By Argentina Matavel Piccin, Representative India and Country Director Bhutan, UNFPA | VK Madhavan, Chief Executive, WaterAid India

Over the last few years, the world has witnessed accelerated action to achieve the Sustainable Development Goals (SDGs), especially SDG 5 on gender equality and women’s empowerment. This has also led to significant interest in menstrual health and hygiene management (MHHM) as a critical factor in girls’ education and women’s participation in many spheres of life. In India, this has led to the introduction of evidence-based guidelines and schemes to enable access to menstrual hygiene products. In 2015, the erstwhile Ministry of Drinking Water and Sanitation (currently, the Ministry of Jal Shakti) launched national guidelines for menstrual hygiene management for school-going adolescent girls. This led to the introduction of state-level operational guidelines in Madhya Pradesh, Bihar, Gujarat, and Jharkhand. Odisha and Rajasthan introduced schemes to improve access to menstrual products for adolescent girls from poor and marginalised groups. India has also witnessed innovations that expand menstrual hygiene product choice and deliver sustainable menstrual waste management solutions.

While the progress is encouraging, an area that continues to stymie the work on MHHM is the emergency context. Today, a number of states are confronted with the challenge of addressing menstrual health needs amidst dual disasters: cyclones and/or floods and the continuing COVID-19 pandemic that has been devastating in its scale and impact. Like other emergencies, COVID-19 has had a differential impact, exacting a heavier toll on women, girls, and sexual and gender minorities. Menstrual health and hygiene is an area that most strongly unmasks this.

‘Periods do not stop for emergencies’ has been a common refrain, especially during the first wave of COVID-19, with organisations and the media highlighting how access to essential sanitary pads was abruptly curtailed due to the lockdown and restrictions on transport and mobility. Some of these challenges have been addressed this year with essential supplies continuing uninterrupted. Yet, for many women and girls, continued access to safe menstrual products, safe and hygienic sanitation facilities, and information on MHHM remains a challenge.

With the closure of schools—which many girls depend on for access to menstrual hygiene products—girls’ ability to manage MHHM with safety and dignity is at risk. Many poor families facing severe economic stress are having to choose between spending on food and other essentials such as rent and buying sanitary pads. The challenges are not only about access to menstrual hygiene products. Women and girls from low-income households have also been facing difficulties in managing menstruation in the changed circumstances where family members are present at home for most of the day in small, confined spaces. For women and girls living with a disability, who may not have access to caregivers in these circumstances, managing menstruation has been even more trying.

MHHM must therefore be integrated, as a priority, in the response to emergencies to ensure women and girls’ privacy and dignity. Living with dignity, even during disasters, is a fundamental human right. In 2020, the United Nations Population Fund (UNFPA) and WaterAid, in consultation with experts and practitioners in the field of MHHM and disaster response across the country, developed a framework for action on MHHM during emergencies in India. The framework calls for the integration of MHHM across the continuum of emergency response—disaster preparedness, disaster response, and recovery. It also highlights the need to integrate MHHM into sexual and reproductive health services, and protection services where they exist.

A comprehensive approach to MHHM in emergencies includes: 

1. Providing essential menstrual products 

Product distribution is the mainstay of relief efforts. This may be accomplished through the provision of hygiene kits with sanitary pads and essential items such as underwear, soap, towel, paper to discard used pads, and usage information; the establishment of pad banks or pad ATMs in relief centres; or cash transfers to facilitate the purchase of menstrual products. Some interventions have considered reusable cloth pads or cotton cloths to meet the needs of cloth users. In supporting product distribution for relief, efforts must keep in mind the product usage patterns and preferences in a community, the need for support materials such as underwear along with sanitary pads, and whether products will be needed once or on a recurring basis. For instance, adolescent girls often prefer disposable sanitary pads, while older women may prefer cloth during menses. Cloth users may find sanitary pad use challenging, especially if they are unfamiliar with the product and do not typically use underwear. In some emergency contexts such as floods and cyclones, girls and women may struggle to use cloth pads hygienically due to water shortage, lack of privacy, and climate conditions. 

