The government must ensure affordable and easy access to sanitary products in remote areas so that adolescents can be healthy and live with a sense of freedom

Women and young girls are resorting to the use of the cloth during their menstruation in Muzaffarpur District, 22 km away from the state of Bihar. While the government provides sanitary napkins to encourage the hygienic use of pads, most women are unaware of the use of the product. “Menstruation causes a lot of problems. I experience itching due to the use of cloth,” said 15-year-old Rani. She can't participate in school activities during her period and even after returning from school, she remains inactive, she added.

According to a study conducted by the Population Research Centre (PRC) of Patna University on 'Menstrual health and hygiene among adolescent girls in climatic vulnerable regions’, about 40% of the rural adolescent girls in Bihar use cloth instead of sanitary napkins during their menstruation and at least 5% of them are not allowed to take bath during their period.

The study further reveals that even among the girls who use sanitary napkins, 90 have not received any government-supplied napkins in the recent past. Further, due to the lack of awareness, even among the girls who use sanitary napkins, 67% of the girls throw the used napkins in open areas. The majority of the girls expressed problems related to privacy, shyness and hesitation about open defecation during menstruation. Some girls said they use neighbours’ or relatives' toilets during menstruation.

16-year-old Radha says that her mother gives her a cloth during menstruation as sanitary pads are unknown to her family. The use of dirty cloth has caused her to suffer from white discharge (leucorrhea). “I am too embarrassed to talk to anyone about it,” she added.

The girls in the village's primary school also revealed that they do not receive money for sanitary pads from the government. “I have never used a pad,” said 15-year-old Kajal Kumari. But she also has trouble wearing cloth, she added. The walk from her school to her home takes half an hour. During menstruation, blood stains her cloth, and she feels dirty the entire way back. Eventually, she stopped going to school during her periods.

The ASHA worker of the area, Mira Devi, revealed that the Health Department does not provide sanitary pads for menstruation for girls. The girls have no knowledge about hygiene and treatment during menstruation. Most of them need regular iron supplements to prevent anaemia. Mira Devi also added that due to the concerned authority’s inaction, women and girls in the area are forced to seek private clinics for health problems. Economically weaker women and girls, therefore, have no option but to live without treatment.

It is imperative that the Ministry of Health and Family Welfare increase awareness among adolescent girls, improve the availability and use of high-quality sanitary napkins, and promote environmentally friendly napkin production. Since 2011, menstrual hygiene has been enforced under various government initiatives such as the Swachh Bharat Abhiyan, Sabla Program, and National Rural Livelihood Mission.

But still, about 50 per cent of women aged 15-24 years use cloth for menstrual protection, according to the latest National Family Health Survey (NFHS) report, with experts attributing it to a lack of awareness and taboo existing around menstruation. The lowest percentage of women use a hygienic method of menstrual protection in Bihar (59 per cent). Women from the lowest wealth quintile are about 3.3 times more likely to use cloth than women from the highest wealth quintile. Thus, social background often determines access to proper menstrual hygiene. The same report also stated that on exposure to infections due to unhygienic menstrual practices, “Many studies have shown reproductive tract infections like bacterial vaginosis or urinary tract infections (UTI) could occur which eventually become pelvic infections.”

As these infections can travel up to the pelvis, they can cause difficulties in getting pregnant or pregnancy complications like preterm labour (resulting in premature birth), the report also mentioned. “Besides, poor hygiene can increase cervical cancer risks in the long-run, as one of the risk factors for this cancer is poor local hygiene,” it added.

Along with authorities, teachers, assistant nurses, ASHA workers, and Anganwadi workers are responsible for spreading awareness under the Rashtriya Kishor Swasthya Karyakram (RKSK). Mission Shakti also aims to raise awareness about menstrual hygiene, the problem of periods, and the use of napkins as part of the "Beti Bachao Beti Padhao" campaign. For menstrual hygiene, the Indian government should provide free period products in all schools, colleges, and public places restrooms. In rural areas, all Anganwadi centres and schools should provide napkins for free. In areas where there are no Jan Aushadhi centres, ASHA didis, PHCs, and panchayat offices should also provide napkins for free or at affordable prices.

(The author is from Bihar and writes on rural and gender issues, views are personal. Charkha features)