- Menstrual hygiene is important to ensure that we empower women and girls – and includes access to safe sanitation and clean water as much as an atmosphere of dignity.
- But several patriarchal notions have dampened our efforts to improve the health of girls and women, and have muted attempts to quell stigma and discrimination.
- The COVID-19 lockdown deepened many of these problems and created others when it restricted the mobility and decision-making power of menstruating individuals.
- May 28 is Menstrual Hygiene Day, and it is fitting that we reflect on the progress we have made, the progress we have lost, the challenges ahead of us and our responsibilities.
Menstrual hygiene is important to ensure that we empower women and girls. It doesn’t just include providing safe sanitation, clean water or environments but also creating an atmosphere of dignity. But several patriarchal notions including taboos around menstruation dampen efforts to improve the health of girls and women.
Discrimination against menstruating women is widespread in India, where periods have long been taboo and considered ‘impure’. Menstruating individuals are often excluded from social and religious events, denied entry into temples and shrines, and even kept out of kitchens in houses.
In some parts of India, women follow strict diets during menstruation, such as eating sour food like curd, tamarind and pickles, in the belief that their contents will ‘disturb’ or ‘stop’ the menstrual flow. The pandemic has further disrupted any strategic progress made to combat societal issues around menstruation. The lockdown affected women’s access to essential sanitary products, facilities and information. As such, stigma and misinformation have been allowed to persist. And they need to be addressed right away.
The pandemic’s effect
The pandemic’s devastation was worldwide but not all its consequences received equal attention – especially the hygiene of young girls in South Asian countries. The closure of factories, job losses and reduced household income all impacted the use of sanitary napkins. The pads also became less affordable, especially to those belonging to weaker socio-economic groups.
Many national schemes, including a free period products distribution scheme under the ‘Rashtriya Kishor Swasthya Karyakram’ (RKSK), failed because schools were closed during the lockdown. And while community health workers were preoccupied with COVID-19 work, anganwadis didn’t receive and couldn’t distribute napkins properly.
Policymakers also failed to ensure sanitary napkins were classified as essential commodities during the pandemic, forcing young girls to arrange pads for themselves.
What stands in our way
A survey in North India, co-conducted by one of the authors of this article, concluded that during the COVID-19 lockdown in 2020, students had to depend on locally available resources such as absorbents during menstruation or that they paid more to buy sanitary pads. At various points, many girls also reported that they reused pads, used them for longer or made do with rags.
The usual recommendation is for sanitary napkins to be changed every six hours. A 2015 study found that prolonged use could lead to infections of the genitals and/or the reproductive tract.
While the discourse around menstrual health has picked up pace in many settings, it remains a long way away from penetrating a meaningful fraction of the surrounding stigma – entrenched there by old attitudes and practices.
Socio-cultural barriers perpetuated by patriarchy aggravate persistent myths and misconceptions around menstruation and hamper open communication on the subject. A shopkeeper wrapping a sanitary pad in a black bag is still a common sight in many countries, including in India. Together with a lack of access to clean water and sanitation facilities, the consequences for the menstrual health of those who menstruate remain severe.
School education in India still doesn’t adequately cover menstrual, sexual and reproductive health.
People with disabilities have it worse thanks to limited access to education and information, services and commodities. Then there are cultural misconceptions around gender identities that further isolate trans- and non-binary people from the mainstream discourse and services around menstrual health.
Then there is affordability: menstrual hygiene products are heavily taxed, placing them out of reach of a large fraction of the population. Safe and sustainable alternatives like biodegradable pads and menstrual cups are becoming increasingly visible in the market. But they are currently limited to the urban and economically sound strata because of either their prices or awareness of their existence.
What we can do
First, sexual and reproductive health sessions are as important as other lessons, and should be revived or continued, as the case may be (and should have been during the pandemic). Government and policymakers need to ensure that these sessions are provided to everyone, even in times of emergency.
Second, we need to shift the focus from using only sanitary pads to include sustainable period products as well. We also need to communicate with individuals who menstruate about the various products, their impact on the environment, and empower them to choose according to their needs.
Third, Since schools were closed and ASHA workers were diverted to COVID-19 duties during the lockdown, the beneficiaries of schemes under the National Health Mission did not receive period products. So we must develop a robust operation, distribution and delivery mechanism to ensure public health emergencies don’t disrupt the supply of these products.
Fourth, we need to improve existing programs, including the RKSK, and include menstrual health management as an integral program component. This will – or ought to – ensure a comprehensive adolescent education programme that in turn will help dismantle the stigma associated with menstruation.
Deena Mariyam, Karan Babbar, Shwetha Jindal, Honey Tandon and Deepika Saluja work with the Indian chapter of Women in Global Health.