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Are We Doing Enough To Understand And Deal With Period Poverty?

More from Alolika A. Dutta

Illustration by Jeannie Phan

In an 8th-grade Biology textbook, menstruation is defined as, “The periodic blood that flows as a discharge from the uterus.” Over the last decade, a vast volume of sociological terminology relating to menstruation has become a part of living room conversations and media discourse.

These terms reflect upon the varied phenomena associated with menstruation—from ‘menstrual stigma’ that is now regarded as a form of misogyny to ‘menstrual liberation’ and ‘menstrual education’, social scientists have coined multiple terms to define society’s relationship with women’s bodies. Throughout this period, we have drawn intersections between menstruation and public policy, healthcare, religion, and gender. However, the economic and financial aspect of menstruation remains largely neglected.

In the last decade, another issue was repeatedly highlighted- the issue of global poverty. In an 8th-grade Civics textbook, poverty is defined as, “A state or condition in which a person or community lacks the financial resources and essentials for a minimum standard of living.” In simpler language, poverty is the practice of living one day at a time.

In 2012, the Indian government reported that about 22% of the Indian population was below the official poverty limit. It further reported that only 27% of adult Indian women had a job. As per a 2018 Oxfam report on Inequality, there had been a marginal upsurge in the percentage of working women, but women still received 34% lesser wages than their male counterparts for the same work.

In another pan-India survey of organisations, launched by the Confederation of Indian Industry’s (CII) Indian Women Network (IWN), gender parity was found to be absent even at senior positions, where 16% of organisations had no women on their board, 47% reported that there were no more than 5% women in senior management roles, 42% female respondents said that they faced managerial bias, and 33% of the female respondents believed that there were different performance standards and expectations for male and female employees working at the same level.

As a consequence of such discriminatory organisational structures, occupational segregation, gender labelling, income inequality, unpaid labour and the overall sexist workplace culture, women across the globe experience disproportionately greater degrees of poverty and even greater consequences of poverty as opposed to men. In the case of Indian women, these consequences are only aggravated by the patriarchal and casteist social structure of the country.

Menstruation And The Pursuit For Substantive Equality

It is important to understand that we are dealing with two significant developmental concerns here- gender discrimination and poverty. It is, therefore, necessary that we acknowledge the intersection between these two realities. The fact that a majority Indians who aren’t well of economically are women is unsurprising, and it leads us to the concept of compound discrimination, which is something that I happened to have spoken about in the past.

Compound discrimination is a subset of structural discrimination that takes place on the basis of several personal grounds or characteristics/identities which operate and interact with each other at the same time and in such a way as to be inseparable. When we speak about poverty and gender, compound discrimination is at play. And, when we speak about overcoming the same, we must look at systemic solutions that address the multidimensional aspects of such discrimination.

According to the Indian Ministry of Health, only 12% of menstruators in India have access to sanitary products.

For instance, we must understand that there are significant cultural, political, and economic differences between women from different communities—between women who hail from so-called ‘upper-castes’ and women from Dalit communities, between cisgender-heterosexual women and from from the LGBT community, and between women from different religions. Therefore, when we speak about securing equality for all women, we must understand it as substantive equality instead of formal equality

Substantive equality is a socio-legal concept which recognises that the policies and methods established for the majority of the population may appear to be non-discriminatory and inclusive, but they may not address the specific needs of certain groups of people thereby leading to a form of discrimination that is often invisible.

We have been speaking about intersectionality and inclusion for years, yet when most people hear the word ‘equality’, they define it as formal equality which openly disregards past discrimination, cultural transgression, implicit bias, and other factors which advance discriminatory attitudes. It also disregards the reality that rights, facilities, entitlements, and privileges are unevenly distributed across society and certain communities might have special needs which other communities might not. This is why formal equality is an insufficient solution to tackle disparity—giving everybody the same resources means while someone is over-equipped, someone is still deprived.

Substantive equality, on the other hand, takes us closer to equity by helping us see how layered discrimination can be and also explains why different people need different resources. When it comes to menstruation, by defining equality substantively, we open the conversation to formerly unaddressed concerns that are specific to marginalised women. One such concern is period poverty. As per Bodyform, one of the UK’s leading menstrual hygiene brands, “Period poverty means being unable to access sanitary products and having poor knowledge of menstruation often due to financial constraints.”

