Menstruation is a natural biological phenomenon that is crucial to women’s health. However, the culture of silence and shame that is attached to menstruation is responsible for not just a complete ignorance of the subject but the perpetuation of many myths associated with it. Consequently, women who, on an average, menstruate for 40 years in their lifetime, risk their health constantly. This risk is exacerbated by the fact that they don’t have access to correct information about menstrual hygiene. The dangers of this ignorance are many – reproductive tract infections (RTI), socio-psychological stress and even gender-based violence. The socio-economic threats are equally critical – girls who attain menarche are more likely to drop out of schools; the lack of education hinders their economic progress and perpetuates the cycle of ignorance to the next generation.
The Tata Water Mission (TWM), a Tata Trusts initiative, was launched to deal with the twin crises of providing safe drinking water and improved sanitation facilities across the neediest communities. With women being the core stakeholders of TWM’s project interventions across geographies, TWM considered menstrual hygiene management (MHM) a crucial link to women’s health, needing immediate intervention.
A detailed primary and secondary research review was conducted, following which TWM initiated pilot programmes with two methodologies in July 2016 in 10 villages each in Rajasthan and Uttarakhand. A comprehensive baseline survey was also conducted by a third party in the states selected for the MHM programme. The findings were startling:
Using this baseline data, and the learnings and findings of the two pilot programmes, the MHM programme was scaled up; currently. the programme is being implemented in seven states in which TWM functions – Uttarakhand, Jharkhand, Gujarat, Rajasthan, Karnataka, Uttar Pradesh and Maharashtra – with the help of associate organisations.
TWM conducted a needs assessment in select states so as to shape a holistic strategy for menstrual hygiene management. The goal was to offer information and solutions across the MHM value chain in order to promote safe and effective menstrual hygiene management in 900 villages, covering 2,50,000 girls and women and 45,000 boys and men in 3 years.
Knowledge and health
TWM’s ultimate aim is the knowledge, adoption and sustained practice of MHM behaviour by girls and women that can be reinforced by a supportive socio-cultural environment. The goal is to change the perception of menstruation as well as inequitable gender norms and practices, while also encouraging increased reporting of, and seeking cures for urogenital infections like infections of the reproductive tract or urinary tract.
In order to achieve these objectives, TWM decided upon a multi-pronged strategy that involves:
In-school interventions target girls from Class VI-XII. Divided into groups of 50, the girls are provided with accurate information about menstruation in easily digestible modules. The capacity of peer mentors and teachers is built up to ensure sustainability within the schools.
Community interventions train local women to become community resource persons or MHM sakhis who mobilise women’s groups, and implement the programme on the ground. Delivered fortnightly across two months, the modules use a variety of IEC tools and processes. They include creating a safe space for women and adolescent girls, where MHM sakhis encourage them to speak openly about menstruation. These modules remove the shame surrounding puberty, and help girls and women understand that this is a natural biological process that’s part of growing up. They are taught about pre-menstrual syndrome and menopause – to understand what is happening in their bodies, and to learn how best to equip themselves to deal with changes like lethargy, mood swings, food cravings, etc.
The modules encourage open dialogue about menstruation, and seek to encourage women to question age-old myths and practices logically, and to rationalise the importance of understanding why they do what they do, so that they can make an informed decision about which practice they want to follow. They focus on how women can break the stigma in their own minds and help make their daughters’ lives easier by sharing accurate information at the correct time. They inspire women to include men in dialogues about menstruation and the impact that menstruation has on women, their health and their married lives.
MHM sakhis provide menstrual kits with different hygienic and affordable products, including compostable sanitary napkins (Aakar), cloth pads (Ecofemme), antibacterial reusable absorbents (Saafkins), menstrual cups and tampons. The cost of each product, along with its pros and cons, is detailed to the group, so they can make an informed decision about which product to use. The girls and women are taught how to manage a healthy menstrual cycle by practicing hygienic practices including washing and drying a cloth pad in sunlight, changing any absorbent at regular 4-6hr intervals, etc.
While no particular product is promoted, TWM identifies and facilitates access to good quality, eco-friendly menstrual products through local federations. TWM also helps develop capacities of women social entrepreneurs at the village level thus ensuring sustainability post direct intervention stage.
Intervening with men and boys primarily involves providing them with accurate information about puberty and the reproductive cycles of both males and females, so to stress on the natural aspect of these biological processes and to encourage them to extend socio-cultural support to the women in their lives. In order to incentivise the safe disposal of sanitary waste, TWM also identifies and pilots various technologies to help develop appropriate treatment mechanisms.
TWM’s focus is on normalising menstruation and breaking the stigma associated with it. So, in addition to these ground sessions, TWM also organises MHM Melas – educative recreational gatherings of a cluster of 2-3 villages to serve as a follow-up to the individual / community sessions conducted with target groups. In the last one year of intervention following the scale-up programme, the MHM programme has trained 200 MHM sakhis, and reached out to approximately 50,000 adolescent girls and women across 7 states.