A Reminder: Periods Don't Stop During a Pandemic

Women in this country, already reeling from a lack of infrastructure to practice menstrual hygiene, are now in even deeper trouble.

In India, the lockdown and its extension impacts access to menstrual hygiene products and the ability to maintain hygiene during periods in privacy and with dignity for millions of girls and women. 

The past decade has seen efforts by government of India (both at the centre and states) and NGOs in creating greater awareness about menstrual hygiene and safe practices, particularly among adolescent girls.

Access to sanitary pads in India has increased significantly during this period, in both rural and urban locations, owing to the efforts of the government, established companies (like Johnson & Johnson, and Procter & Gamble), new entrants (like Niine), entrepreneurs (like Aakar Innovations, and Carmesi), and self-help groups under the National Rural Livelihoods Mission.

Cost barriers have reduced with low cost variants more widely available through local production, free distribution, and subsidised prices. 

Starting March 24, 2020, access to these essential items was curtailed for millions in the country for the duration of the 21-day lockdown. Production and distribution of sanitary pads was stopped or slowed down significantly, as shared by several entrepreneurs who run small and mid-sized production companies. Sanitary pads were included as essential items eligible for supply chain operations only on March 30, 2020, leading to stockouts of products in some locations.

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Girls and women with limited mobility to purchase sanitary pads, are left without a choice, until supply chains are restored fully. Production by small scale units, SHGs and federations, are severely affected, without workers and restricted movement of goods and raw materials.

Small-scale production units are also faced with working capital constraints as operations are paused, impacting their ability to tide over this period. 

Girls and women dependent on free or subsidised supplies from schools, anganwadis and SHGs find themselves cut off for at least a month, if not longer.

For low-income households and those the informal sector and daily wage workers who have lost their livelihoods, affordability comes to the forefront again, with families struggling to purchase enough pads for regular users in the family. Anecdotal evidence suggests that limited availability of sanitary pads may unreasonably escalate prices in some areas, and consequently keep these products out of reach for those most in need.

In relief camps and shelters where food and water are of primary concern, and in quarantine and isolation facilities where testing kits and essential medicines are the necessity, menstrual products for women are not considered an essential item.

Female migrants on the road and women in quarantine or isolation facilities may experience discrimination and stigma more acutely owing to their menses.  

Women and girls may use their menstrual products for longer than recommended, or turn to unhygienic alternatives such as old cloth or rags. 

Irrespective of what is used, changing menstrual products regularly, washing reusable cloth pads, cleaning the body, and disposing of used materials, is now more challenging than usual. In slums, where many are dependent on community toilets, social distancing measures and mobility restrictions makes it difficult for girls and women to use toilets as frequently as they need to during their period.

In rural areas, procuring additional water for washing related needs during menstruation may be a barrier. Privacy to change materials frequently and to discard them is impinged upon for urban and rural residents alike.

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For women migrants, managing periods on the long and tough road home without access to any type of amenity is an unimaginable difficulty. 

Limited availability of menstrual hygiene products and inability to maintain hygiene can affect the health of menstruators adversely. Strikingly, poor and affluent women alike, express anxiety over limited supplies for themselves and female family members.

Menstrual materials are worn for longer than they should be, simply to extend availability of limited stock to deal with restricted mobility, increasing the risk of reproductive tract infections (RTI). Reusable cloth pads, while a good alternative, may not be washed and dried thoroughly due to paucity of water and privacy, posing additional risks for infections.

Women do not seek required healthcare for RTIs even under normal circumstances. With non-essential health services curtailed and frontline health workers focused on the pandemic response activities, RTI symptoms resulting from poor menstrual hygiene are likely to go unaddressed. Hence, action for ensuring access to safe menstrual products and information on menstrual hygiene are critical.

Four simple and essential sets of actions can enable women and girls to manage their periods hygienically within their constrained settings:

Firstly, access to essential menstrual products must be eased through private and public sector channels. Large scale manufacturers must facilitate supply to shops and medical stores, equitably across geographies, and ensure that retail prices are well within MRP limits.

State governments can aggregate and release product stocks through district administrations. District officials can facilitate access at the last mile through frontline workers (ANMs, ASHAs, anganwadi workers), SHGs, community volunteers and groups, and NGOs working with communities. 

Secondly, for girls and women who are unable to access disposable sanitary pads in required numbers, information on making, using and maintaining homemade cloth pads safely is critical. Organisations like Jatan Sansthan provide detailed guidance on homemade cloth pads and their hygienic maintenance. 

Thirdly, sanitary pads and underwear must be made available in isolation and quarantine facilities. Separate and safe toilets for women in these facilities, with sufficient water must be established. Dustbins for immediate disposal, and downstream management of menstrual waste from the facilities are also necessary.

Lastly, information on hygienic use of disposable and reusable menstrual products is needed. Messaging on storing water for washing and maintaining personal hygiene and hygienic maintenance of both disposable and reusable products is needed. 

In times of crisis, the reproductive health and rights of women and girls are often neglected and, worse, threatened. Indian policymakers have made important strides in ensuring safe and dignified menstruation for girls and women, and must continue their efforts at this time.

This will help minimise the adverse health impact of poor menstrual hygiene for millions in the country.  

Arundati Muralidharan, of WaterAid India, and Tanya Mahajan of Development Solutions, coordinate Menstrual Health Alliance India.