Contributions from Subhiksha Manoj, Skye and Bharti Kannan from Team Boondh
As the largest welfare state, India, caters to a population of approximately 1.3 billion. A billion people depend primarily on government schemes for livelihood essentials like food rations and accessing health services for free or at subsidized rates. This extends to menstrual needs as well. A large section of the underprivileged menstruating population depends on government approved schemes to access menstrual hygiene products.
Menstrual products, as essential items, are also procured from government distribution chains like Anganwadi Centers, ASHA workers, Government schools, and local pharmacies at a rate as low as Re 6. However, the media coverage on the “Sanitary Napkin Crisis in India” and the anxiety felt by young school going menstruators as a result of govt schools being shut, make it clear that the government’s SHR and MHH schemes struggle to adapt themselves to emergency situations such as a lockdown.
The media, encouraged by the success of its coverage on menstruating front line worker’s struggle with PPE kit, has been picking up on various aspects of menstruation — including the description of the supply chain of disposable pads. This might make it seem like this is a rather new exposure. It is not. There are glimpses (few) of the government’s shortsightedness of the gendered implications of an emergency and/ disasters reflecting in schemes.
“I had to tear my only sari for my daughter to use as period rag. I also had to spare my only blouse for that too,” says a woman from Odisha’s Puri district that faced the devastating effects of Cyclone Fani, in May 2019. In India, only 58% of menstruators can access safe and hygienic menstrual conditions, whereas the rest of the population face high risk of contracting health complications from using homemade alternatives like rags, hay or dried leaves.
As the focus on menstruation grows in the mainstream discourse, we must take the opportunity to enthusiastically engage in bridging this gap.
Existing Government MHH Policies and Schemes in India
The policies that govern Menstrual Health and Hygiene (MHH)and the Sexual Health and Reproductive Rights (SRHR) are dispersed across various government ministries. Therefore, we will look at the existing frameworks within each of these ministries and address the need for a change in interventions wherever necessary.
- Ministry of Women and Child Development
1.1) Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (SABLA)
Launched on 27th September 2010, SABLA is a scheme that aims to improve the general health and nutritional status of girls from the age of 11–18.
One of the main objectives of the scheme is to tap into the window of opportunity that adolescence represents “to prepare for healthy adult life. During this period, nutritional problems originating earlier in life can be partially corrected, in addition to addressing the current ones.”
This scheme indirectly helps with the menstrual and sexual reproductive health of adolescent girls by helping regulate iron intake and thereby avoiding anemia, which is one of the most widespread deficiencies in girls between the age group of 11- 18. This defect “reduces the capacity to learn and work, resulting in lower productivity and limiting economic and social development. Anaemia during pregnancy leads to high maternal and neonatal mortality and low birth weight etc.”
This scheme has been approved in 200 districts with Anganwadi Centers as the center for distribution of services provided under the scheme. ASHA workers, Medical Officer/Auxiliary Nurse Midwife are the people that are involved in distributing these services, at the location of the Anganwadi Centers, where kids meet. The scheme doesn’t give us clear information on where the distribution takes place, in case of poor infrastructure and what other actions are being taken to develop that infrastructure in an accessible way. There is also no mention of the ground level action to encourage the parents of the children to access the facilities provided by the scheme (most often a large section is left out because they are not aware of beneficiary schemes in the first place).
The scheme offers seven services, the ones that are relevant to MHH and SRHR are Nutrition provisions, Iron and Folic Acid (IFA) supplementation in the form of tablets, Health check-up and Referral Services, and Nutrition & Health Education (NHE).
- Ministry of Health and Family Welfare
2.1) Rashtriya Kishor Swasthya Karyakram (RKSK)
Launched in the year 2011, the RKSK scheme aims to promote the Menstrual Hygiene of adolescent girls in the age group of 10 -19.
While the scheme directly lays a framework to tackle menstruation-related concerns, the larger outlook was to protect and inform children about their susceptibility to “several preventable and treatable health problems, like early & unintended pregnancy, unsafe sex leading to STI/HIV/AIDS, nutritional disorders like malnutrition, anemia & overweight, alcohol, tobacco, and drug abuse, mental health concerns, injuries &violence.”
