India’s Women, Mainly in Bihar, Undergoing Menstrual ‘Revolution’

The Indian government has recently released the factsheet for 17 states and 5 UTs from the National Family Health Survey-5 (NFHS-5), including multiple indicators for women empowerment. One such factor was “women aged 15-24 who use hygienic methods of protection during their menstrual period”.Women use local or commercial sanitary napkins, menstrual cups, tampons during their periods to control the blood flow. These items are called sanitary items.As a part of this study, we are reviewing and understanding the changes in the sanitary item usage from National Family Health Survey-4 (NFHS-4) to National Family Health Survey-5 (NFHS-5) and the factors driving these changes.Shoddy Sanitary Napkins Impact Menstrual Hygiene DriveWomen in Bihar Are Experiencing a ‘Revolution’All the states and union territories have shown an increase in sanitary item usage. Figure 1 shows the percentage of women using sanitary items as captured in NFHS-4 and NFHS-5 surveys. Eight states and UTs, including Andaman and Nicobar Islands, Lakshadweep, Goa, Dadra and Nagra Haveli, Mizoram, Kerala, Telangana, and Himachal Pradesh, had 90% or more women using sanitary items. In contrast, Tripura, Assam, Gujarat, Meghalaya, and Bihar had less than 70% of women using sanitary items.A closer look at these numbers shows that the highest gainer (percentage increase in the sanitary item usage from NFHS4 to NFHS5) was Bihar (90%). It was followed by Tripura (58%), West Bengal (51%), Dadra & Nagra Haveli (51%) and Assam (48%).While Bihar scores the lowest on sanitary items usage among all the 22 States and UTs, it has shown the highest percentage increase (almost double) in sanitary items. Similarly, Assam and Tripura, which rank second lowest and fifth-lowest, showed a higher percentage increase in sanitary item usage.Next, we take a closer look at these states among the urban and rural population in the recently released NFHS-5.All Lakshadweep Women Use Sanitary ProductsFigure 2 shows the percentage of women using sanitary items in urban and rural areas. Eleven states, including Andaman and Nicobar Islands, Lakshadweep, Himachal Pradesh, Goa, Telangana, Kerala, Mizoram, West Bengal, Dadra & Nagra Haveli, Karnataka, and Maharashtra, had 90% or more women using sanitary items in the urban areas. 75% or more women in the urban areas across all the States and UTs use sanitary items.Among the rural areas, only seven states and UTs, including Andaman and Nicobar Islands, Lakshadweep, Himachal Pradesh, Goa, Telangana, Kerala, Mizoram, and Dadra & Nagra Haveli, had 90% or more women using sanitary items. In contrast, Jammu & Kashmir, Tripura, Assam, Meghalaya, Gujarat, and Bihar had 70% or lesser women using sanitary items. Lakshadweep was a big standout with all the women using sanitary items in rural areas.Rural-Urban Divide in Menstrual HygieneTo analyse these numbers further, we have used Figure 3 and Figure 4 to show the percentage increase in the sanitary item usage from NFHS-4 to NFHS-5 in the urban and rural areas. Tripura and Bihar lie in the bottom pyramid for sanitary item usage, and they’ve shown the highest percentage increase in sanitary item usage in urban and rural areas.Bihar specifically had almost twice the number of women in rural areas now using sanitary items as compared to the numbers reported in NFHS-4. Other states with remarkable percentage increase (greater than 50%) in the usage of the sanitary item in rural areas were West Bengal (73%), Dadra & Nagra Haveli (65%), and Assam (52%).The most significant contribution to this upward trend is the higher usage of sanitary items in rural areas. Only seven states, i.e., Andaman & Nicobar Islands, Himachal Pradesh, Sikkim, Kerala, Lakshadweep, Meghalaya, and Mizoram, had a ten percent (or lower) increase in the sanitary item usage. Six of these states/UTs already had a higher percentage of women (>80%) in the rural areas using sanitary items, and hence, the percentage increment was less.Why Are More Women Using Sanitary Products Now?Two significant issues in the lower usage of sanitary items are lack of awareness and accessibility. A meta-analysis study was conducted using data from 138 studies and 97,070 adolescent girls in India, which found that one in two girls are not aware of menarche unless they attain it.Thus, they fail to understand the biological process of menstruation and choose unhygienic alternatives, including old clothes, rags, etc. Since menstruation is taboo, most women, especially in rural areas, feel shy about going to the medical pharmacies to buy sanitary items.Keeping these critical factors in mind, the government started various schemes to improve sanitary item usage among menstruators, especially in rural areas. Some of these schemes are Beti Bachao Beti Padhao, Swachh Bharat Swachh Vidyalaya, MHM Scheme under NHM. These schemes have collectively helped in improving the sanitary item's usage.For instance, Beti Bachao Beti Padhao helped reduce the dropouts by ensuring girl friendly WASH facilities in the school via Swachh Bharat Swachh Vidyalaya. Furthermore, MHM Scheme under NHM was started to increase the awareness level among the adolescent girls, ensuring availability and accessibility of sanitary napkins (6 pads for Rs 6) in rural areas, providing disposable facilities for the sanitary napkins. These schemes helped empower the girls by reducing gender inequality, making them aware of various sanitary items, and giving them a choice to choose their products.How Bihar and West Bengal Governments Are Acing the Period GameGirls miss around 20 percent of their school days during menstruation. To improve these numbers, the state governments in Bihar and West Bengal started distributing sanitary items, with the support of self-help groups, in the middle and high-income schools.Bihar’s Bicycle program improved girls' enrolment level by 32 percent. In 2013, Kanyashree Prakapla Scheme was launched in West Bengal to uplift the girl child by helping the families from economically weaker sections and drop out due to severe economic conditions.These various schemes together led to girls’ higher educational level, which further helps them understand their body’s anatomy and thus, opting for hygienic alternatives to clothes.However, since phase-II data will be collected after the pandemic and lockdown, one may expect the situation to worsen in the remaining states, which are already at the bottom of the pyramid among the sanitary item usage. The real test of such schemes happens in exceptional situations like the recent lockdown.While the full data helps us in getting a clear and better understanding, it cannot be denied that multiple initiatives by the central and state government have potentially shown a tremendous improvement in the usage of sanitary items.Improvement in the sanitary item usage results from multiple indicators, including various socio-demographic factors to multiple interventions by the state government. Hence, we should wait to reach a conclusion (purely based on the numbers of Phase-I) unless the government does not release the Pan India numbers along with the raw data.(Karan Babbar is a PhD scholar at IIM Ahmedabad. This is an opinion piece, and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)

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India’s Women, Mainly in Bihar, Undergoing Menstrual ‘Revolution’

India’s latest National Family Health Survey data shows great impact of governments’ thrust on menstrual health.

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Topics: Women West Bengal Bihar