Since the announcement of the lockdown, Babita has been sleeping and waking up outside a school, anxiously longing for one person to arrange a way for her to go back home. She walked a few kilometres with her family and a group of about 150 people, but frequent police interactions and districts with sealed borders made the group stop in Phalodi, Rajasthan. The government arranged for them to stay at a school.
There isn’t, however, much room at the school, and a large part of the group is sleeping outside the school, in tents, or under the open sky.
Menstrual Hygiene Management Often Not Given Priority
15-year-old Babita is from Jhansi. She came to Phalodi for work, but this unprecedented lockdown has her hustling for the most basic of needs. She got her periods five days ago, and is using ash smeared on pieces of cloth she’s tearing from the three sets of clothes she had. She said, “Bahar sote hain, baarish hoti hai tab bhi, kapde dhoke vahi pehen rahi hun.” (We sleep outside even when it rains, I wash the clothes when the blood leaks, so I can wear the same clothes again.)
Speaking to The Quint, Sub Divisional Magistrate of Phalodi, Yashpal Ahuja, he said, “The school is large enough, now amid a pandemic our attention was focussed on just getting them a place, if you’re saying they are out in the rain we will look into it.”
During the lockdown, official notice of essential services and goods was only recently extended to incorporate sanitary napkin processing. However, accessibility problems that young girls encounter — given the restricted supply of goods and their accessibility restrictions — are still being neglected.
Menstrual hygiene management (MHM) is often not given sufficient priority – and more so during crises and disasters.
Adolescent girls and women among migrant workers in India have been encountering enormous difficulties whilst living in lockdown. Since the extension of the lockdown, supply of essentials including sanitary items has been affected, particularly because it was not previously counted among essential goods.
Resorting to Unsafe Menstrual Practices Due to Lack of Access
Babita and many women like her, tend to use alternative and unsafe measures to deal with menstruation when not provided with proper sanitary napkins. No access to menstrual hygiene is the fifth biggest killer of women in the world. A leading cause of infections, both urinary and vaginal, cervical cancer and removal of reproductive tracts. Bad MHM leads to a variety of infections — which are then ignored due to many factors such as the stigmatisation of menstrual health, negligence from healthcare in rural areas, and misdiagnosis.
Ananya Chhaochharia, the founder of Paint it Red, is part of the initiative Bleed in Peace, which distributes cloth pads to women from marginalised sections across India to ensure accessibility. Her endeavour covers West Bengal, Delhi-NCR, Telangana, Tamil Nadu, Assam, and Karnataka.
“We are facing a huge health risk that comes from limiting the production of sanitary products. Women’s menstruation needs to come way below the hierarchy of Roti-Kapda-Makaan (food, clothes, shelter), and hence, it is difficult for women from such backgrounds to ration their income into their food needs and menstrual needs. Menstrual health should be a priority for the government, and a gendered view should be pandered to.”Ananya Chhaochharia, Founder, ‘Paint it Red’
Pregnant And Sleeping Out In the Rain
Babita’s sister-in-law and aunt are pregnant. They sleep outside, in makeshift tents, and sometimes outside in the rain. A pregnant woman so late into her pregnancy should not be treated with such abject apathy. Urmila, Babita’s sister-in-law says, “It’s very cold outside in the rain. But I sleep close to the fire so nothing happens to me and my baby.”
Babita’s aunt is older, and hence has obvious risks associated with her pregnancy – and by sleeping in the rain, she risks her health even more. Government intervention, in this case, becomes essential.
Despite strides in past decades toward minimising maternal mortality, India constitutes one-fifth of all maternal deaths.
That is more than any other neighbouring country, at 45,000 deaths in 2015 (World Bank 2015a). India's maternal mortality rate (MMR) was 174 per 1 million live births in 2015 (World Bank 2015b).
Women giving birth in hospitals often have a better delivery atmosphere than women giving birth at home, and given information to help avoid infection post-delivery. Sepsis, or fever, are leading causes of maternal mortality in India, and are further related to multiple morbidities (Hussein et al 2011; NHP 2016).
