Menstrual health is a public health issue

Despite many initiatives by governments and NGOs, prominent gaps remain unaddressed in urban spaces

Updated - May 29, 2023 02:02 pm IST

Published - May 29, 2023 12:15 am IST

Sanitary pads collected from various donors being  distributed to underpriviledged women in Tatanagar slums, Belapur in 2016.

Sanitary pads collected from various donors being distributed to underpriviledged women in Tatanagar slums, Belapur in 2016. | Photo Credit: Yogesh Mhatre

In a recent incident, a man from a city in Maharashtra allegedly killed his 12-year-old sister because he mistook period stains on her clothes as a sign of a sexual relationship. The incident is indicative of the extent of misinformation about periods in India’s urban locales.

In urban India, girls and women navigate a good part of their life in the public domain — a young working woman travels for hours by public transport, a teenager living in slums makes her way to school through narrow lanes, a sanitation worker begins her day before dawn cleaning the city, a vegetable vendor spends hours by her stall, and a nurse works busy 12-hour shifts. Their lives are very different, but they all navigate public spaces on a daily basis while dealing with a private aspect of their lives: their periods.

Periods are normal, but continue to be shrouded by shame, stigma and discrimination. Consequently, people face barriers in getting accurate information about periods and related products, using toilets, and seeking help when needed. The popular belief is that rural areas are hubs for ‘period poverty’ — backward, steeped in superstitions and unsafe practices — while urban areas are progressive, with access to modern period products and related necessities. However, the lived experiences of many urban dwellers show otherwise.

The sanitation worker may not know much about her body or periods. She uses waste cloth during her periods and often throws away the cloth after one use as she cannot wash, dry and reuse the cloth hygienically. The teenager wears sanitary pads for 10-12 hours at a stretch. Both may not have a toilet in their homes, and use a community toilet or go to a secluded spot early in the morning or late at night. The community toilets close by 11 p.m. and are often unclean. During summer, the water supply is limited, and bathing daily may not be possible. The working woman wears extra pads as she may not have the time or a clean or separate toilet at work to change.

Barriers to menstrual hygiene

India has been a front runner for action on menstrual hygiene — governments, NGOs and the private sector have all played an important role in spreading awareness and providing menstrual products. But the focus has often been on India’s rural population, and for good reasons. However, India’s large, rapidly growing urban population also calls out for attention.

Field insights and research show that certain groups of urban dwellers face a whole range of limitations that affects their menstrual health. The understanding of periods is still limited, especially among low-income groups. Period products may be more easily available in local kirana shops, chemists and online channels, but continue to be wrapped in paper or black plastic bags due to the associated shame. While many urban homes have toilets, residents of low-income slums, pavement dwellers, and some educational institutions and workplaces still do not have toilets, or have toilets that are not easily accessible, safe or clean and convenient.

Poor awareness, stigma and shame, limited access to products, lack of personal hygiene, poor toilet and water facilities, and difficulties in disposing pads can cause anxiety, discomfort, and infections, and long-term health problems. Menstrual waste management is a looming concern given the growing use of disposable sanitary pads. Routine garbage collection exists in many urban residential areas, but not in low-income areas. Where waste collection mechanisms exist, users don’t always segregate pads. Sanitation workers are then forced to sort through waste with their bare hands. This task undermines their health and dignity.

Doable actions can help improve menstrual health in urban India, especially for low-income groups and in public spaces. Awareness about periods is a key pillar of action, and must be continued, along with efforts to address harmful social and gender norms. Menstrual products, both reusable and disposable, must be more available through various access channels — retail outlets, social enterprises, government schemes and NGOs. People should have the information and right to choose the products that they want to use. Citizen movements such as ‘Green the Red’ support urban populations to use menstrual cups and cloth pads, providing that much-needed exposure to reusable products.

Female-friendly community and public toilets are gaining popularity. ‘She Toilets’ in Telangana and Tamil Nadu and ‘Pink Toilets’ in Delhi provide safe, private, clean facilities with essential amenities needed to manage periods. Waste disposal and management remain a challenge. Yet some promising practices include the provision of dustbins and incinerators in female toilets, which promote waste segregation at source through initiatives like the ‘Red Dot Campaign’ and innovations like ‘PadCare Labs’.

Closing gaps

Some prominent gaps remain unaddressed in urban spaces: reaching people living in unregistered slums, pavements, refugee camps and other vulnerable conditions in urban areas. Worksites, both formal and informal, need to cater to the menstrual needs of women who work. Support should continue for innovations in menstrual waste management that are safe, effective and scalable.

As we marked May 28 as Menstrual Hygiene Day, let us come together to shape the narrative on menstrual health as vital to personal health, public health, and human rights for all.

Aruna Bhattacharya leads the urban health/public health domain at the School of Human Development, Indian Institute for Human Settlements, Bengaluru; Arundhati Muralidharan is the founder of Menstrual Health Alliance India

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