State Level Consultation on

Menstrual Hygiene and Management

Breaking the Silence ……

5 – 6 January 2012

Hyderabad

Organized by

Centre for World Solidarity/APWN/WaterAid

# 12-13-438, Street No. 1

Tarnaka, Secunderabad – 500 017, INDIA

Tel: +91-40-27 018 257, 27 007 906

GLOSSARY OF TERMS USED

CWS Centre for World Solidarity

APWN Andhra Pradesh Women's Network

WASH Water, Sanitation & Hygiene

MHM Menstrual Hygiene Management

MH Menstrual Hygiene

TOT Training of Trainers

SHG Self-help Group

NGO Non-Governmental Organization

DWCD Dept. of Woman & Child Development

NRHM National Rural Health Mission

IKP Indira Kranthi Patham

RVM Rajiv Vidya Mission

UNICEF United Nations Children Fund

NPEGEL National Program for Education of Girls at Elementary Level

MPDO Mandal Parishad Development Officer

MEO Mandal Education Officer

RWS Rural Water Supply

ICDS Integrated Child Development Scheme

UPS Upper Primary School

ISL Individual Sanitary Latrine

SMC School Management Committee

PHC Primary Health Centre

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

NREGS National Rural Employment Guarantee Scheme

PNDT Pre-Natal Diagnostic Techniques

HIV & AIDS Human Immune Virus & Acquired Immunodeficiency Syndrome

RCH Reproductive Child Health

MEPMA Mission for Elimination of Poverty in Municipal Areas

BCC Behavioral Change Communication

SSA Sarva Shiksha Abhiyan

CHF Community Health Facilitator

MCH Municipal Corporation of Hyderabad

IEC Information-Education-Communication

The Background

CWS in collaboration with APWN is working towards planning & implementing

activities for better utilization of water and sanitation facilities and do advocacy with

line departments at mandal, district and even the state level. This Project is being

taken up in partnership with 14 organizations in 57 Gram Panchayats and 17 urban

slums spread across 10 districts of Andhra Pradesh. The Project is attempting to

understand WASH issues from a gender perspective and will contribute to WASH

sector by brining gender perspective to the forefront. Learning’s that emerge out of

these interventions at local level will be used to identify some state level issues

related to WASH.

In the process the network decided to work on the issue of MHM in the state because

isolated efforts have been made in some cases but no concrete work has been done

so far on the issue of MH. Since last year APWN has been addressing the issue of

MHM in the state in a focused way. APWN partners and CWS staff underwent a

training program of TOT with external resource person for three days and the partners

later trained adolescent girls groups/SHGs in the communities in the selected five

Panchayats in each of partners area. Mandal level convergence meetings were later

organized with various line depts. and women’s groups, adolescent girls groups and

Panchayats for understanding and taking initiatives in MHM in their mandals. APWN

also held district level convergence meetings with a similar objective.

In this process CWS organized a state level consultation on Menstrual Hygiene and

Management in Hyderabad on 5th and 6th January 2012 including various stake holders,

likeminded NGOs, APWN partners and state level government line depts. so that the

issue is addressed from grass roots level to state and some resolutions made at state

level which will be further carried at ground. The methodology of the event included

presentations by resource persons from organizations working on the issue of MHM and

group work to analyze the status of MH and make recommendations to the government

in the context of improving the situation at the ground level. A meeting of partner

organizations was held earlier on 4th January 2012 with the objective of reviewing the

progress of their activities in the specific context of MHM, status of government health

schemes and making recommendations to the government for effective implantation of

various schemes.

Two days Sate Level Consultation on Menstrual Hygiene and Management Centre for World Solidarity (CWS), A. P. Women’s Network (APWN) and WaterAid

jointly organized a State Level Consultation on Menstrual Hygiene and Management in

Hyderabad on 5th and 6th January 2012 with the participation of nearly 60 members

representing implementing NGO partners of the Network and likeminded NGOs, various

district level and state officials. The methodology of the event included presentations by

functionaries of organizations that have been involved in addressing the issue of MHM

and group work to analyze the status of MH and make recommendations to the

government in the context of improving the situation at the ground level

Address by Hon. Minister for Woman & Child Development Ms. Sunita Laxma

Reddy : A brief speech by Founder and Honorary Convener of CWS Sri M. V. Sastri

preceded the Hon. Minister’s address. Sri Sastri opined that a lot of change had come

about in the status of women during the last 5 decades. Gender has many dimensions.

