The temperature on my phone read 45 degrees Celsius. The heat surged through me as I stepped out of the car. But I was too nervous to care. We had just flown in to Ahmedabad, the capital of India’s Gujarat province, that morning. After a breakfast of chai and freshly fried ghathiya, a snack made from chickpea flour, we drove to our destination. I parted ways with my supervisor and walked quietly into a room where 200 girls sat, listening intently. Falguni Behen (Behen means “sister” in Gujarati) the local programme leader, was explaining the menstrual cycle.
Every year 28 May marks Menstrual Hygiene Day, a day dedicated to global advocacy for women and girls who continue to experience stigma, hardship and shame around menstruation. In India, millions of women and girls routinely face challenges in managing their menstrual cycle. Stigma and the harmful socio-cultural practices arising from its association with impurity often result in a lack of awareness, poor hygiene, and ultimately, a loss of dignity. In 2018, I had the opportunity to participate in the Menstrual Hygiene Day activities organised by the Aga Khan Foundation (AKF) in India and its Aga Khan Rural Support Programme (AKRSP).
The day was marked with an assortment of activities and educational sessions, including an opportunity to ask a gynaecologist questions. Some raised their hand, but many more wrote their questions on pieces of paper, an option that was provided to ensure girls could ask their questions even if they were feeling shy or embarrassed. Falguni Behen held the papers out to me; there was a thick stack. It was clear the girls had a lot on their minds. The opportunity to speak with a medical professional was rare and they did not waste a minute of it.
Other activities included a human-size Snakes and Ladders game. Girls volunteered to physically move between the squares after rolling the dice, reading aloud the menstrual hygiene practices written on them. A group discussion took place on the various types of sanitary products available, what they looked like and how to use them. One participant expressed the fact that she didn’t know how to use a pad, where to get it, or how to use it – nor did she know there was a choice.
Many of these resources are available to programme leaders like Falguni Behen through a toolkit developed by the Aga Khan Foundation. During my fellowship, I traveled with my supervisor to train frontline field staff on how to use the toolkit to educate women and girls on reproductive biology, nutrition and menstrual hygiene.
Soon, it was my turn to speak. It was important for us to determine the programme’s impact on the girls’ lives and how it could be improved. In just a year since the programme started, over 1,000 girls and women had been educated on menstrual hygiene, but there was much more to be done. The girls looked at me wide-eyed as we sat on the floor together in a circle. They leaned in closer as I asked in broken Hindi:
“Aap yahaa kyo aaiye? (Why are you here today?)”
One focus group participant said:
“We are all here to learn from each other’s experiences with menstruation. In these groups, we learn about menstruation; we learn about each other’s problems. We were not sure what to ask or not ask; what to do or not do. Many of us didn’t know much before our first period. We cried and felt shameful.”
Surveys and interviews done by AKF showed that 63 percent of girls in AKF and AKRSP programme geographies did not know about menstruation before it occurred. It is not discussed in many schools and homes. Worst of all, when girls don’t know how to manage their menstruation, they end up dropping out of school. Without access to sanitary products and a private place to change, girls resort to unhygienic practices that in turn increase their health risks. As most girls use cloth pads, lack of running water, a functional toilet and even a place to discard menstrual waste often leads to girls returning home during menstruation. These issues are further complicated for girls with different abilities or in emergency settings. Because of the monthly challenge, many girls choose not to go back to school. It appeared, however, that this was starting to change.
Another focus group participant said:
“Now we have become confident. We know how to use pads or how to make them from cloth. We know how to manage pain in the stomach. We eat well – fruits and vegetables – and can be active. We feel healthy. We are less scared to talk about this.”
To date, 25,000 women and girls have benefitted from the Menstrual Hygiene Management Programme in India.
This text was adapted from an article written by Nadia Mithani and published on the AKF Canada website. Nadia Mithani, MPH is a Research Programme Coordinator with the Global Control of HPV and Related Diseases group. She has a Bachelor of Science in Food, Nutrition and Health from the University of British Columbia, and a Master of Public Health with a specialisation in Global Health from Simon Fraser University. Her placement at the Aga Khan Foundation in India ran from 2017 to 2018, and was part of an International Youth Fellowship Programme supported by the Government of Canada and the Aga Khan Foundation.