CASE STUDY: CREATING OPPORTUNITIES FOR WOMEN TO BE CHANGE MAKERS IN THEIR COMMUNITY THROUGH ADDRESSING THE SILENCE AROUND MENSTRUATION AND RELATED PRACTICES
Kavya R Menon1, R Vimal2, N Suseela2
1Rural Development Fellow, SBI Youth for India Fellowship and M S Swaminathan Research Foundation, Vedaranyam, e-mail: firstname.lastname@example.org, 2 M S Swaminathan Research Foundation, Vedaranyam
Villages in the Vedaranyam municipality of Nagapattinam district, in Tamil Nadu are culturally closed, especially in the case of women in the age group 12-50. This is reflected in the low levels of education and the habit of following traditional occupations among the villagers. Women usually go out of the village for attending temple functions or for medical purposes, almost always accompanied by some known male member. This work explores how opportunities for women were created in their community through addressing silence around menstruation and related practices. The work was carried out systemically in steps, identifying the extent of awareness on the menstruation process, healthy practises and availability of menstrual management products. This identification was achieved through a household survey conducted among 70 households and interviewing 140 girls and women in the age range of 12-50, from 3 villages, namely – Adhivasi Colony, Kovilankollai and Puthu Road. From these surveys, it became clear that addressing menstruation and providing correct information may also help them to shed their inhibition to discuss issues relating to menstruation and also to come out of many taboos associated with it. To help interact more with women, awareness camps on menstrual health and hygiene management (MHHM) were conducted in the villages. During these camps, enthusiastic, skilled (tailoring) and interested women/girls were chosen to be provided with an opportunity to come out of traditional roles and take up a small scale entrepreneurial role by making reusable cloth napkins.
Keywords: rural, development, global, menstruation/periods, pad/napkin, awareness, availability, camps, puberty
Kavya R Menon (first author of this paper), is currently residing and researching in the Vedaranyam municipality, in Nagapattinam district of Tamil Nadu, as part of her one year Rural Development Fellowship, Youth for India, sponsored by the State Bank of India. During the one year tenure of the fellowship, her work will be executed in the villages of Vedaranyam, with the marginal communities with guidance and support from the partner NGO, M S Swaminathan Research Foundation (MSSRF), in 10 villages adopted by MSSRF.
This work has received support from two major stakeholders: (a) the NGO, MSSRF who implements and executes many developmental activities in the adopted villages in Vedaranyam municipality, and has therefore a good rapport with the villagers. MSSRF also provides with guidance and local support for conducting awareness sessions. (b) Ecofemme is a social enterprise based out of Auroville, Tamil Nadu producing reusable cloth napkins. It is run by foreign nationals Kathy Walkling and Jessamijn Miedema. They have, through their Pad for Pad program, provided reusable cloth napkins free of cost to be supplied to the girls in target villages. Ecofemme is also providing training and raw materials to start the entrepreneurial operation. Phaemie Ng, an Australian entrepreneur has also sponsored through Ecofemme.
The major tsunami of the century, that happened in December 2004, and affected vast parts of south east Asia and India, put Vedaranyam, a nondescript municipality till then, on global map. It attracted lots of national and global NGOs, the United Nations (UN), World Bank, civil societies, individuals and the like who were committed to help out the people affected by the 2004 tsunami. Ever since, there had been global support pouring in, but now after ten years of the tsunami, all of that support has diminished to a large extent. Also, in my experience, I have seen that many houses constructed have problems in physical stability, and the small scale industries started are non-functional. A major reason for this, according to the villagers was that, there was nothing more to take from the helping hands, other than the money. The operations were not sustainable.
Another issue is that the villagers had neither trust nor were they interested to interact more with the volunteers and representatives who came to their lives from all parts of the world. This happened because of a lack of a proper environment for two different cultures to intermingle; more outgoing western culture (representing the relief support) and the more conservative village (beneficiaries) had no platform for a smooth overlap. Also, the villages mostly have a culture, which does not allow the female folks to wander outside the village after attaining puberty. Post puberty, based on needs, women travelled outside only along with known and trusted male family members. This has been repeatedly said by both men and women, and they are still proud of all those who follow this tradition. With this background, the villagers did not welcome the venturing of other males and females, particularly non-Indians, into their villages, and displaying an altogether different culture. Specifically, the villagers had issues with the dress, females travelling alone, sending them for education to far off places and close work-related interaction between males and females. With the scope for creating impact decreasing over the years, most of these foreign groups left Vedaranyam, anywhere between 3-5 years post-tsunami.
