Future Suggestions

from Surkhi- managing menstrual health in urban slums of India

Service Blueprint

SWOT Analysis

Strengths

# tapping into community culture # culturally appropriate # begins a conversation about menstruation #Collaboration between government and non-government sectors # Has the potential to be modified and adapted in different languages so it can be implemented in different parts of India

Weaknesses

# Interdependecnies and information could be misinterpreted # overburdening ASHA workers # Women may not show up or even if they do they might not use the trackers.

# Create hypochondriacs

Opportunities

# Not self-sustaining, relies heavily on funding

Threats

Future Suggestions

1) Scalability

This project can be scaled and adapted in different regional languages to implement in other slums across the country.

2) Experiential toolkit

The experiential tools can be developed further. By looking into other areas of menstruation and menstrual health management. There can be so variants: 1) a physical toolkit for women to learn at their own time and 2) a digital toolkit so that other developing communities over the world can adapt it to their audiences.

3) Hidden Women

Women like Roja (persona 3) that work multiple jobs and have several children have very limited touchpoints. These women are hidden and underserved. They ofen end up suffering in silence. For this, the scope of the service can be broadened by including Roja’s employers who are women belonging to middle and upper class communities. Not only will it help Roja but it will also help these women to fill the gaps in their knowledge about menstrual health.

4) Other non-government organizations

Not just Tata Trusts, the service can be implemented as a collaboration between the government and other organizations working in the Menstrual health and hygiene management sector. Corporates can also be roped in and this service can be a part of their CSR activities.

5) Data points for the government

The service can be used to conduct research and gather data and statistics on women’s menstrual health in India.

Image 57- Semi-permanent house in NBT Nagar slum

7. Reflections & Bibliography

Reflections

The past seven months have been challenging and thrilling at the same time. With every roadblock I encountered, my heart sank a little at first. I’d ask rhetorically, “Could it get any worse?”. To my despair it did get worse, so I stopped asking the question eventually. For a person that despises uncertainty and likes to have at least a loose plan, it was very difficult for me to deal with all the uncertainty COVID-19 brought to the project. In the initial few months, I would hit a slump with every roadblock but towards the end, I learned to take charge and pushed myself over the hurdles. This taught me a very valuable lesson as a designer- to put my stubbornness to good use and to tackle each problem head on and just PIVOT! I guess “embracing uncertainty” is not so bad aferall.

Apart from COVID-19, working on a topic like menstruation in India was a challenge in itself. It was heartbreaking to hear stories of so many women having to deal with trauma due to their menstrual illnesses just because no one would listen to them. It enraged me to think that a woman has to suffer just because her body is performing its functions. But this also motivated me to power through the difficult days. Afer the interviews, several women came back to me and thanked me for normalizing periods through the project, one of them even went to see a doctor afer pushing it off for months and was diagnosed with Polycystic Ovarian Syndrome (PCOS). As a victim of PCOS myself, I was relieved to find that she was finally getting the care she deserved. Women told me that this was the first time they had ever spoken about their periods in such detail- they were either too shy or no one ever bothered listening before. I thought if a small student project is able to create this impact, what would it be like on a large scale? I felt like I had the power to uplif other women around me. Conducting socially-distanced and online research was another challenge. Even though the response I received was overwhelming, I really missed seeing people's faces, catching their fleeting expressions and interacting with them in person. A sensitive topic like menstruation requires extra sensitivity and I was always afraid that the crackling internet connection or the fogging on my spectacles because of the mask was hindering that. It would have been great if I could work more closely with women in the slums and interact with them in their own environments - just sit under a tree and have a nice conversation whilst drinking tea from earthen cups.

Seven months of working alone has been difficult, even though I had support from my friends, I really missed the spirit of teamwork. Building on top of each other's ideas, exploring more avenues, learning from teammates and people with different skill sets. Having said this, afer working on a project of this scale on my own I feel confident and empowered to take on anything. However, I must learn to improve my organizational skills to survive on my own. *abandoned Trello Board glares at me*

The entire masters journey has been a wonderful adventure. One that I am always going to be grateful for. I didn’t get to spend time in London with my friends and classmates and learn in a studio. However, I feel everyone-from my tutors to classmates, did the best they could to recreate the studio set up and made the best of what we had.

Bibliography

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8. Appendix

Appendix 1- ASHA Training Manual

Background

2.1 What is Surkhi? Surkhi is a training programme for ASHA workers designed to impart Snowledge about menstrual health management to women living in slums. This programme is a collaboration between Tata Trusts and NUHM Telangana, India. During its initial stage, the programme will be launched in the slums of Hyderabad, India and will be delivered in regional languages such as Dakhni, Telugu, Urdu & Hindi. The programme has the potential to be adapted to different regional languages and launched in slums across the country.

2.2 Why this programme? The training programme offered by Surkhi is currently targeting married women in the age group of 20-35. Through the programme ASHA workers will be conducting fortnightly workshops that teach women about menstrual health through experiential tools. Afer the education stage, women are encouraged to track their periods on the Period Tracker Calendar designed by Surkhi. These women speak to the ASHA workers during the workshop in case they notice something abnormal with their bodies. The ASHA workers further guide them to seek help from the Primary Healthcare Clinics (PHC) that are located in every slum.

