Narratives of Bodily Functions

Assumption 1: Poor menstrual hygiene is primarily a rural phenomenon in India

While poor menstrual hygiene is an issue in rural areas, there are certain contexts within rural areas as well as in urban India that also require urgent attention. While Arundati Muralidharan highlights the challenges that women and girls face in the informal settlements or slums of Mumbai during their periods, Vasudha Chakravarthy et al discuss the struggles of menstruating women in low-income areas of Delhi and Jaipur. In many ways, the situation in urban areas is worse compared to rural areas, due to densely populated, congested living spaces, lack of privacy and inadequate sanitation infrastructure. Hard to reach rural areas, especially areas prone to disasters, are another aspect that demands more attention. Mayuri Bhattarcharjee’s article takes us to the flood prone regions of Assam and looks at how menstruating women cope when their homes and toilets are submerged under water.

Assumption 2: Access to sanitary pads is the solution to poor menstrual hygiene

For several programmes on menstrual hygiene management, a key indicator of success is whether women and girls are using sanitary pads. Owing to the advertising industry and the distribution of free pads through government schemes, more and more adolescent girls have begun to use disposable pads. In fact, sanitary pads have become an aspirational product for adolescent girls who wish to be different from their mothers who still use cloth. The government is also investing in pads and setting up production units run by women self-help groups with the twin objectives of addressing menstrual hygiene as well as creating livelihood opportunities for women.

There is, however, a danger that MHM gets reduced to the use of sanitary pads alone. Pads are no magic wand. They bring their share of problems – related to both health as well as the environment. In her article, Tanya Mahajan argues that menstrual hygiene depends not so much on the product that is used, but on how it is used. Little is known about the long-term health effects of disposable pads made of plastic and super absorbent gels. Such products also take over 500 years to degrade and lie rotting in landfills that are already overflowing with urban waste. In recent years, the menstrual product landscape has seen a sea change with many more options available for menstruating women. Tanya looks at the range of products available today and emphasises the need for giving women options so that they can make an informed choice about the menstrual absorbent they use. Choice comes with knowledge and the right to information about the product being used. Given this choice, women and girls are capable of selecting alternative products that are more sustainable and environmental friendly. For example, Purvai, a college student, explains why switching to a menstrual cup has been a liberating experience and Savera shares her experience of using reusable cloth pads as an alternative to disposable sanitary pads. Both these personal experiences show that it is misleading and short sighted to promote the use of sanitary pads alone.

Poor menstrual hygiene has its roots in the stigma associated with menstruation and a patriarchal society that sees menstruation as polluting instead of a natural biological process. Rather than just distributing sanitary pads to women, MHM programmes can use menstrual hygiene as an entry point to address gender inequalities and empower women with knowledge and information that enables them to take control over their own lives. The media can play a critical role here. In her film review, Namita Bhandare discusses Padman and other films dealing with menstruation and applauds them for breaking the silence and taking on menstrual taboos with the public at large. Speaking about a very different form of media, Surbhi Bhalla illustrates how creative methods such as grassroots comics can be used at an individual level to raise awareness on menstrual hygiene and debunk taboos, myths and misconceptions.

Assumption 3: Toilets are the answer to women’s sanitation and hygiene woes

Toilets are often projected as the means to protect women’s honour, dignity and security. It is true that going out to defecate in the absence of toilets and finding a private place to change their menstrual absorbents and clean themselves, creates high levels of anxiety and stress for menstruating women and girls. Abdul Azeez et al. illustrate how the lack of toilets and the experience of open defecation in villages of central Rajasthan impact health and overall quality of life, especially of women who are more vulnerable such as the elderly, adolescent girls and pregnant women. However, infrastructure alone is not the answer. Even if women do have access to toilets, they are often not allowed to use them when they are menstruating due to social taboos that view menstruation as polluting. Joshy et al look at the practice of menstrual segregation and its impact on women in the Pindar Valley, Uttarakhand—a state that has been declared open defecation free—but still has women defecating in the open due to menstrual taboos and inequitable gender norms. Without challenging these taboos and norms, menstruating women will continue to suffer the indignities of open defecation and be treated as untouchable.

With more and more women joining the workforce and going out to work, the need for public toilets becomes imperative. While these toilets exist, they are poorly maintained and do not respond to the specific needs of women. In a study done by Srividya Raghavan et al of public toilets in Warangal, users highlight the need for public toilets with easy access, basic facilities and a caretaker who can ensure cleanliness and security. True, toilets can go a long way in addressing women’s sanitation problems, but they also should be located, designed and maintained keeping women’s needs and experiences in mind.

