While menstrual hygiene management, a less-spoken aspect of Swachh Bharat Mission, has witnessed some progress in the country's rural pockets, multi-faceted challenges continue to hamper its implementation.

The government has drawn up an elaborate plan under Swachh Bharat Mission-Gramin (SBM-G) to promote safe menstrual hygiene practices in the villages but its implementation and efficacy have been far from thorough. In response to a question in Lok Sabha in December 2017 about funds allocated and utilised under SBM-G for menstrual hygiene management (MHM), the government stated component-wise funds are not allocated under SBM-G. Replying to the question about the impact of the MHM drive, the government said it does not assess the impact.

According to the National Family Health Survey IV (2015-16), 48.2% rural women under the age of 24 use hygienic methods of protection during their periods. However, the ratio of women who use sanitary napkins—or even know of it—seemed much lower when Youth Ki Awaaz visited backward villages in four states. Lack of knowledge about menstruation, stronghold of myths and availability of low-cost sanitary napkins emerged as the biggest pain points.

Teenage girls from tribal village of Jasondi in Madhya Pradesh's Betul district revealed that 90% of the females in their village use cloth during their periods. The village has a population of about a thousand and is 15 kilometres from Betul city, the district headquarter.

Pooja Paliwal said many women in the village burn these pieces of cloth after using them once. Battling hesitation, Chhaya Salaame shared that she and her folks wash the cloth and reuse it for about six months. Rani Marskole said many girls in the village don't even know what a pad is. She said barely 2-5% girls who study in schools and colleges in Betul use it.

The Anganwadi does sell pads but rural women find them a bit too costly. In villages that are farther away from the district headquarter, women still use ash during their periods.

BL Bishnoi, district officer, Women & Child Development, said they do run an awareness campaign to educate girls about menstruation, the best practices to follow and the perils of ignoring hygiene. He said an NGO had been distributing low-cost sanitary napkins in nearby rural areas until two-three months ago but they discontinued it after some internal disagreements.

Another NGO, Sashakt Nari Sashakt Samaj (meaning empowered women, empowered society), kickstarted a sanitary pad bank in Jasondi on Daughters' Day on September 22. They aim to provide free napkins to women who can't afford them.

Hush hush treatment

Sixteen-year-old Ashima Khan, a student of class 10 at the government girls school in the backward Sitapur district of Uttar Pradesh, said she had got scared when blood stains appeared on her dress when she began menstruating two years ago.

When she told her mother about it, she was told to not talk about it with anyone. She claimed that her mother said, “It [menstruation] is a curse for every woman and we have to live with it till eternity.”

Ashima added that she never discusses menstruation with her mother and claimed that she came to know more about it when some counsellors visited her school. She said the counsellor told the girls that menstruation is a natural body process. After that, they are aware of the sanitation and hygiene aspect and have also started taking iron pills that are provided to them in the school by the hospital.

Kusum Srivastava, the counsellor at the Mishrick block Community Health Centre, said the girls who have attained puberty don’t have the necessary information about their bodies. She added that since the mothers of these girls are unaware, the ignorance is passed on to the next generation. She highlighted that they counsel numerous young girls and ask them to disseminate the information among their family members and friends.

Mental block

In a response to Kerala MP Shashi Tharoor's question this June, the government stated in Lok Sabha that its Suvidha sanitary napkins (which were sold for Rs2.5 apiece until August-end, when their price was revised to Re1) were not sold at all in Goa, Manipur and Tripura this year. Only 80 of these pads were sold in Himachal Pradesh and 800 in Arunachal Pradesh this year. The trends suggest that even if sanitary products are available, the mindset and popular practice prevents many women from using them.

Social worker Madhulika (she doesn’t have a second name), who works in the tribal district of Dungarpur, stated that even today, tribal women don’t use sanitary pads owing to their traditions and practices. A lot of women in the region use the same cloth month after month. Consequently, they become prone to infections and diseases.

Haru Devi, a resident of Alsigarh, 40 kilometres from Udaipur, drew a blank when asked about sanitary pads. She knew nothing about it. She said she uses a piece of cloth during her cycles.