Since the past 3-5 years, it has been regional and national NGOs carrying out most of the developmental work here. Most of these NGOs are also in turn, supported by foreign aid. MSSRF is a very successful national NGO that has been operational in Vedaranyam for a little more than 3 years now. After conducting participatory rural appraisals in 6 villages, along with help from Ministry of Environment and Forests, Government of India and World Bank, as part of a project on Conservation and Development of Vedaranyam Coastal Zone, it was decided to adopt 14 villages and provide them with support on areas such as (i) Natural resource management such as forests, wetlands and water, (ii) Alternate livelihood generation (iii) Microfinance, (iv) Health and Hygiene (v) Support for primary livelihoods among others.
The presence of local and regional NGOs with staff who speak the local slang, and look like the local population, has helped a lot in bringing about a positive change for the communities. This is reflected in the fact that the literacy rates, number of schools, ratio of female to male faculty, number of colleges have all increased in the past 3 years. Thus, at this juncture my presence was welcomed by the female folk, even though language was initially a barrier. Also, they all supported me interacting and involving with each of them, in their daily lives. MSSRF staffs also have good relations with the villagers at each of the villages where I intend to work and this has been particularly helpful.
Currently women practise the following traditional occupations:- daily wage labour in salt pans, agricultural fields or small construction sites near their homes, pick prawns in marshes and swamps around their houses, collecting firewood, honey, fruits and vegetables from forests, selling fresh or dry fishes caught by the husbands from sea, cultivating tobacco and other agricultural produce. All of these are labour intensive and require no formal education. Post-tsunami, there have been few nurses, graduates and teachers from these villages, however, the numbers are still small.
Women, however much educated and earning are always expected to give importance to household work and taking care of children. They take up all jobs only after fulfilling these responsibilities. Girls mostly drop out of school post-puberty, but many of them drop out even before that as they have to stay back at home to take care of younger siblings while both parents go to work. Even in many cases, where puberty or younger siblings are not the problem, the girls drop out after class 10 or class 12, if the next higher education centre is located outside the village. Many girls complain that topics taught in school are not understood and hence they drop out. Parents too agree with this, saying that they are poor villagers who cannot make sense of anything that is written in school textbooks.
School teachers are of the opinion that most of the students end up watching a lot of television and get confused about their ambitions in life. They do not understand the value of continuing studies, and are rather interested in getting married off and getting some new dresses and jewels. Few girls who are interested in studies and get good marks are usually encouraged to go to schools, if they can afford it. In many cases, even when the daughter secures good marks in school, they do not go to college because of affordability or accessibility issues. However, many girls themselves said that they make it a point to complete till class 12 to avail the government sponsored benefits.
The approach to creating new opportunities for women and girls through addressing menstrual issues was derived based on my interactions with the community, mostly at medical camps being conducted in the villages by MSSRF. As a female who were closer to their age, the girls who used to come to medical camps were attracted to speak and interact more. During such interactions they revealed their desires to be able to able to earn on their own, do basic calculations regarding purchases mentally, talk to outsiders, and travel alone to the next city. Such activities which were an everyday matter to me were their ambitions; this realization for me was huge. I wanted to help them and my further interactions with them opened ways for me. During these medical camps they told me that they used to come in the pretext of fever and get medicines, which they used for the menstrual cramps and pains. They did this because they were shy to talk openly about periods. I had imagined that menstruation would be not discussed very openly, based on evidence on such studies (Singh et al., Indian J Med Sci 1999;53:439-43) but still had to find out how good or bad the situation is.
Thus with the guidance from MSSRF, I planned to interact more with the female folk by addressing the silence around menstruation.
METHODS and MATERIALS
Various methods were adopted in carrying out this work. The major ones include:
- Group Interviews – conducted initially while visiting the villages during the monthly medical camps conducted by MSSRF with a professional medical practitioner and support staff. The major purpose of visiting villages during the medical camps was that it allowed meeting a lot of people at a single place, without putting in extra resources. A lot of smiling, some broken Tamil and being closer in age to the girls helped break the ice. Soon the girls began to trust me and tell me their personal problems, of periods, their confusions regarding why it affected girls and whether God was actually doing this to remove them of their sins. Such small groups (3-5 girls) helped them bond well, and soon they wanted me to conduct a class for the same for all their friends who were not around. This had initially happened in a village called Puthu Road, and a similar story happened in all other villages too.
