Potential States for intervention of MHM Introduction Effective Menstrual Hygiene Management is vital to the health, well-being, dignity, empowerment, mobility and productivity of pre-menopausal adult women and adolescent girls. Victims of poor MHM in developing countries like India are mostly poor women of both rural and slum. Certain socio-economic issues with which the poor women deal with will lead to poor MHM. Menstruation is a natural process; however, if not properly managed it can result in health problems, school absenteeism and increased school drop-out rates among adolescent girls, poor performance of work and difficulty in performing physical work. The impact of poor menstrual hygiene on the psychosocial wellbeing of women and girls like stress levels, fear and embarrassment, and social exclusion during menstruation should also be taken into account. India is said to have approximately 355 million 1menstruating women and out of which 113 million 2 adolescent girls are particularly vulnerable at the onset of menarche. According to National Sample Survey Office/Census (2012) and Pratham (2014) Annual Status of Education Report (Rural), 2013, out of 14,724 government schools only 53% had a separate and usable girl’s toilet. This is directly affects MHM of adolescent girls and will lead to absenteeism. In a study carried out by Nielsen on behalf of UNICEF in rural areas of Bihar and Jharkhand, one of the findings was 93% of girls missed 12 days of school on an average every month. Inadequate menstrual protection make adolescent girls aged between 5 and 12 miss out on classes and about 33% of these children will even drop out of schools according to the a survey conducted by Neilson on 1033 women. A study done by A.C Nielson and Plan India, reveal that only 12% of India’s menstruating women use sanitary napkins. Over 88% resort to shocking alternatives such as unsanitised cloth, ash and husk sand. Incidents of urinary tract infection are 70% higher in these women. Poor menstrual hygiene is considered to be one of the main reasons for the high prevalence of STIs and RTIs in the country. Several studies show the presence of Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs) being high in Indian states. The prevalence of RTIs and STIs in women (15–44 years old) in India increased by 26% and in Odisha by 126% between 1998–99 and 2002–04 (reported in the two rounds of District Level Household Survey—Reproductive and Child Health (DLHS-RCH)). A study conducted to determine the prevalence of community acquired-UTI in rural Odisha showed that prevalence of UTI in females was 45.2%. 3 The biggest barrier to the usage of sanitary napkin is affordability in the developing countries like India. About 70% of women in India say that they cannot afford to buy them and would rather spend the money on something more useful. In a survey conducted by Neilson on 1033 women, in North 1 ‘Preferred menstrual absorbents, awareness and hygiene practices during mensuration amongst women in chennai, india’, Dr. Afrose Fathima Farid, International Journal of Science, Engineering and Technology Research (IJSETR) Volume 5, Issue 5, May 2016
2 ‘Menstrual Hygiene Management – National Guidelines (India)’, Ministry of Drinking Water and Sanitation – Government of India, December 2015.
India alone 33% dropped out of school due to menstruation. Hygiene is lowest in eastern India with 83% women stating they cannot afford sanitary napkins. 75% women also lack of awareness on menstrual hygiene. While poverty is an important barrier to positive health outcomes for both men and women, poverty tends to yield a higher burden on women and girls’ health.
Analysis of development indicators If we consider the development indicators like Human Development Index, Life Expectancy at birth, Per capita income, and General Literacy Rate and Female Literacy Rate states like Rajastan, Uttar Pradesh, Jharkand, Madhya Pradesh and Odisha stands in the bottom of the table. Human Development Index of 2007-2008 by UNDP reveals that the above mentioned states pulled national average HDI down. Life Expectancy at Birth in all these five states is lower than the national average. Sex ratio and Female literacy rate, which gives insight to gender parity is also lesser than the standard and national average in all the states except Odisha and Jharkhand that is slightly better. Female literacy rate is much lower than the national average rate. General Literacy Rate is far lesser than the national average and all the five states get ranks after 25.
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‘Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India’, Padma Das, Kelly K.
Baker, Ambarish Dutta, Tapoja Swain, Sunita Sahoo, Bhabani Sankar Das, Bijay Panda, Arati Nayak, Mary Bara, Bibiana Bilung, Pravas Ranjan Mishra, Pinaki Panigrahi, Sandy Cairncross, and Belen Torondel
Table 1 World Development Indicators of Rajastan, Uttar Pradesh, Jharkand, Madhya Pradesh and Odisha
Particulars
HDI (20072008)
National average
0.513
Rajasthan Uttar Pradesh Jharkhand Madhya Pradesh Odisha
0.434 0.38 0.376 0.375 0.362
Rank
17 18 19 20 22
Life expectancy at birth
Rank
NSDP capita (INR at Current Rank prices)1415
67.9
_
_
_
945
67.7 64.1 66.6 64.2 65.8
15 20 16 19 17
72156 40373 52147 59770 59229
23 32 29 28 27
923 908 950 920 987
SexRatio
Rank
Literacy rateGeneral
Rank
74.04 30 29 31 24 21
66.11 67.68 66.41 69.32 72.87
Female literacy rate
Rank
72.89 33 29 32 28 25
52.12 57.18 55.42 59.24 64.01
34 31 33 28 26
Above table clearly indicates that the states like Rajasthan, Uttar Pradesh, Jharkhand, Madhya Pradesh and Odisha certainly needs an intervention in MHM.
References and Bibliography 1. ‘Preferred menstrual absorbents, awareness and hygiene practices during mensuration amongst women in chennai’, India, Dr. Afrose Fathima Farid, International Journal of Science, Engineering and Technology Research (IJSETR) Volume 5, Issue 5, May 2016.
2. ‘Menstrual Hygiene Management – National Guidelines (India)’, Ministry of Drinking Water and Sanitation – Government of India, December 2015.
3. ‘Why India Doesn't Need The Sanitary Napkin Revolution’, Sinu Joseph, July 19, 2015. 4. ‘Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India’, Padma Das, Kelly K. Baker, Ambarish Dutta, Tapoja Swain, Sunita Sahoo, Bhabani Sankar Das, Bijay Panda, Arati Nayak, Mary Bara, Bibiana Bilung, Pravas Ranjan Mishra, Pinaki Panigrahi, Sandy Cairncross, and Belen Torondel
5. ‘Puberty rituals reproductive knowledge and health of adolescent schoolgirls in south Indi’a, Narayan K, Srinivasa D, Pelto P, Veerammal S (2001), Asia-Pacific Population Journal 16: 225–238. 6. Desai GS, Patel R (2011) Incidence of Reproductive tract infections and Sexually transmitted Diseases in India: Levels and Differentials. The Journal of Family welfare 57: 48–60
7. ‘Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India’, Dash M, Padhi S, Mohanty I, Panda P, Parida B, J Family Community Med. 2013 Jan; 20(1):20-6. 8. http://www.nielsen.com/in/en/insights/reports/2016/breaking-the-menstruationtaboo.html 9. https://www.researchgate.net/publication/302900012_PREFERRED_MENSTURAL_ABS ORBENTS_AWARENESS_AND_HYGINE_PRACTICES_DURING_MENSURATION_AMONGST _WOMEN_IN_CHENNAI_INDIA 10. http://www.mdws.gov.in/sites/default/files/Menstrual%20Hygiene%20Management %20-%20Guidelines_0.pdf 11. http://www.evolvewithdignity.com/vision/ 12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488331/