The Illness of Feminine Hygiene
By Swarnendu Biswas

It is common knowledge that hygiene is a neglected issue in India, and among various aspects or facets of hygiene, feminine hygiene is perhaps among the most neglected. In a society which deifies the goddesses and represses, suppresses and humiliates the women of flesh and blood with alarming regularity, this is nothing short of natural.

The appalling state of feminine hygiene is reflected in our high maternal mortality rates, and also through the paucity of private sanitation facilities for women. According to a nationwide survey conducted on the condition of schools and school children by an NGO named Pratham in 2009, four out of ten government primary schools were found to be not having the basic facility of separate toilets for girls. According to the same survey, only 50 percent of government schools did have usable toilets. Moreover, only 30 – 40 percent of the girls’ toilets in Indian schools were found to be useable. In the state of Karnataka, in every fourth high school, girls had to share toilets with boys. I am sure these shocking figures haven’t changed much in the short span of the last two years.

Apathy and Ignorance

The lack of proper toilet facilities is not only a cause of huge embarrassment for the girls, but also compromises on their health, by making them susceptible to diseases like diarrhea, urinary tract infections and other serious diseases. One can imagine the plight of menstruating girls in schools without usable toilets. No wonder, the lack of proper toilet facilities compels many girls in rural India to drop out from schools, thereby leading to a huge potential loss to the economy and society.

In fact, according to Dr. Ranjana Kumari, one of the most prominent social activists of India and the Director of Centre for Social Research; an NGO doing yeomen service to the cause of women’s empowerment, the attitude of adhering to comprehensive feminine hygiene is yet to find its foothold in India’s socio-cultural milieu. “Even today the awareness among menstruating girls and women in India about proper hygienic practices during menstruation is low, which is lamentable to say the least,” averred Ranjana.

The lack of awareness is facilitated by a culture of non transparency and utter neglect regarding feminine hygiene, which is propagated by our society at large. “Feminine hygiene is still a neglected area in the twenty-first century India, and there is very little openness about bodily hygiene among women,” commented Ranjana. She pointed out that menstrual health is still a taboo topic in India. Even today, menstrual girls and women are considered impure, and are prevented from entering temples.

No Sanitation in Menstruation

Of course, the problem of the lack of awareness, neglect and transparency pertaining to feminine hygiene in India, is only compounded by the rampant paucity, or even widespread inaccessibility of the basic sanitation infrastructure in the country. Moreover, it is distressing to note that even the basic sanitation exercises are unaffordable by many women in India.

According to a survey carried out by global information and measurement company AC Nielson, and reviewed and endorsed by the NGO named Plan India, almost 68 percent of rural women in India cannot afford sanitary napkins. The survey revealed extremely low levels of feminine hygiene care in the country, a fact which many of us already knew. The survey also confirmed Ranjana’s statement when it revealed that the awareness about the basic health and feminine hygiene is very low in the country, with a whooping 75 percent of rural women in India not having sufficient levels of knowledge on menstrual hygiene and care.

The study, which is based on a comprehensive nationwide survey carried on 1033 women of menstrual age and 151 gynaecologists, revealed that only 12 percent of the total number of 355 million menstruating population in the country use sanitary napkins. And we do not need gynaecologists to tell us that the resorting to alternative unhygienic measures such as unsterilised cloths, husk sand and ash during menstrual cycle make women susceptible to infections and diseases pertaining to urinary tract and of reproductive nature.

According to the same survey, 23 percent of the adolescent girls in rural India aged between 12 to 18 years have to discontinue their studies because of inadequate sanitation infrastructure in schools. About 97 percent gynaecologists surveyed expressed the view that sanitary napkins can act as a preventive measure against reproductive tract infection, while 64 percent opined that they can reduce the risk of cervical cancer through acting as a precautionary measure.

