As we observe the eleventh World Day of Menstrual Hygiene and celebrate the wins, it equally important to reflect and find the gaps. The Menstrual Health and Hygiene Management discourse cannot be mainstreamed, till we ensure that every menstruator, regardless of their abilities, can manage their menstrual health with dignity and ease.
Chandni Ahuja
In recent years, India has made positive strides towards period positivity. With the collective efforts of the government and civil society to mainstream the conversation around menstrual health and hygiene (MHH), many menstruators now have better access to menstrual health resources.
Despite this positive progress, menstruators with disabilities have been left behind. According to the World Health Organization (WHO), there are over 190 million women worldwide living with disabilities. These Women with Disabilities (WwD) face the double burden of having a disability and being a woman in a patriarchal society. Research indicates that WwDs are at a higher risk of experiencing menstrual disorders and reproductive health issues compared to their non-disabled counterparts.
The concept of menstrual health has evolved since the first world day for menstrual hygiene was observed in 2013. In 2021, a new definition of menstrual health emerged, emphasising it as a holistic state of well-being encompassing physical, mental, and social dimensions, rather than mere absence of disease during the menstrual cycle. This shift broadened the focus from menstrual hygiene to include aspects such access to accurate information, timely diagnosis and treatment, supportive facilities, and fostering a stigma-free environment for all menstruators, regardless of their abilities, gender, or impairments.
In the context of disability, this new definition calls for inclusive Water, Sanitation and Hygiene (WASH) facilities, healthcare, and educational content on menstrual health and hygiene management (MHHM).
Disability-responsive infrastructure and policies
During their menstrual cycle, women and girls with disabilities face amplified challenges due to limited mobility, cognitive capacities, and social perceptions of disability and femininity. Moreover, it is important to acknowledge the diversity and intersectionality within disabilities. Each disability has its own specific need, and a one-size-fits all approach cannot be adopted for disability-inclusive solutions. To understand the challenges faced by menstruators with disabilities, it is imperative to consult them at every stage of decision making and policy making process. By engaging Persons with Disabilities and their organisations, policymakers can ensure that MHM policies and programmes are responsive to the diverse needs and experiences of individuals with disabilities.
One of the biggest barriers faced by menstruators with disabilities is the lack of accessible WASH facilities. Inaccessible public toilets restrict the participation of women and girls with disabilities in public life, limiting their potential to work and enjoy public spaces. This can also translate to serious health complications if a menstruator does not get access to change the menstrual product (sanitary pads, tampons, period cups) on time.
The first step to promote hygiene and safety for all women with disabilities is investing in accessible WASH infrastructure, by promoting inclusive design principles and sensitising stakeholders. As MHHM is context specific, the end-user needs to be consulted for the design to be universally accessible. The infrastructure needs to be responsive enough to accommodate the needs of all women, regardless of their disabilities, and also fit in their caregivers. In some instances, gendered toilets restrict the access of women with disabilities if they are dependent on their caregivers. Therefore, many menstruators may benefit from universally accessible, gender-neutral toilets.
Accessible MHM products and communication
As per the National Family Health Survey 2019-20, less than two-thirds of girls with disabilities aged between 15 to 24 years use hygienic menstrual hygiene products. The less-than-enthusiastic adoption is accredited not just the inaccessible design, but also the lack of awareness.
Communication (IEC) material and training modules on MHM often overlook the needs of WWDs, and remain inaccessible due to their design. These programmes and materials also fail to target the caregivers of WWDs, who are unable to provide the proper care and assistance required to girls and WWDs during their menstruation period. This lack of information also reinforces the social stigmas about the sexual agency and reproductive abilities of WWDs, translating to misconceptions about them being asexual or unable to manage their fertility. In some instances, girls and women with disabilities are advised by their family members and even doctors to get a hysterectomy to manage their periods better.
This calls for a sustained and more focused approach for the promotion of menstrual hygiene products and menstrual health awareness for WWDs and their caregivers. Persons with disabilities require IEC material in multimodal communication (different formats for different abilities) such as braille prints, audio description for visuals, closed captioning for videos and sign language interpretation. It is also important to educate caregivers and WWDs about the variety of menstrual products on the market is crucial. Those with intellectual impairments may have heightened sensitivity to materials and may prefer softer options to minimise irritation. Similarly, women with mobility issues might benefit from products that last longer between changes.
More importantly, persons with disabilities and their caregivers should not be mere participants, but also equal partners in sensitisation programmes, where they are given a stage to share their lived experiences.
Despite being guaranteed equality under the Rights of Persons with Disabilities Act of 2016, more than two crores Indians with disabilities are still denied full access to public spaces due to physical and social barriers. As we observe the eleventh World Day of Menstrual Hygiene and celebrate the wins, it equally important to reflect and find the gaps. The MHHM discourse cannot be mainstreamed, till we ensure that every menstruator, regardless of their abilities, can manage their menstrual health with dignity and ease.
Chandni Ahuja is a communication specialist working at GIZ India. With over 7 years of work experience in the social sector, she is passionate about gender and disability advocacy and has worked with several NGOs to ensure the effective and meaningful participation of persons with disabilities.
Image: UNICEF/Priyanka Parashar