Sometimes a narrow focus on toilets can even exacerbate the situation and increase gender inequalities. In his article, highlighting the disconnect between gender-sensitive sanitation policies and implementation, Sujith Koonan shows how men are ‘triggered’ to build toilets on the pretext of protecting their women’s honour and saving them from sexual violence. This argument reinforces gender stereotypes and social control over women. The lack of toilets and consequent need to go out for defecation are not the root causes of violence against women. Rather, it is structural reasons, such as unequal power relations and gender inequalities that lead to sexual violence. Toilets are important, but they need to be promoted for reasons such as public health and because everyone has a fundamental right to sanitation.

Assumption 4: Menstruation is a private matter

A woman’s experience of menstruation is influenced and controlled by many external factors, including the taboos imposed on her by society, the taxes on menstrual absorbents and the infrastructure she can use. In many parts of the country, menstruation is still a public event. When a menstruating woman is segregated and not allowed to participate in social functions or sleep in the same room as others, then everyone knows about this most intimate bodily function. Rita Mishra’s personal narrative of menstrual taboos across three generations describes the feast held for Kanchana Mishra when she first attained menarche as a young girl growing up in Chilika village, Odisha, followed by six days of seclusion when she had to sleep in a separate room. Even though menarche is celebrated as a coming of age ritual, at the same time, a girl is supposed to stay away from others and hide the fact that she is menstruating. As Rita puts it, menstruation was an open secret.

As evident from these assumptions, menstruation and MHM are complex issues that call for a more holistic understanding that can inform the design of future interventions.

The good news is that there is a growing openness to talking about a once taboo issue like menstruation and acknowledgement that menstrual hygiene management is a critical need for the well-being of women and adolescent girls. Civil society campaigns such as #HappytoBleed and #IAmNotDown have worked to transform the shame and stigma associated with menstruation into confidence and pride (Pandey, 2015). The discourse around menstruation has not just been public—it has also made its way into public policy. The Swachh Bharat Mission (Gramin) guidelines (Ministry of Drinking Water and Sanitation, 2017), for example, recognise that women and girls have specific sanitation and hygiene needs, including those that are linked to their menstrual cycle (SBM Guidelines 6.9.2). Annexure XI (Guidelines on Gender Issues in Sanitation) highlights the gender specific aspects of sanitation and recommends inclusive toilet designs that address the needs of menstruating women and girls, including women with disabilities. The Ministry of Drinking Water and Sanitation has also released MHM Guidelines (MDWS 2015). Districts have started building capacities of government officials and frontline workers on MHM so that they can become champions for menstrual hygiene and break the silence in their respective blocks and gram panchayats. The Swachh Bharat: Swachh Vidyalaya campaign was started to ensure that schools have water, sanitation and hygiene (WASH) facilities, including separate toilets for girls (MHRD, 2014). Several social entrepreneurs and organisations have started developing eco-friendly, compostable sanitary pads and other sustainable menstrual absorbents, like cloth pads, while others are experimenting with incinerators for menstrual waste disposal. The Bureau of Indian Standards is also revising quality parameters for disposable sanitary pads and developing standards for reusable cloth pads.

Owing to these and other MHM initiatives, the momentum created to improve the experience of menstruation for millions of girls and women is palpable today.

To sustain this momentum, it is necessary to recognise that MHM is a cross-cutting issue that requires different ministries and departments to work together, including those of health and family welfare (MoHFW), human resource development (MHRD), women and child development (MWCD), housing and urban affairs (MoHUA) and drinking water and sanitation (MDWS). An inter-ministerial MHM committee to promote convergence between relevant departments would go a long way to ensure that policies are implemented in an effective manner.

It is also necessary to adopt a more holistic approach that looks at the entire MHM value chain ² —from breaking the silence on menstruation and addressing inequitable gender norms, creating awareness about menstrual hygiene, providing clean and private WASH facilities and menstrual absorbents and finally ensuring safe disposal options for menstrual waste. These are interrelated aspects and cannot be addressed in isolation if a sustainable solution is to be found.

More than anything else, menstruation needs to be viewed as a normal fact of life so that menstruating women and girls are no longer shunned, stigmatised and segregated. Menstrual taboos, that view menstrual blood as impure, prevent women and girls from reaching their full potential and are a violation of their human rights (UNGA 2010). The petitions challenging the Supreme Court judgement allowing women in the reproductive age group to enter the Sabarimala shrine and the protests illustrate how deep the patriarchal waters run and the extent to which these values have been internalised by women, many of whom are at the forefront of the protests (Babu, 2018). It is, therefore, necessary to go beyond menstrual hygiene education and talk about wider issues of gender equality and non-discrimination so that women can manage their menstruation without shame and embarrassment and walk tall every day of the month.