Understanding Barriers

In India, only 42% of women have access to sanitary products. Most women use cloth rags in place of sanitary pads—using these rags increases the risk of developing several diseases, even if they are regularly washed and maintained hygienically.

As stated in a report, launched jointly by Bank of America and Dasra, 63 million adolescent girls in India do not have access to a toilet in their homes. In the absence of a clean and private space to use sanitary pads, girls are often unable to manage their own hygiene. This can lead to urinary tract infections, vaginal infections, and rashes which could have long-term health consequences that require medical assistance.

Research states that an estimated 70% of all reproductive diseases are caused due to poor menstrual hygiene. Join the dots. Adolescent girls in India are more prone to developing reproductive diseases later in life and facing complications during pregnancy and childbirth. Hence, providing women with the resources required to practice menstrual hygiene will also help in reducing maternal and neonatal mortality.

Apart from accessibility, even cultural stigma has fostered period poverty in India. Menstruation remains a hushed conversation. This has led to about 71% of girls having no knowledge about menstrual health until after their first period. Due to this, menstrual hygiene is not considered a priority within Indian families and household spending on essential menstrual products is negligible owing to mothers viewing these products as unnecessary. Clearly, menstrual stigma is a larger problem than previously believed.

An Indian woman makes cloth sanitary napkins at the NGO Goonj in New Delhi; many Indian women don’t have more than scraps of old cloth when menstruating, which can pose health risks.

One of the ways through which such stigma can be tackled is incorporating menstrual education into school curricula. For instance, the government of Maharashtra has made menstrual health education mandatory in public schools. As per a UNICEF report, in 2017, the Maharashtra government introduced pilot programs in a few districts in order to provide menstrual health information and resources to students. In addition to teaching children about menstrual health, the government also decided to work towards educating parents. Prior to this initiative, only 13% of menstruating girls and women in Maharashtra knew about periods before they experienced them.

Even the Goa Government, in partnership with Procter and Gamble, introduced an educational module on MHM (Menstrual Hygiene Management) as part of the government school curriculum. Apart from educational institutions, the central government can also use the public healthcare system to educate families about the health-related consequences of improper menstrual practices.

Representational image.

A lack of knowledge about MHM can often lead to menstrual shame. This forces girls to stay out of school which means they miss anywhere between 10%-20% of school days. In certain families, girls are made to drop out of school after menarche, not only because of cultural beliefs, but also due to gender differences becoming more highlighted upon puberty.

It has been estimated that as many as 1 in 5 girls drops out of school after they get their first period and in some regions like Maharashtra that number is nearer to 4 in 5. In parts of India, the outlawed practice of Chhaupadi is still very common. Under this practice, women are sent away to live in menstrual huts during their periods. This is not only unethical but it may also lead to several health concerns.

Hence, the removal of regressive cultural beliefs that perceive menstruation as an unholy or unclean process is necessary to not only retain girls in schools, but also to ensure their safety at home. This kind of cultural change does not only need to happen within homes, but it also needs to be visible in election speeches, headlines, and conversations that induce menstrual shame and eventually restrict women’s education, upliftment, and financial empowerment. 

Most importantly, it is necessary for girls to receive menstrual education before their first period, so that upon menarche, they do not drop out of school; so that upon menarche, they are in a position to defend their right to education, practice safe and sustainable Menstrual Hygiene Management (MHM), and educate others about menstruation. It is a cycle: menstrual health awareness during primary education is a necessary step to higher education. Getting girls into schools is not enough—we need to actively work to retain them.

A seemingly obvious cause of period poverty is the high cost of sanitation products and facilities in India.

Approximately 70.62 million people in India live in extreme poverty, on less than $1.90 per day. The average Indian woman needs 300 rupees ($4.20) per month for menstrual products. Mathematically, it is infeasible for low-income households to invest in MHM and it becomes a deprioritised concern. To prevent this, in July 2018, the government of India took a step towards making menstrual products affordable by scraping the 12% tax imposed on them.

Representational image.

At this point, it is important to note that this move only came about after months of campaigning by activists and journalists from across the country. Evidently, we need more initiative from the government on the forefront of period poverty—we should not have to protest for something so preliminary because from here, the journey is still very long. Making menstrual products tax-free is only a short-term solution to an issue as complex as period poverty. In fact, it is even an unsatisfying solution.

