Menstrual Hygiene Management...
Needed for empowerment, health and well-being of adolescent girls & women

Sh Arun Baroka *

Menstrual Hygiene Day is a global advocacy platform that brings together the voices and actions of non-profits, Government agencies, individuals, the private sector, and the media to promote safe menstrual hygiene manage-ment (MHM) for all women and girls. Observed on May 28th every year, the day seeks to break the silence, raise awareness, and change the negative social norms surrounding menstrual hygiene.

In this context, under the Swachh Bharat Mission-Grameen, the Department of Drinking Water and Sanitation, Ministry of Jal Shalcti, will be celebrating Men-strual Hygiene Day 2022 by spreading awareness on safe menstruation and safe dis-posal of sanitary napkins, as a part of our efforts towards safe sanitation and hygiene for all.

Starting in 2022, Menstrual Hygiene Day will focus on translating in-creased attention for menstrual hygiene into measurable action and in-vestment so that together, we can create a world where no woman or girl is held back because of her period. Although menstruation is a natural biological process, which affects half of the world's population at repro-ductive age (12 to 49), it continues to remain a cause of embarrassment and shame, coupled with deep seated stigma about menstrual impurity, creating a barrier to gender equality. In India, an alarming number of girls drop out of school every year, when they start menstruating and owing to improper menstrual hygiene, face severe health issues.

Further, ar-chaic practices observed for generations in families, forbid girls from participating in normal activities. In the wake of such challenges that women, particularly the girl child face, Menstrual Hygiene Management (MHM) is not just about sanitation. It is a vital step towards protecting the girl child while safe-guarding her dignity and giving her a life of opportunities to pursue her dreams, towards achieving a gender-balanced world.

MHM in SBN1-G : To address this vital aspect, MHM has been included as an important component in the Government's flagship programme, the Swachh Bharat Mission Grameen (SBM-G). In addition to improving the overall sanitation coverage in rural areas of India, it aims at promoting dignity of women and children and to maintain sustainable health and hygiene benefits. It underlines the need for construction of toilets in households and schools which is integral to men-strual hygiene and encourages safe menstrual hygiene practices.

It further calls for skill development and setting up of sanitary napkin dispensers and incinerators in schools and public toilets. The MHM Guidelines issued by the Department of Drinking Water and Sanita-tion (DDWS) to support all adolescent girls and women, outlines what needs to be done by State Governments, district administrations, engineers and technical experts in line departments; as well as school heads and teachers.

The guidelines highlight the essential elements of a MHM programme that should be integrated into other Government schemes. This includes access to knowledge and information; safe menstrual absorbents; water, sanitation and hy-giene infrastructure and safe disposal of used menstrual absorbents. This would result in dignity for adoles-cent girls and women and the ability of adolescent girls to stay in school during menstruation.

Additionally, they call for awareness generation in the society, community, family and individuals and the need to provide informed and trained support for girls and women; and the importance of support-ive policies, guidelines and behaviours.

NFHS Survey : Unsafe menstrual management does lead to girls dropping out of school early when they start menstruating. As per the National Family Health Survey (NFHS) a large-scale, survey conducted by Ministry of Health and Family Welfare (MoHFW) in India, only 77.3% of women age 15-24 years use hygienic methods of protection during their menstrual period.

However, as per Ministry of Education the drop-out rate has decreased from 4.61 per cent to 2.61 per cent in Upper Primary and 16.89 per cent to 13.71 per cent in Secondary level since 2015-16 to 2020-21 respectively. The Ministry of Educa-tion reports that in 2020-21, out of total schools only 16.85 per cent schools have incinerator facilities within the school campus for safe disposal of sanitary waste.

Furthermore, as on date the data entered by States on the SBM-G Phase-II IMIS via the Mobile App, shows that 15,786 villages have ensured availability/access to menstrual absorbents (other than cloth) and 13,684 villages have made provisions for safe disposal of menstrual waste in the village through incinerators or deep burial methods (3248 villages at school level; 4707 villages at com-munity level).

Initiatives in States : Under SBM-G programme funds are available under the IEC component to raise awareness and skills on Menstrual Hygiene Man-agement, and self-help groups are to help in propa-gating such efforts. In keeping with this, States have initiated various pro-grammes that have dispelled myths and taboos surtound-ing menstruation, encouraging girls and women to talk about it and clarify doubts. For instance, in Jharkhand, Men 4 Menstruation (M4M) campaign was launched in Ranchi on World Menstrual Hygiene Day-May 28, 2020.

