Menstrual Health Day 2024
The MH DIALOGUE
28 May 2024
Venue: Jacaranda Hall, Indian Habitat Centre (IHC), New Delhi
Goonj and Centre for Development Policy and Practice, and National Foundation for India
Background
Menstrual Health, Hygiene, and Well-being in India
Introduction
A woman’s menstrual health is crucial to her well-being and the well-being of her family and community. But too often, especially in the developing world, mindsets, customs, and institutional biases prevent women from getting the menstrual health care they need. Because of this, menstrual hygiene continues to be among the most challenging development issues today.
Menstruation is a natural physiological process that occurs in adolescent girls, pre-menopausal women, transgender men, and non-binary individuals of reproductive age. Menstrual Hygiene Management (MHM) is defined as the practice of using a clean menstrual management material to absorb or collect blood, allowing for private and frequent changes throughout the menstruation period. It involves washing the body with soap and water as needed and having access to facilities for the proper disposal of used menstrual management materials. The process of menstruation requires the availability of resources for absorbing or collecting menstrual blood, promoting personal hygiene, and ensuring the proper disposal of waste, ideally in a private setting.
On a global scale, at least 500 million women and girls face inadequate access to menstrual hygiene facilities, and over one-third of schools do not have separate toilets for each gender. As per the National Family Health Survey 5 (NFHS-5), 77.3% of women aged 15–24 in India use hygienic methods to protect themselves during their menstrual period, with 89.4% in urban areas and 72.3% in rural areas.
Menstrual hygiene plays a crucial role in empowering and enhancing the well-being of individuals worldwide. Although these aspects are significant, menstrual hygiene goes beyond mere access to sanitary pads and suitable restroom facilities. It also involves creating an environment where individuals are aware and supported in managing their menstruation with dignity.
Challenges with Maintaining Menstrual Hygiene and Menstrual Health
Period poverty is defined as the lack of access to period products, menstrual health education and Water, Sanitation and Hygiene (WASH) facilities. Practices related to hygiene during menstruation are significantly important, as they have health implications, leading to a higher susceptibility to reproductive tract infections (RTI). For adolescent girls, having a secure water supply and clean, functional, private toilet facilities for handling menstruation can be the determining factor between continuing education and dropping out. Furthermore, the absence of proper menstrual hygiene products heightens the risk of reproductive and urinary tract infections. Hence, prioritising and ensuring proper hygiene practices during menstruation significantly impacts the immediate health and well-being of individuals.
Access to Products and Sustainability
Accessibility to affordable hygienic menstrual absorbents is crucial for healthy menstrual management practices. Despite various initiatives, achieving universal availability and accessibility of clean absorbents remains challenging in India. NFHS 5 reports that 49.3% of women resort to reusable cloth, often due to financial constraints or lack of awareness.
However, due to socio-cultural taboos, these materials may not be properly sanitised or dried. While compostable disposables offer an eco-friendly option, they are limited in availability and expensive. Non-compostable disposables, though providing safe menstrual hygiene, are costly, particularly for low-income households. Addressing these challenges requires efforts to increase affordability and access to both reusable and disposable menstrual absorbents, ensuring comprehensive menstrual health management for all women.
Cultural Taboos and Stigmas
Menstrual Hygiene Management remains a taboo topic in India, leaving girls ill-prepared as they enter puberty due to knowledge gaps and misconceptions. In Uttar Pradesh, a study by McCammon et al. (2020) revealed that young women who participated in their study were unprepared for menstruation, lacking awareness before menarche and facing knowledge gaps and misinformation afterwards. Menstruation was stigmatised socially and within families, limiting discussion and mobility during menstruation. Institutional-level challenges included menstruation-related shame, embarrassment, and insufficient school bathroom facilities. In a 2024 incident, a girl had to resort to committing suicide due to the stress she faced due to her unawareness and a painful experience after her first period.
Adults, including parents and teachers, are uncomfortable discussing sexuality and menstruation, perpetuating cultural taboos. Even adult women may lack awareness, passing on misconceptions. There is a significant knowledge gap among girls regarding the origins of menstrual blood, and men and boys are even less informed. The societal silence and taboos surrounding menstruation, coupled with the perception that it is solely a women's issue, deter men from engaging with the topic. This poses challenges in accessing necessary resources such as sanitary products and toilets for menstrual management.
Furthermore, entrenched in cultural taboos interwoven with caste perceptions, women face a multitude of customs during menstruation. Rooted in patriarchal and caste-based ideologies of purity and pollution, menstruation renders all women impure and untouchable according to prevailing beliefs, reinforcing the notion of inferiority.
Menstrual Waste Management
Menstrual waste consists of blood, bodily tissues, and absorbent materials like cloth and disposable sanitary napkins used to manage menstruation. According to the Menstrual Health Alliance, approximately 36% of India's reproductive-age female population relies on sanitary napkins, resulting in the disposal of one billion used pads monthly.
