More than 100,000 adolescent girls and women in eight states have benefitted from a programme that casts menstruation in its right and natural light
It’s a bright February morning in Bavka village in Gujarat’s Dahod district and about 20 women have assembled to share their experiences about a common and recurring problem they all have to endure but cannot talk about openly. Menstruation is on the agenda for these women, and they are in a place — and a psychological space — where being frank about the subject is welcomed.
Menstruation is, of course and as a matter of course, a normal biological phenomenon that women of reproductive age have to live with. In many parts of India, they also have to live with stigma and silence, shame and ostracisation during what is viewed as a period of shunning and separation. The ‘menstrual hygiene management’ (MHM) programme of the Tata Trusts is helping change that.
“For five days a month I was not allowed to touch kitchen utensils as I was considered impure; I had to sit outside and eat from a separate plate,” says 32-year-old Champaben Solanki, who recalls being ‘purified’ of the ‘contaminants’ brought on by her menstrual cycles with sprinklings of cow urine.
That was before the MHM initiative began to spread the wellness message on menstruation in her village, highlighting the role that menstrual hygiene plays in general and reproductive health. Launched as a pilot project in 10 villages of Rajasthan and Uttarakhand in 2018, MHM has been scaled up since to include villages in six other Indian states: Gujarat, Maharashtra, Uttar Pradesh, Jharkhand, Assam and Karnataka.
The programme has touched the lives of more than 100,000 rural women and adolescent girls, and around 10,000 adolescent boys as well, while also breaking through the thinking of the communities they belong to. Enabling these women to manage menstruation with more dignity is critical to the endeavour.
Many girls in the country are taught from a young age to not talk openly about menstruation. What they learn about in due course is the embarrassment and ignominy that accompanies their menstrual cycles. This could stretch to a ridiculous extent.
“I was told that plants would die if women watered them during their periods,” says Anitha Dhanraj, a 14-year-old from Bandalli in Karnataka’s Chamrajnagar district. In certain parts of India, menstruating women have to live outside their homes, in the cowshed if no other place is available. In others, they are prohibited from touching food articles or playing with boys.
The taboos and myths surrounding menstruation have impaired the understanding many Indian girls and women have of menstruation itself, of puberty and of reproductive health. Sanitary napkins are, consequently, difficult to find in countless rural communities. Such lack of knowledge and safe menstrual practices often combine to cause ill health and disease. “We found women in some regions using dried leaves, hay, ash and cow dung to manage their menstruation periods,” says Lara Gulia, MHM’s programme anchor.
There are three key objectives in the MHM programme: educating adolescent girls about their physiology and good hygiene practices; encouraging adult women to adopt hygienic practices and stitch their own cloth pads; and engaging family members and schools to enhance the reach and impact of the effort. Behavioural change, at the individual and community levels, is central to achieving these objectives.
The primary challenge for the Trusts has been in convincing the people who matter most in the programme. Women and girls from rural backgrounds are rarely inclined to oppose tradition and the perversity of patriarchal norms but, as the MHM initiative has shown, they will when offered a hand to do so.
Community interventions, awareness-building sessions and school-based projects have been employed to help overcome attitudinal obstacles. Community resource people, known as sakhis (friends), are the first point of contact with the beneficiaries. Each sakhi engages with 15-20 adolescent girls and adult women, helping them understand the nature of menstruation and safe practices to manage it.
“Each awareness session is an empowering experience for the women; it enables them to see menstruation as the natural experience it is,” explains Divyang Waghela, head of the Tata Water Mission, under which MHM operates. “Apart from understanding the science behind menstruation, these sessions help them think logically and question traditional social practices.
Education is another aspect the programme addresses. The reason is as straightforward as it is sad. The social stigma associated with menstruation frequently pushes girls in rural India to drop out of school when they attain puberty. Special participatory approaches have been incorporated in school learning modules, for adolescent girls in Standard VI and upwards, to tackle this problem.
Adolescent girls are, in fact, perfect votaries of the MHM credo. When they go home and share their newly gained knowledge with mothers and friends, awareness travels even faster and more reliably within the community.
Sensitising male members of the community, schoolboys and young adults among them, is also integral to the project’s goals “For a rural woman to actually stop believing in the myths about menstruation, it is very important to have the support of the men in the family,” adds Ms Gulia.
Boys from Standard VIII and above have been roped into the circle. They are educated about male and female reproductive cycles and about how to be supportive of mothers and sisters during their menstruation periods. Adult males in the community are contacted separately through peer networks or through the network of husbands of the women participating in the programme.
Sakhis (or friends) are the cornerstone of Menstrual Hygiene Management (MHM) programme. They work as educators, motivators and mobilisers to increase awareness about menstruation and encourage hygiene and sanitation.
A session with a sakhi begins with a ‘bag of shame’, where participating women and adolescent girls are asked to dump all their embarrassments and negative thoughts about menstruation into an imaginary bag. This serves as an effective icebreaker and helps lighten their emotional burden.
That done, the sakhi creates a ‘circle of trust’ where she shares her own menstruation experiences. This makes the women comfortable and they open up about their fears and doubts. “For many of the women, just being able to tell their story is liberating,” says Prastuti Goswami, a programme implementer in Assam.
Meaningful conversations between a mother and daughter regarding menstruation do not usually happen in villages. This limits the understanding of young women about something they have to live with. “When a mother learns that her daughter is having her first menstrual cycle, she gives her a cloth to manage it on her own,” says Ketan Hingu, a programme implementor in Gujarat.
Through their sessions, the sakhis initiate and guide such conversations. They cover a wide range of topics, from puberty and the biology of menstruation to nutrition, the use of absorbents, hygienic behaviour, myths and misconceptions and the need to be open about what is and always has been a natural body function for women.
The ‘couple counselling session’ in MHM was an eye-opener for Mohanlal and Nolakidevi Grasia, a tribal couple in conservative, rural Rajasthan. Mr Grasia understood the process of menstruation and the trouble his wife goes through when it hits. “It is now my mission to educate other males in my community,” he says.
Providing access to clean absorbents for safe and hygienic menstrual management is a further component in the MHM programme. This is done by setting up supply chains through local federations. Then there’s skills training for women to stitch menstrual pads using safe, sustainable and easily available material. These reusable cloth pads are sold by women entrepreneurs and retail outlets.
“With livelihood skills training that ties in with the programme’s objectives, we are able to help women become change agents,” says Mr Waghela.
While considerable ground has been covered, a lot more needs to be done to alter the thinking around menstruation in households across India. What’s uplifting is that women such as Ms Solanki — she who once had to suffer the cow-urine purification — are seeing a difference both within and around them. “I have benefitted hugely by understanding the highs and lows of our reproductive cycles,” she says. “Now I know that periods are not a curse of God.”