The purpose of the campaign was to break the societal si-lence on menstruation and to overcome 'Period Pov-erty.' Period poverty refers to the inadequate access to menstrual hygiene tools and education, including but not limited to sanitary products, washing facilities, and waste management. In May 2021, UNICEF Maharashtra held an IEC campaign called 'It's time for action, let's talk Men-struation Maharashtra' during which various events were held, encouraging peo-ple to talk about menstruation.

An interesting video circulated during the campaign was 'Pass the Pad' where people from all sections of society, men and women passed around sani-tary pads-helping to break the barrier on the subject. On the other hand, in 2020, Raigarh in Chhattisgarh launched a project titled 'Pawns' with the support of UNICEF to provide information to ado-lescent girls and women about best practices for im-proving menstrual hygiene management and make available to them affordable and biodegradable sanitary napkins.

To ensure supply of safe and biodegradable pads, the Self-Help Groups (SHGs) were provided with two machines and empowered to manufacture 30,000 pads a day to meet the demand of the communities. A safe alternative to the ‘Lal Kapada’ the Pawna pads cost less, were biodegradable and of good quality. As of now 3 villages in Raigarh are using the Pawna pads.

SBM (G) has also been supporting the installation of incinerators as part of the program. Karnataka is one of the States that has installed incinerators that can effectively dispose menstrual waste. The pilot project has been introduced in 32 locations–hostels, schools, and Gram Panchayats (GPs) across Karnataka. Post monitoring of their technical and analytical performance, similar sanitary napkin incinerators will be scaled up in more locations.

Meanwhile, Maharashtra has taken a major initiative towards creating awareness for MHM in the aspirational district of Gadchiroli. With the support of UNICEF, it has embarked on a silent revolution in which they are gradually eradicating the cruel practice of exiling menstruating girls and women to a Kurma Ghar or Period Hut during their monthly periods. In other parts of the country, campaigns are being conducted to make adolescent girls and women aware of ways to reduce menstrual waste, through use of products like menstrual cups, reusable sanitary pads, etc.

IEC material : DDWS has also produced various IEC materials that States and districts can use to promote--
MHM for health and dignity;
the use of safe absorbents for healthy menstruation;
the importance of safe infrastructure (accessible toilets, water, covered bins);
methods for safe disposal of menstrual waste;
healthy behaviours for hygienic menstruation
(nutritional needs, healthy habits and taboos related to going to school or work,
refraining from going to the kitchen or certain foods and participating in religious and social activities);
and education of the community that menstruation is not a disease but a natural biological phenomenon.

The Department has also produced brochures with the support of UNICEF to promote MHM.

Funding mechanism for MHM activities : SBM Grameen Phase 2 has earmarked funding for IEC purposes, which is being used to generate awareness about menstrual hygiene management. This funding is being used to support MHM communication and capacity building activities at the state, district, gram panchayat and village level.

Additionally, disposal of menstrual waste including incineration, etc. is supported at the gram panchayat level using 15th Finance Commission tied grants on sanitation. Further, as per a joint advisory issued, funding under the Department of School Education and Literacy, Ministry of Education can be utilized for the purchase of sanitary vending machines and incinerators for schools.

Way forward : Going by the activities in various States, clearly the subject of menstruation is not as much a taboo now and is talked about far more openly in the rural areas, compared to earlier days.

Women and girls are aware of the importance of menstrual hygiene and those who have access to them are using sanitary pads. They are questioning ancient practices of being asked to refrain from entering the place of worship or kitchen etc.

Incinerators are being installed in some schools. But this needs to be expanded to all households and schools around the country. More work needs to be done to help women and girls reach their full potential which effective MHM can ensure.

That said, the silence surrounding the subject of menstruation needs to stop. Men need to be brought into the conversation. They need to be educated and made comfortable during discussion about menstruation, so they can put an end to the attached stigma.

Girls and women should no longer feel embarrassed to talk about menstruation and get their doubts cleared. If we do not encourage girls to grow to their full potential, we would be restricting the growth of our country by half.