Women and Menstrual Health Management – Seen, But Ignored

Author: Megana CK
City Coordinator, Programmes & Policy, WaterAid India

Saamuhika Shakti, the initiative in Solidarity with Waste Pickers aims to improve the quality of life of informal waste pickers, their families, and communities in Bengaluru. This is a unique project where different partner organisations are joining forces to take a holistic and ‘Collective Impact’ approach to improve the dignity of informal waste pickers. It also has a strong focus on equity, addressing the basic needs of marginalized groups such as women and girls in waste picker households.  

As part of the project, WaterAid India (WAI) places considerable significance on hygiene awareness, including menstrual hygiene management (MHM) among adolescent girls and women.  

Despite being a natural bodily process, menstruation is affected by socio-cultural norms, and religious beliefs, and are deeply intertwined with inequitable gender roles, norms and power dynamics. Social norms and practices affect if girls and women receive information on menstruation, the depth of information, access to menstrual products and essential services, as well as their mobility, participation in education and the workforce, and engagement with daily tasks. When girls and women lack access to information and support services and systems, they struggle to manage their periods in a healthy manner. This in turn places them at risk for discomfort, reproductive tract infection, anxiety and even gender-based violence. Further, girls miss school days and women miss workdays. Menstrual health is defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle. This conceptualization outlines that good menstrual health includes access to information on menstruation and the menstrual cycle, access to safe and effective menstrual products as well as facilities to change and wash the body, access to health services, experience a safe social environment free from stigma, discrimination and constraints as a result of gender and menstrual status. 

Findings And Reflections From The Field 

A baseline survey on Water, Sanitation and Hygiene was conducted by WaterAid India in 13 waste pickers’ communities. As part of the study, the team also surveyed the female waste pickers on menstrual hygiene practices at the workplace, and the following are some of the key findings: 

Toilets at Sumanahalli prior to WAI intervention

Lakshmi (name changed) from Deshianagar shared, “Many adolescent girls miss school days during each menstrual cycle due to lack of access to necessary facilities or supplies for managing hygiene during menstruation and disposal of menstrual absorbents.”

Another resident of the area, Parvati (name changed) added, “Pain, discomfort, and fear of leakage during monthly periods adversely affects the adolescent girls’ attendance and performance at school.”  

Rekha (name changed) from Jyotipura shared, “More often than not, many girls drop out of school as a result of the teasing, embarrassment encountered at schools during menstruation, which leads to early marriage.”  

Shanta, a resident of  Kunthigrama, and a worried mother of a teenage daughter said, “When a girl drops out of school and is forced into marriage, she is unable to obtain the requisite education or training for a career, thereby limiting the career alternatives available to her, crushing her aspirations, and making her financially dependent.”  

The case is not very different when it comes to the workplace wither. Ignoring the issue of MHM at the workplace has huge social and financial repercussions for adolescent girls and women.

 Krishna (name changed), resident of Chittoor Bus Stand, who works as an informal waste picker, shared her experience, “Not having a safe and private place to change menstrual absorbents causes anxiety and worry, and decreases our concentration and productivity at work. Some of the female workers prefer to miss hours or even days of work rather than try to control their menstruation under stressful situations, resulting in higher absenteeism. This, in turn, has an adverse impact on their own earnings.”  

Another female waste picker from TC Palya, Amulya (name changed), who works as an informal waste picker, stated, “We have no access to clean, functional toilets. Neither at home nor near the place of work, thereby forcing people like me to opt for open defecation, making us more vulnerable to sexual attack if forced to change in open locations under the cover of darkness.”  

Triveni, a waste picker from Sumanahalli expressed her concerns, “When faced with insufficient bathrooms, women and girls can withhold urination and defecation, but how do we control menstrual flow?” 

Menstrual health conditions and management of female waste workers remain a neglected policy area. Invariably, a majority of women involved in waste picking or domestic work use cloth pieces as absorbents while menstruating. With minimal or no WASH infrastructure accessible to them, they go from morning to evening without changing the cloth or sanitary napkins. Women on the whole had to manage their menstruation for the whole day without any facility to change unless they were doing waste picking near home. Women working in Dry Waste Collection Centers (DWCCs) reported slightly better conditions as they had access to toilets which were common to both men and women and changing menstrual absorbent there was quite challenging. 

WaterAid Interventions  

A pre-test was conducted as part of the process of the awareness program and it was observed that the majority of the girls and women had little to no knowledge about the menstruation cycle, most of their information was rooted in taboos and myths, and they were reluctant to even talk about it. 

In order to eliminate these pre-conceived, baseless notions, the WAI team has been making consistent efforts to actively educate the community, especially the women and adolescent girls on the entire process, through interactive sessions such as body mapping exercises and MHM focused Snake & Ladder game. 

• The team is facilitating discussions on puberty, menstruation, and the menstrual cycle 

• Giving an introduction to the female reproductive system 

• Providing information on managing pre-menstrual symptoms, proper management of menstruation, and MHM and nutrition 

• Facilitating discussion to bust myths and misconceptions 

In addition to the community level interventions, WaterAid has also actively been supporting the Consortium Partners to educate and engage their staff, as well as the adolescent girls they work with, on MHM, to equip them with the right information. 

Intended Outcomes: 

• Increased knowledge and understanding of the menstrual cycle, menstruation and menstrual hygiene 

• Increased awareness of safe menstrual products and hygienic use 

• Positive attitudes towards menstruation and people who menstruate 

Given the socio-cultural sensitivities, discomfort with menstruation, and deep-rooted beliefs and social norms, WAI adopted a four-pronged approach: 

1. Engage with women separately first, through one-on-one discussions, at the individual community level to create a safe environment for them to participate, ask questions, and share their thoughts.

2. Engage community volunteers to further put the adolescent girls and women at ease, and initiate group discussions. The team conducted participatory activities to encourage the community members to shed their inhibitions and speak up about the most neglected aspect of their health.

3. The WAI team also gradually attempted to break the gender barrier and two of our male Community Facilitators (CF) conducted sessions on MHM, in presence of a female CF. 

4. The next step was to facilitate an interactive workshop with a larger group, across locations. In line with this, the team organized an interactive workshop for the women and adolescent girls from our intervention areas, to encourage dialogues and discussions on the topic of MHM.

• A game was conducted to identify the common myths surrounding menstruation  

• An interactive session was facilitated to discuss the bodily changes that occur upon reaching puberty 

• A body-mapping exercise was conducted, followed by discussions on the male and female reproductive system, and the complete menstruation process 

• Product choice availability was discussed with the participants, and samples were shown to give the participants a feel of the product.

Change takes time, and bringing about behavioural change by doing away with deeply ingrained beliefs is a mammoth task. The focus would continue to be on making the MHM awareness programmes culturally/socially sensitive and feasible for women and girls at the community level. The team is also working towards encouraging conversations around the topic and organizing activities that would empower them to speak up and adopt change in an effective manner. Continuous follow-up is critical for better and sustained results.