2.3 How do we promote menstrual health and hygiene? Experiential Tools Setting up a support system Education Tracking- actions for women afer these workshop Normalizing menstruation

2.4 Who Can do it?/Why ASHA? Menstrual health can only be promoted if more women start advocating for it. Since ASHA workers already reach out to expectant mothers and provide care, it’ll be easier for them to include menstrual health in the conversation. Seeing as menstrual health and reproductive health are interconnected. Moreover, ASHA workers are already in close contact with women in the slums. Making it easier for them to reach out to women. Community gatekeepers will be recruited by ASHA workers and this will help to get more women on board. Every community in India has “chatty women” that play the role of a real life agony aunt. Concerted efforts made by the ASHA workers and the community gatekeepers will help to bring about a change in attitude towards menstruation and menstrual health.

2.5 Who is this training for ? The training is for ASHA workers to help married women in the age group of 20-35 in urban slums of India to understand more about their menstrual health.

Note for the trainer

The purpose of this training is to broaden the scope of the ASHA workers to enable them to help women learn about their menstrual health and manage it effectively. Even though this training programme is designed to support ASHA workers they know the women best as they have access and connections within the community. Keeping this in mind, any modifications could be made on the field with regards to delivery of the information. However, all modification and changes must be recorded. It is important for trainers to keep the information cycle in check to ensure that misinformation is not being spread.

4.1 Training schedule The initial training will last for 4 weeks consisting of one hour sessions twice a week. Tentative training schedule: 10 mins- ice breakers 40 mins- training based on weekly curriculum 10 mins- Q and A

Afer the initial training is complete, ASHA workers will receive weekly training on the topic that will be covered in the workshops for women. For example, if the first week ASHA workers are going to teach women about why they menstruate, they will receive training from Surkhi on the knowledge that needs to be shared. Once the programme begins and ASHA workers begin to interact with women, there will be re-training based on the feedback gathered from the workshops.

4.2 Training checklist The trainers must make the following preparations before each training session: Secure space for the session, arranging schedule with local primary school All educational tools must be kept ready Feedback forms for ASHA workers to improve the training session

ASHA Roles and Responsibilities

1) Recruiting community gatekeepers- women that are popular in the community. Leveraging the community gatekeepers networks is a crucial step as it will help to bring more women onboard. 2) Being aware of menstrual health disorders to help other women out 3) Facilitating workshops and report to Surkhi workers afer each session 4) Being alert of women's reactions and ensuring that they have understood the facts. 5) Encouraging women to use the trackers and swatch cards to be more mindful of their symptoms. 6) Encouraging them to learn through experience. 7) Keeping a track of the participants progress and health 8) Guiding women to Primary healthcare clinics if they notice something abnormal 9) Create an atmosphere where sharing experiences is encouraged- women will relate and learn from each other

5.1 Key mindsets

1) Empathy: This will help women to feel more comfortable during the sessions Ask and listen 2) Encouraging women to speak up 3) Motivating them to use trackers 4) Understanding when they speak up about their menstrual health issues 5) Women must feel like they are in a safe space

Training sessions

6. Training Sessions

6.1 Week 1- Introduction Why this is important and how this is going to change their daily schedules and workflow Key tasks Selection of community gatekeepers Getting women on board

6.2 Week 2 Conducting Workshops How to conduct workshops Facilitation tips for workshops Possible questions women might ask and their answers

6.3 Week 3 Educational Tools How to best use the educational tools designed by Surkhi. Tool 1: Period Swatch Cards Objective: The objective of the period swatch cards is for women to understand what their menstrual blood signifies. Women can use these cards and inform the ASHA workers if they spot anything abnormal. These swatch cards will be used during the workshops facilitated by the ASHA workers.

Tool 2: Period Tracker Calendar Objective: For women to track their symptoms and be more aware of their menstrual cycles.

6.4 Week 4 Monitoring and Evaluation What needs to be tracked How to use tablets for digital documentation of feedback Grievance redressal- Guiding women with complaints

Workshop Ideas

Based on the feedback gathered from women and doctors, it was found that there is a lack of knowledge and misinformation about several factors related to menstrual health. Here are some of the topics that women have little to no knowledge about and would like to learn more about the same:

1) What is menstruation 2) How to calculate the length of the menstrual cycle 3) What is PMS and how to manage its symptoms 4) How much bleeding is ok? 5) What does the colour of your blood signify? 6) What is vaginal discharge? How to tell if there’s something unusual? 7) How to dispose of menstrual products? 8) How to sanitize reusable menstrual products? 9) What kind of menstrual products are available to them? 10) DI makeshif menstrual products for emergencies 11) How to manage painful periods? 12) What kind of food are good during periods? 13) What kind of exercises help during periods? 14) Common myths and taboos

ASHA workers can be trained by professionals like doctors to conduct workshops for women on these topics in the future.

Appendix 3- Swatch Cards

SURKHi

My red friend

SWATCH CARD

Instructions: 1) Ask women to identify the colour of the bleeding. 2) If answer is no need for action. 3a) If answer is , check for ! other symptoms like excessive bleeding, fever, pains etc. 3b) Report to supervisor

CLEAR -Healthy discharge -Pregnancy -Ovulation -Hormonal imbalance