Harsh Realities Surrounding Menstruation Experiences in Slums — (2/2)

The issue of menstruation is not only wrapped in myths and taboos, but lack of awareness and education on menstruation is ingrained in both urban and rural parts of India. Safe menstrual hygiene practices are often guided by right knowledge, awareness, and access where all three are intertwined.

My previous blog dealt with the condition of menstruating women and girls in slum communities of Mumbai and how they are affected by the lack of safe sanitation and proper infrastructure. Situations are different in different areas and are rooted in knowledge and access to the proper material. Talking about menstrual hygiene, it is essential we also look into problems that are faced by semi-urban and rural areas.

To provide last mile access of menstrual hygiene product and information, we collaborated with Precision Foundation to reach out to 625 girls in low-income schools in Solapur district. Through this project, I got a chance to interact with girls from slums communities and semi-rural areas in their schools to understand their perspective on menstrual hygiene and their awareness about their monthly cycle.

Initially, it was difficult to start a conversation on menstruation as the girls wouldn’t interact, they were shy. When teachers intervened and motivated girls to start a conversation, it gradually broke the ice and thus begun a healthy period talk.

With the baseline done already with 250 girls, interestingly, a majority of them were using sanitary napkins as opposed to home-made cloth pad or rags. I already had an idea about their demography and backgrounds. The percentage of girls using sanitary napkins was a whopping 89%. Unfortunately, 35% of these girls did not follow safe methods for disposal of soiled sanitary napkins.

These Zilla Parishad schools are in the vicinity of the slum communities of Solapur and according to the teachers, the situation is worse than it appears. Families of these girls have a meagre income. Although most of them use sanitary pads they use one pad for the entire day, or at the most two pads a day, which is an unhealthy practice. There is also the problem of disposal. Waste collection in slums happens only once a week, due to which the surroundings become unhygienic.

To understand the knowledge improvement in girls, at the end of the project, we conducted an end line survey. The findings were encouraging — 68% girls passed the knowledge they received from these sessions to at least one woman/girl, and 18% spoke about it with two women. And that’s not all — 48% respondents said they were now confident about menstruation, and 69% had begun to follow prescribed practices for pad disposal.

Although a lot has changed with our intervention, I was disheartened to know from the teachers that there were still girls dropping out of schools during menstruation or remaining absent during those days. Furthermore, parents discouraged girls from going to schools and married them off early. Sarita (name changed), a teacher in ZP school says, “earlier teachers would talk about periods, but girls were very shy, with a project like this and young girls coming to educate, these school girls started opening up. But it shouldn’t stop here. More such conversations are needed, more awareness is required not only among the girls but their families too. Sessions should be conducted for boys also so that they are aware of periods at an early stage. True that the absenteeism has reduced and attendance is almost 90%, but there are still 10% dropping out and married off early. That needs to stop somewhere for which parents should be aware of menstruation”.

Another teacher Nandini (name changed) suggested that “Girls need to talk more. In my school, they do not talk much about periods. They are even shy to ask for sanitary pads. That needs to be changed somewhere”.

If access to the right knowledge is provided at an early age, girls become educated about sensitive issues early as well. Awareness sessions need to reach every household in low-income communities in rural and urban areas, municipal authorities need to act and improve the sanitation situation. Providing access to affordable menstrual hygiene product is one side of this larger issue, while other side includes informed masses, awareness in households, and openness to accept the information. In Solapur schools, absenteeism and dropout is 10%, situation maybe grave if we consider entire Solapur, but one thing necessary to change immediately the constant involvement and information sharing. Organisations like Precision Foundation are constantly involved in providing access to education and intervening where necessary and thanks to them that we got to shed light on menstrual hygiene issues in Solapur and for helping us change the picture.

“I measure the progress of a community by the degree of progress which women have achieved”  – Dr. B. R. Ambedkar

Harsh Realities Surrounding Menstruation Experiences in Slums — (1/2)

The total population of menstruating women in India is about 355 million, of which according to Census data, 31 million women reside in urban slums.