The objective of the scheme is to increase awareness among adolescent girls on menstrual hygiene, increase the accessibility of good quality disposable pads to adolescent girls in rural areas, and to ensure environmentally friendly disposal of the napkins. This scheme has been approved in all states and each state is expected to come out with a plan to include at least 25% of adolescent girls from each district in their state. However, there is no clear understanding of what ‘friendly disposal’ means — what are the methods to employ? It is important to be as elaborate and distinctive as possible to be able to access the implementation of such government schemes. How is the government going to ensure that the ‘friendly disposable method’ is ingrained in the daily practices of an entire community?
Under this scheme, through ASHA workers, one can avail of a pack of 6 pads for Re 8. These pads will be stored in Anganwadi Centers. Here it is crucial to determine the quality of a disposable pad. This is done by checking if the pads that come to be used under the scheme (by bidding) aligns with the latest BIS (Bureau of Indian Standards) for disposable pads.
The Anganwadi Centers will also be used by the ASHA workers along with other platforms like government schools, to convene monthly meetings on Menstrual Hygiene and Health for adolescent girls. This platform is also used to discuss Sexual Health issues. Is the platform limited only to adolescent girls or is it inclusive of all the children of the adolescent age group, as it is equally important for everyone to be aware of sexual health’s importance and risks.
“A range of IEC material has been developed around MHS, using a 360- degree approach to create awareness among adolescent girls about safe & hygienic menstrual health practices which includes audio, video and reading materials for adolescent girls and job-aids for ASHAs and other field level functionaries for communicating with adolescent girls.”
One of the latest developments to happen under the RKSK scheme is the SAATHIYA Resource Kit and Mobile apps for adolescents. As a part of this project, SAATHIYAs or peer educators will pass age-appropriate knowledge, especially on health matters to adolescents. E-counselling facilities available for adolescents who have the mobile app — SAATHIYA Salah. However, there are no public records or news coverage available on the impact of the continued functioning or COVID specific assistance provided under this project. Since access to the internet itself is a privilege, does the scheme include providing electronic devices and free internet to those who cannot afford it?
3. Ministry of Drinking Water and Sanitation (MoDWS)
3.1) Swacch Bharat Mission (SBM)
Launched in 2014, SBM aims to achieve a high sanitation standard for India and to declare India Open Defecation Free. The scheme only indirectly benefits the women as the construction of toilets would mean a safer space for women and an opportunity to maintain menstrual hygiene.
After 3 years of the functioning of the scheme, however, it became clear to the policy makers that there is a gendered consequence to the lack of toilets — lack of privacy, gender-based violence, sexual health, etc. To tackle this, SBM (Gramin) introduced gender guidelines. These guidelines state, most importantly, state the following:
- The public toilet constructed for women must have the facility for ample light even after daylight. The location of the toilet must be decided through a participatory feedback process.
- Adequate water and space must be ensured inside the toilet to facilitate change of napkins/cloth pads and to wash themselves.
- Toilets must have a nook, shelf, or hook to keep clothing and menstrual absorbents dry.
- To avoid transportation of menstrual waste, incinerators may be built within the toilet with chutes directly adjacent to the toilet building.
- Funds under Solid Liquid Waste Management may be used for setting up incinerators in community toilets.
- Schools must have separate toilets for girls with the above systems in place for Menstrual Health Management.
- Counselling sessions and special educational sessions must be given to adolescent girls by professionals as part of their school education.
Apart from this, SBM also suggested general guidelines on Menstrual Health and Hygiene, where study materials are available to conduct sessions on MHH. It also states the importance of spreading awareness to entire families, especially fathers as this has proven positive responses on adolescents’ approach towards menstruation. Collaborating with a religious leader or a temple authority to talk about MHH will also help fight superstitions around menstruation. While including communities as a whole in the discussion around menstruation is of utmost necessity, the scheme talks very vaguely about the plans on collaborating with male members of the society and religious leaders; considering patriarchy, religion and tradition are the root cause of menstrual taboos in the first place. Do they have any structured modules that are made available for the community to equip them with necessary information and counter the stigma around menstruation?
4. Ministry of Electronics and Information Technology
4.1) Stree Swabhiman Services (SSS)
Launched in Jan 2018, SSS focuses on creating avenues for the self-reliance of rural and semi-urban women. It aims to establish a sanitary napkin unit run by and for women. It also aims to train women and girls to promote menstrual hygiene and collaborate with village-level entrepreneurs and SHG groups.
