Over the last few years, as the World witnessed accelerated action to achieve the SDGs (Sustainable Development Goals), especially SDG 5 on Gender Equality and Women’s Empowerment, there has been significant interest in menstrual health and hygiene management, as a critical factor in girls’ education and women’s participation in many spheres of life. In India, increased attention led to the introduction of evidence-based guidelines and schemes to enable access to menstrual hygiene products. It also fostered innovation towards expanding product choice and sustainable menstrual waste management.
While the progress is encouraging, an area that continues to stymie the work on menstrual health and hygiene management (MHHM), is the emergency context. Today, a number of states are confronted with the challenge of addressing menstrual health needs amidst dual disasters: cyclones and/or floods and the continuing COVID-19 pandemic that has been devastating in its scale and impact. Like other emergencies, COVID-19 has had a differential impact, exacting a heavier toll on women, girls, and sexual and gender minorities. Menstrual health and hygiene is an area that most strongly unmasks this.
“Periods do not stop for emergencies” has been a common refrain, especially during the first wave of COVID-19, with organizations and media highlighting how access to essential sanitary pads was abruptly curtailed due to the lockdown and restrictions on transport and mobility. Some of these challenges have been addressed this year with essential supplies continuing uninterrupted. Yet for many women and girls continued access to safe menstrual products, safe and hygienic sanitation facilities, and information on MHHM remains a challenge.
With closure of schools, on which many girls depended to access menstrual hygiene products, girls’ ability to manage MHHM with safety and dignity is at stake. Many poor families facing severe economic stress, are having to choose between spending on food and other essentials such as rent, and buying sanitary pads. The challenges are not only about access to menstrual hygiene products. Women and girls from low-income households have also been facing difficulties in managing menstruation in the changed circumstances where family members are present at home for most part of the day in small, confined spaces. For women and girls living with disability who may not have access to care-givers in these circumstances, managing menstruation has been even more trying.
MHHM must therefore be integrated as a priority in the response to emergencies, to ensure women and girls’ privacy and dignity. Living with dignity, even during disasters, is a fundamental human right. In 2020, UNFPA and WaterAid in consultation with experts and practitioners in the field of MHHM and disaster response across the country, developed a framework for action on MHHM during emergencies in India. The framework calls for the integration of MHHM across the continuum of emergency response – disaster preparedness, disaster response, and recovery. The framework also highlights the need for integrating MHHM into essential health including sexual and reproductive health services, and protection services where they exist.
A comprehensive approach to MHHM in emergencies includes:
1. Provision of essential menstrual products;
2. Dissemination of information to address access barriers;
3. Essential support to manage menses hygienically by equipping quarantine facilities/relief shelters with accessible, safe and usable toilets, washing/bathing areas, and waste disposal solutions.
Product distribution is the mainstay of relief efforts. This may be accomplished through provision of hygiene kits with sanitary pads and essential items such as underwear, soap, towel, paper to discard used pads, and usage information; establishment of pad banks or pad ATMs in relief centres; or cash transfers to facilitate purchase of menstrual products. Some interventions have considered reusable cloth pads or cotton cloth to meet the needs of cloth users. In supporting product distribution for relief, efforts must keep in mind the product usage patterns and preferences in the community, the need for supportive materials such as underwear along with sanitary pads, and whether products will be needed once or on a recurrent basis.
Relief efforts by civil society organisations (CSOs) have indicated that product distribution accompanied by information dissemination about MHHM is most effective in meeting the needs of women and girls, during disasters. Girls and women need to know how to use, maintain and discard products safely with limited resources. Many older women, may be unfamiliar with sanitary pads, and girls may use a product for a longer duration given limited supplies.
