Menstruation is often seen as ‘biological readiness for bearing a child’ and hence increases the risk of child marriage and likelihood of school dropout and domestic violence. Early marriage increases the risk of teenage pregnancy and other related complications. According to WHO, adolescent girls (10-19 years) are at the highest risk of maternal mortality especially due to complications in pregnancy and childbirth. High rate of malnutrition in girls contributes to increased mortality associated with pregnancy and delivery. Lack of awareness or access to sexual and reproductive health care is a contributing factor as adolescent girls are less likely than older women to access sexual and reproductive health care.

Some facts on Sexual and Reproductive Health and MHH……..

Lack of access to sanitary absorbents or other resources, fear of staining and being noticed for that, lack of usable separate toilets for girls, lack of proper disposal mechanisms in school are common reasons behind missing classes during periods. Besides these external factors, menstrual pain, and lack of proper management mechanisms of this pain are also linked with school absenteeism. Many study reports like “Spot on” (a report by an NGO Dasra in 2014) have proved direct linkages between school dropout and lack of proper menstrual hygiene management facilities.

Some facts on Education and MHH…….. 

Good menstrual hygiene is fundamental to health, hygiene, education, work and wellbeing of women and girls everywhere. MHM aims to ensure that women and girls can manage their periods in a way that is not only healthy, but that enables their full participation in school, work, and other activities. However, despite efforts to increase access to hygienic management of menstruation, the social and cultural stigmatisation around menstruation continues to be a contributing factor to poor awareness on the issue.

Menstruating women and girls are often considered ‘dirty’ or ‘impure’ leading to their forced isolation, reduced mobility, and dietary restrictions. These wide variety of taboos starting from ‘not entering religious places or touching sacred things’ to restrictions keeping them away from other family members and plants with the beliefs that life/blood from these may get sucked by the menstrual blood negatively impact the health and wellbeing of women. Isolating women in unsafe and unhygienic conditions, use of unhygienic absorbents, use of sanitary napkins without proper awareness on usage and disposal increase their vulnerability to infections and are also detrimental to the environment. 

Some facts on Menstrual Taboos……..

MHM is also an integral part of the Swachh Bharat Mission Guidelines (SBM-G, 2015, Ministry of Drinking Water and Sanitation). It clearly lays down instructions for mechanisms to be set in place for managing menstruation and menstrual wastes. Despite having a Solid Waste Management (SWM) Rules 2016 that prioritises disposal of menstrual waste throughout, the current unsustainable disposal practices, especially of the menstrual waste, pose challenges that contribute to health and environmental hazards. These wastes mostly end up in landfills where they stay for centuries adding to more pollution. Those disposed in toilets or drain result in clogging of toilets, sewerage systems and drains that we often get to see in our localities. Cleaning of these clogged drains or segregating used pads from waste not only expose them to a variety of bacteria and illness but also question the dignity of labour of these cleaning personnel. Burning of these wastes in open releases toxic fumes (like dioxins and furans) harmful for users and environment. 

The MHM guidelines categorise ‘safe and unsafe’ practices to ensure destruction of used and soiled materials without human contact and with minimal environmental pollution. However, the superstitions related to the disposal practices prohibit women from following these guidelines at household/community level. Most of these are related to a fear of some mishap that may be cause to them or their family members (like loss of blood of the male member, infertility due to burning or snake crossing over the used pads etc) if they do not follow the disposal practices prescribed by the elders in family. 

Some facts from the Menstrual Waste Management Guide…….. 

Scientific awareness about menstruation and MHM is critical to empower girls in managing their menstruation safely, hygienically, and with confidence. While stigma around menstruation and the associated myths lead to lack of correct knowledge about menstruation among girls/women, it is time to bring discussion on menstruation into open. Open discourse on Menstruation, MHM and menstrual taboos and myths can be the first steps towards breaking the taboos and overcoming the fear and shame associated with menstruation. This may be initiated at different levels:

• Periods talk at home and with peers: Openness to discussion around experiences of menstruation at home and in peer groups help understand menstruation as a normal biological process. Discussion on the myths and taboos will also help them reflect on the issues and empower them to take a stand.
• Periods talk at schools/colleges: Open discourse on MHM in the school level not only with the adolescent girls but also the adolescent boys who could be most misinformed about a natural biological process. It would help engage with adolescent boys as change agents by making them more aware about the MHM needs of the other half population.
• Periods talk at work: Changing pads at workplace becomes embarrassing when the male colleagues are not sensitised to the needs of the female colleagues. Speaking up on occasions when someone uses inappropriate language, jokes, or comments about periods could be a starting point. Using the word "periods" or "menstruation" in our conversation rather than making it symbolic (my visiting aunt, rainy days, monthly EMI etc) is a good alternative.
• Periods talk with change agents/duty bearers: While the MHM guidelines outline what needs to be done by the governments at different levels including different duty bearers starting from the line departments to the school teachers, it is important to sensitise these stakeholders responsible for implementation of the programmes. In the study conducted by Aaina, more than 90% duty bearers believed in the 28 menstrual taboos listed in the study. If these change agents themselves believe in the superstitions and myths related to menstruation, implementation of the guideline in a real sense will be difficult to achieve.
• Periods talk and partnership: Managing health and wellbeing cannot be sole responsibility of girls without conducive environment in family and support from their male counterparts. Role of men and boys is equally important in understanding the issues, disseminating information, sensitization of family and community at large and supporting women in leading a dignified life without any fear & discrimination. Without partnership of men, the objective of making gender sensitive policies and guidelines, preparing road maps for smooth implementation of the policies and building gender/disabled friendly infrastructures for better implementation of MHM wouldn’t be possible. Partnership would also include engaging with media and celebrities to make effective use of their outreach and influence on the larger population.