Though a number of laws have been enacted for gender equality, no real change is

possible until the issues on the agenda of the Workshop are addressed.

The Hon. Minister started off with stating that silence on women’s issues must be

broken. More forums and discussions were necessary in this regard. She expressed

that she had turned up for the event because she had felt it was her responsibility to do

so. She emphasised the need to focus on adolescent girls and to educate girls in tribal

areas, residential schools and hostels on

personal hygiene. She informed that facilities

for making Sanitary Napkins and marketing

them were available under the schemes

launched by her Department. The problem of

gender based inequality at the family level

must also be addressed, she noted.

The Hon. Minister went on to state that the

Sabla scheme has been launched in 7

districts with the objective of generating

awareness among adolescent girls on various issues. She noted that that the woman’s

health is the family’s health and called upon all men to care for women. She ended her

speech with a promise that she would sanction the construction of school toilets

wherever necessary.

Executive Director of CWS Dr. Gnanaprakasam spoke on the activities taken up by

CWS during the course of the last 2 decades for woman’s empowerment. He informed

that the organization had he opined that the patriarchal setup of our society and called

upon one and all to recognise the right of every woman to her health and work to uphold

it. He also noted that Personal is Political in the context of MH and that a shift from

political discourse to policy discourse was necessary on the subject.

Regional Manager – Southern Region of WaterAid Mr. Amit Pandey listed the

following issues that have to be addressed in the context of MH

• Addressing larger social dimensions of MH

• Speaking on the criticality of MH

• Infrastructure Management

• Educating adolescents on the changes associated with adolescence

• Exploring alternatives to reduce and recycle waste

• Challenging the processes that reinforce the concept of shame

He opined that indiscriminate promotion of the use of napkins would lead to negative

results, as free napkins would not be distributed to them once they had crossed the age

of 19 and they would have got used to the concept but would not be able to afford them.

It would, therefore, be better to keep them informed of all available options and leave

the final decision in their hands. Another drawback of the present scheme is that it fails

to establish the need for sanitation and look at the environmental aspect of Napkins.

Convener of APWN Ms. Anuradha informed that 22 organisations are affiliated to the

Network. They had launched an intensive campaign in the year 2000 to address

violence against women. They started focusing on personal hygiene and sanitation at a

later stage. A survey that the Network had undertaken on MH had revealing certain

startling facts, as a follow up of which the Consultation had been organised.

Mr. Amit briefly introduced the activities and agenda of APWN, CWS and WaterAid to

the Hon. Minister. He informed that these organisations had been working on the issue

of MH, which was not merely a women’s issue – it was rather a complex interrelation of

various social and institutional factors. Briefing the Hon. Minister on the proceedings of

the previous sessions in a nutshell, he informed him that some recommendations to the

government would be finalised at the end of the day. He concluded with stating that he

had been invited to the event, as his Department could address the issue of

infrastructure availability.

Address by Hon. Minister for Rural Development Mr. Manikya Vara Prasada Rao:

Observing that MH is an issue of grave concern in rural areas, the Hon. Minister

recollected the measures that he had taken to address adolescent girls’ issues during

his stint as Education Minister. He had aggressively promoted the education of

adolescent girls and had also proposed the distribution of Sanitary Napkins to them. He

had also suggested regular health checkups by doctors. A survey that he had

commissioned as Education Minister had brought out that many girls that had dropped

out of upper primary and high schools had done so due to the unavailability of toilets.

He had declared on the basis of these outcomes that toilets must be provided in every

High School. The Supreme Court has also passed a similar judgment. Standards of

toilet maintenance in rural areas are also poor.

The Hon. Minister went on to state that he had adopted 4 villages in his constituency

with the objective of transforming them into Model Villages and had accordingly passed

instructions to his subordinates but there had been no progress in the status of

sanitation there even after 6 months. It is a matter of concern that even well-off families

are unwilling to spend Rs. 10000 on construction of toilets. They were blissfully unaware

of the ill effects of Open Defecation.

In his concluding remarks, the Hon. Minister stated that he had recently resolved to

improve the status of roads and sanitation in Scheduled Caste and Scheduled Tribe

habitations and had set aside a Matching Grant of Rs. 750 crores through his

department to construct pucca roads and toilets there. 3 villages per mandal of the

State are being covered under this scheme. 4 villages in each mandal would be covered

under the next round. It is proposed to reach out to the entire State in this manner by

2014. He ended with calling upon the members present to do all they could to address

the situation in hand and promised all possible help from his side.

