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In A Pandemic Year, Menstrual Health In India Was Forced To Take A Back Seat

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On March 25, 2020, with COVID-19 cases on the rise around the world, the government of India announced its first lockdown. ‘Lockdown 1.0’ effectively barred any movement within and from outside India’s borders. Various sectors – right from the unorganised workforce to small-scale and large-scale industries/services – came to a standstill, resulting in some obvious, yet largely unaccounted for, repercussions.

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Among such repercussions was the serious lack of accounting for the menstrual health and hygiene of a population of more than 366 million Indians. It should be noted that the number cited is exclusive of the population of menstruating individuals who do not identify as women, but as gender non-binary and trans folks.

In many ways, the pandemic has laid bare the systemic gaps and social prejudices that exist in India. This is particularly true for the heavily hushed subject of menstruation. The climate associated with it has made it challenging to effectively deal with the interconnections of menstrual health and the daily livelihood of menstruating individuals.

In this article, we explore the ripple effects caused by the lacuna in menstrual policies and programmes specifically related to the implementation of emergency interventions in India.

Disrupted Product Supply Chain

Because of the sudden lockdown, I didn’t have time to buy anything. For a month, the anganwadi didi gave us pads, but after that, I had to switch to using a cloth. I also do not have a toilet at home and use the community toilet. Due to the virus, I am afraid to use it,” said Rekha*, a 30-year-old woman from Madhya Pradesh, sharing the effect the lockdown had on her menstrual experience.

According to statistics, nearly half of India’s population does not have a toilet at home. While there has been an increase in toilet construction, as part of the Swachh Bharat Mission, most of these toilets go unused.

The infrastructure within which a menstruator is situated and their lifestyle, has a major influence over the period product they use. It is clear that the unhygienic condition of the community toilet had influenced Rekha’s decision in choosing disposable napkins. Evaluating the mechanics of washing and drying a cloth which is used to absorb blood in an area that is frequented and prone to infections is a reality for every woman in the same circumstance as Rekha.

In response to COVID-19, the government issued a directive listing essentials that needed to continue production to sustain distribution during the lockdown. This list did not include menstrual products, leading to most manufacturing units, especially sanitary napkin industries, shutting down production. After public outcry, the government clarified that sanitary napkins and other menstrual hygiene products are essential products. However, India continues to face a sanitary napkin crisis.

Other than private manufacturers, schemes like the Menstrual Hygiene Scheme (Ministry of Health and Family Welfare), under which rural adolescent girls, between the ages of 10 to 19, can access sanitary pads at a subsidised rate of Re 1, continue to stand uninterrupted. However, there are no records of the availability of these pads during the lockdown.

Under the Kishori Shakti Yojna (Ministry of Women and Child Development), government schools are also made a critical part of the supply chain for schoolgirls. Girls in the age group of 11 to 18 can exercise this scheme. But as government schools remain shut during the lockdown, millions of young girls are left feeling anxious. “Several government school teachers have said that they have been receiving distress calls from their students,” reads a Hindustan Times article.

It is important to note that the schemes mentioned above are decentralised and extend to all states within India, however, some state governments have yet to put these schemes to effect.

Added to this, the most trusted distributor in the chain, the ASHA workers, were also severely hit by a shortage in the supply of napkins during the lockdown. “I have distributed whatever pads I had at my centre (anganwadi) to women and girls in my community. But I really don’t know how they will manage in the coming days,” an ASHA worker told Boondh.

Although government schemes exist, they do so with gaps and lack adaptability to emergencies and proactive circumstantial planning, a shortfall that painfully impacts menstrual experience and overall health of millions. Stakeholders, policymakers, executives of the government machinery must comply at least with the basic minimum of WASH needs.

According to SPHERE Standards, a movement started by humanitarian professionals who seek to improve the quality of humanitarian interventions, especially during emergencies and disasters, WASH policies need to have a three-fold approach. The document that references COVID-specific WASH action states:

“… there are three important overarching factors: Firstly, people should be seen as human beings, not just cases. Human dignity is paramount. Secondly, community engagement is crucial. And thirdly, focusing on preventing the spread of the Coronavirus should not make us forget affected people’s other needs, nor the long-term needs of the wider population.”

woman wearing a mask during lockdown
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Inaccessibility To Menstrual Healthcare And Emergencies

I have been bleeding irregularly for three months now. The gynaecologist near me still hasn’t opened up her clinic. I was also supposed to get an ultrasound done, but I do not know what to do. I can’t go to the lab,” said Sapna, a 25-year-old woman from Madhya Pradesh.

Menstruators who live with disorders like Premenstrual dysphoric disorder (PMDD), Amenorrhea, Polycystic ovary syndrome
(PCOS) etc struggled with access to healthcare as most private clinics remain shut. The absence of PPE kits and the inability to abide by social distancing measures at small clinics makes accessing medical services all the more challenging. While these dilemmas are faced by big private hospital chains as well, some hospitals continue to accept admission but restrict it to COVID-19 patients. This left non COVID-19 patients and people with other medical emergencies mostly stranded with a thin silver lining: online consultations.

Teleconsultations in India saw a 500% spike during the lockdown period with over 80% being first time users. It is also interesting to note that one in three consultations that were referred to were gynaecology related, and period concerns were one of the top queries. As an Indian Express article stated, “Unanticipated irregularity in periods” and “how expectant mothers can have a safe pregnancy” were two of the most common health issues raised online. Other top queries included “period problems, pregnancy complications during coronavirus, birth control techniques, and miscarriage.”

However, this option has its own drawback.

I wanted to see a gynaecologist for abrupt bleeding changes. I instead saw closed shutters with a notice stuck on it which read, ‘In light of the current pandemic, the doctor won’t be seeing any patients until further notice’. I had to find a doctor virtually. This wasn’t very fruitful because the medicines prescribed were not available in the nearby medical store and weren’t getting delivered as well,” said Lenna*, a 22-year-old gender studies student from Dwarka, Delhi, who lives with PCOD.

The major drawbacks of online consultations is affordability and accessibility. Practo, the teleconsultation service platform that has been growing “at an average of over 100% week-on-week”, is a platform that is based in English, and charges a minimum Rs 100.

While this might seem reasonable to some, a large section of our country relies on government welfare schemes and services as they cannot pay such fees for consultations.

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Invisibilisation Of Marginalised Communities

The narrative around menstruation has largely been dominated by cis-able-bodied women. It is important to be critical of homogenising menstruation. Especially during a time of emergency or severe distress, it becomes all the more important to take a more community/individual specific approach when it comes to policy measures.

Abha*, who comes from Ahirwar, a small district in Chhattisgarh, told Boondh that there were organisations who did distribute pads as a part of their relief measure, but their community was overlooked as they belong to a lower caste. To be able to obtain some pads for her 15-year-old daughter, Abha moved to a nearby community where her caste was not a deterrent.

This is one instance where casteist prejudice affects accessibility to not only the product but also menstrual health by extension.

One section of our society that is absent from any of the governmental menstrual policies is the trans community. The transgender community, including trans women, trans men, non-binary, gender non-conforming persons and others whose socio-cultural identities remain in the sidelines.

Lobo noticed a drop in her earnings as the number of women travelling by local trains began to reduce for a week before the lockdown. But she could rely on the vegetable vendors in Dadar to provide her with free groceries. ‘But now I can’t go there or if I do, the police would chase us away,’ says Lobo, who stays alone in a rented room in a slum area in Bandra (West),” reads an anecdote from an article in The Hindu.

Although the government has included disposable pads to the essential commodities list, for a major part of the Bahujan community and trans community, menstrual products still remain a luxury. Interventions by civil society and crowdsourcing are the only support that reaches the community.

Gaps In The Approach To Menstrual Policies

Menstruation, in the popular discourse, is instantly linked to products, especially sanitary napkins. This is a deeply flawed approach and adopting it into policy making severely restricts the scope of socio-cultural and scientific interventions in this space.

The biggest misconception that is reflected in the polices is the generalisation of the demographic which menstruates, thereby losing out on the needs of diverse menstruators.

This is problematic because menstruation is a very personal experience and each person has a different relationship with their menstrual experience. How one navigates this must be facilitated by policies, and not hindered by them. If we push products, for example, non-biodegradable sanitary napkins, to varied demographics without studying a particular socio-economic status or the infrastructure within which they are located, it would be a disservice to that population.

While studying these demographics, it is important to not go in with broad stroke assumptions as well. During a study conducted to find out why women refrain from using menstrual cups, it was found that rural women were more interested in understanding it and trying it out while women in urban setups worried “about the discomfiture cups or tampons might cause because they involve vaginal insertion”.

Apart from this, one cannot completely write off the mental blocks that have been facilitated by our culture. Policy interventions that do not address an issue at its root do not address the issue at all.

The ‘sanitary napkin’ crisis is not necessarily a menstrual crisis. But again, this largely depends on how innovatively the government can turn this into an opportunity to introduce more sustainable and cheaper options like cloth pads, menstrual cups, or even period panties. Period panties at subsidised rates – just imagine!

Another key issue about interventions is the lack of concerted action. The improvement of menstrual health directly contributes to sexual and reproductive health as well, and unless there is a direct body accountable for the development in this area, the cascading effects (disease, gender-based violence etc) of ill development will continue.

To put it plainly, the redressal for issues that concern menstrual health and hygiene must come from a single body or a group of stakeholders who can be held accountable for different aspects based on their definitive roles and responsibilities. Currently, funds that address MHH in India are dispersed to multiple larger ministries like the Ministry of Health and Family Welfare, Ministry of Women and Child Development, Ministry of Human Resource Development, Ministry of Drinking Water and Sanitation, and the Ministry for Textiles. Therefore, the subject of menstruation is at the receiving end of a lot of ambiguity, ill-guided responses, initiatives, and reactions.

Lastly, setting up state and district level guidelines on menstrual health and hygiene would be the best alternative to carrying out schemes/guidelines advised by the Centre. A decentralised approach will naturally allow for more socio-culturally and socioeconomically informed decision-making. The research backed guidelines will also provide a concentrated and detailed database that can be used as a reference for larger studies that aim to look at patterns for improved state and national-level interventions.

*Names have been changed for privacy

With inputs from Sakshi Shrivastava, Naina Ojha and Bharti Kannan

This article was first published here.

Boondh is a social enterprise working in the space of menstrual health, literacy, policy advocacy, and sustainable products. COVID X Menstruation is a series of articles that explores menstrual health and hygiene along multiple intersections like menstrual programming, product supply, government policies, civil society interventions, mental health, and more. You can follow them on TwitterFacebook and Instagram.

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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.

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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.

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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