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Improving Sanitation in India: A Herculean Task [Part 2]

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By Dr. Amrit Patel:

Continued from Part 1 of a 3 part series.

Another pertinent challenge to be dealt with is the rural-urban divide. Government of India’s first Socio-Economic Census and Comprehensive Population Survey, 2011, reveals significantly disappointing progress and developments on certain basic amenities to sustain human life. The number of houses increased from 250 million in 2001 to 330 million (132%) in 2011 whereas Government’s biased policy and enhanced purchasing power of millions in urban and metropolitan centres facilitated them easy access to state-of-the-art technologies and consumer goods, due to complex transition process experienced during post-market economy, in sharp contrast to a large number of rural households lacking access even to the most rudimentary facilities as per Census 2011. For example, while rural households (167,826,730) accounted for 68.03% of total 246,692,667 Households only 17.9% rural households have access to treated source of tap water as against 62.0% urban households and 62.5% rural households depend upon firewood for cooking as compared with 20.5% urban households. It is shocking that only 30.7% rural Households have latrine facilities as compared to 81.4% urban Households. Of this, as high as 63.2% rural Households have toilets with no drainage as against meager 18.2% urban Households and just abysmally as insignificant as 2.2% rural Households have piped sewer system as compared with 18.2% urban Households.

Discrepancies: According to Census 2011, at national level only 32.7% households have toilet facilities. The States with households more than the national average include Kerala (94.40%) Goa (72.6%), Punjab (71.9%), Himachal (67.5%), Haryana (57.7%), Maharashtra (44%), Andhra (34.9%) and Gujarat (34.2%) whereas the States with Households below national average include Jharkhand (8.3%), Madhya Pradesh (13.6%),  Odisha (15.3%), Bihar (18%), Uttar Pradesh (22.9%) and Tamil Nadu (26.7%). Dismally, the number of HH with toilets rose only 16.5% between 2001 and 2011. Increase is, however, just 4.8% in Bihar, followed by 6.12% (UP), 6.3% (MP), 8.3% (Odisha) and 8.4% (Rajasthan). It is  surprising that States reported households with toilets, on website of the TSC run by the Union Ministry of Rural Development, are significantly higher than that under Census 2011, viz. national average (68.15%), Kerala (100%), Himachal (100%), Haryana (96.04%), Uttar Pradesh (81.76%), Gujarat (81.6%), Tamil Nadu (78.11%),  Andhra (77.07%),Goa (76.24%), Madhya Pradesh (76.37%), Maharashtra (71%), Odisha (53.89%), Jharkhand (42.37%) and Bihar (32%). This invariably needs to be corrected since States in their enthusiasm to compete among them have reported significantly high achievements. It is also questioned whether toilets are really being used. People may agree to use toilets. But it is a challenging task to change to new habit when for generations they have been used to open defecation. It is necessary to sustain behavioral change.

Poor Performance: Poor performance with regard to sanitary facilities continues to be a major and serious concern for the country. Factors attributed to this  include, inter alia, (i) Cultural and traditional reasons and lack of education are the primary factors contributing to this unhygienic practice (ii) Most of SCs, STs, BPL families and lower income group  are generally not aware of the importance of sanitation for better health and clean environment. Sanitation is not a “felt need” for them and, therefore, they do not participate in sanitation programs (iii) Low sanitation coverage is due to inadequate and lack of concerted efforts to create awareness among rural households, motivate them to have toilet facilities, lack of affordable sanitation technology and trained implementing agencies and (iv) Non-availability of choice of toilet designs and area specific technologies, inadequate supporting delivery systems and absence of trained masons, skilled workers and technical manpower are reasons for low coverage.

What is needed: The program of TSC needs to be implemented on a missionary zeal fully supported, inter alia, by following critical elements in accomplishing its strategy. Till toilet facilities are provided in each village of the country a village-wide campaign is necessary to make rural people fully aware of the adverse effects of open air defecation which is mainly responsible for infections and a number of diseases. A massive campaign, through employing all available means of communication, has to be launched to make all the people in a village including school children, youth and women fully aware of the fact that they should never go barefoot for open defecation; should always cover the human excreta with the soil after defecation so as to prevent flies sitting on excreta and, in turn, contaminating eatables as this is the main cause of diarrhoea, dysentery, cholera etc. Rural sanitation as a part of heath should find appropriate place as the compulsory subject in primary schools. The ultimate objective of the campaign should be to create demand for safe hygienic toilets and save women in particular from the agony and humiliation of open air defecation.

Safe sanitation and clean water make the population healthier. There is no difference between health and sanitation as both are directly co-related with each other. Recognizing the outbreak of water-borne diseases like cholera, diarrhoea and cancer risks from arsenic in drinking water in several places, it is necessary to consider heath, water supply and sanitation as one sector rather than separate. There are tens of thousands of Accredited Social Health Activists (ASHAs) in rural India. An ASHA worker is a village woman, preferably in the age group of 25 to 45 years and trained in the area of health. The services of ASHAs affiliated to National Rural Health Mission can be of significant help to create awareness among rural masses, more importantly women, in the matter of sensitivity to hygiene and sanitation issues.

For construction of toilets adequate number of masons have to be trained in the construction technology, methodology of implementation and follow-up work. Adequate number of pans and water seals of approved standard specifications and quality have to be made available at various centers so that people of the area can have easy and reliable access to the facility to construct toilets to suit their income and choice.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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