In India, the discussion around menstrual hygiene is either ignored or holds very little importance. Even after taking various steps to ensure menstrual health management through grassroots health workers and various schemes, there has been little to no change. In the grassroots, the government has formulated various schemes, policies and programmes yet, the implementation has been very little.
ANW, ASHA And ANM
ANW ( Anganwadi workers), ANM (Auxiliary Nurse Midwife), and ASHA ( Accredited Social Health Activist) are community grassroots workers and mostly women. ANWs runs a child care centre called “Anganwadi” as a part of Integrated Child Development Services. A centre has to ensure non-formal pre-education to children (age 0-5), Supplementary Nutrition, Health Check-up and referral services. An Anganwadi centre comes under Women and Child Development.
ANM and ASHA are grassroots health workers. Whereas, ANM closely works with children, women and young adolescents. They come under the ambit of National Rural Health Mission, Ministry of Health and Family Welfare. Both Anganwadi and ANM closely work with ASHA.
Role And Responsibilities With Regards To MHM
The Ministry of Women and Child Development provides training to the Angawandi centres around Menstrual health. In addition, the centre has to provide women and adolescents with sanitary pads. Whereas, ASHA, the first contact person, is entrusted with the responsibility of providing adequate knowledge around menstrual hygiene. In addition, ASHA is also a part of Village Health and Sanitation Committee (VHSC) and works along with panchayats.
Therefore, can ensure separate toilets for girls and boys in the government schools. Government of India and various departments have various booklets, flipbooks in place for Anganwadi centres, ANM and ASHA. Further, ASHA has to distribute sanitary napkins at subsidized rates.
They are entrusted with the responsibility of disseminating information about Menstrual Health to the women through the Self- Help Groups. A range of materials have been developed around MHS yet the scope of intervention is limited.
The Ground Reality
Menstrual Hygiene Management should be the priority in the village yet, the effect on the ground has been dismal. In the few villages of Block Jaisinghnagar, women use clothes during menstruation. Adolescents get knowledge around menstruation through the womenfolks of their house once they start menstruating. Anganwadi centres do not have sufficient sanitary pads to distribute among adolescents and women.
ASHA hasn’t organised much of an awareness campaign too. Most of the awareness campaigns have been around child marriage, pregnancy and nutrition. The discussions around menstrual hygiene have been negligible. There is no space for adolescents and women to share their struggles and issues pertaining to menstrual.
Although training has been provided to Anganwadi workers yet, these trainings fail to reach the women of their communities. Poor engagement in the community results in less involvement of panchayats to also notice the need for sanitation in the community. In the villages, the role and responsibilities of these workers get limited to immunization, providing meals to the children and providing referral services to ensure the safe delivery of children.
Through the interaction of women with people, I learnt they do not prefer to approach them. People of the community do not consider them equipped adequately with the knowledge and resources to deal with the concerns pertaining to the health of the women. Interestingly, these women do not deal with concerns pertaining to menstrual health. ANM workers mostly tackle the issue of immunisation. Anganwadi workers are the one who closely work with adolescents, children and women.
Another major issue is the payment of an ASHA worker, she gets paid roughly 2000- 3000 rupees and it is a task-based payment. There’s no fixed salary and incentive-based income is insufficient as a lot of grassroots health workers’ primary source of income is through this work. A lot of ASHA workers in the villages have started taking up another role altogether due to less payment and delay in payment. Therefore, a lot of them do not even perform their work. In addition, Panchayats fail to recognize the importance of their work which further limits the scope of intervention of grassroots health workers to ensure the issues of water and sanitation.
Conclusion
The lack of political will and poor implementation of programmes, which can help tackle these issues related to menstrual health, is concerning. Menstrual Health Management should be the priority of the Panchayat. In addition, the village level committee should be given power and it is the need to make them realize their importance. Timely evaluation and monitoring by civil societies and NGOs need to be considered. A third-party evaluation would help to gauge the accountability and working of the already existing systems.