Women in villages of Sirwar taluk do not have access to basic menstrual hygiene.
On the way to Murkigudda, there was a mud house with thatched roofs and bare concrete walls. In the hot afternoon, Jinamma was washing clothes while her daughter was playing nearby. As I reached there, she turned around and asked me to sit inside. She was not comfortable in discussing menstrual hygiene in front of her male members so she took me to the backyard of her house for the same. Menstrual hygiene is a taboo and many women like Jinamma use cloth during menstruation. This is harmful because the cloth is not sterilized with a disinfectant which can lead to diseases such as bacterial vaginosis and rashes in the pubic area. After washing, the cloth is kept in a secluded away from the gawking eyes of men which makes it prone to bacteria.
A study conducted on Menstrual Hygiene Management by the London School of Hygiene and Tropical Management (LSHTM) highlights that 60 percent of women diagnosed with Bacterial Vaginosis and Urinary Tract Infection (UTI) use reusable cloth.
Dr. Bijaya Lakshmi Pathak retired Associate Professor from Assam Medical College said, “In the long run, using cloth during menstruation can cause Pubic Inflammatory Disease (PID) which can lead to menstrual irregularity, heavy bleeding, infertility and dysmenorrhea.”
Awareness about Hygienic Menstruation Practice
Women in Sirwar taluk are not aware about different types of absorbents.
Jinamma said, “I am not aware of any other absorbent material other than cloth which can be used during menstruation”.
The framework on Menstrual Hygiene Management Guidelines 2015 emphasizes bringing awareness, knowledge and information to every adolescent girl, women including men and adolescent boys’ about menstruation hygiene practices. It is issued by the Ministry of Drinking Water and Sanitation to support all adolescent girls and women. The guidelines state that every adolescent girl and woman must have easy access to sufficient, affordable and hygienic menstrual absorbents during menstruation. At the block level, the responsibility of running menstrual hygiene management is of Block Resource Coordinator (BRC), District Education Officer (DEO), Panchayat officials and teachers.
At the school level, it is the responsibility of a head teacher to train teachers to provide psycho-social support to every adolescent girl, provide regular hygiene promotion classes and include subjects such as biological understanding of puberty and menstruation, myths and misconceptions about menstruation and hygienic management as a part of Menstrual Hygiene Management (MHM) curriculum.
However, Ramakrishna .H, the District Family and Welfare Officer said that they are still educating the women about the usage of sanitary napkins and other related hygiene practices.
Supply of Napkins
The schoolgirls get sanitary napkins from their schools.
Shilpa, a teacher at Jhakaldini Primary School said, “We collect it from the CHC and distribute it to the girls.”
Ambamma, a teacher at Jhakaldini Anganwadi said, “There is no provision of distribution of sanitary napkins to the Anganwadi by CHC. I have to go to Sirwar CHC and collect the sanitary pad and distribute the same to students. She further added that the supply is erratic.”
However, the officer has a contradictory point of view.
Dr. Ramakrishna .H, District Health and Family Welfare Officer said, “There is a regular supply of sanitary napkins and they are kept in the CHCs. The ASHA workers can collect it from there.”
The ASHA workers at Anganwadi distribute sanitary napkins to the school dropout girls aged between 11 to18 years and pregnant women only. “Every year, twice in six months i.e. between January to June and July to December we get a box of sanitary napkins which has 280 packets containing 10 pieces each. Out of these, six packets are distributed to every school dropout girls aged between 11 to 18 years and three packets to the pregnant women post-delivery till six months and if extra packets are there, the maid goes and gives it to other women”, said Ambamma, a teacher at Anganwadi School. The supply of sanitary napkins to remote areas and villages is erratic.
She said that the consignment of sanitary napkins for this part of year (Jan to June) has not been given to Anganwadi till now.
The women apart from adolescent girls and pregnant women do not have access to these napkins and are forced to use cloth and other unhygienic methods during menstruation.
Table 86 of National Family Health Survey 2015-16 highlights that 64.6 percent of women in rural Karnataka use cloth and 0.3 percent use nothing during their menstruation. The statistics of tribal population state that 59.7 percent of Schedule caste, 73.7 percent of Scheduled Tribe, 55.8 percent of Other Backward Class and 55.8 percent of other women are using cloth.
Ministry of Women and Child Development under MHM has the policy to ensure access to absorbents through the production of sanitary napkins at the village level by Self Help Group run units, marketing and demand generation of sanitary napkins under Mahila Arthik Vikas Mahamandal.
