Breaking The Silence Worldwide Foundation, an NGO based in Bangalore and Imphal in India, has been campaigning globally for menstrual health since 2014, launched the theme for its 2020 programs as “multi-sectoral linkages and collaboration” for attaining menstrual hygiene.
The Menstrual Hygiene Management (MHM) sector remains a small area of social development currently. Compared to others while focusing on awareness development, manufacture of sanitary products, their sales and marketing, generation of livelihood opportunities for women, availability of affordable sanitary materials as well as involvement of women in awareness generation, it falls behind other sectors in linking to higher goals of gender equality, sanitation and health. The present narrative tilts towards production, use and disposal without sufficient dialogue and deliberation on addressing the larger evil of gender inequality.
MHM is also a sector which is no one’s baby and not one ministry or department under the Government of India is solely responsible for it. For the same reason, MHM has only been a deliverable on the side of the leading programs for line departments like Drinking Water and Sanitation, Human Resource Development/Education, Panchayati Raj Institutions (PRI), Rural Development, Swachh Bharat Mission, Public Health Engineering Department (implementing Swachh Bharat Mission) and so on.
Though each of these has its own MHM objective and targets, due to the nature of how government works, coordination outside of the departments hardly takes place thereby resulting in each department working on its own whereas menstrual health requires a collective effort.
MHM And Water-Sanitation-Hygiene (WASH) Sector
The Government of India declared MHM as a priority area along with handwashing, ending open defecation and building, using and maintaining toilets through the launch of Nirmal Bharat Abhiyan (NBA) in 2012. Over the years, sanitation has continued to occupy center stage with Swachh Bharat Mission (SBM), its two sub-missions- Swachh Bharat Mission (Gramin) and Swachh Bharat Mission (Urban) and aggressive marketing of toilets.
In addition to building toilets, SBM aimed at bringing improvement in cleanliness and hygiene through effective and scientific solid and liquid waste management systems. This is where MHM was included, and funds allocated for solid and liquid waste management were provisioned to implement safe disposal solutions for menstrual waste (used sanitary cloths and pads) and setting up incinerators in schools, women’s community sanitary complexes, primary health centres, or in any other suitable place in village and collection mechanisms.
MHM remained a sister concern of the sanitation sector in India; the availability and accessibility of toilets offering infrastructure, privacy and security to (menstruating) women. The major stakeholders of MHM in the sanitation sector are the gram panchayats, SBM team, local NGOs and construction companies, school principal and education officers. These are the provisions of MHM programming within the government where MHM still fails to be a central program with no budget allocated distinctly for its activities.
MHM And Waste Management Sector
Sustainable menstruation was accompanied by a growing concern for the disposal of used sanitary napkins because the very proposition of eco-friendly biodegradable sanitary pads was its advantage of not posing as an environmental hazard. So till the time everyone has shifted to eco-friendly products, disposal is going to remain a threat to the environment, and discussions included collection hazard exposing waste pickers to unhygienic sanitary waste, blocking of sewage pipes from people flushing them in toilets and nalas, mix waste and difficulty in segregation for required processing on landfills and toxic fumes generated and so on.
The government bodies- solid and liquid waste management, Rural Development Department, Pollution Control Board and local bodies; the community- households and NGOs, schools and Education department- schools are involved in sanitary waste disposal process.
NGOs have also been engaged in waste management, whether it be in towns and cities in collaboration with the municipality or villages with PRI and SBM teams. Another matter was of classification of used sanitary waste as dry domestic waste or biomedical waste because in case of the latter, it has to be subjected to incineration as per the Biomedical Waste Management Rules 2016.
The treatment of used sanitary waste was taken up employing different methods depending on what people thought it was- solid waste (went to landfills) or biomedical waste (incinerated). You will find both these methods of disposal prevalent in India owing to two different understanding of sanitary waste category and here too, lack of consensus and collective effort is missing altogether.
MHM Programming In Different States In India
Different states within India reached different levels of MHM awareness, sanitary material choice and production and disposal depending on the performance of its government, civil society and NGOs. Here too, lack of standardization was seen; while in few places incineration was banned after reaching a conclusion on its ill-effects to health from impartial or low temperature burning of used sanitary napkins in other places schools were being fitted with incinerators of different types and models.
In cities, use of cloth-based reusable pads have become popular and so have menstrual cups while in rural pockets, disposable sanitary napkins are not just popular but the only available solution. Even these rural regions are connected to the rest of the world through social media and may have access to the advocacy of sustainable menstruation but lack access to choices in reality. If only the deliberation had been collective, a lot of resources and efforts would have been saved, and a comprehensive and effective MHM program would have yielded a greater impact.
