Menstrual health management in India

Introduction

Menstruation is not a problem but poor menstrual hygiene is. This is something that India as a society fails to grasp. The kind of unawareness where 71% of adults and girls are still unaware of menstruation is simply appalling when they get their first period. There are 40 crore menstruating women in India and out of that, barely 20% use sanitary pads, while this number rises only to 52% in urban areas. These statistics provide a clear picture of where India stands in terms of menstrual hygiene and awareness. While there have been a few schemes launched to increase menstrual awareness and hygiene in the country, the practical impact of these schemes has been minimal and unsustainable.

Increasing traction towards menstrual hygiene

There has been a constant silence around menstruation since the independence of the country. One of the reasons behind this could be the already distorted healthcare system with limited access to health facilities. At the same time, there were not many choices in menstrual

products. Due to all these reasons, the topic of menstrual hygiene management never reached the government agenda even till the late 80s and 90s.

National Health Mission

Initially, the Ministry of Health and Family Welfare launched a menstrual hygiene scheme in 2011. This was launched under the National Health Mission to promote menstrual hygiene among girls of 10 to 19 years. It further extended to all districts under Rashtriya Kishore Swasthya Karyakram in 2014 to enhance the knowledge of menstrual hygiene and improve the practices in schools and provide subsidized sanitary products.

It also involves increasing Menstrual Health Management (MHM) by involving other vital parts like ASHAs (Accredited Social Health Activists) were given the responsibility for mental health management. Various self-help groups Supported by the National Rural Livelihood Mission of the Ministry of Rural Development took the responsibility of manufacturing disposable low-cost sanitary napkins. At the same time, devil advertisements were issued to popularise the use of disposable pads among women.

Other initiatives

After the launch of the National Health Mission, there were many programs launched to promote Menstrual health management –

Ministry of Women and Child Development’s last SABLA program with an underlying focus on nutrition, health, hygiene, and reproductive and sexual health at rural mother and child care centers.

One of the integral parts of the Swachh Bharat Mission has been menstrual hygiene management which involves various stakeholders of the society like state governments, district administration, school headteachers and others in supporting the implementation. “Swachh Bharat: Swachh Vidyalaya” campaign has been launched to ensure that every school in India has a set of functioning and well-maintained WASH facilities including soap, appropriate water for washing, and private space for changing and adequate facilities for disposing of menstrual absorbents.

Then in 2017 guidelines for gender issues in sanitization were issued which have been upgraded over time by the Ministry of Drinking Water and sanitation to ensure gender equality and empowerment of women and girls in the arena of sanitation. This was to ensure that menstrual hygiene management is perceived as entirely normal and acceptable in the Indian societal context.

In 2015, the Ministry of Drinking Water and Sanitation issued the national guidelines on menstrual hygiene management, intending to take care of every issue in this area. The start of menstrual hygiene varies from raising awareness, increasing demand for hygiene products, addressing behavior change, and awareness of key stakeholders and others.

Besides this, government initiatives like Nirmal Bharat Yatra aimed to increase menstrual health awareness in Indian society.

Priority was given to sanitary napkins under RMNCH+A under the RKSK program.

Samagra Shiksha Abhiyan was launched, which involved the installation of sanitary napkin vending machines and incinerators to improve accessibility to menstrual hygiene products.

In 2018, on International Women’s Day on March 8, the government launched 100% “Suvidha,” which are oxy-biodegradable sanitary napkins in packs of four at Rs. 10 to be made available at Pradhan Mantri Bhartiya Janaushadhi Pariyojana Stores

Role of ministries

Ministry of Health and Family Welfare: They had one of the beginning responsibilities as they were involved in counseling adolescent girls on the topic of poverty under the Rashtriya Kishore Swasthya Karyakram. They were also responsible for the training of Asha workers.

Ministry of Women and Child Development: They took the responsibility of training Anganwadi supervisors and workers, which helped further implement other menstrual hygiene-related schemes. To create more awareness among women and girls about menstrual hygiene, the ministry reached out to schoolgirls through the SABLA program, integrated child development services, and people from self-help groups under the Mahila Arthik Vikas Mahamandal.

Ministry of Human Resource Development: Their contribution involves training to teachers for providing proper knowledge to girls and boys about puberty-related issues.

Challenges to successful implementation

Even after many initiatives regarding menstrual health management, some challenges exist-

Access to information- Mensuration has always been a taboo in Indian society due to existing socio-cultural beliefs and practices. Hence access to rational and accurate information is still at a big gap. The concept that menstruation is an entirely normal biological phenomenon is rarely seen in different sections of the country. According to one research, 23 million girls drop out of school each year when they reach puberty due to a lack of school menstrual hygiene services, such as sanitary napkins or clean restrooms. This is just one aspect of females getting away from academic and career opportunities while there’s a lot more mental pressure to it which is hard to quantify.

Access to menstrual hygiene products- A more significant fraction of menstruating women do not have access to cost-effective hygiene mensuration products. National Family Health Survey (NFHS 5) data shows that in 17 States and Indian Union Territories, 90% or more women were using appropriate menstruation products. While, in union territories like Andaman and Nicobar Islands and Puducherry, data for this is 99%. While the other side of the data shows that in 7 States and union territories which are Tripura, Chhattisgarh, Assam, Gujarat, Nighali, Madhya Pradesh and Bihar – 70% or fewer women were using appropriate mensuration products. Also, Bihar was the only state with a reported figure lower than 60%.

The data also proves that women in urban areas have more access to mensuration products than women in rural areas. The data for 11 states shows a ga of more than 15% in menstruation product use across urban and rural devices. Madhya Pradesh and Meghalaya had an enormous gap of more than 25%.

Conclusion – the way forward

Menstrual hygiene is one such integral part of society that connects many developmental dots as good menstrual hygiene positively impacts the health, confidence, and self-respect of females, which directly relates to further women empowerment and gender equality. The government has done a great deal in Menstrual health management by initiating various schemes. Still, most of them have not been able to create something significant when the data are seen. Two big obstacles in this successful implementation process have been lack of awareness and lack of accessibility.

With proper redressal of these issues, a huge impact can be seen in menstrual hygiene in India. To enhance awareness, steps like puberty education at curriculum levels should be encouraged in schools to sensitize both the female and male communities. Innovative schemes need to be used to spread awareness, such as community interaction programs and social media, and local influencers should be utilized to work on the taboo aspect of it. To increase accessibility, women must be aware of existing government initiatives for low-cost disposable sanitary pads. Also, decentralized approaches for community-based organizations/self-help groups producing low-cost sanitary napkins might be an excellent alternative to meet the need.

Further, sanitary napkins are still treated as a luxury item in the country when one notices the taxes put on them. Menstrual products are necessary healthcare products and should be recognized as the same. In conclusion, the government should set short-term realistic objectives and goals to achieve menstrual health management in terms of its existing policies and take care of it when implementing new approaches to improve the basic hygiene services given to women.