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Analysing the Menstrual Hygiene Scheme, 2011: A step towards providing for & normalising the normal

Manvee Kumar Saidha, Student, School of Law, CHRIST (Deemed to be University)

Introduction

As far as a physiological phenomenon goes, menstruation is as normal as it gets. Over the years, the undue stigma associated with menstruation has added an absolute indignity, vulnerability, discomfort and fear to the process. Despite being a natural fact of life, and a monthly occurrence at that, millions of menstruators across the world are denied the right to manage their cycle healthily[1]. India fosters a significant number of cultural taboos and discriminatory social norms, especially among its rural population. Such dismissive interpretations deny menstruating individuals of the basic sanitation, health care and self-awareness that would otherwise afford to them, a secure experience. Various measures have been taken in the last decade to ensure good menstrual health, which in turn aid in overcoming long-term obstacles to health, freedom, development and participation of the menstruating population of the country. This article deliberates upon one such scheme introduced to initiate and advance menstrual health management towards adolescent girls in rural India - The Menstrual Hygiene Scheme (MHS).


The Menstrual Hygiene Scheme

The Menstrual Hygiene Scheme was launched by the Ministry of Health and Family Welfare, Government of India to provide subsidised sanitary napkins, in 2011. It was to be implemented at the State level and chiefly targeted promotion of menstrual hygiene among adolescent girls. The main objectives of the scheme are as follows[2]:


(i) To increase awareness among adolescent girls on Menstrual Hygiene


(ii) To increase access to and use of high-quality sanitary napkins to adolescent girls in rural areas.


(iii) To ensure safe disposal of Sanitary Napkins in an environmentally friendly manner.


The inception of the Scheme initially afforded its benefit via the Government to 107 selected districts in 17 States, and via self-help groups in another 45 districts. In 2012, it was decided to extend the Scheme under the National Health Mission by States having to account for the same in their Sate Programme Implementation Plan (PIP). The decentralised procurement of sanitary napkins is done by way of a competitive bidding process, of which Self-Help Groups may also be participants.

The implementation framework demands that the sale of napkins to adolescent girls be fixed at the rate of Rs. 6 per pack of six sanitary napkins. The approach of the sale itself is interesting to note, as the Scheme attempts to incorporate and benefit another stakeholder, the Accredited Social Health Activists (ASHAs), in the process. The ASHAs are advised to conduct sales by way of a ‘door to door’ approach, and may also utilise schools or community platforms such as Anganwadi Centres. The Scheme attempts to incentivise their participation on a monetary basis, i.e. ASHAs are entitled to receive Rs. 1 per pack sold and additionally receive a free pack of sanitary napkins for each month of service. An amount of Rs. 50 is also available as an added impetus to ASHAs for conducting a monthly meeting on health issues surrounding adolescent girls.

Any funds further recouped are utilised towards payment for transportation of the sanitary napkins from facilities, rental and storage costs, if any. In case there exists a remainder amount retrieved as a balanced fund, it is forwarded to the State Health Society Account to be utilised for procurement in the following year.


Drawbacks presented by the Scheme

Though the Scheme, prima facie, seems to be economically self-sufficient and to have assimilated all aspects attached to targeting the menstrual hygiene of rural adolescent girls, it is found to have fallen short on various accounts. Take for instance the evaluation of the Scheme done by Chandigarh’s Postgraduate Institute of Medical Education and Research published in International Journal of Community Medicine and Public Health in 2016[3],

which indicates that it is relatively unpopular due to an irregular supply of sanitary napkins. The study identifies that though 80% of adolescent girls were aware of the concept of sanitary napkins, only about 30% have ever used them, even after the Scheme’s inception.

The study further highlights the inadequacy in incentive provided to the ASHAs. The ASHA workers stated their disappointment in the exiguous margins of profit received and irregular supply of sanitary napkin packs which discouraged their will to continue. Adding to such dissatisfaction towards distribution, villagers and workers attached the blame of poor-implementation with the Village Health and Sanitation Committee (VHSC). The Committee failed to provide appropriate disposal mechanisms such as dust bins, the absence of which was a breeding ground of cultural insensitivity and stigma associated with sanitary napkins.

Conclusion

The Menstrual Hygiene Scheme (MHS) is a theoretical model approach to tackle menstrual health management in rural areas. It is so because it is stakeholder-driven and provokes community engagement. However, these points prove to simultaneously be the Scheme’s greatest strengths as well as setbacks. Social participation demands that the implementation of the Scheme keep-up the motivation of those involved, which entails regular supply and implementation facilities in the present case. Incentivising stakeholders is vital since they facilitate the Scheme to a great extent. It is the ASHA workers who provide the product and awareness thereof at the ground level. While monetarily the Scheme itself does not play with large numbers, an incentive given to the workers must increase in comparison to their stance at present. It will ensure that efforts are not hindered, thereby stimulating collaboration in the absence of administrative hiccups.

Sanitary napkins currently compete with societal-stigma and, more literally, with a cotton cloth. Till sanitary napkins show promise of similar availability and accessibility, if not more, adolescent girls and women will be restrained to comparably unhygienic practices. Thus, to normalise the usage of sanitary napkins, especially in the rural areas of India, a holistic endeavour is required, i.e. one which is pragmatic, all-embracing and most importantly, uninterrupted. The Menstrual Hygiene Scheme certainly postulates such an approach, and with increased concentration on its implementation will undoubtedly be exemplary in the times to come. The slight impediments should not be discouraging as the very intention with which the Scheme has been introduced is an enormous step forward in India’s effort of menstrual health management.

[1] Guidance on Menstrual Health and Hygiene, UNICEF, available at: https://www.unicef.org/wash/files/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf , last seen on 01/06/2020.

[2] Menstrual Hygiene Scheme (MHS), National Health Mission, available at https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1021&lid=391 , last last seen on 01/06/2020. [3] Sudip Bhattacharya and Amarjeet Singh, How effective is the Menstrual Hygiene Scheme? An evaluation study from North India, 3 International Journal of Community Medicine and Public Health, 2584 (2016), available at: https://www.ijcmph.com/index.php/ijcmph/article/view/235/235 , last seen on 01/06/2020.

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