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Uttering the Uterus: Mapping Myths and Menstrual Health in India

Uttering the Uterus: Mapping Myths and Menstrual Health in India

Photo: Nataliya Vaitkevich/Pexels

  • The censorship of menstrual blood, reports of people being “grossed out” by it and being ashamed to talk about a biological event is rooted in discriminatory discourse.
  • Period poverty describes the struggle many women and girls face vis-à-vis affording menstrual products and care. The pandemic created a silent epidemic of period poverty.
  • Myths, stigma and taboo are passed on from one generation to the next, which girls – now in school and reacting to several knowledge systems – are now dispelling.
  • Adolescent girls are more enthusiastic adopters of sustainability, which ties well with their use of the internet and their support for eco-feminist ideals.

Elissa Stein, coauthor of Flow: The Cultural Story of Menstruation (2009), told The New York Times in 2010:

“Fem-care advertising is so sterilised and so removed from what a period is. You never see a bathroom, you never see a woman using a product. They never show someone having cramps or her face breaking out or tearful—it’s always happy, playful, sporty women.”

Most of us remember the collective discomfort in Indian households when a period advertisement would play out on TV screens. In a patriarchal omission, the red period blood would be replaced by a clinical blue. From the hush-hush treatment to the happy faces of women in contemporary period ads, we have come a long way. Last year, Whisper India launched a TV commercial showcasing period red, turning the wheel on the test-tube portrayal of blue.

The censorship of menstrual blood, reports of men and women being “grossed out” by it and being ashamed to talk about a biological event affecting a significant section of the population is rooted in discriminatory discourse.

According to a 2016 study on menstrual hygiene management (MHM) among adolescent girls in India, only 12% of menstruating women and girls had access to sanitary napkins out of 355 million. The number of menstruating women in India who use disposable sanitary napkins stood at 121 million.

Period poverty, according to the UN Population Fund, describes the struggle many low-income women and girls face while trying to afford menstrual products and care.

The pandemic created a silent epidemic of period poverty.

Preeti Poddar, child protection officer at Delhi-based non-profit Protsahan India Foundation, says, “Forget about pads – several adolescent girls whom we cater to in the urban slum colonies in West Delhi and Dwarka do not even have access to underwear. They would often come only wearing a salwar or skirt.” Their mothers work as domestic help while their fathers are engaged in rag-picking activities. Some of the girls are homeless and beg or used to beg on the streets.

Kalindi*, an 18-year-old girl ‘champion’ (a label for a peer educator) at Protsahan, says that when schools stopped the supply of sanitary napkins, several girls from the local communities had to resort to using dry leaves, rags and dirty or discarded used clothes.

Deblina Chatterjee, a public health trainer in Kolkata currently working with the non-profit organisation Anahat for Change Foundation, has previously trained accredited social health activist (ASHA) workers in rural Bengal. Anahat works to accelerate knowledge and awareness of MHM primarily in West Bengal Board of Senior Secondary and Higher Secondary and girls-only schools in Kolkata’s urban and suburban areas and some other districts.

Chatterjee has experience in conducting MHM training among communities for school students and parents. At some of these sessions, several adult menstruators failed to identify the uterus. When Chatterjee asked them if they have ever seen a picture of the female reproductive organ at a health clinic/ultrasound facility, the answer was in the negative. And when she asked them if they knew the outlet of menstrual blood, the silence continued. Most of these women were in the advanced years of their reproductive cycles.

When Chatterjee introduced the sustainable cloth pad to her class, the first thing that came to adolescent minds was: is it washable?

The lack of information about menstruation has allowed a cycle of misinformation to erupt around it. From not entering or touching a site of prayer or rituals to not touching food and cooking utensils and not consuming sour food, the lists of don’ts signify different cultural norms across communities but they are all rooted in the mysteries and the myths surrounding menstruation.

Schools, sanitation and the grammar of periods

“When we started working with adolescent girls in schools and communities, we figured that [there was a long way to go to] break myths, stigma and taboo,” says Purvi Tanwani, co-founder of Anahat for Change. “Firstly, we wanted them to talk openly with us because the populations we were catering to had absolutely no knowledge about menstruation. The first question we asked them was: Did you know about menstruation before you started your periods or did your parents/mothers talk to you about it?.”

The curriculum at Bengali-medium schools in West Bengali doesn’t cover the human reproductive system and elementary sexuality education until class 11, which rules out a large section of students that don’t opt for the science stream at the higher secondary level.

“No matter what the medium, I don’t think any school curriculum covers the human anatomy and reproductive system in as much detail as it is required,” Sanjina Gupta, founder of Kolkata-based non-profit Rangeen Khidki, says. “Some curricula require it to be taught in class 9, some in class 11, but the fact is that most of the time teachers skip the topic or provide very superficial information because they themselves are ashamed to talk about it. And the fact is that by class 9 or 1, most female-bodied individuals have already started menstruating.”

Myths, stigma and taboo are passed on from one generation to the next, which girls – now in school and reacting to several knowledge systems – are now dispelling. “They are questioning the logic behind the myth that period blood is impure or that the menstruator is impure during that time. So we first started by creating a safe environment for them, so they could start talking about their menstrual practices. Then we start addressing the shame and stigma,” Tanwani says.

Education is a great equaliser vis-à-vis the rights and representation of menstruators in the sexual and reproductive rights (SRHR) milieu, but the fact remains that menstruators generally miss going to schools in the first two or three days of the menstrual cycle.

A 2014 report by the NGO Dasra titled, entitled ‘Spot On!,’ found that nearly 23 million girls drop out of school every year due to lack of proper menstrual hygiene management facilities. The report also said that 70% of mothers with menstruating daughters considered menstruation to be “dirty” and 71% of adolescent girls remained unaware of menstruation until menarche1.

“Schools don’t have the proper infrastructure or support – from a dirty washroom to a washroom without locks, and no place to dispose of sanitary napkins,” according to Tawani. “We have also been to girls-only schools not necessarily in remote and rural Bengal, but schools as close by as the Ganga bank in South 24 Parganas” – adjoining Kolkata – have “no bathrooms. The girls had to go to the river bank to wash and dispose of pads. Open defecation among men and women is a fairly normal practice there.”

Jaswant Kaur, vice-president of Pilani Atmanirbhar Resource Centre, an initiative of the BITSAA Trust, said that surveys in Greater Noida, near Delhi, revealed that an overwhelming majority of adolescent girls across marginalised communities lack access to MHM knowledge and basic awareness of menstruation as a natural biological process. Their mothers often revealed their views on menstruation as a “problem”, a “disease” or as something “unnatural and impure”.

(The UN Sustainable Development Goals target 6.2 calls for ‘special attention to the needs of women and girls’, so WASH programmes have been monitoring menstrual health-related needs.)

The principals of some of the “big government schools” shared with Tanwani that they had made allowances for cleaning washrooms. However, they are so tightly budgeted around every time item that the toilet facilities remain practically unusable. In fact, in several such schools, a sanitation worker comes once every week or twice a month to pick up the waste, which also means the dustbins frequently overflow.

“On the contrary, and ironically, teachers’ washrooms were found to be very clean,” Tanwani says. Anahat went on to build a toilet for a school in Diamond Harbour.

Even schools that used pad-vending machines as part of some corporate social responsibility programmes couldn’t solve the problem of supply because the machines weren’t refilled after the first couple times. The machine were also usually transferred to the teachers’ common room, further rendering students hesitant to reach out for pads. Teachers justified it by saying “the girls would end up breaking it,” as Tanwani of Anahat says. Sometimes, most girls didn’t even know that a vending machine existed on the school premises – or what a vending machine was for that matter.

According to Gupta, in reality, to state that menstruators in rural spaces know less than their urban counterparts would be erroneous. It is sometimes true but not as a rule, she adds. Only last week, she recalled, during a visit to a Kolkata school, adolescent menstruators told her they thought they had cancer, had injured themselves severely or were dying when they first started menstruating.

Kaur says that often, in the name of toilets, schools have open seats and unclean spaces without locks, making privacy and safety a big barrier, and which then leads to absenteeism.

The politics of menstrual products

While studying the gaps in the sustainable menstrual hygiene products market, Tanwani found that the maxim is was “jo dikhta nahi, woh bikta nahi” (Hindi for ‘it doesn’t sell if it’s not visible’). The space was plagued by problems of low visibility and advertisements – whereas even the local paanwala had started selling commercial sanitary pads. The sustainable products were also more expensive and available only on a limited platform, mostly online and on demand, and sometimes inside an NGO’s website, making them quite niche.

