When Water Turned to Blood (Menses)

“Auntie, may I have some water?”

Each day, empty 2 litter bottles exchange hands from me to my landlord. A smile stretches across her face while I await the obvious answer, “Haan Ji.” It’s almost a month since my arrival in the small city of Dehradun in the North Indian state of Uttarakhand; here, I have begun to explore the culture and navigate life as a part of AIF’s Maternal and Newborn Survival Initiative (MANSI).

Although tedious and awkward to seek water daily from my neighbor, water is essential to my daily needs. Similarly, access to sanitary napkins and menstrual hygiene education are crucial to a female’s life for a life of dignity, and the future of young girls in India. I’m learning and to a small degree experiencing the discomfort and difficulty with which young women living in India have to overcome to seek water and privacy during menstruation, or have access to sanitary napkins. Water, privacy, and sanitary napkins are the mundane privileges that I took for granted, but their importance is heightened and omnipresent as a female living in the development space. “You don’t know what you have till it’s gone” is a true sentiment in India where menstruation and reproductive health are extremely sensitive topics, often hushed or silenced into ignorance.

Out of India’s 300 million women between the ages of 15 and 54, only 10-11% of the population use sanitary napkins as compared to 73-92% in the U.S. and Europe (Garg et al., 2011). A combination of lack of education about the reproductive health and menstrual hygiene, the lack of accessibility, affordability, and availability of sanitary napkins, and cultural taboos prevent the hygienic practices during mensuration (Chandra-Mouli and Patel, 2017). The disparity in menstrual hygiene between the rural-urban divide in India is even more stark with rural women being more vulnerable to infections like Reproductive Tract Infections (RTI), Urinary Tract Infections (UTI), and other genealogical disorders (Misra et al., 2013) which in turn influence the morbidity and mortality of pregnant mothers and their babies (Sharma et al. 2015). The rural-urban disparity in Uttarakhand state can be witnessed in the lack of literature in reproductive health in the rural districts of the state; the information available focuses solely on the district of Dehradun, the seat of the state capital.

With a vulnerable target population, the Central Government of India in conjecture with state governments initiated the Scheme for Promotion of Menstrual Hygiene Among Adolescent Girls in Rural India (van Eijik et al. 2016) for distributing subsidized sanitary napkins for those women meeting the benchmark of low-income or poverty-line. Supplementary provision of the scheme involves providing subsidies to Self Help Groups (SHG) who locally manufacture sanitary pads for distribution among their communities (“Schemes…”). However, there is a disconnect between the policy level and implementation phase of the government schemes. The outdated government data on Uttarakhand state – from 2013– reveals that distribution of sanitary pads have covered only about five areas of mainly plains topography; however, the data on government schemes in the rural districts on the Himalayan foothills is nonexistent (“Schemes…”).

It is within this vacuum of information that MANSI is seeking to provide evidence-based research and public health intervention programs, targeting the rural and often neglected communities, this time in Uttaarkhand. So, while I begin to normalize the awkward space of seeking the basic necessity of water, I foresee the continued work of MANSI in normalizing the sensitive discourse on menstrual hygiene and sexual education for underserved rural women in the state of Uttarakhand. As a part of the MANSI team, I look forward to contributing to the literature and research on the status of menstrual hygiene in context of rural adolescent (adolescent described by World Health Organization as females aged 10-19 years old). Although a minute role, I hope that my current work will contribute to the vacuum of knowledge on the practices and attitudes of adolescent girls in the three rural, Himalayan districts of Uttarkashi, Pithoragarh, and Haridwar.


References:

Chandra-Mouli, V. and Patel, S. (2017). Mapping the Knowledge and Understanding of Menarche, Menstrual Hygiene and Menstrual Health Among Adolescent Girls in Low- and Middle-Income Countries. Department of Reproductive Health and Research, World Health Organization 14(30), 1-16.  

Garg, R., Goyal, S., and Gupta, S. (2011). India Moves Towards Menstrual Hygiene: Subsidized Sanitary Napkins for Rural Adolescent Girls—Issues and Challenges. Maternal and Child Health Journal 16(4), 767-774.

Misra, P., Upadhyay, R.P., Sharma, V., Anand, K. and Gupta, V. (2013). A Community-Based Study of Menstrual Hygiene Practices and Willingness to Pay for Sanitary Napkins among Women of a Rural Community in Northern India. The National Medical Journal of India 26(6), 335–337.

Schemes – Government of India. (2013). National Rural Health Mission, Government of India, Retrieved October 10, 2017, from http://nhm.gov.in/nrhmcomponnets/reproductive-child-health/adolescent-health/mhs/311-schemes.html.

Sharma, R., Negi, S., Kunj, D., and Sharma, V. (2015). Menstrual Hygiene among Adolescent Girls. Indian Journal of Community Health 27(3), 376-380.

Van Eijk, A.M., Sivakami, M., Thakkar, M.B., Bauman, A., Laserson, K.F., Coates, S., and Phillips-Howard, P. (2016). Menstrual Hygiene Management among Adolescent Girls in India: A Systematic Review and Meta-Analysis. BMJ Open 6(3), 1-12.

 

tseringlhamo

tseringlhamo

Tsering was born in Tibet and raised in a Tibetan Refugee school in India before immigrating to the United States. She studied international relations, focusing on environmental sustainability and global health, and minored in biology from American University. She created and co-led her university’s month-long study-service program to Tibetan Refugee settlements in Northern India to study the impacts of political identity on the social health of the refugees. Originally intending to pursue a medical education, her volunteer experiences abroad in the hospitals of the Philippines and India inspired her passion for global health and the political ecology of disease. Prior to joining the AIF Clinton Fellowship, Tsering worked as a laboratory associate at Yale New Haven Hospital and interned at an international development NGO. In her free time, Tsering enjoys drawing, traveling, learning new languages and exploring new cultures.

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