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Menstrual Health and Hygiene: Strides towards understanding Women’s Issues

It has been a hundred and eleven years since International Women’s Day was first honoured. It has been a really precipitous climb for women all around the world to get the parity women have with their counterparts and to enjoy the rights that women enjoy in today’s date. That being said and witnessed, there’s an evident disparity between women and men, on many fields, and people (men and women alike) have been fighting the good fight still. Today, March 8th is celebrated as Women’s Day globally, and the world has witnessed a significant change and attitudinal shift in both women’s and society’s thoughts about women’s equality and emancipation. Many from a younger generation may feel that ‘all the battles have been won for women’ while many feminists from the 1970’s know only too well the longevity and ingrained complexity of patriarchy. With more women in the boardroom, greater equality in legislative rights, and an increased critical mass of women’s visibility as impressive role models in every aspect of life, one could think that women have gained true equality. The unfortunate fact is that women are still not paid equally to that of their male counterparts, women still are not present in equal numbers in business or politics, and globally women’s education, health and the violence against them is worse than that of men. However, great improvements have been made. We do have female astronauts and prime ministers, school girls are welcomed into university, women can work and have a family, women have real choices. And so each year the world inspires women and celebrates their achievements. IWD is an official holiday in many countries including Afghanistan, Armenia, Azerbaijan, Belarus, Burkina Faso, Cambodia, China (for women only), Cuba, Georgia, Guinea-Bissau, Eritrea, Kazakhstan, Kyrgyzstan, Laos, Madagascar (for women only), Moldova, Mongolia, Montenegro, Nepal (for women only), Russia, Tajikistan, Turkmenistan, Uganda, Ukraine, Uzbekistan, Vietnam and Zambia. The tradition sees men honouring their mothers, wives, girlfriends, colleagues, etc with flowers and small gifts. In some countries IWD has the equivalent status of Mother’s Day where children give small presents to their mothers and grandmothers.
The case however wasn’t always like this, just like humans have had to slowly climb out of caves, to fire to tools, to wheels, to flight, and to space. The fight for women’s rights and emancipation has been a slow burner.
International Women’s Day (IWD) has been observed since the early 1900’s – a time of great expansion and turbulence in the industrialized world that saw booming population growth and the rise of radical ideologies.
1908: Great unrest and critical debate was occurring amongst women. Women’s oppression and inequality was spurring women to become more vocal and active in campaigning for change. Then in 1908, 15,000 women marched through New York City demanding shorter hours, better pay and voting rights.
1909: In accordance with a declaration by the Socialist Party of America, the first National Woman’s Day (NWD) was observed across the United States on February 28. Women continued to celebrate NWD on the last Sunday of February until 1913.
1910: In 1910 a second International Conference of Working Women was held in Copenhagen. A woman named Clara Zetkin (Leader of the ‘Women’s Office’ for the Social Democratic Party in Germany) tabled the idea of an International Women’s Day. She proposed that every year in every country there should be a celebration on the same day – a Women’s Day – to press for their demands. The conference of over 100 women from 17 countries, representing unions, socialist parties, working women’s clubs – and including the first three women elected to the Finnish parliament – greeted Zetkin’s suggestion with unanimous approval and thus International Women’s Day was the result.
1911: Following the decision agreed at Copenhagen in Denmark in 1911, International Women’s Day was honoured the first time in Austria, Denmark, Germany and Switzerland on 19 March. More than one million women and men attended IWD rallies campaigning for women’s rights to work, vote, be trained, to hold public office and end discrimination. However less than a week later on March 25, the tragic ‘Triangle Fire’ in New York City took the lives of more than 140 working women, most of them Italian and Jewish immigrants. This disastrous event drew significant attention to working conditions and labour legislation in the United States that became a focus of subsequent International Women’s Day events. 1911 also saw women’s Bread and Roses campaign.
1913-1914: On the eve of World War I campaigning for peace, Russian women observed their first International Women’s Day on February 23, the last Sunday in February. Following discussions, International Women’s Day was agreed to be marked annually on March 8 that translated in the widely adopted Gregorian calendar from February 23 – and this day has remained the global date for International Women’s Day ever since. In 1914, further women across Europe held rallies to campaign against the war and to express women’s solidarity. For example, in London in the United Kingdom there was a march from Bow to Trafalgar Square in support of women’s suffrage on March 8, 1914. Sylvia Pankhurst was arrested in front of Charing Cross station on her way to speak in Trafalgar Square.
1917: On the last Sunday of February, Russian women began a strike for “bread and peace” in response to the death of over 2 million Russian soldiers in World War 1. Opposed by political leaders, the women continued to strike until four days later the Czar was forced to abdicate and the provisional Government granted women the right to vote. The date the women’s strike commenced was Sunday February 23 on the Julian calendar then in use in Russia. This day on the Gregorian calendar in use elsewhere was March 8.
1975: International Women’s Day was celebrated for the first time by the United Nations in 1975. Then in December 1977, the General Assembly adopted a resolution proclaiming a United Nations Day for Women’s Rights and International Peace to be observed on any day of the year by Member States, in accordance with their historical and national traditions.
1996: The UN announced their first annual theme “Celebrating the past, Planning for the Future” which was followed in 1997 with “Women at the Peace table”, in 1998 with “Women and Human Rights”, in 1999 with “World Free of Violence Against Women”, and so on each year until the current.
2000: By the new millennium, there was little activity occurring for International Women’s Day in most countries. The world had moved on and, in many spheres, feminism wasn’t a popular topic. Something was needed to re-ignite International Women’s Day giving it the respect it deserves and to raise awareness amongst the masses. There was urgent work to do – battles had not been won and gender parity still had not been achieved.