Production of disposable pads by SGHs was largely affected due to the COVID lockdown because of which girls and women who were completely dependent on them could not use disposable pads. Both manufacturers and consumers were equally affected by this. In a lot of areas, SHGs were not given any equipment to protect themselves from the virus while working. According to an article in Hindustan Times, many of these workers had to either buy their own masks or make one themselves. This potentially puts the entire community of workers at risk.
During the pandemic, the State governments failed to share capital resources with the SHGs who were the sole source of the menstrual products, affecting millions of migrating, daily wage and adolescent menstruators. Apart from risking their own lives with Covid, the distribution process also put the menstruators receiving the products at the risk of contracting Covid, due to the unavailability of protective gears.
5. Ministry of Environment, Forest and Climate Change
5.1) SWM Rules 2016
Sanitary Waste Management Rule, established in 2016, seeks to minimize and effectively deal with the disposal of plastic and other non-biodegradable materials. To be able to do this systematically, the rules suggest that the waste be segregated into biodegradable, non- biodegradable, and biochemical waste.
According to the Solid Waste Management (SWM) Rules, 2016, after proper segregation of waste, household waste ( soiled napkins, diapers, condoms, tampons, and blood-soaked cotton) must be disposed of into biodegradable and non-biodegradable components. However, the BioMedical Waste Management Rules, 2016 indicate that items contaminated with blood and body fluids, including cotton, dressings, soiled plaster casts, linens, and bedding, are actually bio-medical waste and should be incinerated, autoclaved, or microwaved to destroy pathogens.
To resolve this conflict, the latest SWM Rules suggest that sanitary waste (in this context, menstrual waste) must be wrapped securely in the pouches provided by the manufacturers or brand owners of these products or in a suitable wrapping material as instructed by the local authorities and shall place the same in the bin meant for dry waste or non- biodegradable waste.
It is also stated that the local authorities, panchayat offices, etc must pass on the message about this new method of disposal. However, the manufacturer’s responsibility/End Producer Responsibility (EPR) is far from executed. The local authorities have also not taken this into cognizance. It is not made clear to us, what methods are the menstruators currently using for disposal of menstrual waste materials and how far along are the government schemes in building a sustainable model of disposing the same. This is further complicated by a non regulated space in incineration, waste collection, segregation and processing.
All of this points to the lack of concern for sanitary waste management in our country. It is reflected in the fact that there was no follow up done by the authorities. This subject has not been dealt with in the popular discourse due to the taboo attached to the subject. As per the resources, it is quite clear that the authorities have taken limited initiative in reporting on the implementation of the schemes that are on paper, thereby allowing room for accountability. However, the main question which arises here is about the allocated funds assigned to these schemes and how are those being put to use. Schemes that are meant for public welfare should also be accountable to the public. As long as menstruation is treated as a secondary issue, overlooking the necessity of the moment, we as a nation cannot ensure accessible, informed choice driven, bodily autonomy claiming menstruation for all.
Proposed Measures
The only way to solve this problem is to treat “Menstrual Health as a continuum and not as a supply only issue.”
- Need to establish a redressal/ feedback loop to be set up for every MHH and SRH scheme in India.
- Study the demand and supply patterns of menstrual products and services within various regions in India, especially with respect to their geographic specifications. For example, it would make more sense to provide reusable products like cloth pads, menstrual cups etc in a natural disaster prone area than just bales of cloth or disposable ones.
- Implementation of the sustainable, regulated and compliant with international standards disposal methods to assist menstruators in rural and semi-urban areas that is feasible and viable.
- Inclusion of menstruators regardless of their gender identity as most of the schemes funded by the government leave out a section of transmen, intersex and non-binary menstruation out of the discussion surrounding periods.
- Establishing menstruator led community level campaigns to start conversations about periods and providing them with adequate resources to do so.
- Social and financial audits on the impact, sustainability and implementation of the varied schemes
- Open source information on financial records and in turn viability of schemes that promote entrepreneurship on menstrual products for replicability and scale considerations across locations
- SOPs (Standard Operating Procedures) for procurement, disbursement and disposal of products that percolate at the last mile delivery and beneficiary levels
- An executive plan for concerted coordination and action, even a nodal convening ministry to coordinate all efforts related to menstrual welfare schemes, as it is currently a siloed disjointed system
- A specific plan to address those marginalized from the system within the service delivery scope of the aforementioned schemes, particularly for street living menstruators/homeless, sex workers, menstruating trans communities, etc