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Strategies to Address Tropical Health and Adolescent Health Issues

Table of Contents

Background:

Approaches Used to Combat This Issue.

Merits and Demerits of The Approaches.

Implications on Public Health..

References:

Background of Menstrual Health and Hygiene in India

The subject of mental health has always been a sensitive issue in India. Menstruation has always been looked at as something which is dirty, impure and has always been spoken about in hushed tones. Surprisingly, this was not always the case. Historically speaking, menstruation was once considered auspicious in many cultures in India and women were worshipped for their ability to bleed and not die. Over time, however, these perceptions changed and it became a tool for oppression. The fact that this common natural process was regarded as an impurity and punishment for the sins of womankind, it led to women being banned from the temple, other public spaces, auspicious events to even their kitchens (Garg & Anand 2015). It is a popular misconception among the ignorant and uninformed that if a menstruating woman touches something, it will be ruined. Hence, women are locked up or kept isolated during the days they have their periods.

Due to the subject being a highly controversial one, it is not surprising that menstrual health and hygiene would be a largely ignored area. Overall, women have been shamed for getting their period in India. The negative attitude towards menstruation has resulted in it being viewed as a psychological burden (Van Ejik et al. 2016, p. e010290). However, it has been the young girls, all of them pre-teens or teenagers and mostly from villages or backward societies, who have had the most to lose due to menstruation – a shot at a bright future. Given the times we are living in, girls need to reach their full potential to achieve gender equality and this is only possible if they can get an education and attend school regularly (United Nations Development Program, 2017). Young girls on their period either did not attend school during periods or dropped out of school. Mensuration is one of the biggest factors that contribute to the drop-out rates of young girls living in rural areas. Around 23 million women drop out of school every year in India on getting their periods. Poor sanitation and lack of good sanitary products are associated with a high drop-out rate, absenteeism and low enrolment (Chandra-Mouli & Patel 2017, p. 30). Being aware and educated about menstrual health and hygiene, access to sanitary pads and proper school facilities would improve the educational experience of adolescent girls in India (Sivakami et al. 2015). Inadequate options for menstrual health are a barrier to education for girls from underdeveloped and developing countries (Sommer et al. 2016, p. 33032). Most adolescent girls are unaware of menstruation until they get their first period (Chandra Mouli & Patel 2017, p. 30). Functional toilets which they can avail do not exist in most villages and sanitary pads are inaccessible, making the situation abysmal. There have been Government initiatives that have been launched. These initiatives have tried to come up with ways to improve facilities regarding disposal, access to products such as subsidiary pads and installation of vending machines that supply pads in schools. The government has also constructed and assigned gender-specific toilets although there have been claims that gender-specific toilets do not exist everywhere and there is a serious scarcity of washing and cleaning facilities for girls in schools (Zaidi, Sivakami & Ramasamy 2015, p. 189-194). 

In such a scenario, it is futile to believe that menstrual health is something they pay attention to. To them, it is a foreign concept, something that is unheard of and not given importance to. The use of sanitary napkins is also a luxury for most rural women in India, as the age-old practice of using old cloth and ashes prevails and has been carried forward from generation to generation. Thus, Indian women have been putting their health at immense risk and it was a time that someone changed that.

Approaches Used to Combat This Issue

In the wake of such alarming occurrences, there have been numerous projects and initiatives that have been launched to combat this issue. Projects like Sakhi, Mukti, and Baala have, in their ways, tried to spread awareness about menstruation, smash taboos and bust myths associated with it and have also encouraged women from rural India to use sanitary napkins and diva cups or eco-friendly napkins so that they do not have to compromise on their day to day living due to a monthly occurrence.

Project Sakhi is an initiative by the Vatsalya Foundation and is headed by a woman named Swati Bedeker. It was launched when it came to the notice of some of the people working at the foundation that women were using leaves with mud which was tied around their waist, unclean cloth and other unhealthy alternatives to a sanitary napkin during their menstrual cycles. As a result, they were suffering from various infections and their menstrual hygiene was in shambles. Bedeker believed that women needed to be educated on the ways to deal with menstruation safely and hygienically. So, she developed a unit which could manufacture low-cost sanitary napkins using wood pulp. The napkins are sold under the “Sakhi” brand and are nominally priced. Each unit produces 1000 napkins per month and there exist five such units. The women from villages have also been employed by this project to produce the napkins, thereby providing them with an opportunity to earn their livelihood. Awareness was spread about this initiative using social media. Through this project, a social enterprise model was created which can be implemented anywhere in the country.

