REIMAGINING MENSTRUAL HEALTH MANAGEMENT AS A HUMAN RIGHTS ISSUE
Updated: Aug 28
By- Swati Rao, Assistant Manager at Centre for Civil Society.
In India, menstruation and menstrual health issues have long been considered women’s issues, driven by fear and shame, to be discussed behind closed doors. With 355 million menstruating girls and women in the country, access and awareness regarding menstrual hygiene are two significant issues, exacerbated further by the urban-rural divide. In rural India, 71% of women, majorly young girls, are not aware of the biological process of menstruation; and 88% of them use homemade alternatives, including rags, hay, or ash, which not only are uncomfortable and inconvenient but also lead to diseases and infections.
The lockdown, in one form or another, has been in place since March 2020, and it has brought with it disruptions to supply chains, closed borders, and shuttered businesses. One overlooked yet far-reaching consequence has been that the availability of menstrual hygiene products like sanitary pads and tampons, menstrual cups, reusable napkins, pain medication, and soap have been impacted. With the gendered social norms in India, the pandemic has exacerbated restrictions on mobility and agency for women. Along with the lockdown, issues of financial instability, social isolation, and psychological hardship have added on to the barriers faced by women in accessing necessary menstrual health information and supplies. For disadvantaged and vulnerable groups, the economic uncertainty and loss of wages has meant that women are having to prioritise food and ration over personal care necessities. As rightly tweeted by UNICEF on Menstrual Hygiene Day, “Periods don’t stop for pandemics — it’s every girl’s right to manage her period safely and with dignity.”
The role of the Government of India thus becomes vital to be able to provide for healthcare for these 355 million menstruating women. One such measure was the Menstrual Hygiene Scheme announced by the Ministry of Health and Family Welfare under the National Health Mission’s Menstrual Hygiene Management Program, aimed at increasing awareness, access to high-quality sanitary napkins, and a better means of disposal. The government’s lack of information on market outcomes and the costs incurred led to the abrupt failure of the scheme. According to the scheme, sanitary napkins were to be supplied in 107 districts by the government, while in another 45, self-help groups were to produce and sell them at a price less than ₹7.5 per pack. The irregular and insufficient supply led to an increased financial burden on the producers, and all others linked to this supply chain were not satisfied with the inputs and subsidies. Cheap and sustainable production could not be ensured due to the use of plastic as input and low revenue from sales. The measures for proper disposal of pads were not provided for, which proved to be antithetical to the purpose itself.
Apart from this scheme, menstrual health management (MHM) has been incorporated into other legislation and guidelines. Released as a part of Swachh Bharat Mission Guidelines, India’s nationwide sanitation initiative, National Guidelines on Menstrual Health Management detail what each key stakeholder must do, why, and how. The guidelines seek to deploy government officials, from the state level to district and Zilla level in establishing a framework for creating awareness about menstrual health issues, provisioning for sanitary products, providing separate sanitation and disposal facilities in communities and capacity building of ground-level staff.
Unfortunately, there are some areas in which the scheme and the guidelines currently fall short. The overdependence on government and public officials fails to leverage private market players and civil society organisations. As research shows, bringing about social reforms cannot be done through the powerful few and needs collaboration between diverse stakeholders. The scheme and guidelines, while designed for managing menstrual health issues, focus more on adolescent and school-going girls. The framework details various interventions that need to be executed in and through schools, thus excluding girls and women who are not currently enrolled in schools.
Since the efficacy of the existing schemes leaves a lot to be desired, what Indian women need is a rights-based approach to MHM. Placing menstrual health within the context of human rights provides a holistic approach to understanding and combating the gendered nature of restriction on human rights. As UNICEF mentions in its report, women and girls who have difficulty exercising their rights to water, sanitation, and education, will likely have difficulty managing their menstruation. Menstruation is intrinsically linked to women’s lived experiences. If India aims to achieve SDGs 3, 5, 6 and 10 on Good Health and Well Being, Gender Equality, Clean Water and Sanitation and Reduced Inequality, it becomes imperative to frame MHM within a human rights framework.
India can take lessons from Kenya, which recently became the first country in the world to develop and implement a standalone Menstrual Health Management Policy. This policy increases the prioritization of MHM and provides a framework for policy implementation as well as clarification of the roles and responsibilities of different stakeholders. Considering the Indian context, a sound MHM policy would incorporate a holistic approach to include all women, increase choice, access, and competition, localise advocacy and resource mobilisation, and advance sustainability.
The existing Menstrual Hygiene Scheme already provides for distributing sanitary pads to adolescent girls. Still, it fails to include fragile and vulnerable communities such as refugees, slum dwellers, and homeless women. A comprehensive and inclusive MHM policy would be able to mainstream marginalised women. Considering that both physiological, as well as psychological needs, are unique for women at different life stages, the issue of menstrual health has to be looked at from a life cycle approach. This would mean that India’s MHM policy takes cognizance of the needs of premenstrual as well as menopausal women. Therefore, a well-balanced MHM policy will look beyond the menstruating age groups to expand its scope of influence.
A sound policy also increases the choice for its beneficiaries. Instead of deploying a paternalistic approach to menstrual health issues, India’s MHM policy should provide informed choice to its beneficiaries, in the form of access to the broadest possible range of safe, effective and acceptable means to manage menstruation and the information necessary to make an informed choice among those. By localizing advocacy and resource mobilisation, such a policy can reduce transaction costs and empower women-led Self Help Groups, which are engaged in the production of menstrual hygiene products. This would result in using more local products during the manufacturing process furthering India’s goal of becoming “Atmanirbhar.” Apart from production, safe disposal of menstrual hygiene products can also be achieved by localising the policy. An environmentally responsible and sustainable approach would move away from menstrual hygiene products that are damaging to the environment and add to global waste.
Another cornerstone of the Indian MHM policy would have to be a commitment to promoting innovation and competition in the market. Promoting Small and Medium Businesses would result in the development of low-cost and biodegradable sanitary pads and other menstrual products. This would further increase access and choice for women, particularly those excluded due to financial and mobility constraints. While small scale entrepreneurs might develop competitively priced products targeted at low-income communities, they will lack the marketing and transportation capacity to achieve scale. Therefore, institutional interventions to mainstream these products through an MHM policy will go a long way in furthering access and choice for menstruating girls and women.
After all, something that affects the lives of almost 50% of the country’s population deserves increased momentum from governments, private sector, and civil society organisations. One of the key takeaways from the current pandemic is that while MHM has already been integrated into existing programming across various sectoral schemes and legislations, a standalone MHM policy is required to uphold the rights of every girl and woman in the country.
(Disclaimer- The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of Child Rights Centre.)