There is still a lot of work to be done globally, but to achieve that one has to act locally. Coming to Sikkim in terms of women’s parity and emancipation, the state has been well know for the safety and respect that women are subjected to.
Harshita and group, a group of 4th year BBA student from West Bengal, studying in SRM University Sikkim say, “Our guardians chose the state of Sikkim for us to study because they had told us that it was one of the safest for women and as this was the first time we went anywhere out of our hometowns, we felt that they were right. Safety is subjective everywhere but we generally feel that there isn’t that much of the feeling of some scary people looking at us from the shadows in public places here (in Sikkim) than we face elsewhere.”
“Not just safety but I really feel freedom here, I can go out without being frowned upon, and not just because I am away from my guardians but there’s a constant pressure of being an ideal “daughter” where I am from, doesn’t matter if the pressure comes from relatives or an aunty out in the streets. Here I feel like I can focus on being the ideal me,” another student adds.
The statistics back the students’ points of views up when we get to brass tacks, here are some of the statistical analyses concerning women

Women in Sikkim enjoy better condition of health and nutrition than women in other North-Eastern state. The Total Fertility Rate (TFR) in Sikkim is 1.17 children per woman. Fertility rates are at 1.17 children per woman in urban areas and at 1.27 children in rural areas. The greatest differentials in fertility are influenced by religion, caste/tribe, residence and education. For instance, at current fertility rates, woman with no education will have 0.68 children more than women who had 12 or more years of schooling. Similarly, Christian women are likely to have more children than others as are women in rural areas. Knowledge of contraceptive among women is almost universal (98%) in Sikkim. Contraceptive use is lower in urban areas (37%) than in rural areas (51%). The most common modern spacing method used by currently married women in Sikkim is pills (12%) followed by IUD (6%) and condoms (5%). Among the districts, current use of any contraceptive method is the highest in West District (66%) followed by South District (59%) and North District (50%) and it is lowest in East District (32%). Among mothers who gave birth in the five years, 94% received antenatal care for their last birth from a health professional. 76% women received antenatal care during the first trimester of pregnancy. One-third of women (33%) and 37 % of men are either too thin or overweight or obese. In Sikkim, 475 persons per 1,00,000 are estimated to have medically treated tuberculosis and 1580 women age 15-49 and 1249 men age 15-49 per 1,00,000 have diabetes. 18% of women age 15-49 in Sikkim have hypertension. Over 40% of men and 7% of women age 15-49 use some form of tobacco.