Dr. Gnanaprakasam expressed optimism that change would definitely come about due

to the initiatives of both the Woman & Child Development and the Rural Development

departments. Mr. Qasim Peera suggested extending the scheme mentioned by the Hon.

Minister to all Below-the-Poverty-Line families as well. The latter replied that this would

be done in the second phase of the scheme. Ms. Bhanuja requested the Hon. Minister

to consider supply of Sanitary Napkins to women at worksites, which he promised to do

after March 2012.

Presentations by Resource Persons

Vikalpa Design, Udaipur

Ms. Lakshmi Murthy spoke briefly on the outcomes of a study that she had taken up in

a women’s engineering college to study practices during menstrual hygiene. She

concluded that the negative attitude of an individual leads to a negative collective

attitude by society, further resulting in poor policy and manifesting in poor

quality/unavailability of infrastructure, finally ending in poor reproductive health. BCC

aims at a change from negative to positive attitude and at sustaining the same.

Providing a supportive environment can help catalyse change.

Working towards change in the context of MH is

not easy, as it is a sensitive cultural issue. The

speaker went on to illustrate the means by which

her organisation had been trying to being about

such change. She noted that non-degradable

material is used in preparing sanitary napkins

and emphasised the need to suggest

alternatives. It is important, at the same time, to

let the user make the final decision. Responding

to a question, the speaker informed that it is preferable to approach the issue of MH

material from a demand point of view rather than the supply point.

ExNoRa, Chennai

Mr. Vijayanand spoke at length on the issue of solid waste management. He involved

the participants in an interactive brainstorming session to send across his message. He

noted that waste management is a key issue of concern in an urban locale. The public

sanitation implications of improper disposal of waste, of which napkins are an integral

part, are grave. Dioxene, which is a carcinogenic gas that is soluble only in fat, is

emitted when plastic waste is crudely burnt. Inhalation of Dioxene causes health

complications in newborns and during childbirth. Though the incidence of Open

Defecation has gone down considerably, the poor quality of the drainage system often

results in contamination of the groundwater table.

The speaker went on to state that solutions to the problem

include BCC, incineration, sanitary pits and Cat Sanitation (in

rural areas). He suggested going for a process oriented

rather that a problem oriented approach to the problem, as

this alone would be sustainable. Small ideas can sometimes

lead to long-lasting results. Mr. Vijayanand next presented

some pictures of waste management alternatives and

concluded that lined sanitary pits are the best option of

disposing of sanitary napkins in a rural setup.

During the feedback session, one of the participants asked what steps were being taken

for disposal of napkins where public toilets had no water facility. The presenter replied

that old newspaper rolls were being placed at the entrance so that the napkin/pad could

be wrapped and disposed properly. ExNoRa is also designing an incinerator. Ms.

Lakshmi Murthy suggested that APWN could organise a competition for design of an

environment- and woman- friendly napkin. Another member opined that companies

producing MH material ought to be involved in the issue and invited to consultations.

The presenter informed that the concept of Extended Producer Responsibility, which is

in vogue in the West, is due to be introduced shortly in India. A lot of positive change

could be expected as a consequence.

National Institute of Mental Health, Secunderabad

Ms. Sheilaja Rao started off by defining the concept of

Mental Retardation. She informed that parents/ guardians of

such children have a particularly tough time coping with them,

as their general development is slower than others’ and their

abilities to comprehend are also lesser. They are thus

excluded from the process of socialisation. Areas in which

they need to be given inputs include Toilet Training, Privacy

& Dressing, Handling of Genitals, Hygiene and Indiscriminate

Physical Contact.

A number of physical and emotional changes are associated with adolescence. Such

children must be educated on these changes and prepared mentally to cope with this

change. At the end of her presentation, the speaker presented some readymade

garments that the Institute had designed for retarded adolescent girls.

During the feedback session, one of the members asked if the Institute had been

working with children having high levels of retardation. The presenter replied that not

much could unfortunately be done in such cases and that much of the onus was on the

child’s parents/guardians.