Effective management of menstrual waste is imperative due to its potential environmental impact and its repercussions on waste pickers. In a report by TOI, Manwara Begum, a waste-picker, expresses dismay, "People don't even wrap the pad properly; they just throw it like that with their dry waste. We must separate it to make a living. No one thinks about the person who is picking their waste — we are also human beings."
Nutrition and Lifestyle and Menstrual Health
Poor nutrition, high Body Mass Index (BMI), junk food consumption, meal skipping during menses, female dieting, and low physical activity contribute to menstrual problems. Foods that lack vital micronutrients like vitamin B6, calcium, magnesium, and potassium exacerbate premenstrual symptoms (PMS) and irregular periods. Studies link intake of a low-nutritious diet with issues such as abnormal flow, dysmenorrhea, and PMS. Addressing these dietary habits is critical for enhancing menstrual health, especially among young girls.
Additionally, socioeconomic status influences menstrual health, with a higher prevalence of menstrual disorders observed in those with middle socioeconomic status due to sedentary lifestyles and junk food consumption, challenging the conventional understanding that lower socioeconomic status correlates with more health issues.
Regular physical activity is strongly associated with menstrual regularity and overall well-being. Compared to those who do not exercise regularly, individuals engaging in regular physical activity experience fewer menstrual irregularities, including cycle length, flow, dysmenorrhea, and PMS. Therefore, promoting healthy lifestyle habits, including regular physical activity and balanced nutrition, is essential for improving menstrual health outcomes.
Draft Menstrual Health Policy
The draft menstrual health policy in India is necessary to effectively cater to the needs of all menstruators and promote positive change in our society. Its core objective is to promote the health, well-being, and empowerment of individuals who menstruate.
The policy's comprehensive approach encompasses ensuring access to safe and hygienic menstrual products, enhancing sanitation facilities, providing extensive menstrual health education, dismantling social taboos, and fostering an inclusive and supportive environment. Through these endeavours, the policy aims to dismantle barriers, eradicate stigma, and cultivate a society where menstrual hygiene is both prioritised and celebrated, thereby paving the way for gender equality, education, and overall development.
The policy's objectives include access to safe menstrual products, creating an enabling environment by addressing myths, stigma, and gender issues, creating menstrual-friendly spaces at educational institutions, workplaces, homes, and public spaces, and strengthening environmentally sustainable menstrual waste disposal.
The policy is guided by principles such as access and affordability, equity, education and awareness, safe and hygienic facilities, waste management, and collaboration and partnerships. It sets a framework for addressing the complex challenges surrounding menstruation in India.
The draft policy also addresses concerns about emergency and humanitarian crises and PwDs. However, it has no separate strategy for women prisoners, although the policy's target population includes prisoners. Also, while the roles and responsibilities of various stakeholders have been outlined, an important ministry missing is the Ministry of Labour and Employment.
Intersectionality of Menstrual management and other aspects
To manage menstrual health and hygiene well, we need more than just awareness and easy access to products. It's crucial to also have proper water, sanitation, and hygiene (WASH) facilities at home, work, and in public places. Without the availability of the necessary infrastructure, awareness is ineffective.
Especially with reusable menstrual products becoming more popular, it's important to have access to water and sunlight to clean them properly for reuse. But many people lack the resources and privacy needed to clean these products well. This, along with the shame and taboo around periods, makes it hard to use them safely.
Also, the lack of necessary infrastructure facilities also impacts the livelihoods of women, especially those in the informal sector. Additionally, the intersectionality of the prevalent social norms, cultural practices and stigma against menstruation with caste. Giving out more menstrual products won't get rid of the shame. Plus, the extra work caused by people not disposing of products properly affects sanitation workers (often Dalit men).
Why discuss Menstrual Health, What Can Be Done?
A policy discussion about menstrual health and hygiene in India is imperative to address systemic challenges and disparities surrounding this fundamental aspect of women's health. Despite progress in recent years, significant gaps persist in access to menstrual products, education, and facilities, particularly for marginalized communities. By engaging in policy discourse, India can create comprehensive frameworks that destigmatize menstruation, ensure universal access to hygienic products and facilities, promote health education, and empower women and girls.
Addressing the intersectionality of menstrual management requires a holistic approach that considers the interplay of various factors and the diverse hyper local needs of individuals across different contexts. Policymakers must prioritize menstrual health as a fundamental aspect of gender equity and public health, incorporating it into broader hyper local development agendas and ensuring that policies are inclusive, rights-based, and locally responsive to the diverse needs of menstruating individuals.
About the Event
Goonj, partnering with CDPP (Centre for Development Policy and Practice) and NFI (National Foundation for India), is proud to announce the MH Dialogue 2024 scheduled for 28th May, which coincides with Menstrual Hygiene Day. This significant event will take place at the India Habitat Centre in Delhi, where experts will convene for a day-long conference to engage in insightful discussions on menstrual health and hygiene.
