FIELD REPORT

Menstrual Health, Hygiene and Women: Facts, Figures and Untold Story

Dr. Antarjeeta Nayak
Founder Director, ARDF

Introduction

There are so many colours around us. Every color is unique in this beautiful creation. The ‘Red’ color among all has some uniqueness, importance and charm. A beautiful red ‘Sindoor’ line in the forehead or a red lining of ‘Alta’ in the feet ; the spark of red sky during the sun set, or a life giving flow of red blood in the human body ; there is something different in the red color. There is always a little bit of red color in every one’s life. But, when it comes to the life giving drop of menstrual blood, it becomes an issue of fear, shame, embarrassment and full of taboos. In a state like Odisha, where we celebrate womanhood and periods through “Raja” festival, many women are still unaware of menstrual health and hygiene and perceive periods a matter of inhibition and the most unwanted topic for discussion. Survey says, only 36% of Indian women use sanitary pads. Rest women are still using cloth, dried leaves, bamboo, sand filled socks and several unhealthy and deadly things, leading to many diseases and even infertility and reproductive disorders. Buying the sanitary pads is a costly affair and a matter of shy too. Such problems are more persistent in rural and tribal societies.

Menstruation is more a matter of shy, a taboo pitch and a costly affair, than a normal physiological change that happens to every girl. Menstruation is an indication of the beginning of a reproductive life and a power to create and bring a new life to the earth. Menstruation is every woman’s pride and bleeding is divine. Menstrual health and hygiene is every woman’s right. Even though, menstruation is normal and a healthy part of life, yet girls and women in India go through extreme struggles to manage their periods every month. A large chuck of the Indian population believes this natural menstrual cycle to be a ‘curse’, ‘impure’ and ‘dirty’ among several other things. The cultural and social influences on people create a major hurdle in ensuring that the women are given proper knowledge on menstrual health and hygiene. In many families, menstruation is being perceived as an embarrassing thing, extending even to the mention of menstruation both in public and in private. Most women even hide themselves out of fear or embarrassment on their way to a medical store, rather majority of them cannot afford to buy hygienic sanitary pads. Menstruation is expected to be a hush affair and kept under wraps of the ‘black plastic bags’. In this journey of menstruation and the menstrual cycle, not only women need to be educated and get aware, but also the men and the society as a whole need to be included. There is certainly an urgent need of awareness among all to make periods happy, healthy and hygienic. With this perspective, Abhibyakti Research and Development Foundation (ARDF) had arranged an awareness programme on “Menstrual Health & Hygiene” at Kundra

Before deciding Kundra village as the venue for the awareness event, ARDF’s volunteers visited Kundra for a pilot study. During the period of our pilot study, we observed the village women are shy and reluctant discussing anything about menstruation. Some women started avoiding us, when they came to know we are talking about menstruation openly. After that we consulted the Anganwadi workers and ASHA regarding the menstrual issues of the village women. They are in fact the ground level workers who contribute to some extent assisting the village women with their menstrual issues. With this regard, the ARDF team decided to organize an awareness programme keeping menstruation as focus; before the issue affects the women. During our course of pilot survey, we gathered varied other information revolving in and around menstruation. Based upon the pilot survey, we prepared a questionnaire to address the menstruation issues through ordinal measures. Through our experiences and observation before and during the event, we tried to address some issues regarding the menstruation.

Red vs. Red

During our interaction with the Kundra villagers, we noticed a serious conflict between two red drops; red drop of ending life vs. red drop of creating life, i.e., Red Alcohol Vs Red Menstrual Blood. Alcoholism is a great issue at Kundra village. Most of the men at Kundra are fascinated and addicted for red liquor. The male members of the family relentlessly spend both time and money on liquor. They do not feel shy to buy the liquor and even consume it openly. After the consumption of liquor, violence at family becomes obvious. Basically, women are prone to domestic violence prior to liquor consumption. Whereas, women feel shy discussing their menstruation issues. Buying and using sanitary pads is a matter of shy and a costly affair for women. In almost every family, money was spent on liquor, but the same money falls sort to be spent on sanitary pads. Availability of red liquor is easy as compared to the sanitary pads. Being a drunkard is more affordable than having healthy and happy periods. In fact, in order to deal with menstrual health and hygiene, alcoholism as an issue needs to be addressed first. The friction and conflict between red liquor and menstrual bleeding is a matter of concern not only at Kundra village of Odisha, but in many villages across India.

