COVID-19 lockdown: Impact on menstrual hygiene management

‘We don’t have enough money for food. How can I ask my husband to buy me sanitary napkins? So I started using an old cloth again. I am worried about my health but what can I do?’ says Shakuntala (named changed), a young mother from one of the scores of slums that dot Mumbai’s landscape. Shakuntala isn’t alone. Lakhs of women in the urban slums of Mumbai are in a similar situation and things may be worse than what they appear as such issues are not discussed openly. At a time when personal hygiene is of utmost importance, the need for hygienic means for women to manage their periods is all the more crucial.

The impact of the COVID-19 lockdown has not been gender-neutral and is being felt disproportionately by women and the third gender. As CNBC-TV18 highlighted earlier, the transgender community--one of the most vulnerable and marginalised communities – is facing immense hardships since the lockdown.

When it comes to personal health & hygiene - women are facing the brunt of the lockdown when compared to men. Recent data on the number of menstruating girls and women in Mumbai is hard to come by. As per a 2014 report - there were as many as 35.5 crores menstruating girls and women in all of India. Maharashtra is the second most populous Indian state behind only Uttar Pradesh. It’s safe to assume in the years since the report – those numbers have risen significantly and that a large proportion of menstruating girls and women reside here in aamchi Mumbai.

During the initial phase of the lockdown, sanitary napkins were not included in the list of the essential items. This resulted in severe production and supply disruptions which led to a shortage at chemists, grocery stores and e-commerce websites as people began panic buying/ hoarding. This left many girls and women with no choice but to resort to the age-old, unhygienic practice of using old clothes/rags to manage their periods. Only after massive public outrage did the authorities rectify this. On March 29, Ajay Bhalla, the Home Secretary to India, clarified to Chief Secretaries of all the states via an addendum that sanitary napkins were to be included in the list of the essential items.

Two months since the lockdown was first announced, the situation on the ground has not improved. Many chemists in densely populated areas like Dadar say that there isn’t any new stock coming in. Some of them who do have stock are rationing them to curb hoarding and bulk purchases by people.

The lockdown’s effects are being felt disproportionately across socio-economic lines too, with those in the low-income strata feeling it the most. The latest data (May 24) from the Centre for Monitoring Indian Economy (CMIE) indicates that the unemployment rate (rural & urban) continues to remains very high, above 24 percent (same as in April, up from 8.75 in Mar). “The small relaxations in the lockdown since April 20 have not had any positive impact on the unemployment rate, yet”, says Mahesh Vyas, MD & CEO of CMIE.

Furthermore – the spectre of COVID-19 still looms large over Maharashtra and those employed in manufacturing sanitary napkins as well as those working in factories, industries, mills, construction sites etc. are understandably wary of venturing out of their homes for fear of contracting COVID-19 thus impairing productivity across sectors. Thus, with poorer families living off savings and/or alms, in a lot of households – buying sanitary napkins becomes a luxury.

The majority of Mumbai’s active cases are from the low-income and densely populated neighbourhoods such as Dharavi, Sion, Mahim, Worli, Pydhonie, Dadar, etc. How is one supposed to maintain social distancing in these narrow streets and the extremely tight internal spaces of their homes? Poor access to water and sanitation isn’t helping either. With the lockdown mandating everyone to stay at home, girls and women in these areas are left with little to no privacy in which to properly manage their periods.

Savitri (named changed), an adolescent girl in a family of 5, living in one such Mumbai slum says “We would get sanitary pads and information about our periods at school but with schools shut, what am I to do? I have to go to a corner of our tiny home to dry my cloth (away from the men of the house) while trying to get more info about menstrual hygiene via YouTube,” she says.

Dr Kranti Rayamane, a gynaecologist with over 27 years of experience and one of the most vocal advocates of menstrual hygiene management (MHM) has implemented programs in schools as well as mentoring teachers and trainers. He says, “Current knowledge level of MHM is deficient and with this lockdown, existing problems will be aggravated.”

Dr Kranti warns of a looming health crisis beyond the COVID-19 pandemic. Cloth, when used for absorbing period blood, needs to be properly cleaned with soap and dried in direct sunlight before being used again. Poor access to water and sanitation in slums, poor personal hygiene standards coupled with the incredibly tight living spaces and taboos surrounding menstruation is making it extremely difficult for the lakhs of underprivileged girls and women to manage their periods properly. The poorest have always been the most vulnerable he adds.

Poor MHM can lead to urinary tract infections (UTIs), abdominal pain, high fever and anaemia amongst other problems. Anaemia, in turn, can result in heavier than normal menstruation which will only add to the plight of girls and women. He adds that in chronic cases there can be compromised immunity, inflammation of vagina and uterus, cervical cancer and even infertility. Compromised immunity of the poor makes them vulnerable to COVID-19 and other prevalent diseases such as TB along with aggravating existing health issues such as hypertension, liver disease and cholesterol. Why aren’t we seeing these problems being reported right now?

