Latest survey reveals closure of education institutions and community organizations has severely degraded the supply chain of menstrual hygiene products

Adolescents | May 21, 2020

62% respondents state that in the communities they work with, access from regular channels for consumers has become challenging and 22% organizations report that there is no access to menstrual products

12:00 noon; May 21, 2020; Mumbai: Dasra in partnership with hosted an online workshop to bring in representatives from Menstrual Health Alliance of India (MHAI), campaigners from platforms, and International Centre for Research on Women (ICRW). As part of the workshop, MHAI shared findings from a rapid survey conducted online amongst 67 organizations involved in relief work during COVID-19 across India, Africa and other nations; 45 India, 16 African region and 6 other countries. The online survey assessed the status of production, distribution and access to menstrual hygiene products to understand challenges and propose recommendations for relief work.

Tanya Mahajan, Development Solutions (Coordinator, Menstrual Health Alliance India -MHAI), a network of NGOs, manufacturers and other experts that works to create awareness about menstrual health, says, "Production and distribution of information and products to manage menstrual hygiene demands of women and girls is a constant challenge and has been exacerbated by the COVID-19 pandemic. In our recent survey with NGO partners, 84% stated that there is either no or severely restricted access to menstrual products in communities that they work in, especially for sanitary pads. 50% of the small and medium scale manufacturers reported that they are unable to operate at capacity and 25% are not operational at all. Availability of labour, raw materials and working capital are all looming concerns for these units."

She further adds, "Most adolescent girls from low income household depended on school-based supply in Government schools. Given that schools have been closed since the lockdown, they have started using cloth pads. We need to look at how reusable product choices like cloth pads and menstrual cups can be promoted with information on maintenance of hygiene in order to build resilient MHM practices."

Before COVID19, 89% of the organizations were reaching the community through community-based networks and organizations, 61% were distributing menstrual products through schools, 28% through door to door retail, 26% through online retail channels and 22% through traditional retail stores (FMCG and pharmacists). Post COVID19 and with physical distancing measures, 67% organizations have had to pause normal operations. Given the current national lockdown measures, and uncertain working conditions owing to social distancing and reverse migration, there is expected a heightened decrease in access to menstrual hygiene products. We need to immediately plan for a severe shortfall in production and distribution of menstrual hygiene products.

“Menstrual health programs need to take into account feedback from girls and women. This feedback loop, must consider women and girls experience with various menstrual health products and services in terms of - availability, accessibility, affordability (costs), acceptability (quality and other local factors). Programs also need to account for the unique challenges during a situation like the current pandemic by looking at Menstrual Health as a continuum and not as a supply only issue,” says, Sapna Kedia, Technical Expert, International Centre for Research on Women (ICRW) Asia. In regard to adolescent health, the dataset from the 2017-18 baseline study conducted by Dasra in the state of Jharkhand spotlights the gaps in awareness, access and usage among the adolescent girls.

Government schemes/programs run via community health workers including ASHAs, Anganwadi Workers, and Auxiliary Nurse Midwife (ANMs), and non-profit organization efforts play a key role in providing women and girls the required relief from their Menstrual Hygiene Management (MHM) challenges. However, close coordinated efforts are required for timely procurement, stock management and distribution.  

Shailja Mehta, Associate Director, Dasraexplains, “As a country we have made some progress on acknowledging Menstrual Hygiene Management (MHM) challenges. Over the past few weeks, we have made recommendations to Ministries and State Departments to provide access to sanitary napkins at village level through government functionaries, frontline workers, self-help groups, civil society and other partners who work in the field. We know Government of Jharkhand has taken a step to resolve this through last mile delivery of menstrual hygiene products during the COVID19. It will also require other stakeholders including funders and civil society to continue to support this.” 

Bringing these issues to the forefront is an effort to ensure that the needs of women and girls continue to be prioritized at a time of this pandemic. As a first step towards this, Government of Jharkhand is ensuring that girls who are enrolled in school in class 6 to 12, are identified by the block education officer, and ANMs, ASHAs and Aanganwadi workers will closely coordinate with the BEOs to provide free of cost sanitary napkin (sakhis) through community health centre, VHNDs, household visits and Aanganwadi centres to girls for the next three months.  

“With Super Cyclone Amphan hitting Indian coasts on the one hand and the COVID-19 crisis on the other, India's disaster management plan should include Menstrual hygiene management as an integral part of our Emergency response. Instead, we see that Menstrual hygiene is one of the first issues to fall by the wayside. Millions of women and adolescent girls are more vulnerable than ever before. Our ground interventions show that they are struggling to talk publicly and even find clean pieces of cloth for their urgent menstrual hygiene needs. We need to urgently revisit the country's COVID-19 response strategy on Menstrual health and introduce last mile access to menstrual hygiene information and products, as one of our top priorities,” says, Mayuri Bhattacharjee, Changemaker, She Creates Change, 

Civil society organisations will have two key roles to play – one is to provide necessary support to frontline workers to ensure that girls get the benefits of the scheme, as well as and also continue to engage with out-of-school girls, so they have access and awareness of safe menstrual health and hygiene practices.  

Some possible solutions for COVID-19 relief work are: 

  • Effective management of access to menstrual hygiene products 
  • Short term distribution through relief centres and food supply operations 
  • Facilitate linkages from wholesalers to community-level women entrepreneurs, SHGs 
  • Substitution of wood pulp with locally available materials like jute, banana fibre 
  • Increase dependence on reusable products 
  • Provide knowledge and information on making cloth pads, maintenance, safe use 
  • Involve men, boys and community stakeholders to ensure women have access to private and clean WASH facilities via targeted messaging 
  • Explore co-production of masks and cloth pads to ensure an adequate supply of cotton cloth 
  • Communicate safe hygiene practices using digital platforms, influencer videos, IVR, direct community outreach 
  • Engage local administration for unlocking storage in schools, CHC/PHC, with ASHAs, integrating WASH and hygiene along with COVID-19 related messaging, gender-segregated WASH facilities that are clean, safe and private in quarantine and isolation centres 
  • Provide guidance on segregation and safe disposal of menstrual products and mask at levels of household, community and health facilities 

The National Family and Health Survey (NFHS) 4 reported that 57.6% of young women, the age group of 15-24 years, uses sanitary napkins. MHAI estimates India has 336 million menstruating women, of which 121 million use sanitary pads i.e. 1 billion pads/month. With production becoming constrained, availability at the last mile rural retail points is most affected. Consumers who could access products at block or district level markets are unable to do so due to lack of public transport and mobility restrictions under lockdown. Various States and District Governments have school-based distribution of sanitary pads. With schools closing down, many such girls and their female family members now have no access to sanitary pads. 

According to the latest survey by MHAI, 62% respondents stated that in the communities they work with, access from regular channels for consumers has become challenging and 22% organizations report that there is no access to menstrual products. This has forced many girls and women to shift from disposable sanitary pads to cloth pads. Cloth pads can be a hygienic means of managing menstruation, if accompanied by information and water and sanitation facilities for hygienic management. 

In recent years, Menstrual Hygiene Management (MHM) received its due importance in government policy, planning and action. And, civil society actively acknowledged and stepped up to solve for women and girls' MHM challenges. However, crisis situations including floods, COVID-19, have provided timely exposure to the persistent gaps between effort and on-ground realities. We must work towards taking corrective measures in the immediate and building resilient MHM practices.

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