Do Beneficiaries Benefit from the Government Schemes

Under the ‘Khusi’ scheme, a Government of Odisha initiative; free sanitary pads are being provided to adolescent students of class 6-12 of the state. Under this scheme, every month, each girl will be provided 18 sanitary pads for free. Along with the school girls, the Odisha Government also provided sanitary pads to rural women at subsidized rates through ASHA at one rupee for a pad that actually costs six rupees to eight rupees. Besides ‘Khusi’ ‘Ujjwala sanitary napkin’ initiative is also launched. The scheme has two primary objectives to improve accessibility to basic hygienic product and create employment opportunity to women. The program is an initiative to provide the rural women a dignified means to earn their livelihood and ensure a healthy and hygienic menstruation.

No doubt, the central as well as the State Government, through several initiatives trying to ensure every girl and women a healthy and happy periods, the dilemma found at Kundra village is that many are not even aware of the ‘Ujjwala sanitary Napkin’ initiative and not even in their village such initiative is operational. Besides, the pads distributed to adolescent girls under ‘Khusi’ scheme is not satisfactory, as recorded by the girls using those. Girls of the Kundra village reported “the sanitary pads given under ‘Khusi’ scheme at our schools are very thin. There is often a chance of leakage. During the heavy flows, the pad is not up to the mark. The size of the pad is also small. Menstrual blood very often trickles back, causing leakage. So we generally fear to use the sanitary pads and sometimes feel uncomfortable too due to wetness.” The Adolescent girls generally have a heavy menstrual flow as compared to the women of latter age. So, the quality of free pads needs to be improved and modified. If the quality of pads did not get any attention, then certainly the purpose, objective and focus of the scheme will lose the importance.

From our interaction and conversation with the village women, we came to know that the sanitary pads which are supposed to be sold to the women at a subsidized rate of six rupees per packet (6pads) as government guidelines, the same is sold at ten rupees. So, in villages like Kundra, where menstruation is a costly affair, the affordability for healthy and hygienic periods is reduced. Unawareness of the rural and tribal women regarding the Government schemes for menstrual health is a serious problem that needs to be addressed. Moreover, during the Corona days, the menstrual health and hygiene is very vulnerable. Schools are closed due to Corona. Under the’Khusi’ scheme, adolescent girls fail to get the sanitary pads resulting in use of cloth during their periods. Soon, this limitation and helplessness becomes their practice. So, in this scenario, we hope our awareness camp and free distribution of sanitary pads as an intervention to deal with Corona and Menstrual crisis would have been of some use.

Ordinal Measurement of Menstruation

With a purpose to measure the menstrual issues through an ordinal measure, we used a structured questionnaire, which covered 65 women from Kundra village. The questionnaire was designed to give a brief idea about the knowledge, practice and attitude of the women towards menstruation and menstrual related and caused issues. The event witnessed the participation of women of various age groups; and various age groups had their own menstrual practices and beliefs. So in order to capture a holistic picture of the menstruation, we have analyzed the collected data age wise.

Beyond the Ordinal Measures

The survey also reported that, women who do not use sanitary pads during their periods are facing many problems like itching in the genital, foul smell from vagina, pain in thighs, rashes due to use of cloth, uncomfortable during periods and many more alike. Our gynecologist present at the program suggested several remedial alternatives to combat the menstrual hygiene problems. Still it was observed at the event that, even though our gynecologist was a lady doctor, the women present over there were reluctant to ask questions related to menstrual health and hygiene, and actively participate in the interaction course. Besides the health issues and menstrual problems, another shocking and serious concern came forward from the gathered mass; it was reported by one woman of about 21 years of age, present at the event that, when the 9menstrual flow is low someday, like some few drops of blood only , then she would wash the sanitary pad and dry it up to use it for the next time. As the economic condition of her family was not so sound to afford sanitary pads every time, she followed the dangerous action of using the sanitary pads for double use. After hearing the woman, our gynecologist strictly suggested all the women who used sanitary pads; even though there number was very small, to use the pads for single use and dispose them safely. Reuse of the pads may lead to severe health issues.

Conclusion

The major objective behind arranging such programme is to create a general awareness on menstrual health and hygiene among the women, basically the tribal women and adolescent girls. Menstruation and menstrual health are still a taboo which needs serious attention for the wellness and wellbeing of women population. In our future programme and projects related to menstruation and menstrual health and hygiene, we shall not only involve women, but shall also give priority in involving the men as well. It was also observed at the event that, there are still several women in their late forties and heading towards their menopause, who have not even seen the sanitary pads. They have seen the sanitary pad packets, but not the pads inside it. So, on the spot we made all see and touch the sanitary pads and demonstrated how to use those. With this, we distributed sanitary pads among the women present over there, and ended the programme with an assurance from everyone that they would make their periods happy and healthy, and discuss the menstrual issues without any inhibition and reluctance as ‘Menstruation is the pride of every woman.’

-Abhibyakti Research and Development Foundation (ARDF)