Walk in the urban slums of Delhi or Bengaluru and one might witness several scenes from Akshay Kumar’s hit Hindi film Padman acting out in real life. Talk to any woman there about sanitary napkins and you might just hear Radhika Apte’s dialogue: ‘Hum auraton ke liye bimari se marna sharm ke saath jeene se behtar hai.’ (For women like us, it is better to die of an illness than live with shame).

According to a survey by an NGO Smile Foundation, only about 10% girls in East Delhi’s Shashi Garden slum use sanitary napkins. Most women in the area still use clothes. The taboo around menstrual hygiene is so high that no one wants to walk into a chemist shop asking for a pad.

Those who got free napkins in school, stopped using it later on when they had to buy it. Middle-aged and married women prefer using old rags to sanitary napkins, partially because of the cost but more because of the shame associated with going out and buying it. Only about 10% girls used sanitary napkins and said that they would find it difficult to go back to rags, because they felt clean and safe using the napkin, according to the survey.

Even at the age of 48, Jayalakshmi Amma, who lives in a slum near Nandini Layout in Bengaluru, did not know the biological role of menstruation in a woman’s body till she attended an awareness session conducted by Smile Foundation.

“We want to know more about the menstrual process and related hygiene. It is the first time that I have come to know why I bleed every month. Earlier, I thought that this was because all the girls were cursed. Now that I know that this happens because of biological reasons and not some myth, I feel so much better about myself and about being a woman,” she said.

Thirty-six-year-old Asha Devi recounts a similar tale. “I now know that menstruation is important for a woman’s well-being. It is also necessary to have these periodic cycles for healthy childbirth, and also for the feeding for the foetus as the unborn baby gets his nutrition from the blood,” she said.

“I also learned that if a girl is 16-18 years of age and not menstruating, then there is a problem, especially if she hopes to have children in the future. So, menstruation is indeed good news,” she said, sharing her learning.

Slums lagging behind
Smile Foundation’s Seema Kumar, who leads the women empowerment programme, said menstrual hygiene is a topic that has found considerable acceptability in urban spaces but not much urban slums and rural areas. “Young girls have no prior knowledge about the biological process they will go through the most of their life,” she highlighted.

Kumar and her team go from slum to slum with community mobilisers and health counsellors to establish a bond with poor women and create awareness on menstruation-related health issues. “We don’t discuss menstrual hygiene, women’s health and nutrition in silos. We talk of all issues—family planning, nutrition, anaemia, breastfeeding, and reproductive health. The idea is to get a conversation going so that these issues are not discussed behind doors and women can feel free to talk about their problems, know their bodies and also take charge of their health and well-being,” Kumar said.

Smile Foundation’s Swabhiman programme has been working towards women’s health since 2012. Women from daily walks of life have been trained to become change agents and lead conversations.

Ten percent of India’s population is made up of adolescent girls of menstruating age. A Review of Indian Studies showed that over half of these 1.2 crore girls do not know how and why periods happen. A survey done by the United Nations showed that a third of school-going girls do not finish school owing to limited or no access to sanitation during periods.

Another 2015 study published in BMJ Journal on menstrual hygiene practices in India shows that only 15% of women use commercial sanitary protection, while 85% use home-made products. The interviews for this study revealed that these products range from cloth to make-do pads stuffed with ash, husk and even sand.

In a massive push for female hygiene, the central government has also recently slashed down the costs of sanitary napkins Suvidha sold in its Jan Aushadhi Kendras to Re1 from Rs2.5.

In the recent past, several state governments like Kerala, Chhattisgarh, Odisha, Andhra Pradesh and Maharashtra have even pushed for free distribution for sanitary napkins but the impact is yet to be felt.

“Bringing down the costs of sanitary napkins to promote better health and hygiene is only a part of the work done. The bigger and the more important hurdle is changing mindsets. The focus should be on reducing and finally removing the stigma around the issue,” said a senior official from the ministry of health, requesting anonymity.

“Non-profits along with ASHA workers also have a role to play in empowering young girls and women by spreading the right information and dispelling myths and taboos associated with menstruation,” she said.

This menstrual hygiene plan is in line with the reasoning put forth in Padman, “Auraton wali baat aurat ko aurat hi samjha sakti hai.” (Only a woman can explain women-related things to another woman).