- Household Surveys – To verify the findings that I had at the small group sessions, I conducted household surveys. This helped to identify the current patterns of menstrual health management, knowledge and acceptance regarding the same. Such surveys were carried out in 3 villages out of the 10 villages where awareness camps were planned. A total of 70 households and 140 women were interviewed. They were asked questions regarding their readiness to talk about menses, knowledge regarding the same pre- and post-puberty, methods used to manage blood flow, disposal methods, myths customs and hygiene practised. The results from the surveys had made clear the extent of importance of conducting awareness camps on menstrual health and hygiene management and the acceptance levels for the same from the communities.
- Awareness Camps – Awareness camps, with not more than 35 girls per session were conducted based on the results of the household survey. The awareness camp included topics such as body changes while growing up and body mapping, periods – process and functions and activities around it to learn the process, menstrual flow control methods and their pros and cons, simple exercises and home remedies to control pain or flow, identifying conditions where medical help needs to be sought, exposure to reusable cloth napkins, gifting reusable pads to girls who are comfortable in using them, and lastly, teaching them how to make a pad on their own. In all the 5 camps conducted till now, all the girls have unanimously expressed that coming for the camp was valuable, both in terms of information and in obtaining pads. More than 50% of them agree to share the knowledge with friends or other female relatives. MSSRF’s staff nurse, Mrs. Suseela accompanies me on each of these camps.
- Post-camp Personal Interviews – A week to 10 days after the camp, I along with Mrs. Suseela meets the girls individually. A gap is provided between the camp and the interviews, so that the girls get some time to mull over it, personally, among friends or family and form a plethora of opinions. The questions in the personal interview lets them tell how they felt after attending the camps, their knowledge and acceptance levels towards menses, any further support required, and so on. As these personal interviews happen mostly in their houses, the response of the parents too can be captured. In few cases, if the girl is not at home, personal interviews are conducted over the phone. A group interview is not possible after a camp, because the villagers are not very comfortable letting their daughters come out of homes regularly for meetings or trainings.
- Blogging and Social Networking – These are 2 methods mainly used to make public my work. This has helped in getting sponsors and supporters from around the world. Twitter, Facebook and WordPress are utilized for the same. The extent of technology in bridging across all cultural boundaries has been tremendous and instantaneous.
I have been provided with pads and some educational material by Ecofemme, the social enterprise based out of Auroville. Other educational materials used have been sourced from various sources online.
RESULTS AND DISCUSSION
The impact of this work can be seen at each step attempted. Right from the initial interactions till identifying girls/women with potential talent involved a lot of thought and also relied a lot on fate. It was really gratifying to see that the work has received ample support from the village and more villages are requesting to implement in their place too.
As part of my visit to the villages during medical camps, I noticed that the girls, mostly adolescents and other unmarried, falling in the wide range of 12 -24 years were interested in talking to me. On regularly attending the medical camps in all villages and learning to speak basic Tamil, I realized that the number of girls in the said age group attending the medical camp increased from 2-3 to 8-10, a 3x increase. This was a significant change, considering the fact that girls are not encouraged to go to any place other than school, if they are not at home. Also, the assurance that they are interacting with another young female only, was also welcoming for the parents. I have visited 10 villages during the medical camps and all of them are beneficiaries of this project.
It was during these interactions that they revealed the myths and the need to be silent around the topic of periods. They also expressed their need to know more. My project on menstrual health and hygiene management started with these interactions.
To identify the exact nature of taboos and silence around menstruation, I started with a household survey in 3 of the ten villages visited. These 3 villages were chosen, because they had families practising all the three major occupations in Vedaranyam; namely – salt pan labour, fishing and agricultural labour. The 3 villages are – Adhivasi Colony, Kovilankollai and Puthu Road. These villages also have a good rapport with MSSRF, and hence entering the village was easier, even though I did not speak the language fluently at that time.
The survey was carried out in 70 households with 140 respondents. Open urination and open defecation is very common here, only two out of the 70 households interviewed have a toilet. The survey results are given in figure 2.
The survey results indicate that menses is mostly a hushed topic (90%), and a majority of the girls were not aware about it before the first period (96%). Everyone admitted to have cried and become scared on the first period. However, it affected the studies of a lesser number of girls (38%).
Also, majority of the girls use disposable pads as opposed to cloth (38%), by citing reasons such as safety that pad will remain secure on panties and the comfort of disposal. Among the ones who used cloth, majority admitted to using synthetic cloth, which was easily available, but not good for the body. Nevertheless, all of these girls have used cloth at least once in their life and hence was not alien to the concept of using cloth and washing it. Many of them continue to use cloth at home and pad when outside (54%).