MHM intervention in Tamil Nadu

Dr. Manimekalai informed that sanitary napkins are being issued by the state

government to adolescent girls, women and women in prison. The Dept. of Women’s

Studies – Bharatidasan University has involved key line departments in its MHM

intervention. The government has been training women’s SHGs in the production of

low-cost Sanitary Napkins. Procurement of Napkins is also being done through

Tenders. A 10-point Action Plan has been

chalked out under the banner of the Trichy

Declaration to mainstream MHM. 100 Master

Trainers have been identified across the State.

Awareness generation competitions have been

organised for girls on MHM. A 2-day workshop

on safe disposal of Napkins has been organised

with support from UNICEF. MHM is being

integrated into the National Service Scheme. The concept of Girl Friendly Toilets has

been successfully launched in Krishnagiri. Workshops have been held for girls and

MHM councils formed at the school level. 250 teachers have been trained in MHM. The

SSA and UNICEF have undertaken an assessment of the intervention and have listed

out some gaps.

Replying to questions from the participants, the presenter informed that use of Napkins

and accessibility to them has improved due to the intervention. Lack of awareness

prevents many girls from coming into the open to discuss such issues. Village Health

Nurses have been undertaking regular school visits. Poor maintenance of incinerators

has resulted in sub-optimal/poor usage. More work is necessary on devising disposal

mechanisms.

Vacha Resource Centre, Mumbai

Ms. Sonal Shukla informed that Vacha has brought out a wide range of resource

material for women and girls. It seeks to empower girls by federating them and by

building their capacities through workshops and seminars on wide ranging issues. The

organisation looks at the process of growth from a holistic

perspective and attempts to change the way women and

girls think about their bodies. Parents and teachers are not

involved in this process, as they reinforce conservative,

irrational beliefs. Educating them in this regard can help

change the situation at the ground level. Strategies to

address this issue must be customised on the basis of local

beliefs and practices, she summed up.

Referring to an observation by the presenter on

women’s/girls’ isolation during their menstrual periods, one of

the participants opined that this practice could be justified on

the ground that they needed enough rest. The presenter

replied that this argument was baseless, as all persons – male or female, were entitled

to have some form of rest.

OXFAM India

Mr. Akshaya Kumar Biswal informed that though MHM was not a key issue on the

OXFAM agenda, the organisation had been addressing this issue during emergencies

through a WASH intervention. Public health response during emergencies can not only

help prevent epidemics but also save lives. Women are in a particularly difficult situation

during emergencies, as they lack privacy and access to treatment and proper sanitation.

Personal hygiene also becomes secondary to them in an emergency. There is high risk

of infection.

WASH initiatives during emergency include providing access

to Sanitary Napkins, sufficient and safe water and sanitation

facilities, promoting good hygiene behaviour and ensuring

women’s privacy. The WASH Triangle has four components,

namely Shelter (at the core) and Water Supply, Sanitation

and Hygiene Promotion. Shortage of sanitary napkins is a

key issue of concern during an emergency. Bearing this in

mind, OXFAM has trained 3 SHGs in preparation of

reusable napkins. An important point to remember in the

context of promoting MH behaviour is that all practices may

not be accepted by all communities. The presenter later

displayed some pictures of emergency WASH initiatives.

One of the members wanted to know why there was no focus on supplying food during

emergencies. The presenter replied that the government was expected to play this role.

In addition, access to WASH is more important than food in this case. Another member

wished to know if the organisation had any special plans during a situation of riot. The

presenter replied that the same strategy would apply even in the case of riots, as

victims would inevitably be accommodated in camps.

CARMDAKSH, Chhattisgarh

The organisation is operational in 3 blocks of Korba district, North Chhattisgarh.

Development indicators in these blocks are quite poor. Hardly any village has regular

electrical supply though the district has the highest number of power stations in the

State. Superstitious beliefs are prevalent in the context of napkin disposal. Incinerators

have been provided to 4 schools but have remained unused. Awareness on the link

between menstrual hygiene and health is very limited. A Sanitary Napkin- making unit

has been set up by the organisation but the village is unfortunately remotely located.

Key challenges to the intervention are Social Taboo, Low levels of awareness, Low

priority to MH, Unwillingness by service providers to broach the issue of MH, Minimal

exposure of team members to MH issues and High costs of quality certification.

CARMDAKSH undertook a survey of 1510 women, men, adolescent girls, teachers,

Mitanin, Anganwadi Workers, Sarpanchs and Panchs to study MH related behaviour.