Amari Devi, 39, a resident of Dungarpur, had been using a piece of cloth during her menstruation until recently. It was only when her daughter Pooja started getting sanitary pads from her school two years ago that she too started using them. 

Arvind Chobisa, the coordinator of SBM in Dungarpur, highlighted that there is awareness about menstrual hygiene in urban areas but sorely missing in rural areas and even more so in tribal-populated districts like Dungarpur. 

While no initiative on menstrual hygiene was launched under the SBM banner, they have carried out many awareness programmes at the panchayat- and gram sabha-level, he stated. He said a district-level workshop was organised in Dungarpur last year where menstruation and the myths related to it were openly discussed. 

He contended that the availability of menstruation-related information in a tribal-dominated area is a great achievement and added that age-old habits take a while to change. However, with education and awareness programmes, it surely is changing for the good, he added.

Old habits die hard

Responding to a query on the promotion of menstrual hygiene among adolescent girls in rural areas, the Health and Family Welfare Ministry had stated in Lok Sabha this January that it has been working to increase awareness as well as improve access to low-cost sanitary napkins. It said the Menstrual Hygiene Scheme under National Health Mission has been carried out using a 360-degree approach to create awareness among girls through audio, video, reading material and monthly meetings with Accredited Social Health Activists (ASHAs). 

Recently, awareness drives have started in several tribal-dominated pockets of Odisha. However, women and girls still use old pieces of cloth during their cycle. 

Srimati Hembram, the Sarpanch of Baunsanali, a tribal-dominated area situated around the Similipal Biosphere Reserve under Joshipur block of Mayurbhanj district, stated that women and girls in the area have been shying away from even discussing menstruation. However, in the last few years, a few educated women and adolescent girls have started using sanitary napkins. She added that although the number of people using it is low, it is good that the change is happening.

She explained that the girls who go to school use sanitary napkins as they are provided in the school and the female students in the residential (Sevashram) schools also use sanitary napkins. However, after their school education is over, a few of them discontinue using sanitary napkins as their financial background deters them from buying it, she commented.

The ASHA and Anganwadi workers regularly conduct awareness meetings in their villages to educate the girls and women on the importance of menstrual hygiene, methods of using sanitary napkins and their safe disposal. However, more than 80% of women and girls under her panchayat limits still use old clothes, she noted.

Hembram pointed out that last year, ASHA and Anganwadi workers distributed sanitary napkins to each house in the village for a few months to make women use them. While it remained unused in most houses, only a few who have received some education used them and later, only those who used them were given pads, she added. 

Pami Gagarai, the Anganwadi worker in Tangarabalada village in Joshipur block, stated that most women and girls use pieces of old clothes as their period rags despite regular awareness meetings. These people are advised to use clean and dry clothes, but there is no significant change in their practice yet, Gagarai claimed. 

All those who use clothes, wash them in dirty and unhygienic corners of the village ponds, where all the people bathe, clean their utensils, wash clothes and bathe domestic animals, she stated. She added that these women dry their period rags under dirty and damp conditions in their backyards and sometimes under their saris to ensure that the male members can’t see it.

She pointed out that sometimes bugs and insects crawl on these rags and they don’t even receive sunlight. They are either kept hanging in a dark corner of the outside wall of their house, in the cattle sheds, firewood-storage area or where the cow dung cakes are stored till it is taken out to be utilised for their next cycle.

The government is aware of the difficulty in bringing about a behavioural change. It had cited this as one of the reasons for lagging behind its MHM goals in Lok Sabha in July 2014. It had contended a longer time is needed to ward off the rigid thinking pattern. Further, it had said a lack of orientation of ASHAs and Aanganwadi workers was also an issue.

While the deadline of the SBM expires on Wednesday, the government has a long way to go to ensure the objectives it had set are met in the near future.

-Ends-

With inputs from Pushpendra Vaidya, Saurabh Sharma, Madhav Sharma and Pragati Prava.