products that one can use. During our flood relief work, we distributed tons of menstrual cups to the women in the police department and the women forest guards of the Kaziranga National Park. Menstrual Cups in general can be a very effective product especially during Assam floods but how many women in the rural areas know of menstrual cups? How many have ever heard of it or have seen it? It wouldn’t surprise me if the number is zero,” he reflects.
“However at the end of the day, I feel it is a choice that the women need to make for their bodies. I only provide them information on all types of menstrual products, be it menstrual cups, tampons, cloth pads or just normal cloth. Information on what it is made of, who is making it, the cost that one needs to pay, how economical other products are comparatively in the long run, disposal, how much waste is generated, etc. Once the women are informed and educated on this, I am sure they would make the right choice for themselves and they are rightly doing so,” he adds.
Nelson also feels the government programmes so far haven’t been able to make much impact due to lack of proper planning, corrupt officials, and low funds.
“Although the government has some programmes in place, in reality, they need to check if those are being implemented on the ground. For eg: the government had a scheme where they would provide 600 rupees to every BPL girl for procurement of sanitary pads for a year. Firstly is that much money enough to meet the needs of menstrual products for a girl for a year, well no! Second – how is the government so sure that the girl would utilise that money for buying pads? Would she really visit the bank and withdraw the money or go to the ATM, I haven’t heard of. Third, for a BPL family where money is always a shortage, do you think that money would be used in buying pads or something more important for them like food maybe? The decision-maker in most of the BPL families are the men or the father, he wouldn’t even let the daughter know where the money was being used, maybe even buying liquor (in a lot of tea tribes). A lot of girls haven’t even received this money as yet, so when will they receive it? Where is the money? Why haven’t they received it as yet?” he questions.
“Once upon a time there were subsidised pads being supplied to government school girls. But most of the schools received about 100 packets only once a year and few never received anything. The ASHA was appointed to also visit schools and localities to make the pads available to women, these ASHA workers have started selling these packets at a higher rate, the consumers had no option and weren’t aware that these were to be sold at subsidised rates so they bought them. Where were these pads procured from? Why can’t these be procured from local SHG’s or manufacturers, that way women working get a steady income and employment too. NHM in their website had it very clearly mentioned that these pads can and should be procured from local SHGs manufacturing them but I don’t know of any local units who have supplied pads for this scheme in Assam.
The government can consult with local professionals working in the MHM space before implementing such programs and schemes, that way we can suggest ways to deal with the problem rather than doing something for the sake of it,” Nelson adds.