Most women and girls were found to have been educated on menstruation from their

mothers and most men from their wives and

from books. 100% of girls aged 11-13 were

dependent on their mothers. It is, therefore,

important to educate mothers. Awareness on

the issue of MH is higher among literate

groups. There are many restrictions on women

/girls during their menstrual periods. Some

women believe that if an animal makes contact

with a disposed sanitary napkin/pad, this could

affect the health of the girl/woman.

One in three women and nearly one-half of adolescent girls had never heard of a

sanitary pad. Mitanin have never been oriented on MH and ANMs opine that they need

more inputs. Teachers are aware of the concept but have not been able to organise a

forum that can address the issue. The same could be said of PRI members. Future

plans of the organisation include Designing an orientation programme for adolescents

and a TOT Module for Mitanin and Anganwadi Workers, Orientation of women/girls on

quality MH material, Orientation of teachers and PRI members on MHM, Preparing a

Business Plan to reduce the cost of Sanitary Pads, Demonstrating models of Disposal

Unit and Providing adolescent girls and women with a forum to discuss MHM.

Goonj, New Delhi

Mr. Anshu noted that though clothing is one of mankind’s basic needs, it is hardly

discussed in a serious manner. It is unfortunate that most of us wait for a disaster to

occur before we speak of clothing. The presenter had drawn inspiration for his work on

clothing from a collector of corpses for the Delhi Municipal Corporation. He had realised

from his interactions with him that lack of clothing is a major cause of deaths, especially

in the winters.

Most hand pumps are located in public places and women are often in no position to

wash their Sanitary Pads/Napkins. The practice of sharing napkins among women is not

uncommon. Rural woman in their menstrual periods generally use any medium that they

can lay hands on as MH material. Health complications – sometimes death, often result.

Though a number of programmes have been initiated for women, none of them has a

specific component of Sanitary Pads/Napkins. This had been the bone of contention

with a World Bank delegation on one occasion.

Goonj has been focusing on meeting

clothing needs of people. Its

functionaries collect and recycle waste

clothes, which are also used as a

resource for basic developmental

activities. Preference is given to

cotton/semi-cotton clothes. It has been

focusing on access, availability and

affordability in the context of Sanitary

Pads. Addressing bio-degradability is

more important than focusing on subsidies, the presenter noted. There was initial

opposition from local NGOs, as they doubted they would be beaten up by the women’s

husbands if the functionaries discussed MH. The impact of the efforts made by Goonj

has been quite positive. The culture of silence has been broken and more women have

begun talking about MH openly.

During the feedback session, Mr. Anshu informed that 1.5 – 2 lakh Napkins were being

produced by Goonj a month at a cost of Rs. 8.50 for a pack of 5 in an urban locality.

The same was being sold at Rs. 5. The cost of production could be reduced in a rural

locality and by training women’s groups. Responding to another question, he stated that

it was equally difficult to reach out to men and women. He quoted the example of a

corporate event that he had organised on MHM. He was surprised to note that though

the firm had a high market standing, not one of the 30 participants was male. Another

member wanted to know if the material was sterilised. He informed that it was soaked

overnight and washed and ironed the next morning.

Muruganathan’s model

Mr. Thyagaraj informed that Mr. Muruganathan had designed three Sanitary Napkin

making machines after having dropped out of school. They cost Rs. 70,000, Rs.

1,00,000 and Rs. 2,00,000 respectively. The capacity of these machines ranges from

1000-3000 Pads per day. Two units are being set up in Hyderabad and Warangal. More

than 10 machines have been supplied to Mahabubnagar district alone. Massachusetts

Institute of Technology has also applauded the work done by Muruganathan. Setting up

Napkin Making units at the village level could also help generate employment. The

production cost of a single napkin works out to Rs.1.30.

Ms. Lakshmi Murthy suggested that pressure ought to be built on the government to

supply napkins exclusively through SHGs. One of the members replied that this could

possibly not be feasible in view of their limited capacities. Ms. Lakshmi Murthy

responded that a demand could be put forth to the effect that that procurement must be

made through any other source with the exception of corporate firms. Another

participant opined that it would be best to revert to the old gauze model on Napkin. Mr.

Qasim Peera came up with the idea of transferring cash to the beneficiary directly so

that no corruption was possible. Mr. Anshu replied that this was not advisable, as MH

material were often a low priority issue for most women and it would therefore be best to

supply such material directly in kind. Most of the other members voiced a similar

opinion.

