By Dr Swati Jindal Garg
In a recent move, the apex court gave the centre an ultimatum to finalise an optimum menstrual hygiene policy that focuses on the distribution of sanitary napkins in India. The Court also directed the government to set down a national model for the number of girls’ toilets per female population across government-aided and residential schools in the country.
It is a harsh reality that the government has not yet come up with a menstrual hygiene policy, though this impacts half the population. Menstruation remains a taboo subject and chemists continue to sell sanitary napkins in black plastic bags. It is ultimately the judiciary that has taken cognizance of the fact and decided to push the government to take strict and immediate action in a time bound manner.
Despite being on the route to progress, Indian women are still constrained to use sub-standard menstrual hygiene products, mostly due to the inability to afford good ones and due to their non-availability in semi-urban and rural areas.
The latest National Family Health Survey-5 (NFHS) shows that 73% of rural women and 90% of urban women use a hygienic method of menstrual protection. There has also been a significant improvement in the percentage of women aged between 15 and 24 who use a hygienic method of protection during their menstrual cycle (primarily sanitary napkins, cloth and locally prepared napkins) and this has risen from 58% in NFHS-4 to 78% in NFHS-5.
The survey also revealed a close link between education and hygiene preferences as it was observed that women who had received 12 or more years of schooling are more than twice as likely to use a hygienic method compared to those with no schooling at all. Studies have also established an irrefutable link between menstruation and dropping out of school as a result of the stigma attached to it, coupled with patchy or no access to sanitation (in terms of access to products, toilets and water). Despite the availability of data, the fact is that little has been done to address this issue by the government.
In its defence, the centre has apprised the Court that a draft policy has been circulated for comments from various stakeholders and that it would be ready in four weeks. Even though this seems to be a step in the right direction, the policy would only be the tip of the mammoth work that needs to be accomplished in the field of menstrual health in India.
It is imperative that the government, apart from drafting and putting in place a policy, not only ensures access to affordable menstrual hygiene products, but also provides clean toilets and water. There is also a need to take into consideration the entire lifecycle of a menstruating woman and make provisions for her health and social requirements that result from it.
The Court, while hearing a plea filed by Madhya Pradesh Congress leader Jaya Thakur in the beginning of this year, had asked the centre to formulate a standard operating procedure and a national model to be adopted by all states and Union Territories (UTs) for managing menstrual hygiene of girls studying in schools. It had also appointed the secretary of the Ministry of Health and Family Welfare as the nodal officer to coordinate with all the states and UTs and collect relevant data for formulating a national policy.
The plea had sought a direction to states and the central government to ensure the provision of free sanitary pads to every female child studying from Classes 6 to 12 and separate toilets for women in all government-aided and residential schools. Thakur in her plea had said serious difficulties were faced by adolescent females between the ages of 11 and 18 who come from poor backgrounds in receiving education on account of lack of access to education, a constitutional right under Article 21A of the Constitution. “These are adolescent females who are not equipped with and are also not educated by their parents about menstruation and menstrual hygiene. The deprived economic status and illiteracy leads to prevalence of unhygienic and unhealthy practices which has serious health consequences, increase obstinacy and leads to eventual dropping out from schools,” the plea said.
Chief Justice Dr DY Chandrachud also highlighted the significance of workplace flexibility and open dialogues concerning menstrual health during a recent event by sharing an incident involving a female colleague who requested work from home. He reassured her saying: “Feel free to work from home; I am sure you can manage your work as usual. Health should always be a priority.” Chandrachud also stressed the importance of openly discussing menstrual health issues within society. “It’s crucial that we engage in these conversations. We must acknowledge that these issues exist in our society,” he said.
He further said that last year, out of five law clerks, four were women. “It’s common for them to inform me about their menstrual cramps. I encourage them to work from home and prioritise their health. Additionally, we have installed sanitary napkin dispensers in the female restrooms at the Supreme Court of India.”
Incidentally, the Court had earlier this year dismissed a petition advocating for nationwide menstrual leave for employees and students. It cited it as a policy matter and said menstrual leave policies could discourage employers from hiring female workers. However, it added that institutions still have the freedom to independently make decisions and offer more favourable employment terms to their female employees than those mandated by legal provisions.
Ensuring adequate availability of menstrual hygiene products through the implementation of a proper policy is not the only mammoth task facing the government today. Through its Swachh Bharat Mission, it is also committed to proper Menstrual Hygiene Management.
Point 5.9.2 of the Swachh Bharat Mission Guidelines states: “Issues relating to women’s personal hygiene namely menstrual hygiene are to be focused under the SBM (Gramin). Girls and women have hygiene and sanitation needs linked to their menstrual cycle. Women suffer in the absence of knowledge about safe practices on Menstrual Hygiene Management (MHM).”
The Guidelines also make provision for dealing with menstrual waste: “Funds allocated for Solid and Liquid Waste Management may be used to implement safe disposal solutions for menstrual waste (used sanitary cloths and pads) and setting up incinerators in Schools, Women’s Community Sanitary Complexes, Primary Health Centre, or in any other suitable place in village and collection mechanisms etc can be taken up. Technologies may include appropriate options that are socially acceptable and environmentally safe.”
Apart from the Swachh Bharat Mission Guidelines, the Menstrual Hygiene Management Guidelines issued in 2015 by the Ministry of Drinking Water and Sanitation (the nodal ministry in charge of SBM) also talk about various means of on-site disposal of menstrual waste which includes deep burial, composting, pit burning and incineration.
There has, however, been a call from environment activists to declare sanitary waste as bio-medical waste. Once this is done, the used pads will be capable of only being incinerated in registered and approved centralised incinerators. Municipal governments, however, are not keen on this solution given the sheer amount of menstrual hygiene waste that is generated and also the costs involved to incinerate one sanitary napkin.
Since 2010, the government under the National Rural Health Mission has been supplying sanitary napkins under the brand-name, Freedays, which are sold to adolescents girls at Rs 6 per pack of six napkins by Accredited Social Health Activists. There are also many other brands that have made inroads even into rural India. Single use and disposable products represent approximately 125kg of sanitary waste generated per person during the menstruating years. Menstrual waste from commercial sanitary napkins is the newest problem child in the WASH (Water, Sanitation and Hygiene) sector, and at present, our cities and villages are grossly ill-equipped to deal with it in a sustainable way.
Whether the new Menstrual Hygiene Policy also takes care of the problems of disposal remains to be seen. At present, it is best to go one step at a time and once the policy is implemented, it will surely be a Herculean task to see to its proper working at the grassroots level.
—The writer is an Advocate-on-Record practicing in the Supreme Court, Delhi High Court and all district courts and tribunals in Delhi