Covid-19 pandemic has demonstrated that menstrual hygiene is a multifaceted challenge in India

Every year on May 28, governments, NGOs and the media come together to celebrate World Menstrual Hygiene Day – a global event aimed at promoting the importance of safe menstrual hygiene management. But for millions of women across the world, the past year has made it more difficult than ever to safely manage their periods.

When India first went into a countrywide lockdown in March 2020, there were widespread reports of a “sanitary-pad crisis”. As sanitary pads were not included in the government’s list of essential items, pharmacies and supermarkets began to quickly run out of stocks. Although they were eventually added to the list of the essential items, a number of barriers to accessing sanitary products remain.

Schools that play a central role in distributing pads to young girls have remained shut for much of the past year and on-and-off lockdowns have made it difficult for those outside of cities to stock up on pads.

Women in villages often have to travel to the nearest town to purchase sanitary products. When movement outside of their village becomes restricted, they switch to homemade solutions such as cloth rags. Indeed, even where travel is permitted, the added financial stress that many families are experiencing means that sanitary products are deprioritised in favour of other essentials such as food.

Not just products

Although access to period products has received the most attention, it is just the tip of the iceberg when it comes to the impact of the pandemic on menstrual hygiene. Aside from being a distribution hub for much-needed sanitary pads, schools are information centres, the only space where young people are taught about puberty, their health and their bodies. School closures have meant that an entire generation of students has missed out on critical education regarding menstrual hygiene management.

“During a lockdown, schools, community centres and other places where girls usually get access to information are no longer available,” explained Mariana Lopez, a UK-based researcher on gender equality. “This means that those who do not have access to the internet or to other sources of reliable information are left with no way to understand what is going on with their bodies when they begin menstruating, and what the best practices are to manage their periods.”

United Nations Children’s Emergency Fund estimates that over 15 lakh schools have closed in India due to the pandemic, impacting nearly 25 crore children.

While NGOs have tried to step in with online courses, these have had very limited impact due to poor access to technology. Project Devi, a Bangalore-based initiative focused on menstrual education for young girls, attempted to run online sessions but faced resistance from parents.

“If a family owns just one internet-enabled device, they are unlikely to prioritise a menstrual health session for their children,” said Malavika Nair, Founder of Project Devi. “As a result, there has been a worrying gap in learning. Many girls have started their period without knowing what is happening to them.”

It is not only young girls who have been impacted by a lack of reliable information sources. Research has shown that lifestyle changes caused by the pandemic, together with a rise in anxiety and stress, have altered the length and variability of menstrual cycles for women of different ages. Prior to the pandemic, the proportion of people in India who visited gynaecologists was low. Now it is now even lower as the healthcare system is overwhelmed by coronavirus cases. Those experiencing changes in their menstrual cycles are thus left clueless about what these changes mean and how to adapt to them.

Worryingly, this lack of access to accurate information has been accompanied by a social media-fueled rise in misinformation regarding menstrual health. Last month, when vaccinations for the 18 years-45 years age group were announced in India, a Whatsapp forward telling women not to get vaccinated for five days before and after their period due to “lower immunity” went viral. Considering that the average menstrual period is 5 days, this means that women were being advised that for 15 days out of every month, it was unsafe for them to take the vaccine.

Although there is no scientific basis for this claim and several websites published fact-checking stories, such misleading guidance can have a tremendous impact. Not only does it contribute to vaccine scepticism at a time when there is a desperate need for the population to get vaccinated, it also perpetuates the outdated and patriarchal belief that menstruating women are tainted and cannot participate in essential activities.

Impact on frontline workers

While misinformation about periods has threatened to jeopardise vaccination efforts for the broader public, healthcare workers have complained that it has been hugely challenging for them to manage their own periods whilst working round-the-clock in critical care wards.

Dr Pravallika Vellanki, a gynecologist from Gulbarga Institute of Medical Sciences, explained the challenges she and her colleagues face when forced to wear a personal protective equipment suit while menstruating. “Wearing a PPE suit during eight-hour shifts is uncomfortable enough – but having to remove it every few hours to change sanitary products is extremely challenging,” Vellanki said. “It is an added anxiety that makes it difficult for us to perform our jobs.” Vellanki added that she overcame this challenge by using a reusable menstrual cup, which can be worn for longer than sanitary pads – but not all health workers have access to alternatives such as cups.

Unlike healthcare workers who have struggled to manage periods whilst wearing PPE, another category of frontline worker – waste workers – have had the opposite problem. Those who are responsible for cleaning, sorting and segregating our sanitary waste have been given inadequate protection in the form of gloves and masks.

Their job involves having to handle and pick apart soiled sanitary pads, which in itself exposes them to harmful bacteria. Inadequate PPE means that they are now also at greater risk of contracting coronavirus. Indeed, a worrying number of waste and sanitation workers have tested positive for Covid-19, with some tragically dying from the disease.

Road ahead

The Covid-19 pandemic has been devastating in ways that we could never expect. At the same time, it has provided an opportunity for reflection on how to build communities that are safer, healthier and more resilient.

Safe menstrual hygiene management must be a crucial part of our recovery efforts – not only because having a healthy period should be regarded as a fundamental right, but also because it has the potential to fuel women’s economic participation and promote gender equality.

Prior to the pandemic, efforts to promote menstrual hygiene focused primarily on the distribution of sanitary pads. But the pandemic has demonstrated that menstrual hygiene is a complex and multi-faceted challenge.

In addition to the affordability and supply of products, we must take into account access to knowledge and education, the spread of misinformation via social media and the downstream impacts of sanitary waste. We now have an opportunity to revise our approach to incorporate all of these factors, and to combat stigmas and unsafe practices that have persisted for too long.

Ira Guha is the founder of Asan, a social enterprise with a mission to eradicate period poverty.

May 28 is World Menstrual Hygiene Day.