Healing Fields Foundation, Secunderabad

Mr. Madhu Sudhan Reddy informed that the organisation had

been working to improve access to basic healthcare services,

increase affordability of health services through innovative

financing mechanisms and use health management tools to

improve service delivery. Its interventions include Health

Education, Field Research, Programme Linkages, Health

Financing and Capacity Building. These activities are taken up

through the agency of semi-literate local CHFs with

entrepreneurial abilities. They are oriented intensively across a

period of one year. 150 health Savings Groups have been

formed so far.

An MH initiative was launched in collaboration with Goonj in Ranga Reddy district of

Andhra Pradesh, where 25 Health Leaders were trained and involved in a survey to

assess the utility of Sanitary Pads in 5 villages. Nearly 9 in 10 of the respondents had a

positive opinion of the Pads. 3 in 4 of them were willing to purchase the pads at Rs. 5

per pack of 5.

A mobile based survey had also been taken up with school-going girls aged 12-18 that

were enrolled in Classes 5-10 in 3 villages of Ibrahimpatnam mandal, Ranga Reddy

district.3 in 4 of the girls preferred the use of Pads and more than 9 in 10 girls had been

reusing their cloth after washing it with soap and water. More than 95% of girls using

Pads had bought their supplies from the organisation. 96% of them wanted to use the

Pads regularly.

Sanitary Pad manufacturing units set up by the organisation in Buxar – Bihar and

Warangal – Andhra Pradesh have benefited 24 CHFs, who sell their output locally with

a marginal profit. They also train the buyers in safe disposal of Pads. Based on an

evaluation, the organisation has concluded that a cooperative manufacturing model that

involves up to 50 CHFs could be more effective than an individual manufacturing model

with 12 CHFs and has proposed to promote the former model.

At the end of the presentation, Ms. Lakshmi Murthy wanted to know if the girls/women

that had used the Pads procured from Goonj have begun attempting to make their own

napkins. The presenter replied that no feedback had been collected in this regard.

Literally no woman had been willing to purchase the Pads in Rajganjpur, Orissa. This

was possibly due to cultural reasons, the presenter opined. Ms. Sheilaja Rao noted that

it was also important to correlate the agenda with the buying power of the local

community.

Discussions on Group Work on Recommendations

The participants took part in a group exercise during the post-lunch session of the first

day to finalise the recommendations to be made to the State and to discuss the role that

they would themselves play in the context of lobbying with the government for the

effective implementation of the same. Another round of discussions was held after the

presentations to fine-tune the list.

The representative of the SSA informed that focus was being placed on educating

teachers and girls on disposal under Balika Chetana. Mr. Jagannath Reddy, District

Project Officer – NRHM, Medak stated that interactive sessions were being organised

with children towards this end. Nodal lady teachers at the school level were being

proposed in the district. However, there is uncertainty about what would happen post-

NRHM. The SSA official pointed out that thrust areas of the Balika Chetana intervention

include gender, discrimination, violence, health, child rights, leadership qualities, social

responsibility and the influence of mass media. The District project Officer suggested

considering the supply of low-cost supplementary nutrition under the Aaharam

Aarogyam component of the SSA.

Presentation by government officials

National Rural Health Mission (NRHM)

Addl. Director – MCH Dr. Raja Prasanna Kumar and Addl.

Director – SPL/o CH&FW, AP, Dr. Balaramaiah spoke on

governmental interventions during the first and second days

respectively. They made a brief presentation on the status of

adolescents. Approximately a fifth of our population is

accounted for by adolescents and nearly 47% of them are

female. More than one half of illiterate married women are

aged below 18 and nearly 2 in 10 women that had been

married before the age of 15 are mothers. The incidence of

anaemia among adolescent girls and sexual activeness of

most adolescents aged 15-24 are major causes for concern.

The State government has been procuring and supplying Sanitary Napkins to

adolescent girls through SHGs in 6 districts and from the open market through Tenders

in 3 districts under RCH-II. TOT and training sessions have been organised for district

level officials, ANMs and ASHA Workers. ASHA Workers have been given Reading

Material, Flip Books and Adolescent Girls’ Menstrual Calendars. They have also been

instructed to sell napkins to adolescent girls, educate them on MH and safe disposal of

napkins. They have also been acting as a link between health centres and the girls.