Inaccessibility to Reproductive Healthcare
Babita also says her mother and younger sister are feeling sick. It is this inaccessibility to healthcare that is most common among marginalised women.
It is common to see inadequate access to much-needed maternal healthcare for women during pandemics, when only the most basic healthcare needs are addressed. Pre-existing gender disparity leaves women and girls disproportionately vulnerable in these emergencies, increasing the burden of healthcare. A gendered approach, therefore, is of utmost necessity, especially in concentrated informal settlements, to satisfy the specific needs of critical WATSAN (Water and Sanitation) services.
In the early hours of 14 April, a migrant woman delivered her child on a street, across from a Bengaluru dental clinic.
Dr Ramya Himanish, who owns the dental clinic, had to aid her delivery. If she wasn’t there, there could have been severe consequences that stem from unsafe deliveries.
Yashpal Ahuja said, “We will surely make arrangements for pregnant women. It was not pointed out to us before.” This also points to lack of women in the political scenario; as decision-makers, women should be better equipped to deal with issues such as menstruation and maternity care, as it is important to them. To men, usually, it doesn’t seem to be a priority.
Sanitary Napkins Fall Under Essentials
Maternal deaths in India are largely preventable. These are attributed, according to the World Bank, to a lack of proper treatment during pregnancy and childbirth, and insufficient facilities to detect and treat complications. The national survey showed that the women who failed to seek care tended to be older (ages 35 to 49), with a high number of previous pregnancies, and to be illiterate and socioeconomically disadvantaged.
Kanti, an Adivasi woman walking back from Jaisalmer, Rajasthan to Sheopur, Madhya Pradesh, says she has been using ashes nowadays, and she cannot let the men find out or she will be made to walk in a separate group, and she is scared.
Female migrants and women in rural areas may encounter more severe discrimination and stigma due to menstruation.
Women and girls may be keeping their menstrual items longer than usual, or changing to unhygienic substitutes such as ashes, soil, old cloth or rug.
On 30 March, the Women and Child Development Ministry notified that sanitary napkins fall under essentials. However, unclear notifications lead to confusion, and a disruption of these services has resulted in a low supply of sanitary products.
‘Sanitary Napkins Must Be Distributed For Free At Relief Camps’
“Sanitary napkins should be distributed for free to ensure accessibility, medical expenses must be borne, and doctors should be sent at all the relief sites to ensure that these women's health is not ignored. Longer-term solutions could include quality, affordable and accessible products. Women must be able to access such products, and penetration of these products should be deep into the market — unaffected by the urban-rural divide of the country,” Chhaochharia says.
“The government must resume production of sanitary products, and should come up with alternatives to be distributed to women in relief centres, in hospitals, at homes. Migrant women, sex workers, transgender groups, DBA women, lower-income strata women must be tended to at once because their needs are often the ones neglected,” she adds.
There should be direct beneficiary transfers to women who are often more vulnerable to crises.
Women who don’t have themselves registered under government schemes like ‘Matru Vandana Yojana’ that provides maternity benefits should also be given these benefits in a crisis like this.
De-Prioritising Maternal Healthcare Will Lead to Disaster
Maternal healthcare also requires access to nutrition/food, maternal entitlements through schemes like ‘Janani Suraksha Yojana’ / ‘Janani Shishu Suraksha Karyakaram’ and others.
Although some disparities in the unconditional implementation of these entitlements have been identified time and again, they must be maintained without question in the light of the social and economic effects of the global health crises, such as the ongoing pandemic, health care and allied resources.
From Urmila and her aunt’s experience, we can be sure that the deep-seated inequalities and impoverishments based on caste, class, sexuality, gender become more evident in times of crisis.
Rendering maternal wellbeing and other SRH issues as a 'lesser priority zone' in the rush to address the pandemic is likely to have wide-ranging implications for health. Reproductive health services, as well as other SRH healthcare, should be recognised as essential services, and uncompromising access should be part of the State's pandemic response.
(Suchitra is a freelance journalist focussing on governance and social justice, primarily gender justice. She tweets @Suchitrawrites. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for the same.)