In an effort to raise concerns around effective menstrual health, Menstrual Health Alliance India (MHAI), a network working on menstrual health and hygiene in India, Dasra, a philanthropic organisation and Change.org, a technology platform for social change hosted an online workshop recently to discuss the issue of access to menstrual products during Covid-19. 

MHAI launched findings from a rapid survey conducted with 67 organizations across India (45), African region (16) and other countries (6) during the Covid-19 relief work. The online survey assessed the status of production, distribution and access to menstrual hygiene products to understand challenges and propose recommendations for relief work. 

Periods don’t stop for pandemics

In India, the series of lockdowns impacted the production as well as access to menstrual hygiene information and products. This affected the ability to maintain hygiene during periods in privacy and with dignity for millions of girls and women, the MHAI observed in the survey.

India has 336 million menstruating women, of which 121 million use sanitary pads, i.e. 1 billion pads per month, as per MHAI estimates. The survey findings indicate that the pandemic had disrupted the production of menstrual hygiene products, with many small and medium scale manufacturing units facing a shortage of labour, raw material and working capital.

The survey found that of the 44 small and medium scale manufacturers who responded, only 25 percent were operating fully and 50 percent partially. Very few units had raw material availability for the next 3 months – only 25 percent has availability and 40 percent has partial availability. Many organisations had initiated mask production in their facilities, due to which production of menstrual hygiene products got adversely affected.

Other than the  production constraints, the availability – supply and distribution of menstrual hygiene products including disposable and reusable sanitary pads at the last mile rural retail points also got affected, the survey points. People were unable to access the products at block or district level markets due to lack of public transport and mobility restrictions under the lockdown.

During the lockdown with physical distancing measures in place, 67 percent of the partner organisations working on menstrual health and hygiene in India have had to pause normal operations. Before Covid-19, 89 percent of the organisations were reaching the community through community-based networks, 61 percent were distributing menstrual products through schools, 28 percent through door to door retail, 26 percent through online retail channels and 22 percent through traditional retail stores and pharmacists.

Supply chain challenges appeared with road transport restrictions leading to constraints in wholesale distribution. As the lockdown eased up again, transportation costs (road and air freight) continued to be high. There is a need to immediately plan for a severe shortfall in production and distribution of menstrual hygiene products. 

New production is likely to be at limited capacity given physical distancing norms for factories and lack of availability of labour where migrant labourers were employed. Working capital has become a looming challenge for many small-scale units, especially self-help group-based production units – also showing that the business models are not very viable in the current form.

"The production and distribution of information and products to manage menstrual hygiene demands of women and girls is a constant challenge. In this survey, 84 percent of the partner organisations stated that there is either no or severely restricted access to menstrual products in communities that they work in, especially for sanitary pads," says Tanya Mahajan, coordinator, MHAI.

Most adolescent girls from low-income households depend on school-based supply of menstrual hygiene products. The closure of schools has compounded the problem and compelled the girls to shift to using cloth pads. “There is a need to look at how reusable product choices like cloth pads and menstrual cups can be promoted with information on maintenance of hygiene in order to build resilient menstrual hygiene management practices,” says Mahajan.

Accessing toilets for managing menstruation was a challenge, with the problem especially more acute in urban slums where community sanitation facilities are used. “Availability of water is also constrained and use for menstrual hygiene is not prioritised,” MHAI observed, adding that due to the lack of clean, private and safe water and sanitation facilities, women were unable to practice personal hygiene like changing the menstrual product (disposable or reusable pad) every 4-6 hours and washing cloth pads and drying them in the open sunlight for proper disinfection.

“Girls also end up limiting food and water intake to minimize use of the toilet, which can lead to adverse health outcomes,” it noted.

“Menstrual health programs need to take into account feedback from girls and women. This feedback loop, must consider women and girls experience with various menstrual health products and services in terms of - availability, accessibility, affordability (costs), acceptability (quality and other local factors). Programs also need to account for the unique challenges during a situation like the current pandemic by looking at menstrual health as a continuum and not as a supply only issue,” says, Sapna Kedia, Technical Expert, International Centre for Research on Women (ICRW) Asia. 

Government schemes/programs run via community health workers including ASHAs, Anganwadi workers, and Auxiliary Nurse Midwife (ANMs), and non-profit organization efforts play a key role in providing women and girls the required relief from their menstrual hygiene management challenges. However, close coordinated efforts are required for timely procurement, stock management and distribution. 

“As a country we have made some progress on acknowledging menstrual hygiene management challenges. Over the past few weeks, we have made recommendations to ministries and state departments to provide access to sanitary napkins at village level through government functionaries, frontline workers, self-help groups, civil society and other partners who work in the field. We know Government of Jharkhand has taken a step to resolve this through last mile delivery of menstrual hygiene products during the Covid-19. It will also require other stakeholders including funders and civil society to continue to support this,” says Shailja Mehta, Associate Director, Dasra.

Bringing these issues to the forefront is an effort to ensure that the needs of women and girls continue to be prioritized at the time of this pandemic. As a first step towards this, Government of Jharkhand is ensuring that girls who are enrolled in school in class 6 to 12, are identified by the block education officer (BEO), and ANMs, ASHAs and Anganwadi workers will closely coordinate with the BEOs to provide free of cost sanitary napkin through community health centre, VHNDs, household visits and Anganwadi centres to girls for the next three months. 

“With supercyclone Amphan hitting Indian coasts on the one hand and the Covid-19 crisis on the other, India's disaster management plan should include menstrual hygiene management as an integral part of our emergency response. Instead, we see that menstrual hygiene is one of the first issues to fall by the wayside. Millions of women and adolescent girls are more vulnerable than ever before. Our ground interventions show that they are struggling to talk publicly and find clean pieces of cloth for their urgent menstrual hygiene needs. We need to urgently revisit the country's Covid-19 response strategy on menstrual health and introduce last mile access to menstrual hygiene information and products, as one of our top priorities,” says, Mayuri Bhattacharjee, Changemaker, She Creates Change, Change.org.

Civil society organisations will have two key roles to play – one is to provide necessary support to frontline workers to ensure that girls get the benefits of the scheme, as well as continue to engage with out-of-school girls, so they have access and awareness of safe menstrual health and hygiene practices. 

Way forward

Some possible solutions for Covid-19 relief work are:

• Effective management of access to menstrual hygiene products
  • Short term distribution through relief centres and food supply operations
  • Facilitate linkages from wholesalers to community level women entrepreneurs, SHGs
  • Substitution of wood pulp with locally available materials like jute, banana fiber
• Increase dependence on reusable products
  • Provide knowledge and information on making cloth pads, maintenance, safe use
  • Involve men, boys and community stakeholders to ensure women have access to private and clean WASH facilities via targeted messaging
  • Explore co-production of masks and cloth pads to ensure adequate supply of cotton cloth
• Communicate safe hygiene practices using digital platforms, influencer videos, IVR, direct community outreach
• Engage local administration for unlocking storage in schools, CHC/PHC, with ASHAs, integrating WASH and hygiene along with Covid-19 related messaging, gender segregated WASH facilities that are clean, safe and private in quarantine and isolation centres
• Provide guidance on segregation and safe disposal of menstrual products and mask at levels of household, community and health facilities

In recent years, menstrual hygiene management received its due importance in government policy, planning and action. And, civil society actively acknowledged and stepped up to solve women and girls' menstrual hygiene management challenges. However, crisis situations including floods, Covid-19, have provided timely exposure to the persistent gaps between effort and on-ground realities. There is a need to work towards taking corrective measures in the immediate future and build resilient menstrual hygiene management practices.