Till date, no such setup has come up in the village to ensure regular access to sanitary napkins to all women of the village.
Availability of Toilet and water to facilitate change of absorbents
Jinamma works in the field and lives in a shabby house with a huge family. She along with other ladies of the house gets up early in the morning and goes outside to answer nature’s call. She often faces more problems during her monthly cycle. She said, “On other days, I manage somehow but the situation worsens more during menstruation.”
The guidelines of Ministry of Drinking Water and Sanitation (MDWS) under Swachh Bharat Mission (SBM) state that every household of the village should have a toilet to ensure proper sanitation and defecation.
It has not yet reached Jinamma’s house.
In a primary school in Jhakaldini village, there are four toilets for the school children but none of them are usable. The toilets do not have water taps and soaps inside them. The doors of the toilets open at the gush of wind making it unsafe for the girls to use it. So, the students prefer to go outside to relieve themselves.
A 2014 report ‘Spot On!’ by NGO Dasra found that nearly 23 percent of girls drop out and 31% of women including teachers on an average 2.2 days of work drop out of work during menstruation.
Shaila, a 13-year-old student said, “We prefer to stay at home during menstruation as there is no proper changing facility .The toilets do not have water , dustbin, soap and even the doors are without a lock.”
Ministry of Drinking Water and Sanitation under MHM guideline states that every school is required to have basic water and sanitation infrastructure like separate toilets for girls and boys including separate washrooms for male and female teachers, water supply (based on approximately 500 litres water storage capacity for 100 children), soap availability for washing hands and space for washing laundering menstrual absorbent and facilities for safe disposal of used menstrual absorbents, so that girls and female staff can manage their menstruation with dignity
Even the teachers are a victim of these defunct toilets.
Suzanna, a teacher at Jhakaldini government primary school said, “We face problems during the first two days of the cycle, so we remain absent. Even the girl students are excused by teachers from school during their monthly cycle.”
Devi, who works in an Anganwadi, is given sanitary napkins free of cost. After her cycle ends, she wraps the pad in black polythene and throws it inside the open drain opposite her house.
Women are unhappy with the disposal facility in their village. There are no dustbins for disposing of the used sanitary napkins or cloths after the menstruation cycle. They either bury the napkins in the ground or throw them inside the gutter or burn them. The Newsnet observed that the blood-stained pads were scattered near the bushes. A pile of napkins was found in black polythene.
On being asked, Devi said, “When the napkins pile up, we burn them to get rid of it.” Unlike Devi, Lakshmi who is 36 years old uses a cloth during menstruation and buries it under the ground.
The guidelines in MHM state that there should be a safe disposal mechanism of absorbents in each school and community by installing incinerators and deep pit burning.
An Officer suggested a solution of installing dustbins but refused to comment on anything on the emptying schedule of the bins and transport of waste to disposal sites.
“We will supply six lakh dustbins to the seven taluks of Raichur very soon,” said Lakshmi Reddy, Chief Executive Officer of Zilla Panchayat
However, urban areas portray a different picture. Women in urban areas are using other absorbent materials like Eco-friendly pads, tampons and menstrual cups.
The medicine shops in Bangalore have few buyers for other absorbents.
G. Mahesh, owner of Bengaluru based Yasho Pharma said, “Approximately 80 percent of women prefer sanitary napkins whereas close to 15 percent of working women prefer tampons.” He further added that the supply of menstrual cups is poor and they fail to reach medicine shops.
Pratigya Patel, a fine arts student at the Maharaja Sayajirao University of Baroda said, “I purchased a menstrual cup online and have been using it for five years. They are convenient, comfortable and reusable. They are cheaper as compared to sanitary napkins.”
Experts suggested manifold solutions for proper management of menstrual hygiene practice in rural areas.
Dr. Sheela Saggard, an individual practitioner said, “The ASHA workers should spread awareness in the villages and a sanitary napkin vending machine should be installed at major points such as bus stands and schools. In addition to this, women should be taught about the usage of cloth pads”.
Dr. Shradda Kapile, Lead Trainer at the Myna Mahila Foundation said, “Women should be made aware of the proper usage of cloth during menstruation through ASHA workers and Anganwadi teachers. There should be frequent interactive sessions with the women about menstrual hygiene and through those sessions they can be educated about new-age absorbents such as menstrual cups and tampons.”