Opinion: Safeguarding Menstrual Health During A Pandemic

New Delhi: An estimated 1.8 billion women worldwide menstruate, yet millions cannot manage their monthly cycle with dignity. Even in the best of times, gender inequality, discriminatory social norms, cultural taboos, poverty and the lack of basic services often mean that menstrual health and hygiene needs are unmet. In India, the fourth National Family Health Survey (NFHS-4) 2015-2016 estimates that, of the 336 million menstruating women in India, only 36 per cent (121 million) women and girls use sanitary napkins, locally or commercially produced. There is a significant divide in the use of products between rural and urban areas. In urban areas, only 21 per cent of women and girls aged 15-24 years exclusively use homemade cloth products while more than 50 per cent in rural areas do the same. The survey also found that the use of products has strong correlations with income, and that as wealth increases so does the use of commercial products.

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Menstrual Health And Hygiene During COVID-19 Pandemic

The problems that women and girls face in managing menstrual hygiene are exacerbated during emergencies like the COVID-19 pandemic. Reductions in income and mobility during lockdowns in 2020 and 2021 have decreased access to menstrual hygiene supplies resulting in an increase in the use of alternative, home-made products, which are known to cause reproductive infections if not used hygienically, states UNICEF Brief. This causes far-reaching negative impacts on the lives of those women and girls who menstruate, including, restricting mobility, reducing participation in work and community life, compromising safety, and causing stress and anxiety.

Lack Of Knowledge And Access To Menstrual Hygiene Products

We often hear that unhygienic period health and disposal practices can have major consequences on the health of women, but what exactly is at risk here? Every person – male or female – should be aware of the diseases that could be caused if a woman does not have access to menstrual hygiene products. Poor menstrual hygiene can increase a woman’s chances of contracting cervical cancer, Reproductive Tract Infections, Hepatitis B infection, various types of yeast infections and Urinary Tract Infection, to name a few.

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Access to hygienic menstrual hygiene products is a matter of health, freedom and choice. When the menstrual health needs of women and girls are met, it ensures that gender equality and inclusive education are attained. An article by the People’s Archive of Rural India (PARI) highlighted the plight of teenagers who were denied access to menstrual hygiene products due to the pandemic. Under normal circumstances, adolescent girls would have received sanitary products at school under a Central government scheme. However, with schools closed for over a year now, these girls have had no recourse but to go back to using cloth under conditions that put their sexual and reproductive wellbeing at risk. In India, only 48 per cent of adolescent girls are aware of what menstruation is before getting their first period. Parents and teachers educating girls about menstruation before their first period encourages healthy habits and dispels stigma and fears. Unfortunately, simply providing the information is not enough. A 2014-report by non-profit organisation Dasra titled ‘Spot On!’ reported how around 23 million girls in India drop out of school every year due to lack of menstrual hygiene management facilities – clean toilets with running water and disposal bins – as well as a lack of access to sanitary napkins and awareness about the issue. The report further suggested that the girls, who don’t drop out, miss up to five days of school every month.

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The lack of sustainable and safe menstrual waste disposal facilities is an additional barrier to improving women’s menstrual health in India, as the lack of proper disposal facilities leads to overuse of menstrual hygiene products beyond the recommended time, putting women at the risk for infections.

During the COVID-19 crisis, women’s access to menstrual hygiene and health have been severely challenged. At workplaces, including hospitals, the lack of adequate facilities for women to manage their menstrual hygiene needs reveals a lack of acknowledgement of these needs. Since the start of the pandemic, women have been at the forefront of the COVID-19 response, making up 70 per cent of the global health care workforce. In India, frontline health workers, such as, the ASHA workers, nurses and community health workers, who form the backbone of rural healthcare, face additional challenges managing their menstruation. This may compromise their health and dignity as well as the ability of the health system to deliver. Women medical personnel at hospitals have contributed equally to the fight to save lives; but how many have considered how difficult it must be for women health workers to manage their menstrual hygiene while using Personal Protective Equipment (PPE). Furthermore, girls and women who are hospitalised or in quarantine centres for COVID-19, may lack access to adequate sanitation and menstrual health supplies. It is important that health facility managers are made aware of and encouraged to prioritize menstrual health and hygiene needs of female health care workers and patients.

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Ensuring Menstrual Hygiene During A Pandemic

It is critical that key stakeholders, including governments and non-government agencies come together to, first, respond to the emergency and, in the longer-term, ensure improved access to quality menstrual health for all women and girls. By ensuring that sanitary pads are considered essential commodities, we must remove barriers to their manufacture and supply.

During the COVID-19 crisis, establishing alternative methods for women and girls to access menstrual hygiene products is essential. Where washing is possible, we could consider promoting the safe use of cloth pads as well as promote do-it-yourself designs and instructions for safe reuse and disposal through women’s networks or digital platforms that reach girls and women. Door-to-door delivery of products through community health workers or other community workers could be promoted.

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Reducing the cost of sanitary napkins is equally important, with many women unable to afford them. The Central government’s Jan Aushadhi Suvidha sanitary napkins, sold at Rs. 1, have proven to be an effective solution and the unimpeded supply of sanitary napkins through this scheme should be prioritized. Additionally, behavior-change communications campaigns through alternatives to interpersonal communication such as online, radio, telephone or messaging services to highlight the need for menstrual hygiene and dispelling the stigma around the subject is just as important.

This International Menstrual Hygiene Day, on May 28, we must look forward to firm action from policymakers, program officials and other key stakeholders in meeting the health requirements of women and girls nationwide. This way, as we begin to pick up the pieces and rebuild a post-COVID-19 world, we can look forward to new ways of sustainably securing women’s menstrual health and also ensuring that the issue is placed strongly and meaningfully in decision-making agendas.

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(The article was co-authored by Dipa Nag Chowdhury, Director Programmes at Population Foundation of India and Poonam Muttreja, Executive Director at Population Foundation of India.)

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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.