Menstrual hygiene: A challenging development issue

Context

A woman’s menstrual health is crucial to her well-being and also to the well-being of her family and community. But too often — especially in the developing world — mind-sets, customs and institutional biases prevent women from getting the menstrual health care they need. Menstrual hygiene continues to be amongst the most challenging development issues today.

Background

• Menstruation is a natural, normal biological process experienced by all adolescent girls and women, yet it is not spoken about openly causing unnecessary embarrassment and shame.
• India’s 113 million adolescent girls are particularly vulnerable at the onset of menarche. At this time they need a safe environment that offers protection and guidance to ensure their basic health, well-being and educational opportunity is realised.
• Assessments show that reproductive tract infections are 70 per cent more common among women who use unhygienic materials during menstruation.
• Lack of a separate and usable girl’s toilet in schools and a toilet at home leaves adolescent girls and women to face the indignity of open defecation.
• The taboo to talk about “periods” and lack of girls toilets in schools leads to an astounding 30 per cent drop out of girls upon reaching puberty.

Infrastructural Challenges

• At least 500 million women and girls globally lack adequate facilities for menstrual hygiene management (MHM).
• Inadequate WASH (water, sanitation and hygiene) facilities, particularly in public places, such as in schools, workplaces or health centers, can pose a major obstacle to women and girls.
• The lack of separate toilets with doors that can be safely closed, or the unavailability of means to dispose of used sanitary pads and water to wash hands, means that women and girls face challenges in maintaining their menstrual hygiene in a private, safe and dignified manner.

Challenges due to social norms and beliefs

• Even today in many families freedom of women continues to be in the hands of patriarchal discourse and thus there has not been any significant change in people’s attitudes and mentality towards menstruation.
• In many cultures, menstruating women are considered impure and are systematically excluded from participating in every-day activities, such as education, employment, and cultural and religious practices.
• The taboos and stigmas attached to menstruation lead to an overall culture of silence around the topic, resulting in limited information on menstruation and menstrual hygiene. Even mothers are reluctant to talk about this topic with their daughters and many of them lack scientific knowledge on puberty and menstruation.

Impacts due to inadequate menstrual hygiene management (MHM)

• A recent World Bank Group (WBG) study illustrated how a disregard of menstrual hygiene needs serves to entrench the lower status of women and girls.
• It brings with it rules, restrictions, isolation and changed expectations from the girls by the society. This changed attitude towards girls such as restrictions on their self-expressions, schooling, mobility and freedom has far reaching consequences on the mind-set of women.
• A growing body of evidence shows that girls’ inability to manage their menstrual hygiene in schools, results in school absenteeism, which in turn, has severe economic costs on their lives and on the country.
• The misinformation on menstrual hygiene management can have ramifications on the health and dignity of girls and women.

Steps taken by government and civil society to address the problem

• Over the last few years, the issue of menstrual hygiene has been addressed by the government, NGOs and corporates under their CSR activities. Eco-friendly and affordable sanitary napkins are catching on in the country.
• The Menstrual Hygiene Management Guideline is issued by the Ministry of Drinking Water and Sanitation to support all adolescent girls and women. It outlines what needs to be done by state governments, district administrations, engineers and technical experts in line departments; and school head teachers and teachers.
• Menstrual Hygiene for Adolescent girls Schemes is supported by Government of India under which, funds are provided to States/UTs through National Health Mission for decentralized procurement of sanitary napkins packs for provision primarily to rural adolescent girls at subsidized rates as per proposals received from the States and UTs in their Programme Implementation Plans. It encompasses the following:
• Increasing awareness among adolescent girls on Menstrual Hygiene
• Improving access to and use of high quality sanitary napkins by adolescent girls in rural areas.
• Ensuring safe disposal of Sanitary Napkins in an environmentally friendly manner.
• Provision of funds to ASHAs to hold monthly meeting with adolescents to discuss issues related to menstrual hygiene.
• A Member of Parliament is asking for 100% exemption on the production and distribution of health-friendly sanitary napkins.
• Movies like PadMan and #YesIBleed campaign are causing awareness in the masses about this social taboo.
• NGO Humanify Foundation has started a nationwide campaign Paavni to make people aware about menstrual health and hygiene. It also provides information to dispel myths and taboos surrounding this issue

Menstrual Waste: A rising problem

• India has 12.3 billion disposable sanitary napkins to take care of every year, majority of which are not biodegradable / compostable.
• Sanitary waste disposal has become an increasing problem in India as the plastic used in disposable sanitary napkins are not bio-degradable and lead to health and environmental hazards.
• Unorganised ways of municipal solid waste management and poor community collection, disposal and transportation networks in the cities and villages have further enhanced the problem.
• According to the MHAI, three main concerns are central to management of this largely non-compostable menstrual waste in India
• Paucity of appropriate disposal and treatment options leading to unsafe management of the waste.
• Many girls and women lack access to those waste management options that exist due to their limited ability to negotiate for solutions because of a continued culture of silence associated with menstruation.
• Lack of access to disposal options may lead girls and women using otherwise hygienic products in an unhygienic manner (e.g., use a pad for longer than it should be).

Thus it is important to consider safe menstrual hygiene disposal options and ensure that girls and female teachers know how to use them. The Ministry of Drinking Water and Sanitation along with the Ministry of Environment and Forests and Climate Change, Ministry of Housing and Urban Affairs efforts should be directed to offer safe and appropriate waste management solutions.

Way forward

Human Rights Watch and WASH United recommend that groups that provide services to women evaluate their programs to determine whether a woman or girl has:

• Adequate, acceptable, and affordable menstrual management materials;
• Access to adequate facilities, sanitation, infrastructure, and supplies to enable women and girls to change and dispose of menstrual materials; and
• Knowledge of the process of menstruation and of options available for menstrual hygiene management.

Practitioners engaged in programming or advocacy related to menstrual management should also:

• Have an awareness of stigma and harmful practices related to menstruation in the specific cultural context where they are working;
• Support efforts to change harmful cultural norms and practices that stigmatize menstruation and menstruating women and girls;
• Address discrimination that affects the ability to deal with menstruation, including for women and girls with disabilities, LBTI and gender non-conforming people, and other at-risk populations; and
• Be aware of and incorporate human rights principles in their programming and advocacy, including the right to participate in decision-making and to get information.