Urban Slums in Mumbai

The UN operationally defines a slum as “one or a group of individuals living under the same roof in an urban area, lacking in one or more of the following five amenities”: 1) Durable housing (a permanent structure providing protection from extreme climatic conditions); 2) Sufficient living area (no more than three people sharing a room); 3) Access to improved water (water that is sufficient, affordable, and can be obtained without extreme effort); 4) Access to improved sanitation facilities (a private toilet, or a public one shared with a reasonable number of people); and 5) Secure tenure (de facto or de jure secure tenure status and protection against forced eviction).

Mumbai alone has a total population of 12.44 million of which 42% live in slums. Several government reports make it evident that people who live in slums face challenges in accessing proper sanitation. Instances of open defecation are 28% in Mumbai slums as per Mumbai Sewerage Development Project- II and the same data shows that 73% of the slum population depend on community toilets. These community toilets are poorly maintained. There is only one toilet seat for every 50 persons. Often, water supply is erratic and many households have no access to electricity. Poor sanitation particularly causes problems for women and children.

Public toilet and menstruation

Most of the children attending municipal schools are from slums. While implementing one of our CSR projects in schools for adolescents girls, I met Jayshree who lives in the Siddharth Nagar slum of Worli, who explained me the plight of women living in slums and the issue of menstruation. She suggested Saral Designs start a program for sanitary pad distribution in that slum to ease the lives of women staying there. This is how I had my first experience of menstrual hygiene problem in slums.

Jayshree is a middle-aged woman who lives in a 100 sq ft house with her family in this slum which is a settlement located in a hillock. Jayshree is actively involved in putting efforts for social good, having worked on issues particularly of children and women in her community for over 10 years. Before meeting her, I had a vague idea about menstruation situation in slums, but after a couple of meetings with Jayshree over pad distribution, I realized that challenges of menstrual hygiene sanitation are more grave than it appears.  Now, why is menstruation a challenge in slums- 1. Access to safe sanitation, 2. Access to infrastructure and 3. Access to affordable pads.

More than Menstruation

Being on a hillock, this informal settlement of Worli poses a grave challenge in terms of clean toilets. Women who stay high up on the hillock have to come down to access the toilets and by the end of the day, toilets are dirty.

I got a chance to speak to Jayshree’s neighbors who are of the menstruating age-group. They told me about their difficulties in accessing toilets, and proper sanitation in general. Siddharth Nagar has just one community toilet, which has about four toilet seats. Pooja, one of Jayshree’s neighbors, says, “Using the public toilet is difficult, as there are so many people who use it. It is particularly tough when women get their periods. If bleeding begins in the wee hours, sometimes, there is no electricity in the toilets. Also, by the end of the day, the toilet becomes very dirty.”

Slums in Mumbai

In a similar vein, Jayshree’s daughter said that as there is only one community dustbin, everyone throws their garbage there. For her, discarding used sanitary napkins is a challenge. She says, “For us, access to safe sanitation facility is a major issue. If I do not get access to proper sanitation — for example, water supply, clean toilets — there is a fear of contracting reproductive tract infection or urinary tract infection”.

Another woman spoke about problems of accessibility that people who live in slums in hilly areas (such as Siddharth Nagar) face, for example, even when they get access to affordable sanitary napkins, it is difficult for them to access toilets when needed and discard soiled sanitary napkins. Many women who have their houses at the top, have to come down to use the toilet and while menstruating, it becomes even more difficult if they want to access the toilets in the night. Majority of the women here have some or the other infection either due to inability to access hygienic toilets or being forced to use unclean toilets.

Menstruation Matters

It is evident after interacting with women from Jayshree’s neighbourhood in the hillock, that even though affordability and accessibility of sanitary napkin can be solved through technological innovations and awareness intervention, larger issues surrounding women’s health and hygiene will persist if they are not provided with the basic means like water supply and safe sanitation in the form of clean toilets.