March 2022

The seen and unseen: Waste picker women and menstrual health management

By Hemalatha Patil, State Programme Director, WaterAid India

As part of the Saamuhika Shakti collective impact, WaterAid India (WAI) focuses on enabling access to clean drinking water, educating the informal waste picker community on hygienic practices and promoting positive behaviour change. To this end, WaterAid India places considerable significance on hygiene awareness, including menstrual hygiene management (MHM) among adolescent girls and women. 

Menstrual health is defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle. This conceptualization outlines that good menstrual health includes access to information on menstruation and the menstrual cycle, access to safe and effective menstrual products as well as facilities to change and wash the body, access to health services, the experience of a safe social environment free from stigma, discrimination and constraints as a result of gender and menstrual status.

Despite being a natural bodily process, menstruation is surrounded by socio-cultural norms, and religious beliefs - all of which are deeply intertwined with inequitable gender roles, norms and power dynamics. Social norms and practices determine whether girls and women receive information on menstruation, the depth of that information, access to menstrual products and essential services, as well as their mobility, participation in education and the workforce, and engagement with daily tasks. 

When girls and women lack access to information and support services and systems, they struggle to manage their periods in a healthy manner. This in turn places them at risk of discomfort, reproductive tract infection, anxiety and even gender-based violence. Furthermore, this often results in girls missing school and women missing work. 

Findings and reflections from the field

A baseline survey on Water, Sanitation and Hygiene was conducted by WaterAid India in 13 waste picker communities.  As part of the study, the team also surveyed female waste pickers on menstrual hygiene practices at the workplace, and the following are some of the key findings:

At the workplace too, ignoring the issue of menstrual health management has huge social and financial repercussions for adolescent girls and women. 

The state of toilets available to women and girls.

Krishna , a resident of Chittoor Bus Stand who works as an informal waste picker, said not having a safe and private place to change menstrual absorbents causes anxiety and worry.

"It decreases our concentration and productivity at work. Some female workers prefer to miss hours or even days of work rather than try to manage their menstruation under stressful situations, resulting in higher absenteeism. This, in turn, has an adverse impact on their own earnings," she said.

Amulya, a waste picker from TC Palya, pointed out how women have no access to clean, functional toilets at home or near their place of work.

"People like me opt for open defecation, making us more vulnerable to sexual attack if forced to change in open locations under the cover of darkness,” Amulya said.

When faced with insufficient bathrooms, women and girls can withhold urination and defecation, but how do we control menstrual flow?” - Triveni*, a waste picker from Sumanahalli.

Menstrual health conditions and management for female waste workers remain a neglected policy area. Invariably, a majority of women involved in waste picking or domestic work use cloth pieces as absorbents while menstruating. With minimal or no WASH infrastructure accessible to them, they go from morning to evening without changing the cloth or sanitary napkins. Women on the whole had to manage their menstruation for the whole day without any facility to change unless they were doing waste picking near their homes. Women working in Dry Waste Collection Centers (DWCCs) reported slightly better conditions as they had access to toilets which were common to both men and women, however changing menstrual absorbent there was quite challenging.

WaterAid Interventions 

A pre-test was conducted as part of our awareness program and we found that the majority of the girls and women had little to no knowledge about the menstruation cycle. Most of their information was rooted in taboos and myths, and they were reluctant to even talk about it.

In order to eliminate these preconceived, baseless notions, the WAI team has been making consistent efforts to actively educate the community, especially women and adolescent girls, on the entire process, through interactive sessions such as body mapping exercises and an MHM focused Snake & Ladder game.

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An interactive awareness session by WaterAid.

  • The team is facilitating discussions on puberty, menstruation, and menstrual cycle
  • Giving an introduction to the female reproductive system
  • Providing information on managing pre-menstrual symptoms, proper management of menstruation, and MHM and nutrition
  • Facilitating discussion to bust myths and misconceptions

In addition to the community-level interventions, WaterAid has also actively been supporting Saamuhika Shakti partners to educate and engage their staff, as well as the adolescent girls they work with, on MHM, to equip them with the right information.

Intended Outcomes

  • Increased knowledge and understanding of the menstrual cycle, menstruation and menstrual hygiene
  • Increased awareness of safe menstrual products and hygienic use
  • Positive attitudes towards menstruation and people who menstruate

Given the socio-cultural sensitivities, discomfort with menstruation, and deep-rooted beliefs and social norms, WaterAid India  adopted a four-pronged approach: 

1. Engage with women separately first, through one-on-one discussions, at the individual community level to create a safe environment for them to participate, ask questions, and share their thoughts. 

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2. Engage community volunteers to further put the adolescent girls and women at ease, and initiate group discussions. The team conducted participatory activities to encourage the community members to shed their inhibitions and speak up about the most neglected aspect of their health.

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3. The WAI team also gradually attempted to break the gender barrier and two of our male Community Facilitators (CF) conducted sessions on MHM, in presence of a female CF.

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4. The next step was to facilitate an interactive workshop with a larger group, across locations. In line with this, the team organized an interactive workshop for the women and adolescent girls from our intervention areas, to encourage dialogues and discussions on the topic of MHM.  

  • A game was conducted to identify the common myths surrounding menstruation 
  • An interactive session was facilitated to discuss the bodily changes that occur upon reaching puberty
  • Body mapping exercise was conducted, followed by discussions on the male and female reproductive system, and the complete menstruation process
  • Product choice availability was discussed with the participants, and samples were shown to give the participants a feel of the product

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Change takes time, and bringing about behavioural change by doing away with deeply ingrained beliefs is a mammoth task.

The focus will continue to be on making the MHM awareness programmes culturally/socially sensitive and feasible for women and girls at the community level. The team is also working towards encouraging conversations around the topic and organising activities that would empower them to speak up and adopt change in an effective manner. Continuous follow-up is critical for better and sustained results. 

*all the names used in the article have been changed to protect the identity of the person.

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