MENSTRUAL HYGIENE

IMPORTANCE:
An issue characterized by cultural taboos and superstitions, menstrual hygiene
management (MHM) in India is challenged by:

 Lack of Awareness: 200 million girls in India lack awareness of menstrual

hygiene and associated healthcare practices.
 Unavailability of Material: 88% of menstruating women in India use home-
grown alternatives such as old fabric, rags, sand, ash, wood shavings,
newspapers, dried leaves, hay and plastic.
 Lack of Access to Facilities: 63 million adolescent girls live in homes
without toilet facilities.
Addressing menstrual health and hygiene generates a triple return on investment
with improved outcomes in health, education and environment:

 Education: Lack of functioning toilets results in 23% adolescent girls

dropping out of school every year
 Environment: A single use disposable pad is estimated to take between 500 –
800 years to decompose.
 Over 200 million women in India are ignorant of safe menstrual hygiene
practices. More than 88% of menstruating women and girls in India use
unsanitized cloth during menstruation. Poor menstrual management results
in girls dropping out of school, poor reproductive health, lower workforce
participation for girls and increased healthcare costs.
ECO FEMME

Eco Femme is a women-led social enterprise founded in 2010. Based in Tamil

Nadu, India, our goal is to create environmental and social change through
revitalising menstrual practices that are healthy, environmentally sustainable,
culturally responsive and empowering. We produce and sell washable cloth pads,
provide menstrual health education to adolescents, and open dialogues on
menstruation all along the way.

Our mission:

Eco Femme is a global women’s empowerment initiative.Rising from rural India,

reaching out to people around the world, we promote and revitalise menstrual
practices that are healthy, dignified, affordable and eco-positive.

Eco Femme gives women access to affordable, reusable and ecological cloth-
based sanitary pads, and drives behavior change communication with adolescent
girls to encourage positive menstrual practices. Cotton cloth, hygienically used,
has been declared as an acceptable sanitary material by international agencies
such as UNICEF.

Design, Production and Distribution:

• Eco Femme designs and manufactures premium cloth washable pads.
• Pads are sold to international and urban Indian buyers, and to rural poor women
at a subsidized rate.
• Eco Femme offers a Pad for Pad scheme on its international pads sold, which
allows it to cross-subsidize a menstrual product kit with four free pads and a travel
pouch for rural adolescent girls.
• It uses both, a direct and partnership model for distributing pads in schools.
It has partnered with organizations in Tamil Nadu, Andhra Pradesh, Uttar
Pradesh, Puducherry, Goa and Karnataka.
Education
• Eco Femme conducts awareness and behavior change communication in schools
in batches of up to 30 girls with two sessions of 1-1.5 hours each before
distributing free pads.
• The first session introduces the menstrual cycle, menstrual hygiene and
menstrual products; the second is conducted three months later to get feedback
and understand usage.
Livelihood
• Eco Femme enables livelihood for women – the pads are produced by women’s
self-help groups after being trained in advanced tailoring.

Eco Femme has offered menstrual hygiene education and kits to 1,616 adolescent
girls directly, and has reached out to 404 adolescent girls through partner
organizations

REVIEW OF LITERATURE

(SECONDARY RESEARCH):

Only 12% of India's 355 million menstruating women use sanitary napkins (SNs).
Over 88% of women resort to shocking alternatives like unsanitised cloth, ashes
and husk sand.
Incidents of Reproductive Tract Infection (RTI) is 70% more common among these
women.
Inadequate menstrual protection makes adolescent girls (age group 12-18 years)
miss 5 days of school in a month (50 days a year). Around 23% of these girls
actually drop out of school after they started menstruating.
The biggest barrier to using a sanitary napkin is affordability. Around 70% of
women in India say their family can't afford to buy them.
These are the findings of the latest study, "Sanitary Protection: Every Woman's
Health Right", undertaken by AC Nielsen.
Reviewed and endorsed by community development organisation Plan India, the
survey was conducted in October 2010 and involved 1,033 women in the menstrual
age and 151 gynaecologists from across India.
Bhagyashri Dengle, executive director, Plan India, said, "This study reveals the
dismal state of feminine hygiene care in India and shows rampant unhygienic
sanitary practices. In comparison, 100% women in Singapore and Japan, 88% in
Indonesia and 64% in China use SNs."
Gynaecologist Dr Malvika Sabharwal from Jeewan Mala hospital added, "Talking
about menstrual health is still a societal taboo. Women are barred from entering
temples and kitchens at such times. Some don't even take a bath during periods.
Such practices need to change.
Women menstruating should take a bath more than twice a day and change
sanitary towels thrice a day. Unhygienic practices could lead to ascending
infections -- bacteria entering the urinary tract or uterus from outside."
Nearly 97% gynaecologists in the study believed that use of napkins reduced the
risk of severe RTIs. Around 64% of them also believed that STs reduce the risk of
cervical cancer.
In the survey conducted in Delhi, Chennai, Kolkata, Bangalore, Lucknow,
Hyderabad, Gorakhpur, Aurangabad and Vijayawada, around 31% women
reported a drop in productivity levels during their periods, missing 2.2 days of
work on an average. Menstrual hygiene is lowest in eastern India with 83% women
saying their families can't afford SNs. In north India, over 30% of girls interviewed
said they dropped out of school after started menstruating.