“There will be an obvious lag effect in the reporting of these cases what with no income, movements restricted and lack of public transportation,” says Dr Kranti.

“How will these poor people go to hospitals to get themselves checked?  Additionally, most people are afraid they might catch the Coronavirus if they step into a hospital. The imminent arrival of the monsoons will only make the problem worse,” he adds.

When CNBC-TV18 contacted Dr Sangita Hasnale, Assistant Commissioner Planning, MCGM said, “No one could have predicted that the COVID-19 situation would worsen to such an extent and that the lockdown would keep getting extended. We never thought on the lines of there being problems arising due to poor MHM in the slums and containment zones until it was brought to our notice. Our first response was to contain the spread of COVID-19. Eventually, along with the food grains kit, we did provide a couple of sanitary pads along with soap and co-ordinated their distributions via NGOs.”

When asked about the production and supply disruptions she said that the MCGM has asked the various self-help groups (SHGs) under their women empowerment programs to produce sanitary napkins at a cheaper rate while providing them with the necessary machines and raw materials to do so.

In our largely patriarchal society, men along with women perpetuate the stigma and taboo around periods. Menarche or the first occurrence of periods in an adolescent girl is a very personal experience, one that impacts her in a multitude of ways.

Deane de Menezes is the founder of Red is the New Green (RING), a Mumbai city-based organisation that has been focussing on MHM for the past 4 years. They conduct MHM awareness sessions with the support of UNICEF WASH materials and also install sanitary napkins vending machines and incinerators to create access to sanitary napkin supplies and eliminate menstrual waste at source. RING encourages the active participation of parents at their various sessions. During our interaction, Deane recalled a very profound moment at one such event.

“I noticed a mother of one of the children there begin to weep uncontrollably,” Menezes said.

Fearing she might have said something to upset her, she went over to console her.

“During the session, the lady started reflecting on her own experiences growing up and recalled how when she first got her period, she was in her classroom at school and was petrified, not knowing what was happening. The boys and girls started making fun of her. It scarred her so much so that she dropped out of school in class 8,” Menezes said.

Her story is not an isolated one. Scores of women have grown up with crippling experiences of shame, disgust and ridicule.

RING and Dr Kranti firmly believe that sensitisation is key, not just for adolescent girls and women but boys and men too - as they grow up to be allies of women everywhere in the fight against period stigma.

Asmita Yojana, an initiative spearheaded by R Vimala, IAS & CEO of Maharashtra State Rural Livelihoods Mission (MSRLM) leverages the power of women SHGs to sell (proceeds kept by SHGs) affordable sanitary napkins – Asmita+. For adolescent girls from Zilla Parishad schools, a pack of 8 sanitary napkins is provided at a subsidized rate of Rs 5, while women can purchase it for Rs 24.

Maharashtra State Innovation Society, Government of Maharashtra is channelising the start-up ecosystem to help in making affordable sanitary napkins. Ruchi Singhania, Corporate Affairs Manager says, ‘We procured around 25,000 packets of sanitary napkins from one such start-up - Saral designs via Essar foundation’s CSR support.’ Plans are in motion to procure more she adds.

Myna Mahila Foundation employs women from urban slums in Mumbai to manufacture and sell Myna affordable sanitary pads (Rs 200-250/ pack of 35) back into their communities, improving menstrual hygiene, providing stable employment and building a trusted network.

RING too has stepped up and fulfilled the requirements of NGOs across Mumbai by linking donors with NGOs and co-ordinating delivery and distribution efforts. So far, RING has managed to distribute 2.4 lakh sanitary pads across Mumbai.

It’s 2020 but menstruation is still very much a taboo topic across the nation! There is a clear and urgent need for the Centre and state governments to ramp up sensitisation programs to ensure menstrual hygiene as an essential health need. In addition to making MHM affordable and accessible to girls and women everywhere, such programs need to address safe disposal of used menstrual hygiene products as well.

Rajesh Tope, Health Minister, Maharashtra told CNBC-TV18, “There were difficulties initially (when the lockdown was announced) but I am not aware of a shortage now. Thank you for bringing it up. We will aggressively ramp up manufacturing and distribution of sanitary napkins. I will get in touch with the District Collectors for the same.”

When asked what about the need for long-term changes he said, “No girl should have to leave school due to their periods. COVID-19 is a temporary phenomenon and we could not have anticipated the lockdown’s effect on MHM.  We will step up sensitisation, MHM advertisements and outreach programs. Applaud the work done by NGOs in the field. We will support them in every way we can.’

Ahead of the upcoming Menstrual Hygiene Day on May 28, let’s give girls and women everywhere a reason to cheer and celebrate their womanhood.