Kallola 2021 invites your thoughts in the form of short scripts for videos /Radio Jingles to show us ways towards a society that does not stigmatise menstruation and treat menstruating women as ‘impure’ or a society where it is normal to talk about menarche, periods, menopause etc. Let your creativity lead us to a more equitable, inclusive and gender sensitive world irrespective of their age, caste, religion or financial status. We look forward to your stories that focus on creating a society that is open to discussing culturally stigmatised issues like menstruation.

Some facts on sexual and reproductive health and MHH:

• Maternal Mortality Ratio (MMR) of Odisha is the 6th highest in India with 150 deaths per 100,000 live births. This is 32.7% higher than the national average of 122 deaths per 100,000 live births (Source: MMR Bulletin, 2016-18).
• Anaemia: As per National Family Health Survey – 4 (NFHS 4), 2015-16, more than half (51%) of the women aged 15-49 years and close to half (45%) of the children under five years are anaemic in Odisha. This is higher in rural areas and among scheduled caste and scheduled tribe population. 
• Early Marriage: one in five (21%) women in Odisha get married before the legal age of 18 years (NFHS 4, 2015-16).
• Teenage Pregnancy: NFHS 4 (2015-16) data shows that 7.6% women in Odisha begin childbearing in the age group 15-19 years. This is higher in rural (8.0%) areas and among Scheduled Tribes (10.0%).
• Miscarriage: Odisha reported 7th highest percentage of miscarriages in the country, higher than national average (NFHS 4, 2015-16).
• Violence: Odisha reported 
  • 9^th highest cases of spousal violence in India—36.4% (NFHS-4, 2015-16). 
  • 2^nd highest rate of crime against women among all states and union territories in 2020, that is, 112.9 per lakh population (NCRB, 2020).

Some facts on Education and MHM:

• Dropout: While engaging in domestic activities and marriage were the most important reasons for dropout among girls, non-availability of female teachers and girl’s toilet were also reported as other reasons (75^th round of National Sample Survey). 
• Functional Girls’ Toilet:8% schools in Odisha have girls’ toilet but only 84.4% schools have functional girls’ toilet that is 8^th lowest in India (UDISE+ 2019_20_Report).
• While using hygienic management of menstruation is important for women’s health, the NFHS 4 (2015-16) report highlights the following facts on menstrual hygiene: 
  • More than half of menstruating women in Odisha use unhygienic methods of menstrual protection (52.6%). This is higher in rural Odisha (57.2%). 
  • The proportion of women using a hygienic method of menstrual protection rises sharply with increasing level of schooling among women, that is, usage of hygienic methods ranged from only 12 percent for women with no schooling to 77 percent women with 12 or more years of schooling.
  • However, only 13 percent of women aged 15-49 in Odisha have completed 12 or more years of schooling and 28 percent of women have never been to school.

Some facts on Menstrual Taboos:

In a study titled, “Flying Wings: Empowering adolescent girls on MHM and Sexual and Reproductive Health Rights (SRHR) and Nutrition” in Ganjam district of Odisha, the following findings on menstrual taboos were reported by adolescent girls:

• More than 75% were not allowed to enter religious places including kitchen, touch holy books or take offerings made to Gods (prasad).
• Another 50%-75% were restricted from participating in religious rituals/functions, touching any male member, or sleeping on bed/mattress.
• More than one-third reported 
• Restrictions on touching pickles, eating non-vegetarian food, visiting relatives or friends, sleeping during the daytime, seeing babies, touching plants etc. 
• Expectations to take bath immediately after starting with periods (even in midnight/winter), take head bath before sunrise on the 3rd day to be pure again, add cow dung and turmeric in water for bathing, take medicine to postpone/prepone dates (to participate in rituals/marriage), keep separate dresses for periods as clothes worn during periods become impure for life.
• Other forms of restrictions like not combing hair, staying separate from the family members, not taking dinner after sunset, not eating/drinking sour food, getting clothes worn during periods washed by "Washerman", not burning used napkins (it leads to infertility), or not crossing over the broom etc were also reported by upto 33% respondents.

Some facts on from the Menstrual Waste Management Guide

• There are about 336 million menstruating women in India out of which atleast 36% use disposable sanitary napkins. 
• At a conservative average of eight napkins per cycle per woman, India generates about 12 billion disposable sanitary pads every year, majority of which are not biodegradable/compostable. 
• Each non-compostable/nonbiodegradable sanitary napkin disposed in open or buried takes 800-900 years to decompose.