Challenges related to MHHM during emergencies may be further intensified by menstruation-related discriminatory norms and taboos that impose restrictions on women and girls. Dissemination of accurate and scientific information is an important tool for tackling such discriminatory norms and the stigma associated with menstruation. Norms that stigmatize menstruation can erode the dignity and self-esteem of women and girls, as well as transgender men and gender-diverse individuals who menstruate. According to a survey conducted by the Water Supply and Sanitation Collaborative Council (WSSCC) and Youth Ki Awaaz (YKA) in 2020, 80 percent of the respondents reported experiencing a negative emotion when they had their first period. The stigma and taboo related to menstruation has also had a far-reaching impact in terms of preventing an integrated public health response to menstrual health management for many years in both development and emergency settings.
Gender-sensitive sanitation is another essential aspect of MHHM in emergencies. In many disaster settings, temporary or mobile toilet and bathing facilities are established, segregated by gender. However, menstrual waste disposal remains a challenge. Some simple, temporary solutions include providing containers with lids in or near toilet stalls to collect menstrual waste, and digging of disposal pits near the women’s toilet facility. These should be marked for menstrual waste to aid appropriate disposal. Long term relief settings or established relief centres can institute other solutions such as quality incinerators and disposal chutes attached to a deep burial pit or burning chambers. Central to disposal is the need for discrete, usable and culturally relevant solutions. For instance, incinerator solutions may not be appropriate for introduction communities that have strong beliefs around burning of menstrual waste.
Efforts for MHHM product distribution, information dissemination and ensuring hygienic sanitation during emergencies can only succeed with sensitized and trained frontline responders to understand and address the needs of girls and women. This is particularly relevant in light of the culture of silence around women’s sexual and reproductive health, including MHHM needs. Incorporation of brief sessions on the needs of girls and women including MHHM needs, in the capacity building initiatives for those involved in disaster response, can help mainstream the issue and strengthen the efforts for integrating MHHM in emergency response.
There is a lot to be learned about integrating MHHM in emergency response from states such as Kerala, Odisha, West Bengal, Bihar, and North Eastern India, that face natural disasters frequently. A few of these states have demonstrated how integration of MHHM in disaster preparedness can be done in simple ways: routine MHM interventions delivered in schools and in communities can impart basic information on menstrual health and hygiene, and equip girls and women with the knowledge and capacities to manage their menses safely during disasters. Girls can be given information on making their own emergency hygiene kit with sufficient menstrual materials, underclothes, soap, and other essentials. Schools, Anganwadis and health centres can prepare themselves to be depots for menstrual products that girls and women can access when disaster strikes. Such measures also help in the recovery phase.
Some states have initiated vulnerability and capacity assessments before disasters using participatory tools to engage communities to predict, plan for, mitigate, and effectively respond to emergencies that are likely to affect them. In some Gram Panchayats, adolescents and women have engaged in community discussions, planning and mitigation efforts, resulting in essential information being imparted to girls and women in the community, provision of menstrual products for all, ensuring availability of and access to safe sanitation facilities during the disaster, and disposal options for menstrual waste as a part of overall waste management.
Finally, ensuring appropriate budget allocation is critical for integrating MHHM in emergency response efforts. Funds need to be apportioned for menstrual product distribution, and facilities that meet MHHM needs. For instance, if mobile toilets are being installed, the budget must accommodate for sufficient number of separate toilets for men and women. Fund raising and mobilization of in-kind resources must consider the duration of the emergency, whether certain supplies may be required regularly, and the number of girls and women who are in need.
Menstrual hygiene supplies, akin to food rations, will be required regularly, and not just during immediate relief efforts. They must be factored into budgets for continued support to communities till normalcy is restored.
Ensuring that women, girls, transgender men and gender-diverse individuals are able to manage menstruation with dignity during emergencies is a matter of human rights. This Menstrual Hygiene Day, we ask you to join us to commit to ensuring MHHM as a basic right to be protected and advanced, in emergencies and beyond.
(The article was co-authored by Argentina Matavel Piccin, UNFPA Representative India and Country Director Bhutan and VK Madhavan, Chief Executive, WaterAid India)
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.