FIGURE 2: shows the household survey results conducted in over 70 households in 3 villages among 140 respondents
Of the pad users, a majority (79%) use both the free pads given by government (brand name – Puthuyugam) and the ones bought from shop, but in this case, Puthuyugam is used at home. Puthuyugam is distributed through school for school goers and through anganwadis (government sponsored child care centre) by ASHA (Accredited Social Health Activist) worker or the ANM (Auxiliary Nurse Midwife) for the drop outs who are 18 years of age or below. Even though most of the girls utilize it, all of them were unsatisfied with its quality. Gums not proper to stick on to the panty and pad easily tearing off are the common complaints.
Even though there are discomforts, there are many who still manage to not drop out of school or job (salt pan work, agriculture labour, sales girl in shops in Vedaranyam town). Among the ones who manage to continue studying or working, 47% miss a day or two during periods every month. It especially affects them, as all of them work for daily wages. Also, none of this stops them from doing daily household chores, a major work being that of carrying water for household use or carrying salt in salt pans. Both these works require them to carry up to 20 kilogram either on the head or on the hip. 80% of the respondents admitted to carrying both the types of weights even during periods.
Taboos related to periods are practised here too, the major ones being: keeping away from all male members (100%), following traditional practices, sleeping isolated, not going to temple or watering plants (all 99.2%). However, in spite of this, none of them consider women to be impure during menstruation; some believe it to be a “gift” and others believe it to be a “curse” from God. The cultural practise of celebrating the first period for every girl as a mini-marriage has given a lot of acceptance to this, both, among men and women, even though relating this to God and following traditional practises are the norm. A detailed discussion with the women revealed that this question is a highly subjective one, and is dependent on what one defines to be “pure” or “impure”. The younger girls definitely liked the isolation associated, as no one expects them to sit inside house or do household chores during periods, for them it is a time of liberation.
Another major issue that was identified during the interactions is that of pad disposal. The various methods of pad disposal followed are shown in figure 3. It clearly shows that the different methods of pad disposal followed are: burying (51%), burning (17%), throwing in water (7.8%), and the following combinations: burning and burying (17.8%), throwing in water or burning (6.2%).
As it is, disposable pads pose a lot of hazards to the individual and the environment on prolonged use. The risks are even more when it is disposed off after use. Hazards are caused due to the super absorbent molecules and dioxins used for bleaching the cellulose core which are compounds that cause harm by getting into the food chain. The plastic layer along with the super absorbents and dioxins form highly hazardous carcinogens on burning at temperatures lower than 800 deg centigrade. Also the plastics don’t degrade for about 800 plus years. Throwing the used pads into water also poses risks of contaminating the water bodies and spreading it, because all the surrounding water bodies are used for bathing and other washing purposes by the villagers.
FIGURE 3: shows the various methods of pad disposal followed here
Thus it becomes clear how much important it is for the women and girls to know what goes into each pad and its pros and cons, and how best to dispose it. This becomes a very important point for consideration, in view of the fact that there exists really huge landfill areas and also that regular fights happen when dogs drag out the used pads and spread it all over the village. It was also an eye-opener, isolation and taboos are a problem in most cases, only if it is an alien concept.
Awareness Camps on Menstrual Health and Hygiene Management in Villages
The awareness camps were planned to be conducted in the 3 surveyed villages initially, and if found to be useful, to be extended to the remaining 7 villages. The entire module of the camp is based on the requirements as understood from the results of the household survey conducted.
A 3-4 hour session consisting of educative modules, some show and tell activities, personal story telling, group activities, pad gifting and pad making is conducted. Starting with a small session on sharing personal experiences, The talk naturally progress on to the reason for assembling there. The girls have been observed to be shy initially, but soon start interacting.
Different terms in English and Tamil for “periods” along with the suggestions from the girls is introduced. Body mapping, uterus processes and functions and the menstrual cycle are dealt with next. The difference between excretion of urine, faeces, menstruation and child delivery is also brought out. A lot of pictorial aids and real size models are utilized. The girls also made the menstrual cycle on their own with multi-coloured seeds and explained it back to us. They also answered other questions we asked; but almost always in a group.
