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What Role Do Anganwadi And Asha Workers Play In Ensuring Menstrual Health?

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This post is a part of Periodपाठ, a campaign by Youth Ki Awaaz in collaboration with WSSCC to highlight the need for better menstrual hygiene management in India. Click here to find out more.

In India, the discussion around menstrual hygiene is either ignored or holds very little importance. Even after taking various steps to ensure menstrual health management through grassroots health workers and various schemes, there has been little to no change. In the grassroots, the government has formulated various schemes, policies and programmes yet, the implementation has been very little. 

ANW, ASHA And ANM

ANW ( Anganwadi workers), ANM (Auxiliary Nurse Midwife), and ASHA ( Accredited Social Health Activist) are community grassroots workers and mostly women. ANWs runs a child care centre called “Anganwadi” as a part of Integrated Child Development Services. A centre has to ensure non-formal pre-education to children (age 0-5), Supplementary Nutrition, Health Check-up and referral services. An Anganwadi centre comes under Women and Child Development.

ANM and ASHA are grassroots health workers. Whereas, ANM closely works with children, women and young adolescents. They come under the ambit of National Rural Health Mission, Ministry of Health and Family Welfare. Both Anganwadi and ANM closely work with ASHA. 

Anganwadi workers learning kitchen gardening in Surat (Picture from Urban Health & Climate Resilience Centre Training, 2016/Representational image.

Role And Responsibilities With Regards To MHM

The Ministry of Women and Child Development provides training to the Angawandi centres around Menstrual health. In addition, the centre has to provide women and adolescents with sanitary pads. Whereas, ASHA, the first contact person, is entrusted with the responsibility of providing adequate knowledge around menstrual hygiene. In addition, ASHA is also a part of Village Health and Sanitation Committee (VHSC) and works along with panchayats.

Therefore, can ensure separate toilets for girls and boys in the government schools. Government of India and various departments have various booklets, flipbooks in place for Anganwadi centres, ANM and ASHA. Further, ASHA has to distribute sanitary napkins at subsidized rates. 

They are entrusted with the responsibility of disseminating information about Menstrual Health to the women through the Self- Help Groups. A range of materials have been developed around MHS yet the scope of intervention is limited. 

The Ground Reality 

Menstrual Hygiene Management should be the priority in the village yet, the effect on the ground has been dismal. In the few villages of Block Jaisinghnagar, women use clothes during menstruation. Adolescents get knowledge around menstruation through the womenfolks of their house once they start menstruating. Anganwadi centres do not have sufficient sanitary pads to distribute among adolescents and women.

ASHA hasn’t organised much of an awareness campaign too. Most of the awareness campaigns have been around child marriage, pregnancy and nutrition. The discussions around menstrual hygiene have been negligible. There is no space for adolescents and women to share their struggles and issues pertaining to menstrual. 

Although training has been provided to Anganwadi workers yet, these trainings fail to reach the women of their communities. Poor engagement in the community results in less involvement of panchayats to also notice the need for sanitation in the community. In the villages, the role and responsibilities of these workers get limited to immunization, providing meals to the children and providing referral services to ensure the safe delivery of children.

Through the interaction of women with people, I learnt they do not prefer to approach them. People of the community do not consider them equipped adequately with the knowledge and resources to deal with the concerns pertaining to the health of the women. Interestingly, these women do not deal with concerns pertaining to menstrual health. ANM workers mostly tackle the issue of immunisation. Anganwadi workers are the one who closely work with adolescents, children and women.

Another major issue is the payment of an ASHA worker, she gets paid roughly 2000- 3000 rupees and it is a task-based payment. There’s no fixed salary and incentive-based income is insufficient as a lot of grassroots health workers’ primary source of income is through this work. A lot of ASHA workers in the villages have started taking up another role altogether due to less payment and delay in payment. Therefore, a lot of them do not even perform their work.  In addition, Panchayats fail to recognize the importance of their work which further limits the scope of intervention of grassroots health workers to ensure the issues of water and sanitation. 

Conclusion

The lack of political will and poor implementation of programmes, which can help tackle these issues related to menstrual health, is concerning. Menstrual Health Management should be the priority of the Panchayat. In addition, the village level committee should be given power and it is the need to make them realize their importance. Timely evaluation and monitoring by civil societies and NGOs need to be considered. A third-party evaluation would help to gauge the accountability and working of the already existing systems.

The author is a part of the current batch of the #PeriodParGyan Writer’s Training Program“.
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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.

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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.

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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.

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