Roti, Kapda, Makaan and Tampon

BENGALURU: Women’s health and wellbeing is very intricately woven with their reproductive health. It has been found the 88 percent of India’s 355 million menstruating women have no access to menstrual products, which directly affects their maternal and overall health and wellbeing.

The challenges faced by menstruating adolescent girls and women in India are manifold – from socio – cultural taboos around the issue of menstruation, lack of access and affordability, poor awareness, lack of toilets to poor sanitary disposal systems. While only 12 percent of these girls and women have access to sanitary napkins and products, women in rural India often use cloth, cotton, sand, ashes and straws instead; which makes them direly vulnerable to a range reproductive infection, affecting their maternal health and overall wellbeing.

While the usage of cotton cloth and reusable cloth pads is recommended for their affordability and accessibility, they too pose the threat of causing infection like the usage of sand, straw, etc. The reasons for this, particularly in rural India are more socio – cultural in nature. Cotton cloth or cloth pads need to be thoroughly washed and dried in sunlight in order to ensure sanitation. However, given the silence and stigma attached to menstruation, women are unable to dry these cloths or cloth pads out in the open and have to dry them in dark damp places where they aren’t visible, which makes these products prone to causing bacterial infections, thus posing a challenge for reusability.

The Union health ministry taking note of this in 2010 announced a Rs 150-crore scheme to increase the access to and usage of menstrual products to adolescent girls in rural areas. In its initial phase the scheme was aimed at covering 25 percent of rural adolescent girls in India.

The scheme envisages supplying a pack of six sanitary napkins to those Below Poverty Line (BPL) girls at a nominal cost of Rs 1 per pack and for those Above Poverty Line (APL) at a cost of Rs 5 per pack of sanitary napkins.

At the time of introduction of this scheme in 2010 the ministry officials had said "this initiative will roll out in phases, with 25% of the country being covered in the first -- 150 districts (1,500 blocks) out of a total of approximately 600 districts. In the first year, this will be rolled out in 150 districts across the country, of which 30 districts will be from the four southern states, Maharashtra and Gujarat, and 120 districts from the northern, central and north-eastern states."

In 2012, it was decided that the scheme would be extended in all districts by making provisions in the State programme implementation plan (PIP) using the funds from the National Health Mission.

In a circular released by the Ministry of Health and Family Welfare in March 2016, it reads ‘In 2014 – 15 and 2015 – 16 only few States proposed budget for decentralised procurement of sanitary napkins. From 2016 – 17, the States have been requested to roll out scheme in all districts and propose budget for the same in their State programme implementation programme.’

While the introduction of the scheme is a welcome move, there are several glaring loopholes in its implementation:

• Introduced in 2010 and implemented in 2012, the scheme in 2016 covers only 107 districts across the country out of the 580.
• The scheme only targets adolescent girls between the age of 10 -19 years. The sanitary napkins are sold by the ASHA workers by going door to door or in schools. However, there are no schemes which make them available for menstruating women who fall outside this age bracket and, cannot access and afford menstrual products. Therefore leaving out a huge population of individuals who require but are unable to access and afford menstrual products.
• The scheme lays down guidelines for the health education of the girls, which again is welcome but does not address the problem holistically. Health education sessions need to also be held for women who fall outside the age bracket of 10 - 19 years and other members of the communities in order to address the socio – cultural taboos and stigma surrounding menstruation.

In making menstrual products available and accessible what is lacking at present is that these are unavailable, inaccessible and unaffordable for a huge part of the population requiring these products. While most schemes target adolescent girls leaving out women, policies and strategies over look homeless individuals, nomadic communities or other members (women, girls, transmen, etc.) of marginalised communities.

While it is known that menstrual products are a ‘basic necessity’ and not just a ‘need’ for several individuals across the world their accessibility and affordability pose a huge challenge. In countries across the world, menstrual products are listed as ‘luxury products’ and have taxes imposed upon them.

There is not just a need to bring this discourse on accessible and affordable menstrual products into the public domain, but there is also a need for a shift in perspective regarding menstrual products and for them to be listed and more importantly recognised as a ‘basic necessity.’

Perhaps it is time that across the world and in India, basic welfare needs be reconsidered and be listed as ‘roti, kapda, makaan and tampon.’