Categories
Issue 10

Menstrual Health in Rural India

Ananya Rao

The state’s emphasis on sanitary pads above all other forms of menstrual hygiene, without the ability to provide enough, is not only economically expensive and environmentally unsustainable but also weans women away from traditional methods such as cloth without providing a viable alternative. Further, the solution is also ineffective as it does not address larger issues such as lack of infrastructure or restrictive social stigmas, both of which are systemic problems in maintaining menstrual hygiene in India.

The nationwide lockdown that was declared in March 2020 to limit the spread of COVID-19, had a number of social and economic consequences. India faced a massive crisis of reverse migration of labour from urban to rural areas, rise in unemployment and a massive economic slowdown. Amidst this, another setback that became visible only much later was the rapid deterioration of menstrual hygiene, especially in rural and peri-urban regions of the country. Articles published in the first few months of 2021 highlight  how the pandemic has influenced menstrual hygiene, particularly with regards to reduced accessibility and affordability of hygiene products and hence an increase in health problems associated with it. 

The main issue that these articles describe is lack of access to sanitary pads. Government schemes that provide sanitary pads were disrupted at different points along the supply chain, ranging from the unavailability of pads to the closure of schools, which earlier acted as distribution points for these products . Other sources of sanitary pads, namely ASHA and Anganwadi workers, also faced similar shortages  and hence were unable to distribute them as they usually did. Finally, the loss of employment especially in the informal sector left many families with very limited, if any, income to make ends meet , which resulted in sanitary pads becoming a “luxury item” that were abandoned in favour of “essentials”

The  mainstream discourse in India, claims that the main hindrance to menstrual hygiene in India is either the unavailability or the unaffordability of sanitary products by  women in rural areas. This assumption is based on a study conducted by Plan India in 2010 which states that only 12% of all women in India use sanitary pads and the remaining 88% use unsanitary means of managing menstruation. However, not only are these numbers highly contested by multiple studies that have followed, but the assumption that any method apart from the use of sanitary pads is unhygienic is also deeply flawed. The National Family Health Survey (NFHS) data finds that 58% of women use hygienic means of managing menstruation, and a large proportion of these depend on the use of cloth. 

While the need to improve affordability and availability definitely does exist, this is far from being the main barrier to menstrual hygiene in the country. Rather, there are multiple pressing challenges that are far more prevalent and damaging. To begin with, most women do not have access to clean toilets and changing spaces, which is one of the most common reasons for infections to fester. In addition to the lack of infrastructure, social taboos also indirectly contribute to the spread of infection. For cloth to be a hygienic method of managing menstruation, it requires frequent washing and drying in sunlight. However, due to the taboo associated with these clothes being visible to others, many women are either not allowed to or are themselves ashamed to dry them in the open. Instead, they resort to drying them in small hidden spaces that tend to be damp and dark, which rapidly increases the chances of infection due to bacteria build up. 

Government schemes too are based on the assumption that menstrual hygiene can only be ensured through the provision of sanitary pads. Central government schemes such as a the Menstrual Hygiene Scheme and the Rashtriya Kishor Swasthya Karyakram (RKSK), while in theory aim to promote menstrual hygiene as a whole, in practice only promote interventions that “increase awareness of access to sanitary pads”. State government schemes also follow the same trajectory, either by distributing pads or providing funds to buy pads. However, these programs are quite inadequate as data shows that women only receive 5 or 6 pads every month, which is simply not enough as 12 to 20 pads are required to manage a single menstrual cycle. 

The state’s emphasis on sanitary pads above all other forms of menstrual hygiene, without the ability to provide enough, is not only economically expensive and environmentally unsustainable but also weans women away from traditional methods such as cloth without providing a viable alternative. Further, the solution is also ineffective as it does not address larger issues such as lack of infrastructure or restrictive social stigmas, both of which are systemic problems in ensuring menstrual hygiene in India. Any solution that hopes to be effective must take into account and attempt to combat these issues in order to improve menstrual hygiene as a whole should be made. 

While acknowledging the flaws in the social system that we operate within, namely the taboos and stigmas that drive people, it is also equally imperative that one acknowledges and leverages the strengths of the same social system to improve the existing conditions. This could be done in a number of ways. For instance, there are festivals in multiple different cultures across the country that celebrate the start of menstruation for a girl child, such as Mithuna Sankranti in Orissa or Ritushuddhi in Karnataka. Instead of depending solely on logic or scientific rationale to combat existing taboos that view menstruation as shameful or unimportant, drawing on existing cultural traditions that celebrate the process would be an effective method as it is rooted in people’s sentiments and beliefs. 

This process of addressing wider issues of physical infrastructure as well as cultural mindsets rather than limiting the scope of menstrual hygiene to simply promoting the use of sanitary pads can also be extremely beneficial to the environment. If women are provided with clean and private changing spaces and the acceptance to wash and dry their menstrual products, cloth pads can become a safe, hygienic, inexpensive and sustainable method of managing menstruation. 

Further, to make its implementation more successful, environmentally sustainable solutions can be propagated without framing it as such. Cloth pads, for instance, are preferred by women in rural areas due to their low cost, comfort, and familiarity. Studies show that concern for the environment is not a major reason for women preferring cloth. Therefore, if it is propagated as a method of sanitary hygiene in a way that appeals to the users, without necessarily presenting it merely as a sustainable solution, the chances of its uptake increase significantly. 

It must be recognized that both the hindrance as well as the solution to improving menstrual health in India is not limited to access to and affordability of sanitary pads. The problem is a far more systemic one that calls for seeing menstrual health not as a women’s issue but as a public health issue. A solution that employs a multi-pronged approach involving financial, infrastructural, and cultural interventions that are mindful of current social structures can be economically and environmentally sustainable as well as produce better health outcomes. 

Ananya Rao is a fourth year student at Ashoka University studying anthropology, environment studies, and political science. In her free time you’ll find her either painting, writing, or exploring the outdoors

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s