• Urban India is debating the topic of menstruation and the associated stigma.
• But breaking the mould in rural areas is far more challenging, which calls for an integrated approach.

What does NFHS data show?

• Government data suggest positive developments in the use of hygienic methods of managing menstrual periods.
• As per NFHS-4 (National Family Health Survey), 42% women in the 15-24 age group uses sanitary napkins.
• Of this, 16% use locally-prepared napkins, while 62% use cloth.
• In all, at least 58% are estimated to be using a hygienic method of menstruation.
• The data says that nearly 48% rural women in this age group are using hygienic methods.
• However, menstrual age of women goes up to 40-45 years, and a large section of women has still been left out of the survey.
• The ground reality is a lot different, with several challenges to bring about change in rural areas.

What are the limitations?

• Mindset - In rural India, the outdated value system related to periods, sexuality, etc, are much ingrained.
• The resistance is severe, and much is kept literally under wraps.

• Social structure - The social structure is largely patriarchal; women individuality and needs mostly come second.
• There is even lesser sensitivity with respect to women’s sexuality and physiology.
• Taboo subject - Menstruation remains one of the biggest taboo subjects, and breaking the notions on such matters are truly challenging.
• Financial viability - Making sanitary pads affordable for money-starved rural families is a limitation for promoting its use.
• Media - Till date, sanitary pads’ advertisements use blue as the colour to prove the effectiveness of pads.
• It is essential that platforms as these turn mature enough to show the liquid and gel with what it should be, the colour red.

What are the notable initiatives?

• Chuppi Todo-Sayani Bano (roughly translated as ‘break the silence and grow up’) is an on-ground menstrual hygiene awareness initiative in parts of Rajasthan.
• It is a private rural healthcare delivery enterprise for sanitary pads dispensation.
• A key effort includes disassociating morality from menstruation.
• It aims at replacing the 'right or wrong' debate with that on health, education, and development viewpoints.
• Approaching topics such as menstruation with sensitivity, internal workshops are conducted.
• They sensitise the field workers along with the network of Anganwadi workers from the villages.
• To gain trust, influential people from village neighbourhood are identified and entrusted with implementation.
• Student groups are also involved, making the efforts of sensitisation more effective.

What lies ahead?

• Poor menstrual hygiene practices have serious health challenges.
• They range from urogenital or non-sexually transmitted infections, to yeast, fungal and urinary tract infections, to even cervical cancer.
• Thus, the cost of following hygienic practices is far less than bearing the cost for treatment of diseases.
• Initiatives as discussed above should be financed appropriately to be scaled to multiple states and remote regions.
• For further progress, the discourse on menstruation needs to change in both urban and rural spaces.
• A multi-layered approach focusing on awareness, accessibility, behavioural change, and identifying the target groups is essential.
• Knowing which group is more approachable helps in drawing out strategies to initiate discourse, educate and trigger behaviour change.
• E.g. Schoolgirls, literate and educated women are more willing to listen and contribute. Men who are socially-involved and less politically-invested are easier to convince and engage.