They were also told about the variations in the processes between girls, according to each person’s body type. Situations and cases demanding special medical attention were explicitly explained. They were also told to seek doctor’s aid depending on the severity. Issues of white discharge and monthly tracking of periods was also taught. Common myths and their given reasoning were explained; but it was left to them to follow it or not. That is a cultural boundary which I do not wish to crush yet. Locally available medicinal plants and home remedies, along with a couple of yoga poses were demonstrated to handle irregular periods and associated pains. Hygiene, especially keeping in view the lack of toilets was also addressed.
They were then introduced to the various products available in market for containing the menstrual blood. Cloth and Sanitary napkin was familiar to most of them. Tampons and menstrual cups were seen with much curiosity. The pros and cons of each product, their regular use and availability, costs, impacts on body and environment, use and care, was explained. The discussion also steered to the raw materials used in each product, their costs and availability, and processes used. These different products were circulated among the girls to touch and feel. The various methods of disposal of these items were discussed; especially highlighted the issues caused due to the improper disposal. Ecofemme cloth pads were introduced next. The girls’ choice regarding whether they would want to use these cloth pads was inquired. We also shared our personal experience of using the cloth pads. Till now, only 2 of them have not showed interest, the remaining girls were all gifted the pads. A single unstitched pad too is included in the kit. The girls are taught to make the pad with this. This part is always the engaging and exciting part, as seen in all camps. This is when they all became naturally comfortable with themselves, each other and with us. In fact, when we personally explained to the girls about the pad making steps, they started asking more questions.
The pad making session always helps the girls to open up and interact more. It is also a point for conveying the fact that unhealthy and costly disposable pads need not be the only answer. This is the most important part, as it enables to identify girls with skill and interest in pad making. It is this group from each village who will be trained fully to start an entrepreneurial venture on their own.
Post-Camp Personal Interviews
These are usually conducted 7 to 10 days after the camp. I, along with Mrs. Suseela (MSSRF nurse) meet the girls individually. The questions in the personal interview lets them tell how they felt after attending the camps, their knowledge and acceptance levels towards menses, any further support required, and so on. As these personal interviews happen mostly in their houses, the response of the parents too is captured. In few cases, if the girl is not at home, personal interviews are conducted over the phone. Girls, along with mother, grandmothers, sister-in-law, teachers and even male members who can be present will be around to give their comments. The information obtained and the free pads are always highly appreciated. In two months of study, among the first 50 beneficiaries, except 1 all others have been finding the pad to be highly useful and effective.
During these interactions, we also communicate to the girls and women, who exhibited skill and interest, and their family about providing them with an entrepreneurial opportunity in pad making. Out of 11 such girls and women, identified from 4 villages, 7 have shown interest to be involved in an entrepreneurial venture. They have also been initiated into some discussions to begin talking about this venture in their villages to potential supporters, well-wishers and customers. Allowing men also to be part of this discussion has given women more confidence and support from within the family. The final training will be started only after identifying potential candidates in all ten villages where the menstrual health and hygiene awareness camps will be conducted.
From this work, it can be seen how addressing the silence around a very important, yet unspoken everyday topic such as menstruation has opened up a way to interact more with the female folk and bring them to mainstream across all socio-cultural, economical and technical boundaries. This work has helped develop more cohesion among females, and given them a platform to interact more. They have also had the advantage to break the silence around menstruation and also receive correct information, along with free and safe pads and also the knowledge to make one on their own.
The post-camp personal interviews have been the best feedback wherein girls, their mothers and grandmothers, teachers and in few cases, fathers also have expressed their happiness in the usefulness of such camps and the pads given. Though not enough time has elapsed since these pads have been given, to conduct a study as to ascertain its economic impact, the girls and their mothers have remarked that it has definitely been a boon, as now they have to buy one item less for the family.
This work has not yet been completed. I will be continuing my work till the beginning of November 2015, and therefore will be including medical camps with specialists such as gynaecologists, nutritionists and paediatricians to address all women’s issues in a more holistic way. Also, girls and women who have the interest and basic skill will be trained to start a small unit for pad making and selling in the local market, work for which has already started. The success of the entrepreneurial venture would be a direct impact on the level of opportunities and the culture of leadership created for women from this intervention.
The authors wish to thank Dr. V. Selvam and Dr. Rajan, MSSRF Vedaranyam, for their guidance and support for this work. We also thank the entire Ecofemme Auroville team for their support with pads and other resources.
- Singh M M, Devi R, Gupta S S, Awareness and health seeking behaviour of rural adolescent school girls on menstrual and reproductive health problems. Indian J Med Sci 1999;53:439-43