However, COVID-19 accelerated the demand for reusable pads. When the Indian government announced the first nationwide lockdown, only “essential services” were allowed to continue – and sanitary napkins weren’t classified as ‘essential’. Many women’s groups, doctors and non-governmental organisations came forward saying that COVID-19 wasn’t going to stop menstrual cycles.

There are three categories of adopters – or those who switch from using mass-market use-and-throw pads to sustainable cloth pads. These are those who adopt sustainable products over environmental concerns, those switching for economic reasons, and those switching to avoid itching, irritation or vaginal rashes due to use-and-throw napkins.

“A pack of regular sanitary napkins comes roughly at Rs 30-40, and a menstruator will require two such packs during a single menstrual cycle,” Chatterjee says. “If there are two or three menstruators in a family, you can do the maths yourself. For several community members and socio-economic groups, this is a huge burden, owing to which they readily adopt a cheaper alternative, which is also sustainable and has a longer shelf life.”

Anahat manufactures reusable and leak-proof ‘Unnati’ cloth pads, which it claims are 100% cotton and can be washed and reused for up to three years. This initiative also helps the young women who make them earn a living. An ‘Unnati’ pack comes at Rs 360 (retail price) and lasts for three years.

Charu*, a 19-year-old girl ‘champion’ at Protsahan, had been told to not touch objects of prayer, eat pickle or bathe during her menstrual cycle by her mother. The story is similar for her friends, who had all been asked to not go to school and to hide their pain and menstrual hygiene products. Today, via the NGO’s menstrual health awareness programme, Charu knows about issues as diverse as vaginal rashes, medicines related to menstruation, cervical cancer, sustainable hygiene products and the comfort of soft pillows.

In fact, according to Tanwani, adolescent girls are some of the most enthusiastic adopters of sustainability, tying well with their consumption of content on the internet and their support for eco-feminist ideals.

“The very fact that you have to wash and dry a reusable cloth pad in the open itself is a stigma-shattering practice,” says Namrata Karamchandani, co-founder of Anahat for Change.

A menstrual cup – a funnel-shaped container that is tucked inside the vagina to collect menstrual fluid – allows up to 10 hours of continuous use, as opposed to a regular sanitary napkin or cloth pad, which is recommended to be changed every six hours. This sounds especially good for menstruators on the go.

A woman holds up a menstrual cup. Photo: Oana Cristina/Unsplash

Chatterjee, however, says that the menstrual cup evokes strong sentiments of fear and discomfort among adolescent girls. A menstrual cup also requires a private washroom or a privacy-friendly washroom fit with a Western commode or at least a tool with which to insert the cup, later dispose the menstrual fluid, and a sterilisation facility. “Most Indian mothers wouldn’t allow the household gas oven to be used to boil water for sterilising a menstrual cup,” says Chatterjee.

But the politics of menstrual cups runs deeper and can be traced to a lack of access to WASH. A UNICEF-WHO Joint Monitoring Programme report on drinking water and sanitation says that billions of people will lack access to safely managed household drinking water, sanitation and hygiene services by 2030 unless the rate of progress towards meeting the sustainable development goals quadruples.

The decision-making agency and purchasing power in the case of an adolescent menstruator mostly lies with the mother or a parent more broadly. While members of marginalised socio-economic groups are often early adopters of sustainable menstrual hygiene products, their counterparts in urban slums cite problems of common toilets, Chatterjee says. When she points out that they could use emergency toilet provisions instead of dumping the regular sanitary napkins in the nearby pond, which she describes as giving off a stench, they veer away from the conversation.

In several households in Murshidabad, 230 km north of Kolkata, where Chatterjee went on field visits, there are no lights in bathrooms.

On the other hand, there’s a nurse working in a Kolkata hospital who, according to Chatterjee, wished to switch to sustainable cloth pads but wasn’t ‘allowed’ by her mother.

These conversations are not easy to have. Should menstruators be shamed for inhabiting unfriendly spaces defined by controlling masculinities and thereby being unable to use a sustainable product, where their only option could perhaps be a commercially available pad? As Chatterjee says, adopting sustainable menstrual hygiene products has to be a matter of choice and not coercion.

“A product-centric view of menstruation is limiting in its scope as it doesn’t necessarily help destigmatise menstruation. The narrative of sustainability/sustainable products will remain superficial if it doesn’t address that,” says Gupta of Rangeen Khidki.