The officials came up with the following responses to the members’ queries during the

feedback session

• The State government had been following norms prescribed by the Central

government in implementing RCH – II and had not framed any rules of its own

• NGOs had not been included in the State level Steering Committee but the issue

would be raised with the authorities during the ongoing Ninth Review Session of

the NRHM

• Teams have been formed with the joint representation of ANMs, Anganwadi

Workers and ASHA Workers to work for convergence

• The Module that has been developed for ASHA Workers has a section on safe

disposal of napkins

• Disposal of napkins is proposed through layered pits

• Bio-waste disposal facilities are available in PHCs and Sub-Centres in the

context of napkins. This activity has not yet been initiated at the school level

• A requisition will be made to the authorities concerned for installation of Napkin

Vending Machines at public places such as railway and bus stations, in

accordance with the participants’ suggestion

• A proposal will be forwarded to the authorities for making available Hygiene Kits

and setting up restrooms in government offices

• Norms for eco-friendly MHM material would be specified at the earliest

• A circular would be issued facilitating free supply of napkins to all girls enrolled in

KGBVs

• Awareness programs on basic principles of human anatomy are being conducted

for girls on a daily basis under the DENHI scheme

• School level awards are being proposed for girls under the Crèche programme

• Nearly 1.5 lakh teachers and paramedics have been trained on MH through half-

day orientation sessions

• Health standards prescribed by the Institute or Public Health are being used as a

benchmark. Children are being tested for anaemia twice a year and de-worming

is being done.

• RCH – II is proposed to be extended to urban areas from 2013 on

• RCH-II has an inbuilt monitoring mechanism. Review meetings are held once in a

quarter. Plans are afoot to track children with identified diseases and extend the

necessary treatment to them

Mr. Amit Pandey opined that the scheme had been creating the need for napkins

through the supply mode. This would prove to be a disadvantage, as the girls would get

used to them and would not be able to spend on them when they would no longer be

issued free of cost. They were also non-degradable and not environment-friendly.

Training sessions of 2-3 days’ duration were also not capable of bringing about

attitudinal change, he noted.

Dr. Balaramaiah responded that budgetary

constraints ruled out the conduct of ongoing

training sessions. The government also had 3

goals – immediate, short-run and long-run.

Eco-friendly alternatives would be considered

by the government in consultation with

experts. Replying to another suggestion that

an MHM campaign could be launched in rural

areas, he stated that the SWASTHA

intervention was already in place. Speaking on women aged above 19 years, he opined

that they would have some form of economic support or the other by then and would not

need free supplies.

Department of Woman & Child Development

Rajiv Vidya Mission

Ms. Jyothi, Joint Director & Ms. Lakshmi, PO –WCD

Ms. Anita, Girls Child development Officer – RVM

WCD had been launched for adolescent girls’ way back in 1997. Focus was placed on

creating awareness among girls aged 11-14 and on orienting older girls aged 14-15 on

RCH. This activity had been initiated at the Anganwadi Centre level but has expanded

since then to its present state – SABLA. Response to the intervention has been quite

positive. There was initial opposition from parents but the project staff had invited them

to attend the meetings and then decide whether to accept the concept or not. Disposal

of napkins has been recognised as a problem and plans are being chalked out to

address this issue. Napkins made entirely of cotton are most ideal. Attempts are on to

partner with NGOs to look into this issue. Talks are also on with the Education

Department, the speaker concluded.

The final recommendations were shared with the govt. officials

The group has worked out few common agreed principles upon which they derived

certain recommendations

Agreed principles on MHM

• Maintaining hygiene is essential for a person to live with dignity.

• Menstrual hygiene is not an issue of only hygiene; it has strong linkage with

social issue like patriarchy.

• Managing menstruation is not only managing hygiene, it is managing other

aspects like psychological and biological aspects.

• Managing menstrual hygiene processes should be environment friendly.

• Menstrual Hygiene is not an issue of women; it is an issue of the society.

• Maintaining MH has a strong linkage with access to other basic needs like water

and sanitation.

• User should be completely informed about MHM, but should make the final

choice for hygiene management at personal level.

Role of State

1. RCH – II program need to be extended to urban area.

2. Appropriate Incinerator designs and Deep Burial Pits approved by the BIS have to be formulated and standardized norms to be prescribed.