Project Mukhti was targeted at young girls living in slums who were forced to drop out of school on receiving their periods. Girls from economically weaker backgrounds would either drop out or miss school for a week due to embarrassment or anxiety about staining their uniforms. This would lead to a fall in their grades and eventually, lack of interest in studies. Due to the ignorance about menstruation in society, this project came into existence. It spoke about and spread awareness on topics such as menstrual health and hygiene, safe and unsafe touches and other aspects of menstruation.

Project Baala is another initiative which deals with solving issues about menstrual health through awareness and sustainability. Project Baala encourages the use of and distributes reusable sanitary pads to women who do not have access to such amenities. The reusable pads are good for use for up to two years. This does not only tackle the problems surrounding menstrual health but also deals with the issue of the environmental implications that occur due to disposal of pads. The disposable pads are eco-friendly and biodegradable making their disposal environment friendly.

One of the first initiatives involving low-cost sanitary napkins has to be credited to a social entrepreneur named Arunachalam Muruganantham. He is responsible for developing a machine which makes sanitary napkins which are cost-effective for women living in rural India, thereby spreading awareness about menstrual health as well as stopping unhygienic practices. He started the revolution which has now gained momentum.

The WASH (Water Sanitation and Hygiene) Project by UNICEF has been dealing with various sanitation-related issues in India. According to this project, clean water, decent toilets, along with good hygiene should be made accessible and mandatory to all. It should be integrated into the normal lives of everyone. Unfortunately, many people living in rural areas and small towns do not have access to even basic facilities. This poses a huge problem, especially to menstruating women. WASH aims at working through the existing system to achieve its objectives involving sustainability and equality. For instance, the menstrual health and hygiene interventions are added to the already existing successful programmes involving skill development, awareness about sexual health, reproductive health and rights, adolescent nutrition and adolescent participation. Water, sanitary facilities and hygiene are the basic blocks of achieving success in the field of menstrual health. The initiative works with the local government bodies, civil society organisations, schools and other partners who help them deliver programmes and training about basic facts involving menstruation and ways of improving menstrual hygiene. Building these skills has been the cornerstone of the UNICEF approach.

Merits and Demerits of The Approaches

The above-mentioned projects have all been successful in their way. Since they are mostly targeted at women from rural areas, care has been taken to make the sanitary napkins cost-effective. Projects Sakhi, Baala and the initiative by Arunachalam Muruganantham are all scalable to other settings and have also been successful in generating employment opportunities to women from backward societies and rural backgrounds. In addition to this, these small-scale sanitary pad manufacturing units have done a commendable job in keeping the environment in mind by making the pads eco-friendly, thus making these a sustainable option for the long run.

However, some concerns do exist. For starters, the quality of the pads is a question. It has been noticed that in some cases the quality of the pads varies and need to be monitored. A good quality check mechanism needs to be in place. Another issue that arises is whether all the girls and women know the product they are using. Care should be taken to talk to them about menstrual hygiene, the different practices involved, the importance of keeping themselves clean and if required, a demonstration on how to use sanitary napkins. Women must be empowered enough to make educated choices about their sexual and reproductive health. To do this, they require adequate knowledge about the reproductive system, the products available to them to maintain a healthy reproductive system and they need to be made aware of the fact that they do have a choice and a right to express their opinions about their bodies. Women should also be taught how to safely dispose of the napkins. Disposing of sanitary napkins without taking proper measures is an extremely unhygienic and unhealthy practice and hence, care should be taken to not indulge in such practices.

Implications on Public Health

Majority of the rural population in India lives in conditions where they do not have access to proper sanitation facilities. This lack of access has more of an adverse impact on women, as compared to men. Due to inaccessibility to proper toilets or access to unclean facilities, it is difficult for women and girls to maintain personal hygiene, especially during menstruation. Some women wait for sundown to use public washroom facilities, which is a risk as they become vulnerable to physical violence and attacks in the dark.