2. Disseminating information 

Relief efforts by civil society organisations have indicated that product distribution, accompanied by information dissemination about MHHM is most effective in meeting the needs of women and girls during disasters. Girls and women need to know how to use, maintain, and discard products safely with limited resources. Older women may be unfamiliar with sanitary pads and girls may use a product for a longer duration given limited supplies. 

Challenges related to MHHM during emergencies may be further intensified by discriminatory norms and taboos that impose restrictions on women and girls. In many communities, girls and women are considered to be impure during menstruation. They may be segregated from other family members for a few days, may not be allowed to present themselves in front of male members, or may face restrictions around leaving the home and interacting with people outside the home. Norms and practices related to discreet use and disposal of menstrual absorbents also exist. They act as a barrier when girls and women access menstrual products in constrained circumstances and may place additional psycho-social stress on them during crises. The stigma and taboos related to menstruation have also prevented an integrated public health response to MHHM for many years in both development and emergency settings. Dissemination of accurate and scientific information is an important tool to tackle the discriminatory norms and stigma associated with menstruation. 

3. Providing safe sanitation and waste disposal solutions

Gender-sensitive sanitation is another essential aspect of MHHM in emergencies. In many disaster settings, temporary or mobile toilets and bathing facilities are established. However, menstrual waste disposal remains a challenge. Some simple, temporary solutions include providing containers with lids in or near toilet stalls to collect menstrual waste and digging disposal pits near women’s toilet facilities. These should be marked for menstrual waste to aid appropriate disposal. Long-term relief settings or established relief centres can institute other solutions such as quality incinerators and disposal chutes attached to a deep burial pit or burning chambers. Central to disposal is the need for discrete, usable, and culturally relevant solutions. For instance, it may not be appropriate to introduce incinerator solutions to communities that have strong beliefs around the burning of menstrual waste. 

Efforts for MHHM product distribution, information dissemination, and ensuring hygienic sanitation during emergencies can only succeed when frontline responders are sensitised and trained to understand and address the needs of girls and women. This is particularly relevant in light of the culture of silence around women’s sexual and reproductive health, including MHHM needs. Incorporating brief sessions on the needs of girls and women, including MHHM needs, in capacity building initiatives for those involved in disaster response can help make the issue mainstream and strengthen the effort to integrate MHHM into emergency responses.

There is a lot to be learned about integrating MHHM into the emergency response from states such as Kerala, Assam, and Bihar that face natural disasters frequently. These states have demonstrated how the integration of MHHM in disaster preparedness can be done in simple ways: routine MHHM interventions delivered in schools and in communities can impart basic information on menstrual health and hygiene and equip girls and women to manage their menses safely during disasters. Girls can be given information on making their own emergency hygiene kit with sufficient menstrual materials, underclothes, soap, and other essentials. Schools, anganwadis, and health centres can prepare themselves to be depots for menstrual products that girls and women can access when disaster strikes. Such measures also help in the recovery phase.

Some states, such as Odisha, have initiated vulnerability and capacity assessments before disasters using participatory tools to engage communities to predict, plan for, mitigate, and effectively respond to emergencies that are likely to affect them. 

Finally, ensuring appropriate budget allocation is critical for integrating MHHM in emergency response efforts. Funds need to be apportioned for menstrual product distribution and facilities that meet MHHM needs. For instance, if mobile toilets are being installed, the budget must accommodate for a sufficient number of separate toilets for men and women. Fundraising and mobilisation of in-kind resources must consider the duration of the emergency, whether certain supplies may be required regularly, and the number of girls and women who are in need. Menstrual hygiene supplies, akin to food rations, will be required regularly, not just during immediate relief efforts. They must be factored into budgets for continued support to communities till normalcy is restored.

Ensuring that women, girls, transgender men, and gender-diverse individuals are able to manage menstruation with dignity during emergencies is a matter of human rights. We ask you to join us to commit to ensuring MHHM as a basic right to be protected and advanced, in emergencies and beyond.

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This article was published in Banega Swasth India (a joint initiative by Dettol India & NDTV) and India Development Review (IDR)