A country which has more people with mobile phones than with toilets, feminine hygiene is always likely to be compromised, especially if it happens to be a by and large feudalistic society like India. The lack of proper sanitation infrastructure does make Indian women suffer more than their male counterparts because of the additional burden of social stigma that they have to carry. In rural India, many women without proper toilet facilities have to get up before the onset of dawn; before the rest of the village folk, to relieve themselves without being seen. If they are seen going to the fields to relieve themselves, they are likely to invite scorn and ridicule.

A Statistical Embarrassment

The apathetic treatment to feminine hygiene in our society and the by and large lackadaisical approach of our government towards this pressing issue is one of the major reasons behind our high maternal mortality rates. According to the report titled ‘Trends in Maternal Mortality’, released jointly by WHO, UNICEF, UNFPA and World Bank, the number of women in India dying as a result of complications during pregnancy and childbirth was estimated at 3.58 lakhs in 2008.

Though according to the report, it plummeted by 34 percent from an estimated figure of 5.46 lakhs in 1990, but we can very easily see that the figure of 2008 is also nothing short of dismal. According to the same report, maternal mortality rate in India was 230 per 100,000 live births even in 2008, though it declined significantly from 570 in 1990. According to the report, India recorded 63,000 maternal deaths in 2008, which was highest in the world. In every eight minutes a woman in India dies of child birth.

According to Ranjana, the high maternal mortality in India is contributed by the abysmal standards of feminine hygiene in the country, especially in the rural areas. Most of the births in India still happen in homes because of wrong attitude among the families, and also because of the inaccessibility of healthcare infrastructure, especially in rural areas where most of the population of the country lives. In births in Indian homes through midwives, high risk and unhygienic delivery practices are common, which often take the toll on would be mothers’ lives.

“And even if the woman is taken to a hospital for delivery, she cannot get an assured protection from infections,” asserted Ranjana, while adding, “It is a known fact that most of our public hospitals and government run nursing homes, which are often the only options the majority of our populace can afford in terms of institutionalised healthcare, severely lack in sanitation. They often present a sordid picture in terms of pathetic hygienic standards, where the pregnant women could be prone to catching various infections.” The nutrition of would be mothers is also often neglected in the by and large feudalistic Indian society, thereby making them unprepared to tackle the rigours of pregnancy.

Ideas and Initiatives

We need at least a handful of visionaries and thought leaders like Dr. Ranjana Kumari in our midst to make some perceptible difference to the apathetic treatment that our society metes out to the concerns of health and hygiene of almost half of our population. Over the years, the Centre for Social Research has conceived and executed some commendable initiatives to address the issue of feminine hygiene in the country.

One of them is the setting up of a sanitary napkin production unit in Kanpur, where sanitary napkins at extremely affordable rates were distributed. “We had also created an eight bed hospital in the Etawah district of Uttar Pradesh in 1998, which is being equipped with gynaecologists on duty and a comprehensive medical infrastructure. Over the decade, the hospital has contributed to create a perceptible difference in maternal mortality of the district, for the better,” said the remarkable lady.

Of course, Ranjana firmly believes that the allocation for healthcare in the Union Budget should be raised drastically in the near future, but that is not what makes her a peerless revolutionary thinker that she is. “I think 50 percent of the health budget of the state should be focussed on women’s healthcare,” she averred, while stating that only through such revolutionary measures we can attempt to alter the pathetic condition of feminine hygiene in our country.

She also has an innovative proposal to safeguard the health and hygiene requirements of the vulnerable old and destitute women. “I think we should have a health insurance for these marginalised women, where a certain healthy sum in case of eventuality would be assured. The premium for this insurance cover should be waived off or be made absolutely negligible. The state government should pay one third of the cost incurred, while the remaining two third of the cost should be equally shared between the union government and the respective insurance company,” she explained. I was totally bowled over by the wonderful sensitivity and vision that the proposal reflected. I hope the government is listening, for I think no government in the world can afford to ignore the thoughts emanating from minds of such magnitude.