Girls, sanitation and education

Dr. Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

In India, menstruation and menstrual practices are clouded by taboos and socio-cultural restrictions for girls and women. Menstruation and menstrual hygiene-related discussions are still a taboo in the Indian villages and across a large section of the urban society even now. Though menstruation is a natural process, yet people, even women, hesitate to talk about it. Menstrual hygiene is an issue that every girl and woman has to deal with in her life, but there is lack of awareness regarding menstrual hygiene management (MHM) in India. As a result, most of the Indian girls and women are unaware of the menstrual hygiene-related practices that they should be adopting and their adverse health impacts on them.

As per the fourth National Family Health Survey (NFHS-4) 2015-16, only 57.6% Indian girls and women aged between 15 and 24 years use hygienic methods of protection during their menstrual periods. The figure is 77.5% in urban areas and 48.2 % in rural areas. The NFHS-4, 2015-16 also states that the respective figures are 44.8%, 70.8% and 40.9% in Assam. The rest use unsanitary old cloth pieces, papers, dried leaves, grasses, etc. These unhygienic and unsanitary practices lead to a lot of infections such as fungal infections, urinary tract infections, reproductive tract infections, etc., which can cause infertility and even death.

Issues associated with menstruation and MHM are never discussed and this burdens the Indian adolescent girls by keeping them ignorant of this biological function. 75% of Indian adolescent girls do not have any idea about what material to use to absorb period flow. Menstrual hygiene is crucial in the reproductive life of every female. Therefore, each and every adolescent girl should have sound knowledge on menstruation and menstrual hygiene-related practices (using sanitary napkins, washing of external genitalia and taking bath during menstruation etc.) and ideally a mother should be the main informant at this tender age.

In India, about 255 million adolescent girls struggle every month to go to schools and colleges because of their periods. About 200 million rural adolescent girls lack basic education on menstrual hygiene. Sanitary napkins come at a price beyond their affordability. Barely 20% of rural girl students can afford to costly, disposable sanitary napkins. The rest 80% can't afford to sanitary protection during their periods. Over 40 million school girls have no place for urination as 40% of the government schools lack separate girls' toilet. They need to go home for urination in the school time during their periods. Most of the government schools in India lack facilities of adequate and private space for changing sanitary napkins, soap and adequate water to wash themselves and their cloths during period, and safe disposal facilities for soiled sanitary napkins. Limited access to safe sanitary products and facilities during their periods forces them to miss five days of school every month (about 20% of the school year). The regular monthly absenteeism in the school often serves as a trigger for school dropouts. As a result, one in five girl students in India are forced to drop out of school because of her period.

Lack of MHM in schools is a major reason for majority of the Indian girls skipping schools during their periods and eventually dropping out at an early age and missing out on their education. This is a matter of grave concern as it can be detrimental to the country's image and economic progress. We should concentrate on girl students that they don't miss school during their periods thereby not quitting schools. There is a strong need to encourage menstrual hygienic practices among the Indian girl students. MHM training needs to be imparted to girl students. Girl students must be taught MHM by female teachers, female health workers and female members of NGOs in a sensitive and supportive manner. Steps should be taken to encourage and support girls during menstruation, so that they do not miss schools. MHM involves menstrual hygiene education sessions at schools and colleges along with steps to ensure that girls have separate toilets and sanitation blocks located at a safe location to assure privacy; based on a ratio one toilet for every 40 girls (and/or one urinal for every 20 girls), private place with well-positioned mirrors so that girls can check for stains on their clothes, private bathing or changing units to change their clothes/sanitary napkins and to wash themselves including a place with a shelf, hooks or niche to keep clothing and menstrual adsorbents dry, provision of sanitary napkin vending machines and incinerators or dust bins for safe disposal of soiled sanitary napkins in schools, colleges and girls hostels. Other than these, education officials and teachers would have to compulsorily undergo MHM training workshops in all districts, so that girl students get the maximum information related to menstrual hygiene. Moreover, girls can establish 'Girls Hygiene Clubs' for ensuring peer-to-peer learning and sharing of menstrual hygiene information. Apart from MHM training to girl students, there is need to talk to adolescent boys, male teachers and parents about MHM in the context of girl's access to education and school completion. These will not only boost the confidence of girl students but also improve their attendance in schools during their periods.

There is need to mobilize Indian girl students to use sanitary napkins. India should be a 100% sanitary napkin-using girl students' country. Major publicity campaign should be launched for girls to use sanitary napkins to enable them to understand their importance. Commercial sanitary napkins are not cheap. For the girl students, the luxury of affording sanitary napkins is a far-fetched dream. The need of the hour is to improve the quality of life of these poor girls by providing them free or highly subsidized and easily accessible sanitary napkins which give them freedom and protection from their monthly dilemma and discomfort. Though there are government schemes to distribute highly subsidized sanitary napkins for rural areas, but their reach remains limited. The scheme needs to improve it coverage to all girl students. The Government should launch new scheme to provide free sanitary napkins to girl students to reduce the absenteeism of girls in schools during their periods. The scheme will check girl students from dropping out of schools. It will be a massive health booster for girl students and will enhance better academic and personal development of girl students. Good news is that, in Assam, the State Finance Minister Dr. Himanta Biswa Sarma allotted Rs 25 crore for the 2020-21 FY budget to provide free sanitary napkins to girls studying in classes 6 to 12 in government and government-aided schools. Each girl will get 18 beltless sanitary napkins per month. The scheme will be a tremendous help to the young girls of Assam if it is implemented in letter and spirit. The scheme needs to improve its coverage to all girl students of the State irrespective of government or private school and upto bachelor degree level and their family income so that Assam becomes a 100% sanitary napkin-using healthy girl students' state and reduce the absenteeism of girls in schools during their periods.