The literacy rate of Sikkim stands at 76.43% among females and 87.30% among males in 2011. This is marked increase from 60.41% among females and 76.04% males in 2001. Average literacy improved from 68.81% in 2001 to 82.20% in 2011. The literacy is found to be highest in the East districts 84.67% and lowest in the North 77.39%. (Data only seen till the census of 2011 as per government websites, and there has been a further increase in the general demographic rates coming to women.) In Sikkimese society historically women have been always involved in household decision making.  The data too shows that 93.6 % women were involved in decision making during NFHS 3, which has increased to 95 % in NFHS 4. Spouse violence use to be quite prevalent in our society but the data shows marked decrease. It was 16.3 % during 2005-06, decreased significantly in 2015-16. The women having their own bank account and using them themselves have improved more than three fold in Sikkim. It was 20.9 % during 2005-06 and is 63.5 during 2015-16.
The National Family Health Survey (NFHS 4), with the data of 2015-16, said that 41 per cent women in Sikkim have 10 or more years of schooling , this is way better than the country’s average, which is 36 per cent. Sikkim, along with Meghalaya, occupies the top two positions in the best performing region of Northeast on women’s empowerment index comprising of participation of women in household decisions, ownership of land, cell phones and bank account, and instances of spousal violence. Women in Sikkim are more empowered to take decisions than women in other parts of the country. According to NFHS-4, in 2015-16, 85 per cent women have the freedom of movement, including going to market, health facility and places outside the village or community compared to national average. Only 15 per cent women, age 20-24 years, were married before age of 18 years as against the national average of 27 per cent. There are only 3 per cent teenage pregnancies in the state placing Sikkim as the best among the northeastern states. The infant mortality rate in the state is 30 against national average of 34. Sikkim has improved its performance with regard to safe delivery remarkably by 43 per cent points from NFHS 3 to 97 per cent in NFHS 4, the best in northeastern states. – (Sources NFHS-4, Business Standard) In Sikkimese society historically women have been always involved in household decision making.  The data too shows that 93.6 % women were involved in decision making during NFHS 3, which has increased to 95 % in NFHS 4. Spouse violence use to be quite prevalent in our society but the data shows marked decrease. It was 16.3 % during 2005-06, decreased significantly in 2015-16. The women having their own bank account and using them themselves have improved more than three fold in Sikkim. It was 20.9 % during 2005-06 and is 63.5 during 2015-16.
As seen by the veritable credibility of the data and the statistical analyses which reveal clearly the conditions for women in Sikkim, not even coming to the steps that have been taken subsequent to the data presented above. Sikkim has taken tremendous strides in empowering women and bringing women to parity with their conspecific counterparts. However, as the saying goes, “parity requires perfection”, another goes “perfection is a myth” and in that limbo of imperfection and disparity, there is always a pathway for progress.
Speaking of disparity, there’s always a disparity between men and women by the time of birth and that is because of basic biology and also because of culture, and in that window the most striking feature that stands out is the women’s ability to give birth the quality that comes with menstrual cycles. Menstruation is a woman’s monthly bleeding, often called their “period.” When one menstruates, one’s body discards the monthly buildup of the lining of one’s uterus or the womb. Menstrual blood and tissue flow from one’s uterus through the small opening in one’s cervix and pass out of their body through the the During the monthly menstrual cycle, the uterus lining builds up to prepare for pregnancy. If a female does not get pregnant, estrogen and progesterone hormone levels begin falling. Very low levels of estrogen and progesterone tell the body to begin menstruation again, which is repeated, hence called the menstrual cycle.
People in Sikkim, let alone India, are still oblivious of the obvious biological process and still demonizing it, while people should most ostentatiously be getting educated and helping build better conditions for menstrual health. However, slowly but steadily strides have been taken towards understanding rather than making it a taboo. Menstrual health in India is still largely governed by taboos and a lack of information. It needs to be addressed through social and behavioral change programs. There is little knowledge about the health consequences of using unhygienic methods for menstrual management. The usage of cloth, which is a traditional method, in itself is not unhygienic and is also a sustainable option, but it requires washing and drying in the sun. Most women in India do not feel comfortable with the washing and drying because of prevailing taboos, apart from lack of access to water also proving to be a problem.
In the last decade, policymaking in India has increasingly focused on menstrual health. The Menstrual Hygiene Scheme was launched in 2011 under the National Health Mission for the promotion of menstrual hygiene amongst 15 million adolescent girls in the age group of 10 to 19 in 152 districts across 20 states. The Rashtriya Kishor Swasthya Karyakram (RKSK) was launched in 2014 to increase awareness of and access to sanitary pads among adolescent girls in rural areas.
A report by the National Institute of Public Cooperation and Child Development, funded by ICMR, found that the awareness of adolescent girls about menstruation till its onset had gone up from 29.4 percent in 2007 to 72.6 percent in 2012, while knowledge on washing and reusing cloth had gone up from 57.6 to 82.5 percent. There were no recent figures available. The ICMR is currently conducting a study to find cost-effective menstrual hygiene solutions for schoolgirls, like the use of biodegradable sanitary napkins or reusable menstrual cups.
Perhaps the strides taken are more like small staggering steps, tip toeing, and playing hopscotch trying to swerve away from taboos and misinformation, but these are strides nonetheless. The most recent stride in all the steps from the Government of Sikkim, conspicuously addressing the issue of menstrual hygiene as a health issue rather than a women’s issue, was launching “BAHINI”, which will work on providing free sanitary napkin dispensing machines in school going girls all over Sikkim.
This stride came with the background of the saddening fact that only 12% of India’s 355 million women use sanitary napkins. 23% of adolescent girls drop out of school since proper facilities are not provided to them when they are menstruating. In schools, girls do not have access to functional toilets, access to clean water and proper sanitation and disposable facilities. Even among the school going girls, it is believed that inadequate menstrual protection makes adolescent girls among the 12-18 years age group miss 5 days of school in a month.

The prime objective of BAHINI, as per the GOS, installing all the dispensing machines is
100% access to free and safe sanitary pads to secondary and senior secondary school going girls
To create awareness about menstrual hygiene and to sensitise the students that “menstrual cycle” is a natural process.
To reduce the dropouts in adolescent girls and provide them safe and healthy environment.
Modalities
There are 120 Secondary schools and 90 Senior Secondary Schools in the state of Sikkim. Total of these 210 schools have 18,666 female students (9586 in Secondary schools and 9079 in Senior Secondary schools).
The proposed idea under the scheme is
Establishing sanitary pad vending machines in all the secondary and senior secondary schools. This will give access to free sanitary pads to girls of these schools, round the year.
Along with this, awareness and sensitisation programme will be carried out in these schools about menstrual health and hygiene and safe disposal of sanitary pads.
In schools where vending machines cannot be connected, the distribution will be done manually through identified lady teachers.
Funds for the scheme will be provided partly by the State Government and partly through CSR contribution.

Benefits of the scheme:
Women are prone to reproductive track diseases, much of which stems from un-hygienic menstrual health. Every school girl from class to class will use sanitary napkins and dispose their used pads in an eco-friendly way. This will benefit the health and hygiene of every girl. This facility will bring relief and build confidence in the minds of girls.
Along with this the GOS has also conducted many seminars in schools and awareness programmes in different districts and conducting training and awareness on menstrual health the most recent being a successful training and awareness program on menstrual health and hygiene in South Sikkim. The program funded by GEF-GOI-UNDP- SECURE Himalaya Project, Sikkim was organized at State Institute of Rural Development and Panchayat Raj ( SIRDPR), Karfectar. The main objective of this program was to educate women regarding poor menstrual hygiene caused by lack of education on the issue ,persisting taboos & stigma ,limited access to hygienic menstrual products and poor sanitation infrastructure undermining the educational opportunities.
Dr.Reshma Subba, a panellist in the program highlighted about the million of girls in India who drop out of school annually because of the lack of menstrual hygiene management facilities,including the availability of sanitary napkins and awareness about mensuration.She said that the social taboo associated with it has to go with changing times and added that the womens’ menstrual health & hygiene has to be taken seriously & scientific solutions should be implemented. The program also had a discussion about First own ‘Made in Sikkim’ Reusable cloth pads made by Self Help Groups with a brand called “RAMROO” under Sikkim Pragatishil Nari Cooperative Society. They highlighted about the reusable cloth pad as a great solution both for the female fraternity as well as for the Mother Earth.
With these steps it is evident that Sikkim has started to address the need for situating menstrual health and hygiene not as a women’s issue but an incumbent part of the society’s step towards placing it as a major health issue. These local steps can be just as pivotal in moving the world, like the world has seen in with 15,000 women who marched through New York City demanding shorter hours, better pay and voting rights, to establishing the need to address the awareness for menstrual health and hygiene, ultimately nudging the world into the direction of providing better education not only for women but for society as a whole.

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