According to a study conducted by European Sting, when Ugandan girls were provided free reusable sanitary pads, it did not necessarily improve school attendance. In one instance, girls were not aware of how the pads should be used and ended up not using them at all.

In another, girls had to miss school despite using the reusable pads because their schools lacked the infrastructure needed to clean and maintain the cloth pads. In other cases, girls were hesitant about using pads at school due to teasing from male classmates. This was primarily because, in Uganda, menstruation is associated with witchcraft.

Hence, the government will have to go beyond just making menstrual products affordable. It will have to address menstrual stigma by enhancing the supply chain of menstrual hygiene products in different corners of the country while also ensuring that the facilities needed to use these products are available to women.

A picture of women workers making sanitary pads at Myna Mahila Foundation.

In India, there are several organisations working towards providing menstrual facilities. One such organisation is the Myna Mahila Foundation. Founded in June of 2015, Myna Mahila Foundation is based in Mumbai, Maharashtra. The organisation works towards improving menstrual hygiene affordably, generating female employment in slums, and building women’s networks. In March 2018, they launched the Sponsor A Girl campaign to provide sanitary pads to 600 girls across five slum communities.

There are multiple such woman-owned organisations working to uplift and empower marginalised women, thereby proving how necessary MHM is. Despite this, the shame and silence around menstruation are alarming.

It is time ‘MHM‘ became a part of election speeches, of manifestos, and of media debates. It is time we hear our leaders speak about issues that concern approximately 48.3% of their voter base and 48.02% of the total Indian population. 

Apart from community organisations and the government, even academia has a role to play. In academic circles, a particularly surprising element of the conversation around period poverty is that women who define themselves as “progressive” and “liberal” have failed to adequately address the issue. This is primarily because most of these circles are dominated by privileged upper-caste women who do not pass the microphone to women from Dalit and rural communities, who do not actively work to make dialogue inclusive by accommodating diverse voices, who do not address issues that concern women from minority communities, who construct elitist and exclusionary intellectual spaces that sideline the non-English speaking part of the population; who co-opt Dalit leaders, and who are only echo chambers for Brahmanical ideas that perpetuate institutionalised patriarchy that targets poor, underprivileged women who lack the resources to secure their rights.

It is important to understand that the movement for women’s rights and the movement against Brahmanism must unify because the patriarchal ideology in India is inherently brahmanical. In order to abolish brahmanical patriarchy, we will have to start by bringing up intersectional issues such as period poverty and we will have to make space for women from Dalit communities in our conversations. As allies, we must understand that women from Dalit communities who come from historically oppressed communities are the stakeholders when we speak about period poverty and must be given the centre stage.

Different menstrual hygiene products used widely
Representative image.

After academia, even individuals can adopt a number of measures to help solve period poverty. Apart from donating period products at local shelters, signing petitions, and participating in marches that pressure the government to bring about legislative changes that favour menstruators, you can take two other steps to make lives easier,

First, if you are someone who can afford proper menstrual hygiene products, ensure that you purchase from brands that donate a portion of their revenue to alleviate period poverty or partner with a non-profit organisation that works to provide menstrual products and education to marginalised women.

Second, consider donating to a charity. You can donate to Binti, which is an organisation that has adopted a threefold solution to overcoming period poverty through access, education, and destigmatisation. You can also donate to Goonj under their ‘Not Just A Piece Of Cloth’ initiative. As part of this initiative, they distribute reusable cloth pads across India and organize meetings to inform women about MHM.

Along with this, ensure that you and the people around you are sufficiently educated about period poverty. The World Economic forum adopts a threefold approach to understanding period poverty: a lack of awareness, a lack of acceptance, and a lack of access. A lack of awareness is why menstrual needs end up getting deprioritised. A lack of acceptance is why women end up using unsafe sanitary products and girls miss school during their period. And, a lack of access is how women get exposed to illnesses arising out of inadequate menstrual hygiene.

In the end, if governments, community organisations, corporate brands, and we as individuals choose to mobilise resources to fight period poverty, we will be able to make lives better for 23 million women in India alone.

Join the fight.

This article was first published here.

Featured image for representation only.
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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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