In the face of the stigma associated with menstruation, growing efforts are underway to help girls understand menstrual hygiene management as a health concept.
NEW DEHLI — "Going to school has become so much more convenient..." says Nisha, an adolescent girl from Thakurpura, a small village in north-central India. Nisha was explaining that she'd started using Freedays sanitary napkins, as part of the Menstrual Hygiene Scheme (MHS) run by India's National Health Mission.
The program was launched for the promotion of menstrual hygiene among adolescent girls (10-19 years), which is focused on increased awareness, access and proper waste treatment.
Apart from improving the access to affordable sanitary napkins, MHS plays a pivotal role in creating awareness among adolescent girls about safe and hygienic menstrual health practices through the use of audio, video and reading materials. Owing to the stigma associated with menstruation, it is important for government authorities and non-profit organizations to spread information for understanding menstrual hygiene management as a health concept.
Negative social attitudes towards menstruation and a lack of access to toilets in school has long discouraged girls from attending classes while on their period.
Seven states are implementing the MHS using health policy funds from the previous financial year. As a part of this, a pack of six sanitary napkins is provided to girls across India. The government understands that the challenges faced by adolescent girls in accessing quality care and information, and these multi-layered challenges cannot be tackled by improving access alone. It requires the creation of a sustainable ecosystem.
The MHM ecosystem consists of awareness, safe usage of menstrual products and access to menstrual waste disposal facilities. Keeping this in mind, 7,470 Adolescent-Friendly Health Clinics across India are providing clinical and counseling services on diverse adolescent health challenges including menstruation through counseling and expert advice. To encourage discussion about health issues including menstruation among adolescents, a peer educator program "Saathiya" has been launched where two male and two female adolescents are selected per 1,000 population in 214 districts.
But the mammoth task of providing access to around 120 million adolescent girls in India cannot be fulfilled only by such interventions. Schools will play a key role in accelerating the progress on menstrual health. Just like Nisha from Thakurpura, negative social attitudes towards menstruation and a lack of access to toilets in school has long discouraged girls from attending classes while on their period. Taking note of that, the Ministry of Drinking Water and Sanitation launched the Menstrual Hygiene Management Guidelines for schools and households to address specific sanitation and hygiene requirements of adolescent girls and women. Apart from separate toilets and safe menstrual waste mechanisms for girls, the guidelines also call for the sensitization of men, boys, communities and families about menstruation.
Given India's vast socioeconomic diversity, we need to understand the different contexts and needs of girls across the country.
The newly launched School Health Program — where teachers are supposed to act as health ambassadors to inform students about health and disease prevention through interesting activities — will also complement the government's efforts. Given India's vast socioeconomic diversity, we should start by understanding the different contexts and needs of girls across the country. Such large-scale data collection and analysis efforts can help us understand fundamental questions like who adolescent girls prefer to approach for information, products they prefer and how challenges related to menstruation are linked with issues of limited resources and poverty.
For example, in the latest edition of the National Family Health Survey (2015-16), it was observed that around 57% of women between the ages of 15 and 24 use a hygienic method during menstruation. This was the first time indicators related to menstrual hygiene product use were added in the survey. These data points helped us to further focus on improving access to menstrual hygiene products in communities.
This is just the beginning. We need to break down silos and work in a holistic manner. From engaging a range of stakeholders across the government, media, non-profits and communities and the girls themselves, to bridging data gaps to reveal specific, sociogeographical contextual needs, working in collaboration might be the most promising way forward.
*Ajay Khera is deputy commissioner for the Child Health Program at the Ministry of Health & Family Welfare, Government of India.