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.
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.
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.
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.”
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.
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.