These women are also known to use old pieces of cloth or dirty rags, maybe even leaves, sticks and mud as alternatives to a sanitary napkin during their periods. As a consequence of inadequate menstrual health, they suffer from different types of urinary tract infections and extremely poor levels of reproductive health (Das et al. 2015, p. e0130777; Anand, Singh & Unisa 2015, p. 249-254). Even if they are provided with reusable and washable products, it is challenging to clean and dry them due to lack of access to clean water, private facilities to dry them and societal taboos associated with periods. Commercially produced sanitary napkin cannot be afforded by them, so that is not even an option.

One of the major challenges has been the disposal of sanitary napkins. A serious lack of adequate disposal facilities has been witnessed (Ronitzch 2015). Indeed, the options of biodegradable and reusable napkins have recently come into the picture, mostly at the grass-root level. However, they are limited in number and most women prefer the options that they were already using and trust. Other alternatives such as the diva cup have also entered the market, but this too has limited takers, as most women are sceptical of using new products while they are comfortable and perfectly happy with their existing options. This clearly shows how unaware most women are about the hazards caused to the environment due to sanitary napkins, as well as the lack of awareness in the manufacturers of such products. Improper disposal of sanitary napkins also poses a health hazard to waste pickers. It exposes them to illnesses and infections.

Grassroot level organisations are also doing their bit and their efforts are commendable, concerning making eco-friendly pads and thinking about sustainable options. With time, if they expand their project and improve on quality, they will be able to get many women on board with using environment-friendly and reusable products. UNICEF has also been working with the rural population in India and coming up with initiatives to manage issues revolving around waste disposal and menstrual hygiene. Their WASH (Water, Sanitation and Hygiene project has been yielding satisfactory results in India.

References for Menstrual Health and Hygiene in India

Anand, E., Singh, J. and Unisa, S., 2015. Menstrual hygiene practices and its association with reproductive tract infections and abnormal vaginal discharge among women in India. Sexual & Reproductive Healthcare, 6(4), pp.249-254.

Das, P., Baker, K., Dutta, A., Swain, T., Sahoo, S., Das, B., Panda, B., Nayak, A., Bara, M., Bilung, B., Mishra, P., Panigrahi, P., Cairncross, S. and Torondel, B., 2015. Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India. PLOS ONE, 10(6), p.e0130777.

Phillips-Howard, P., Caruso, B., Torondel, B., Zulaika, G., Sahin, M. and Sommer, M., 2016. Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities. Global Health Action, 9(1), p.33032.

van Eijk, A., Sivakami, M., Thakkar, M., Bauman, A., Laserson, K., Coates, S. and Phillips-Howard, P., 2016. Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis. BMJ Open, 6(3), p.e010290.

Zaidi, S., Sivakami, A. and Ramasamy, D., 2015. Menstrual hygiene and sanitation practices among adolescent school going girls: a study from a South Indian town. International Journal of Community Medicine and Public Health, 2(2), pp.189-194.

OTHER SOURCES:

Jazeera, A., 2020. India's Menstruation Man. [online] Interactive.aljazeera.com. Available at: <https://interactive.aljazeera.com/aje/shorts/india-menstruation-man/> [Accessed 6 October 2020].

Joshi, S., 2020. How Swati Made Menstruation Not Only More Hygienic But Also More Profitable For Rural Women - The Better India. [online] The Better India. Available at: <https://www.thebetterindia.com/17661/woman-swati-bedeker-made-menstruation-more-hygienic-profitable-rural-women-vatsalya/> [Accessed 6 October 2020].

Ravi, R., 2020. #Menstrualhygieneweek: Project Baala Is Taking Sanitary Pads And Hygiene Awareness To Women Amid Lockdown. [online] Thelogicalindian.com. Available at: <https://thelogicalindian.com/story-feed/awareness/project-baala-sanitary-pads-menstrual-hygiene-covid-19-lockdown-21397> [Accessed 6 October 2020].

Singh, T., 2020. Why Should Girls Quit Schools Once They Get Their Periods? Two Women In Mumbai Fight The Taboo.. [online] The Better India. Available at: <https://www.thebetterindia.com/55968/mukti-project-mumbai-menstrual-health/> [Accessed 6 October 2020].

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