What happens when you combine a country’s taboo on female menstrual health with the impact of a global pandemic? Dr Saswati Chaudhuri highlights the situation of the urban poor in India and paints a rather alarming picture of how the most common needs of Indian women are (not) met.
As the world grapples and fumbles at every point with an unprecedented global health emergency caused by the outbreak of COVID-19, the intimate world of adolescent girls and women in India is still surrounded by hushed voices and whispers. Even long before the pandemic, inadequate access to toilets, water and female health products has been a major problem in India, but this has now reached unmanageable proportions in most urban slums.
Access is Privilege: The Situation of the Urban Poor
The urban poor in India have been disproportionately bearing the adverse impacts of the pandemic and the economic slowdown triggered by it. Unable to maintain their living due to the lockdown imposed by the government, most of them decided to return back to their hometowns and villages in India’s rural hinterlands. Others, who decided to take the hardships in their stride, were left to face informal employment, overcrowding and limited access to basic infrastructure and health services.
Indeed, the 2011 Census data of India reveals that only about 74 per cent of households have access to tap water, and for many people this too has to be procured from a common tap. Standing in long queues and putting up with fights over water access is unfortunately quite common in these areas. In most of the informal settlements, common bathrooms, which sometimes have to be shared with 15 families, are generally the norm. The fourth National Family Health Survey (NFHS-4) shows furthermore that around 27 per cent of female slum dwellers have to settle for shared toilets. Having access to toilets or bathrooms with sufficient water is thus something that only a privileged being can hope for.
It is not surprising that Indian women and girls also face a severe inability to access menstrual hygiene products during the pandemic. Lockdowns have an adverse impact on the autonomy of girls, reinforcing their status as the inferior lot or the second in rung in their households. Most Indian schools used to distribute sanitary pads to girls free of cost, but the pandemic and nationwide school closures prevent all school visits.
Similar to many other countries, the lockdown in India has also created panic with families stocking up on food supplies and common medicines. Sanitary pads or napkins, which are considered luxury items even under normal circumstances, did unfortunately not secure their rightful place in the household budget of most families. They have to compete with other priorities and are not considered an essential commodity, since the same amount of money could buy a family food and water for drinking and cooking.
Lockdowns and Female Menstrual Health
Furthermore, a survey conducted by the Menstrual Health Alliance India (MHAI) observed that only 33 per cent of the organisations that distributed menstrual products before COVID-19 were able to do so during the lockdown. On close examination it was revealed that at least 22 per cent of these organisations could not access menstrual products for distribution and the others were having a hard time getting hold of the supply channel. This is very unfortunate as NFHS-4 data already indicates that only about half of the women living in Indian slums use sanitary napkins, while the rest use cloth or homemade napkins.
Indeed, India’s already strong taboo on female menstrual health combined with the impact of the lockdown, further restricts the movement of the urban poor, and even hinders their ability to perform their daily activities. One can only shudder with regards to those countless migrant women who had to walk for days to reach their home villages and could not attend to their menstrual health needs, such as changing sanitary pads every five or six hours. Even if they actually had access to used cloth, pads would still need to be properly washed and dried in sunlight for disinfection. One can be certain that these women consumed less food and drastically reduced their water intake so that toilet visits could be effectively minimised. This can have disastrous consequences however, as improper menstrual health management is often associated with greater infection risks.
Addressing India’s Indifference
The COVID-19 pandemic has greatly exposed India’s structural indifference to the needs of women and their menstrual health and hygiene. What we need now is a rethinking of the contours of state intervention, especially in the health sector, so that massive investments in sustainable WASH services are ensured. In practical terms, this means the state must complement the sufficient distribution of sanitary towels with access to private bathrooms for all women. It also has to be kept in mind that India’s water shortage combined with the increased water consumption for hygiene practices during COVID-19, may lead to less water availability for women’s health and menstrual needs. However, any official containment and lockdown strategy must consider this, lest we forget about the very basic needs of half of India’s population.