Feature story

Stemming the stigma

Menstrual health has been brought front and centre in about 200 Rajasthan villages thanks to an effort that involves the community as a whole

Conversations about menstrual health are uncommon in traditional pockets of India. It was worse in tiny Dhawali, a village in Rajasthan’s Sirohi district, where the topic had long been taboo. That reality caused 48-year-old Sharda Devi Meghwal a lifetime of silent suffering.

“We used to wear a ‘timepiece’ during our monthly cycles. It was horribly uncomfortable,” says Ms Meghwal. The timepiece is what local women call an improvised menstrual pad made of thick towel-like material.

So prevalent was the stigma that Ms Meghwal didn’t even talk to her own daughters about menstruation. “Before they got sanitary napkins through a government scheme, my girls somehow managed their menses,” she says.

Like Ms Meghwal, most of the women in Sirohi’s villages would suffer stoically through period pain and shame, but those days are much rarer now. Hanja Devi Parjapat, a 28-year-old with a young daughter, is clear there will be no hesitation on her part when the time comes.

Being vocal about periods is routine for Ms Meghwal and Ms Parjapat as both are menstrual health advocates for girls and women in their community. A big factor in their social transformation is the Tata Trusts’ menstrual hygiene management (MHM) programme, launched in 2018 under a wider water, sanitation and hygiene (WaSH) initiative in Sirohi and Pali districts.

Feedback from the ground was what made menstrual health a focused intervention for the Trusts. Teams working on WaSH realised that this demanded immediate attention, in the wider context of community health and particularly because village women were largely unaware of the role hygiene plays in reproductive health.

Schoolgirls in Chandravati playing a game that helps them understand menstrual hygiene practices better

Extensive reach

The MHM initiative was rolled out across eight Indian states by the Tata Water Mission. In Rajasthan alone the programme has reached more than 51,000 women and adolescent girls in around 200 villages across Sirohi and Pali districts.

Many couples have received counselling and some 800 ‘peer mentors’ have been trained to build menstrual health awareness among students. These peer mentors are students themselves, chosen for their ability to understand and explain the concepts of menstrual hygiene to younger adolescents. They also train the next lot of peer mentors and the cycle is expected to continue even after the Trusts project is completed.

The Trusts have also worked to make menstrual health products available through local self-help groups. Among these are reusable cloth pads stitched by local women entrepreneurs trained under the programme.

“Just four years ago, it was impossible to imagine women talking about menstruation,” says Pankaj Papnoi, who anchors the WaSH programme for the Trusts in Rajasthan. “Today they discuss it like experts, with zero inhibition.”

The MHM initiative is a massive effort involving multiple Trusts-run programmes, in maternal and child health, WaSH and in skilling. In Rajasthan the initiative is led by the Centre for MicroFinance, an associate organisation of the Trusts.

The programme was kickstarted in Sirohi and Pali districts, tribal-dominated regions where awareness of menstrual health was once abysmal. “We were working on WaSH initiatives and found that many women didn’t wear pads during their cycles,” says Parikshit Singh Tomar, who leads the MHM programme in Rajasthan.

Rajasthan is not unique in scoring poorly on menstrual health awareness, but the problem has been especially acute in the state. Even where modern menstrual products or healthcare services are available, ignorance or embarrassment leads numerous women to shrink from using these products or services (in some communities women are still confined to their homes during their periods).

Shying away from the subject

Tackling the situation was a challenge. The team wanted to build awareness in the community — among both women and men — but early attempts to discuss the topic were a dampener. Those who cared to listen were painfully shy and many avoided the subject altogether.

It took the team more than six months and an integrated, four-module approach to break through the wall of resistance: the science of menstruation; hygiene and menstrual product usage; myths and taboos; and the need for open conversations.

A variety of outreach projects came into play. Going door-to-door, team members shared their own experiences and the challenges they faced. They also explained the science of menstruation and why it is a biological process and not an ‘impure’ thing. Talks on MHM were held in 160 schools, where girls and boys were roped in for fun games and learning activities.

In the villages the team spoke to women, individually and in pairs: mothers and daughters, husbands and wives, and daughters- and mothers-in-law. Village gatherings were organised and MHM-based events, games and activities were conducted to spread the word in easy-to-grasp ways.

Progress was gradual as the rural women at the centre of the programme felt emboldened and slowly opened up to the MHM workers. Says Ms Parjapat, “It was a relief to talk about our problems to someone who could understand and help us find a solution.”

Sheela Soni has made a profitable business of pad making

Padding the bottom line

Up until 2020, Sheela Soni, a resident of Swaroopganj in Rajasthan’s Sirohi district, was a regular housewife with no great ambitions, especially not of the entrepreneurial kind. A meeting organised under the Tata Trusts’ menstrual hygiene management (MHM) programme changed all that.

The MHM team was looking for village women willing to be trained to stitch reusable cloth pads for commercial gains. Wanting to set up her own business, Ms Soni volunteered for the training. “The Trusts team took me to villages to interact with local women and I saw that there was considerable demand for sanitary pads.” 

Sourcing raw material for the pads locally was difficult, so Ms Soni and her husband travelled to Gujarat to buy the stock they needed. To control costs and keep the pads affordable, Ms Soni tied up with a wholesaler. She also got smart with marketing, canvassing in areas where women cluster — village council meetings, local factories employing female workers, etc — and hiring saleswomen to work on commission.

Ms Soni has made a profit of more than 100,000 in the two years she has been in the pad-making and selling business. This has encouraged her to diversify into cloth bags and she plans to soon launch readymade women’s clothing as well. Ms Soni puts her success down to the personal connections she has forged with buyers. “Customer satisfaction comes first for me,” she says.

Once the women were convinced about the need to use sanitary pads, the question of sourcing these arose. While the Rajasthan government had a scheme to distribute branded sanitary napkins for free in schools, there was no disposal mechanism in villages (women would often keep the pads somewhere out of sight).

The sustainable solution lay in reusable, biodegradable, easily-washable and affordable sanitary pads. In addition to being eco-friendly, the idea to switch to cloth pads also presented the opportunity to augment incomes of local women by turning them into entrepreneurs. That’s how, in September 2020, the MHM team launched an entrepreneurship programme to train women in pad-stitching.

In excess of 1,650 women have been trained in pad-stitching workshops over the past two years. While most women pick up the skill to make pads for themselves, a handful have taken it up as a business. For the latter group the MHM team subsidises the cost of raw materials until the women are able to run the show on their own.

Taboo no more

There’s no doubting the impact the MHM initiative has made in the four years it has been in operation. Pooja Kumari, a 20-year-old from Dhawali in Sirohi, says the programme has taught women like her about their own bodies, things that neither their parents nor schoolteachers had ever discussed with them.

“Women should know exactly what’s going on in their bodies,” she adds. “It’s simply nature at work; nothing to be ashamed about.” For Ms Meghwal, conversations about health issues with her husband are much different now. “I have a better understanding of the science and can explain things to him more accurately,” she says.

Men, too, have stepped up to support the menstrual health cause. Where earlier male members would prevent their womenfolk from attending MHM meetings, today they themselves participate in counselling sessions.

The change in mindset has also helped dismantle sundry curbs on women’s freedom. For instance, women in Sirohi are no longer forbidden from entering temples while menstruating. Many still prefer to stay away but that’s a personal choice. “It takes a very long time to change attitudes,” says Mr Papnoi.

Sunita, a tribal woman from Bhaisasingh village near Abu Road, learns how to stitch cloth pads at a training workshop