3. Incorporate MHM inclusive (disability friendly) curriculum in prescribed for

Teacher Training courses (TTC, B. Ed., D. Ed.) 4. NRHM must take up the responsibility for installing Napkin Vending Machines in

public places such as Bus Stations and Railway Stations and public/community toilets – these machines could be termed as ATSN (All Time Sanitary Napkins)

5. Ensure availability of Hygiene Kits containing Napkins and Soaps in all educational institutions and government offices.

6. Provision of restrooms must be made mandatory in all UPS and HS.

7. All schools should have functional toilets with water supply with appropriate

Operation & Maintenance measures in place with a dedicated person for sanitation.

8. Involve local NGOs in TOT and other training sessions being organized at

various levels under the NRHM and RCH-II. 9. Budget will be released on the basis of expenditure against software component

of previous year budget on MHM of RCH II, SABALA and Rajiv Vidya mission 10. The Govt. must provide standardized training and communication material on

MHM and related issues (user-friendly form and in the vernacular language) that is customized for use by AASHA Workers, Anganwadi Workers and NGO functionaries.

11. Process of cross sharing of IEC material on MHM across all the concerned

departments and NGOs through setting up IEC Resource Centre either at WCD or NRHM

12. The Govt. must provide sufficient supply of Menstrual Management material at

the village/ward level at subsidized rate.

13. The Govt. level Steering Committee under RCH – II should have NGO with domain expertise as members.

14. Earmark separate funds for sanitation including Menstrual Hygiene in all educational institutions.

15. Separate funds proportionate to the population percentage of adolescent girls

must be drawn from the budget allotted to NRHM 16. Review the implementation of the RCH – II intervention at various functional

levels through Social Audit.

17. All govt. communication on Menstrual Hygiene Management must project it as a social issue and integrate this issue in awareness and training programs at all levels

18. NRHM must initiate R & D for development of eco-friendly and user friendly Menstrual Management products to be percolated down to RVM, SABLA, TSC, SSA and RCH II for implementation.

19. The Govt. must promote awareness on and access to eco-friendly options of

MHM and disseminate the same. 20. The government must enable access to Audited Reports and information on

budgetary allocations related to schools at central locations in the vernacular language with a view to transparency.

21. Best schools awards also incorporate Menstrual Hygiene Management as one of the criteria

22. Specific needs of specially abled women and girl children and needs of

emergency situations should be given focus on all Menstrual Hygiene programs

Role of NGO

1. Ensuring all hardware schemes related to Menstrual Hygiene Management are implemented effectively in intervention area, conduct assessments, social audits, etc. and provide necessary support to Govt for implementation of those components.

2. Train and orient Govt/ NGOs field workers on effective communication on MH to different stakeholders.

3. NGOs must collaborate with community organizations for effective implementation

of Menstrual Hygiene Management schemes in a participatory manner to review the designed schemes for necessary changes.

4. Train and orient community (men, women, adolescent boys and girls) on Menstrual

Hygiene Management issues and available schemes. 5. Design effective and context specific sustainable Menstrual Hygiene Management

models behavior change materials/ strategy/ processes for wider replication.

6. Participate in convergence and steering committee meetings at all level.

7. Ensure that all hardware schemes related to Menstrual Hygiene Management are implemented effectively in intervention area.

8. Conduct assessments, social audits, etc. and provide necessary support to the

government for implementation of hardware components. 9. NGOs must collaborate with community organizations for effective implementation

of Menstrual Hygiene Management schemes in a participatory manner 10. Design effective and context specific sustainable models and Behavioral Change

materials/strategy/processes for wider replication.

All three depts., keenly observed the recommendations, WCD said they are with NGOs

in implementing all the women and child development schemes in the state.

Responding to the recommendations Dr. Balaramaiah from NRMH said that the dept. is

now finalizing the steering committee at state level and he assured that he will

recommend to the govt. for NGO representation in the committee. He said from April

onwards the NRHM scheme is going to come in a big way especially in urban areas so

there is a definitely it is extended to urban areas. He also agreed to put forth our

demands like putting napkin vending machines in public transport places, involving local

NGOs in TOT and other training sessions being organized at various levels under the

NRHM and also cross sharing of IEC material etc,.

The organizers assured that the final recommendations along with the two days

documentation will be shared with concerned ministers and all departments for future

follow-up.

Two day proceedings concluded with Vote of Thanks.