Most of the women do not use a product as they do not feel the need for it as the
bleeding was not very heavy. Whether this is their perception or the reality is a
different matter. The women who bleed freely sometimes wear two undergarments.
Some of them use two underskirts and keep wiping the trickling blood with the
skirts. Some of them innovatively lift the ends of the skirt and tuck them on the hips
of the opposite side – this way there is more cloth to absorb the flowing blood.
Quite a few women, do not wear undergarments as they find it very uncomfortable
and complained of rashes when they use it. Come to think of it, unless they have
access to high quality cotton undergarments and can change it often, they are
probably better off without it. These women work hard, sweat constantly and their
vaginal region is better off when it is aired rather than closed.
FOCUS AREAS:
 Training stakeholders: Since menstruation is a taboo topic, even those
responsible for spreading awareness do not have the correct information.
Hence, it is critical to train the trainers such as community health workers,
and teachers on best practices for managing menstruation.

 Creating peer leaders: Girls tend to discuss menstrual problems and

develop solutions with their peers. Peer leaders act as models, mentors,
educators or counselors for their peer groups, as well as inspire them
through their own example.

 Mobilizing communities: It is critical to engage important decision-makers

such as men, older women, panchayat leaders to create an enabling
environment for ensuring better MHM. To truly mobilize a community and
the most important gatekeepers, an intensive awareness campaign
accompanied by regular meetings and events is required.

 Leveraging government schemes: The Ministry of Drinking Water and

Sanitation has been taking positive steps by studies integrating MHM into its
schemes. Non-profit organizations guide communities to leverage these
schemes to address the issue of availability of sanitary material and to build
requisite infrastructure.

 Supporting Self-Help Groups (SHGs): Several social businesses have

developed machines that can produce low-cost sanitary napkins. These
organizations use existing SHGs to promote these machines and methods.
SHGs are part of the community therefore making it easier for them to
approach girls and women, drive change around menstrual habits, and
promote sanitary material.

 Creating awareness: Most common intervention used to break the silence on

MHM and provide information on health, nutrition and sanitary material
options for better period management.
  Developing innovative solutions: Social enterprises and non-profit
organizations have been experimenting in product design, environment-
friendly materials, disposal solutions, and simplified, cost-effective
production processes

 Building/Renewing infrastructure: Some organizations are working to

address the lack of facilities by building or renovating toilets in schools and
communities. Organizations should partner with organizations in the
sanitation sector to implement this intervention, since it is capital-intensive.

 Establishing production units: To address the issue of lack of supply of

sanitary materials, some organizations are producing napkins for areas
neglected by larger, established companies.

 Ensuring last-mile delivery of products 70% of India lives in 600,000

villages. Non- profits are establishing or supporting women entrepreneurs
in villages, to sell sanitary napkins by linking them to a supply source and
training them to educate the community on MHM best practices

NEED FOR TRAINING:

1. Same age old strategies to change the age old practices.

2. Communication gap
3. Lack of proper information.
4. Lack of grassroot level of research.
5. Lack of creative and innovative techniques.
TRAINING OF TRAINERS:

Teachers become the most significant source of information for girls especially
when mothers are an inadequate source of information. Schools provide a platform
to educate and prepare a critical mass of girls on menstrual hygiene best
practices.

1. How to talk about menstruation: giving guidance to new facilitators about

how to engage with women and girls on what is typically a sensitive topic –
includes activities for getting comfortable with your own experience of
menstruation so as to be able to communicate with confidence and
sensitivity.

2. Cultural practices and how to relate to them: Menstrual taboos arise from
complex systems and are not always simply ‘good’ or ‘bad’. Concentrate on
explaining which practices are unsafe and on providing a chance to inquire
into the roots of these practices which are often adopted without real choice

3. Understanding the function of the reproductive system and learning about

the menstrual cycle and how to track it.

4. Normal and abnormal periods: includes understanding the different types

of cervical mucus and vaginal discharge and recognising indicators for
when to seek help.

5. Self care: the role of nutrition, exercise and personal hygiene

6. Products to manage menstruation: examines the pros and cons of various

menstrual products and disposal. Special attention is given to reusable
menstrual products like cloth pads and menstrual cups and their safe use
and proper care to ensure healthy menstruation

GOAL: To make the trainers well versed in training. So, they can help the
community in future with their endeavors

Where, when and how : The place and time is yet to be decided. The training of
trainers will take place in 4 sesssions:
 1. Introduction to the new methods of communication. New methods to be
adopted like fish bowl method, world café method, positive deviation etc
will be used in this session. Liberating structures can be used to initiate
conversation between the community and trainers.
2. Break the taboo. No more cultural barriers. Inquire the roots and work on
the same.
3. Provide a crisp understanding about the reproductive tract with proper
flipcharts and comic strips.
4. Usage of pads and the safety and affordability quotient attached with the
same.

DEEPIKA LALWANI
MA DEVELOPMENT COMMUNICATION