On a hot summer morning in India in the early 1980s, Asha was getting ready for school when she noticed a red patch on her inner cloth. Scared, she rushed out yelling. Her mother took her aside and tried to comfort her. She gave her a cotton cloth and told her how to use it. Asha went to school with a turbulent mind, wondering what had happened to her; the anxiety consumed her the whole day. A heavy burden For years she struggled to cope with changing, washing, drying and taking care of her needs on ‘those days’ of the month. It was taxing to maintain secrecy, hiding while drying her cloth pads – often in shade, covered by other clean clothes. At school and college she had to wait to change her pad or even to relieve herself because the toilets and washrooms were poorly maintained. She heard elderly women in the family whispering about women in the neighbourhood going through ‘that time’ of the month, and she found that her activities were restricted. Growing up in an environment of secrecy, taboos, myths and misplaced practices, Asha grappled to understand how a natural biological process (which she studied in her biology class) could be impure and treated with shame and embarrassment. Today, almost three decades later, the situation in India remains more or less unchanged. Asha is like millions of girls and women who grow up ill-prepared to manage their periods and face a lifetime of stigma and danger. Despite the leaps India has made in economic growth, literacy and healthcare, about 66% of girls-only schools do not have functioning toilets, more than 10% of girls believe that menstruation is a disease, 88% of India’s menstruating women have no access to sanitary pads, and about 12% of girls drop out of school for lack of proper sanitation facilities. All this is in addition to the largely unchanged social system which subscribes to the belief that menstruating girls and women are impure and dirty, and that menstruation should not be talked about. A simple biological process has been overshadowed by taboos, myths and unscientific practices. Why does it matter? Menstruation-related stigma and lack of information lead to poor hygiene, stress, fear, shame and social exclusion. The problem is accentuated for women and girls with special needs who have no appropriate facilities. The number of girls dropping out or hesitating to go to school once they reach puberty or during menstruation is rising due to a lack of support in schools. Studies indicate that girls in India miss approximately five school days every month because of an inadequate environment and facilities to safely and privately manage their menstruation. Practices induced by India’s patriarchal social structure violate women and girls’ rights to dignity, health, education and freedom. The politics of conventional norms and practices around menstruation have often been criticised in various movements across the globe, which have showed why and how these norms are used to establish women as weak and thus unable to be relied upon to take important roles in society. An interactive snake and ladder game to generate awareness about menstruation among boys.Photo: WaterAid India Are policies adequate to effect change? The burden of maintaining secrecy, poor hygiene and irrational social practices impacts on physical and mental health and on social wellbeing. It reinforces gender inequality – a topic largely missing from the important political and policy debates. For example, the Beijing Conference on Women in 1995 called for the issue of reproductive health to be addressed and demanded sex education, but missed out on talking about challenges around menstruation. The resolutions of the World Health Assembly 2014 on water and sanitation, reproductive health, child and adolescent health and development did not include menstrual hygiene as an important component needing to be addressed for other human rights to be realised. However, the current environment indicates a change in favour of the issue. On 2 October 2014, the UN Human Rights Council recognised menstruation as a critical issue, providing the debates and discussions with a much-needed impetus. This endorsement is particularly important as it links lack of menstrual hygiene management (MHM) to lack of adequate water and sanitation services for poor people. It recognises the long-standing demand from various women’s movements across the globe that MHM is intrinsically linked with other women’s rights and thus essential for the complete realisation of the rights to health, dignity, education and equality. Commitments made in three consecutive conferences on sanitation in South Asia (SACOSAN – 2008, 2011 and 2013) emphasised the need to give special sanitation facilities to women, making this integral to planning, implementation, monitoring and measurement. Recognition in the post-2015 goals It is encouraging to see MHM finding a place in the post-2015 discussions around the Sustainable Development Goals (SDGs). The proposed Goal 6 on water and sanitation includes a target on hygiene. It states that, by 2030, countries must achieve access to adequate and equitable sanitation and hygiene services for all, paying special attention to the needs of women and girls and those in vulnerable situations. Ensuring Goal 6 retains the level of ambition set out in the draft is essential. The final framework must also include an indicator by which to monitor MHM. Decisions are still being made about whether and how to measure hygiene within the UN framework. WaterAid is calling for a globally agreed indicator to measure the presence of hygienic, safe and private facilities for girls and women in homes, schools and healthcare facilities. A global indicator will help hold world leaders to account and ensure they recognise menstruation as an integral part of discussions around women’s health. To help establish an equitable society for women we must ensure a goal on hygiene is not just an empty promise, but backed up by evidence of measurable progress. Imparting knowledge about the importance of menstruation to men.Photo: WaterAid India Pushing for change The battles against deep-seated socio-cultural values and practices riddled with the vested interests of the dominant ruling class need to be fought on different levels. Recognition of menstruation as a critical issue in policy and political processes at regional and international levels is a welcome step, and provides us with the potential to include it as an integral part of the discourse on WASH and gender equality. This, along with a vibrant civil society taking the lead in clearing doubts and confidently forging a path ahead, will help dissipate the shame, secrecy, stigma, taboo and misconceptions linked to menstruation. It is ironic that on one hand we celebrate and even worship motherhood while on the other we heap shame and indignity on the bodily process that signifies female fertility. It is time that this critical issue is discussed openly and without shame, and the associated taboos and myths are debunked, so that girls and women everywhere can understand and deal with this natural process in a healthy and dignified way. It is as much your need and right as it is mine. Period. Mamata Dash is Manager – Campaigns & Rights, Equity & Inclusion at WaterAid India. For more news and updates from WaterAid India follow @wateraidindia on Twitter. For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter.