Mausam Kumari is the group leader of a Kishori Samooh (Adolescent Girls’ Group) in Rajauli block of Nawada district in Bihar. She, along with her peers from the community decided to set up a sanitary napkin bank through their own monthly contributions. Girls who would, under normal circumstances, have lost school days or have been restricted to their homes during menstruation were instead able to take care of their personal hygiene, and control their mobility.
Mausam and her peers were part of one of the many young or adolescent girls’ groups formed in the district in 2016 through a programme implemented by the Population Foundation of India, with the objective to enable young people, especially girls to take control of their lives and their health. These girls’ groups meet every month, share information on subjects concerning them, which include gender equality, delaying age at marriage, mental and reproductive health, hygiene and nutrition.
Menstrual hygiene emerged as an important concern in most group discussions- an issue which has yet again gained prominence since its mention in the Prime Ministers’ Independence Day speech on 15th August 2020. The Prime Minister spoke at length about women’s empowerment, including delaying age of girls’ marriage and provision of sanitary napkins to ensure their health and wellbeing. He also stated that the Centre is reconsidering the minimum age of marriage for girls and a committee has been set up to make recommendations in this regard.
Menstrual hygiene, the stigma and taboo surrounding the subject have stirred conversations, debates and discussions increasingly in the last couple of decades. Evidence suggests a high unmet need for sanitary pads in the country. According to National Family Health Survey – 4 (NFHS 4), 42% of young women (15-24 years) use sanitary napkins, while 16 percent use locally prepared napkins. Only forty-eight percent of rural women use a hygienic method of menstrual protection, compared with 78 percent of urban women.
The unmet need for sanitary pads has been exacerbated with the outbreak of COVID-19 and subsequent country wide lockdown. The availability of essential healthcare services have been severely impacted, especially for vulnerable population groups such as young women and girls. Findings from a recent three-state study conducted by Population Foundation of India in April-May, 2020 showed that a little more than half (56%) of the young girls interviewed in three states reported having an unmet need for sanitary pads, with the highest number of females from Rajasthan (73%) and the least number from Uttar Pradesh (19%).
The government must ensure that sanitary napkins reach these young girls, who enjoy limited mobility, through the large network of ASHAs and ANMs in the country. It takes tremendous convincing on the part of front line health workers to encourage and educate school-going girls to use sanitary napkins. Unavailability may not only reverse this trend but also affect the young girl psychologically as well as cause diseases.
Even beyond menstrual hygiene, the impact of the pandemic on women is multifold. According to UNFPA’s recently released State of the World Population (SWOP) report, COVID 19 may exacerbate the already concerning numbers around early marriage, violence and sex birth ratio at birth. UNFPA’s recent projections estimate COVID-19 will disrupt efforts to end child marriage, potentially resulting in an additional 13 million child marriages taking place between 2020 and 2030 that could otherwise have been averted.
Since the pre-COVID-19 era, India has been home to the largest number of child brides in the world, with over 1 in 4 women, age 20-24 years, getting married as children, before their 18th birthday. Early marriages lead to early pregnancies and young women who become pregnant experience a number of health, social, economic and emotional problems. In addition to the relatively high level of pregnancy complications among young mothers due to physiological immaturity, women lose out of educational and employment opportunities which could equip them with greater autonomy and control of their lives.
While we welcome the Prime Minister’s announcement to end child marriages in India, we must remain cognizant of the fact that the prevalence of this age old practice has its roots in the societal sanction it enjoys, especially in rural India. A girl is seen as a temporary visitor in her parental home and an unwelcome guest in her in-law’s house. The community often views marriage as the ultimate goal of a girl’s life and getting her married early is seen as a means to secure her future. With the pandemic and its socio-economic consequences unfolding gradually, several families who have been pushed further into poverty may view child marriages as a solution to pull themselves out of their dire economic consequences. It is therefore, not surprising that there have been media reports suggesting that many adolescent girls may never return to school post the lockdown as they are being forcefully married off by their parents.
What we see as a problem, the community, ironically, sees as a solution. Hence, while legal enactment on child marriage is necessary, this complex and largely societal issue needs to be tackled on several fronts. The lack of awareness on the issue and the irreparable damage it causes to a girl’s life needs to be tackled with greater sensitization on this harmful practice. The socio-economic causes which perpetuate the practice include poverty, lack of access to education, healthcare gender inequalities, regressive social norms and weak implementation and enforcement of the law, to name a few.
Going forward, keeping girls in school and creating employment opportunities will be a critical pathway to help delay age at marriage. This can have multiple impact on the health and wellbeing of the girls, enhance their self-esteem and raise social and economic prospects for them. Social and behaviour change communication strategies will be helpful in addressing and transforming social and cultural norms which promote child marriages. Population Foundation of India’s social and behaviour change communication initiative, `Main Kuch Bhi Kar Sakti Hoon – I, a woman can achieve anything’ is one such initiative which, over the years has communicated and engaged with audiences to challenge and change social norms and individual behaviours. We need to enhance knowledge, change perceptions and challenge social norms around early marriages, contraceptive use and sex selection as we work towards our ultimate objective of attaining gender equality. We hope that the Prime Minister’s voice will resonate with the communities and make a difference in changing this age-old social norm.The author is the Executive Director, Population Foundation of India, and a public health expert.