MHM, NGOs/CSOs Movement
In the NGO/CSO and development sector several innovative, effective and impactful initiatives have been implemented, the sad part being they were localized in regions where the organizations operated, were project based and therefore subject to a time-frame for as long as the project lasted or the cross pollination between organizations failed to take off to facilitate the replication of best practices at scale.
A shift from FMCG manufactured disposable sanitary napkins to decentralized production of sanitary napkins resulted in affordability and accessibility of sanitary napkins among the lower economic level segment and at the same time giving income to women who were making these sanitary napkins. In Uttar Pradesh and few other states, the district Panchayati Raj Institutions (PRI) sponsored the production of low-cost sanitary napkins, their marketing and distribution involving schools and education institutions, SHGs, NGOs, ASHAs, local dispensaries.
MHM And Environment Conservation
In other parts of the country, biodegradable and eco-friendly sanitary pads made of banana, pineapple, even corn fibre and also of cotton cloth picked up the pace and menstrual cups made an entry. The vocabulary and the tone used in relation to menstruation all underwent review and scrutiny with heightened sensitization.
A movement to question the choice of name by “Whisper” brand of disposable sanitary napkins was also started on the logic that the name signified the presence of shame around menstruation when it was a natural phenomenon and nothing to be ashamed about. When menstrual cups and tampons began to be considered as new options available for the modern women, it carried the stigma of ‘insertion technology’ which was met with resistance, fear and suspicion.
The issue of loss of virginity in girls was central to this resistance. Though domestic companies’ production made it possible to get menstrual cups for a lower price as compared to cups imported from abroad that could go up to ₹3000 apiece, but there was a varying range of quality and uptake of this sanitary innovation. Despite these developments, sustainable menstruation came to stay, and menstrual cups, reusable and eco-friendly products swarmed the discussions, social media and conferences but strangely, they did not dominate the market and have remained limited to online marketing.
MHM And Human Rights
The waste management process is experiencing multiple challenges like the lack of awareness, interest in citizens and stringent rules to segregate the waste people generate into dry waste, wet waste and biomedical and sanitary waste at source. The common norm is mixed waste, and people hardly segregate used sanitary materials at home or workplace. This puts the entire burden on waste pickers and sanitation workers in the chain for segregation and sanitary waste along with biomedical waste pose as a health risk for frontline workers.
Collection, transportation (dry, wet, biomedical waste separately inside the vehicle or separate vehicles for different types of waste), segregation, treatment or recycling of waste, limiting space available for dumping in landfills with progress of time, toxicity from the waste lying in the open in the dumping grounds causing environment pollution, the risk of frontline waste workers in these massive landfills along with the stigma of sanitation workers and waste management workers.
In Pune, the Red Dot Campaign was in that way a very significant citizen-led movement of segregation of sanitary waste at source using a red bindi on the garbage bag carrying used sanitary to help waste pickers identify its content and treat it likewise. There is no reason why this practice can’t be scaled across the country.
MHM, Bollywood, Films And Entertainment
A film on periods won the Oscars and Bollywood made two important films – Padman and Toilet, Ek Prem Katha sponsored by the Government of India which were significant for both the WASH and MHM sector. The films reached the remotest villages, and even district administrations organized mass screenings in village or cluster level so that where workshops, nukkad natak and lectures failed, Bollywood will never fail with people in India. While one was aimed to increase the building and using of toilets, the other put the spotlight on the need to end isolation and stigma of menstruating girls and women and developing affordable sanitary pads.
MHM And Collaborations Within The Government/Civil Society
There are many NGOs and CSOs working on different aspects of MHM program. However, there is a need for facilitating linkages to all these programs and foster multi-sectoral collaborations with an aim to take the MHM agenda beyond health, water and sanitation, education and livelihood to touch industry, IT, environment, waste management, media, entertainment, human rights, police, administration, defence establishments, corporate, legal aspects and any other spaces and last but not the least, ensure all the stakeholders across India are ‘on the same page’ on awareness, sanitary materials and disposal mechanism.
In one corner, a district administration is spending crores in procurement, installation of incinerators in schools, hostels and colleges, training on use and maintenance and hiring of staff for its working while in the same country, one school of thought has concluded that incineration cannot be the method employed for safe disposal of sanitary waste.
Confusion, waste of precious resources, conflict and ineffective programming are results of not ‘coming together.’ Standardization of the different components of the MHM program across India is the need of the hour.
Multi-sectoral linkages and collaboration is the way forward for menstrual hygiene management sector and aiming to develop into an independent and robust program can do justice to the 355 million menstruating girls and women in India.