She had written to several state bodies and stakeholders of the West Bengal government when the COVID-19 lockdown and cyclone Amphan disrupted the supply of sanitary napkins.

“Movies like Padman, with their community saviour syndrome, insist on using products, telling us that using cloth in essence is bad practice. But such a view discredits an indigenous practice, which has been there through generations of grandmothers and mothers,” she says. “Obviously, one has to understand the difference between using discarded, used and dirty pieces of clothes versus clean cloth.”

The culture of using clothes, often discarded and old, often paves the way for a transition to sustainable cloth pads intrinsically organic. And in that sense, the practice of sustainability has already been woven in the culture of using kapda/kapor, within the domestic fabric of sexual and reproductive rubric. However, to equate this homegrown culture with a choice-based sustainability practice would be to gloss over determinants of socio-economic conditions that perhaps produced, shaped and normalised a lack of access.

A purely product-centric and technocratic approach to menstruation might be limiting as it glosses over such intergenerational factors and depoliticises the marginalisation of menstruators in terms of denial of sexual and reproductive health rights (SRHR). “India had to scrap its 12% tax on all sanitary products only after months of campaigning. But just tax-free sanitary supplies are not enough. Access to clean toilets for women with clean water supply in schools and public spaces is as important,” says Sonal Kapoor, founder and board member, Protsahan India Foundation.

By placing the onus of sustainability on already marginalised women/menstruators are we overburdening them with an added moral/ethical responsibility? Caste and other identities that have historically shaped and perpetuated the marginalisation is embedded in the SRHR discourse, neglected in public healthcare.

Is their economic and social vulnerability or lack of access to education and medical systems making them being passively co-opted by the sustainability movement?

Tanwani says, “Even two-three years back, sustainable menstrual products used to be available only to privileged sections of the population owing to unequal knowledge and access systems. I think the growing distribution of such products among hitherto underserved populations via online mediums is only democratising the supply chain or the larger discourse.”

“Equally critical is understanding that placing the burden of sustainability on the poorest of poor is not fair,” adds Kapoor. “The sustainability burden is to be first shared by those in the hierarchy who have a privilege of choice and resources. Equity is the real secret ingredient to getting anything done right at scale.”

Pain and power dynamics

Going back to Elissa Stein’s observation on happy women in period adverts, the practice of omitting or disguising period pain also indicates a vacuum in popular culture.

In several informal conversations with peers, the writer has come across stories of women who had to face stigma owing to their reluctance to hide the black bag, or openly talk about menstrual cramps in so-called progressive households.

In fact, pain as a function of the female body, has been treated with a unique silence. Often invalidated, girls are culturised into shunning or normalising pain. Gupta says, “Even the conversation around painkillers is seen in a bad light. I have heard mothers cautioning young girls to not consume any pill as it might end up making them infertile. Conditions such as endometriosis and vaginal discharge before and after period are often shrouded in ignorance and unacceptance, and also fear.”

The site of menstruation is also not a cisgendered, female-only space. The degendering menstruation framework urges to acknowledge the reality that all women menstruate, and that not all those who menstruate are women.

Dr Aqsa Shaikh, founder, Human Solidarity Foundation, says, “The menstruation discourse in India is yet to include and invest in the non-binary and trans persons lens, which leaves a significant population of menstruators cut off from access to safe menstrual hygiene products, knowledge, awareness and exercise their rights to safe menstrual healthcare. The apathy is visible in how there is a severe lack of gender-neutral washrooms.”

Vandita Morarka, founder and CEO of One Future Collective, says, “It is important to include queer, trans and non-binary in the menstruation discourse because not only women menstruate, people of all genders menstruate. And, including this in our curriculum, conversations and dialogues ensures representation, rights, access to products, services, policy and infrastructure required by anyone who menstruates.”

A non-inclusive MHM space would mean perpetuating a taboo within a taboo. “To not include the fact that people of different genders menstruate in the mainstream discourse is to erase our identity, our bodies and our experiences. It brings visibility, it normalises this as something that happens, and as a consequence of that it allows you to get support, access rights, and get social protection, which otherwise doesn’t exist,” adds Morarka.

* The names of adolescent girls have been changed to protect their identities.

This story is part of the Laadli Media Fellowship 2022.

Sanhati Banerjee is a Kolkata-based independent journalist with special interests in gender, health and popular culture. She is a winner of the Laadli Media Awards for Gender Sensitivity 2021.

  1. The first occurence

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