Shocked doctor provides sanitary pads to impoverished girls
Asiya, a school-going girl from Nadpora area of Srinagar, says her mother and grandmother had been using cloth instead of sanitary pads during periods, which was worrying her at home but she was helpless.
“As I went to school, I heard from friends that they were using sanitary pads. They endorsed same for me. Back home, I asked my mother to use it but she refused and told me to use cloth only,” she said.
“My mother told me that she couldn’t afford sanitary pads and that she believed that pads were causing infertility,” said Asiya, a 7th standard student.
A section of women in Kashmir, mostly belonging to low income families, use cloth during periods.
Like Asiya, families of many adolescent girls in the Valley are reluctant to allow them to use sanitary napkins fearing it led to diseases.
Another girl, Aliya, a 9th standard student from Srinagar, said although she was using sanitary pads she reuses them after washing.
“I reuse it. We have another taboo here that during periods, a girl can’t touch anything, which is very unfortunate,” she said.
The menstrual hygiene of women in Kashmir has remained less important and women still hesitate to talk about it, which is worrisome for the doctors.
However, adolescent girls here have got a good friend.
Dr Auqfeen Nisar, who is pursuing MD in Community Medicine at Government Medical College, Srinagar was treating patients during a weekly OPD in Nandpora, Srinagar last year where she got shocked after listening to adolescent girls using cloth during their periods.
She was deputed to a sub-centre there to monitor the government’s immunisation programme. It was at this time that many adolescent girls turned up to her to seek consultation about the problems related to menstrual hygiene. This pained her.
“I was there for a year. Girls would come to me with complaints of poor menstrual hygiene. I counselled them and tried to find out the barriers,” she said.
It was an eye-opener for Auqfeen. She conducted door-to-door visits in Nandpora – catering to a population of 4000 people and interviewed 200 adolescent girls.
Of the 200 female, she said 75 percent were in reproductive age group. They weren’t using sanitary pads, a worrisome situation. Most of them belonged to lower economic class.
The 31-year-old doctor said affordability and lack of awareness about menstrual hygiene were the biggest barriers.
“Most girls complained of irritation and allergy. Many of them would spend more time in washroom. When I asked why they were not using pads, they said their mothers had told them that the materials used in napkins leads to infertility,” she said.
Auqfeen started crowd-funding to provide sanitary pads to the impoverished girls.
She began with an individual project in January 2019 and named it 'Panen Fiker' that translates to ‘Let's take care of ourselves’- project in social marketing to enhance the use of sanitary pads among the adolescent girls.
To sustain the project, she decided to buy low-cost sanitary napkins and distributed it among the girls at subsidised rates.
“Sustainability was a problem. I organised programmes on behavioural change communication for them and asked them to talk about menstrual hygiene,” she said.
Auqfeen said the adolescent girls had a wrong notion that menstrual hygiene was bad and that they would deal with it badly.
“The families were not supportive to the adolescent girls. It was scary for them. Behavioural change was the important part of the project,” she said.
After motivating girls to use pads, the next step Auqfeen plans is to create self-help groups among the community that would raise and utilise the initiative.
“Even in the heart of Srinagar, girls were still using cloth during periods. It is really heart rendering. In villages, the condition is worse,” she said.
Among the poorer sections of the society, women still face inequality, landing them in trouble.
“Even if people have good social-economic status, girls don’t get money for menstrual hygiene,” the doctor said.
She said during her awareness programmes in Nandpora, she advised school-going girls to carry a polythene bag with them and dispose it off at home.
Auqfeen has also decided to start her website where she can seek support of stakeholders in the Valley for her individual project.
“Many women, mostly young adolescent girls, with different ailments come to me. In most of the cases, girls have menstrual hygiene problems,” she said.
Auqfeen had never thought that the girls would have such poor knowledge of menstrual hygiene. She tried to find out the barriers that had kept them from getting this knowledge and found two reasons: Lack of awareness and impoverishment.
“These girls were influenced by their mothers. I found mothers would discourage them from using sanitary pads as they had a notion that it caused infertility. Apart from the wrong counselling, social taboos also keep girls away,” the doctor said. “Being the story of the girls who reside in the city, one can only imagine what will be the state of awareness of hygiene among the girls in far-off rural places.”
For spreading awareness about menstrual hygiene, Auqfeen wants to go to the peripheries where social taboos are more prevalent.
“I will start a website where I can ask people to contribute for the cause so that I can assist the girls to come out and speak,” she said.
In March this year, Auqfeen went to Sumbal area of Bandipora where she was surprised after observing that there was no concept of menstrual hygiene.
“The adult and married women are reluctant to change. Adolescents girls can help the community if they are counseled properly,” she said. “Awareness sessions should be held to make females aware about menstrual hygiene. There should be specific clinics in hospitals to provide counseling to women.”
Head Department of Obstetrics and Gynecology, GMC Srinagar, Dr Shahnaz Taing, said women, especially girls, must know what menstrual hygiene was.
“Females should know about their body and the requirements they have. Females havebeen following their mothers and use cloth which may not be washed,” she said. “With the result, girls suffer from different reproductive tract infections.”
Taing, who also treats patients at Kashmir’s largest maternity hospital, Lal Ded, said menstruation is physiological process which emerges in various forms.
“This is not a disease, it is something very natural. A girl who has menstruation is not ill. She is to be taught how to deal with it,” she said.
There is still stigma of menstruation among the girls.
“The fear has to be taken out. Menstrual hygiene should be made part of the curriculum in schools. Education can play a very important role,” she said.
Taing explains that initially periods may not be regular that might affect the health of a girl as she may develop anemia and for that she needed to be treated.
“Otherwise, she will develop lethargy and loss of interest,” she said.
Medicos said menstrual hygiene was an issue that every girl and women must deal with her life, but there was a lack of awareness on the process of menstruation and proper requirements for managing menstruation among the adolescent girls.
“Here once a girl menstruates, mothers or family members say the girl is ill. So it is considered a disease and it goes in her mind and psyche. This has to go,” she said.
Taing suggests that there should be a female health visitor to attend schools and check the health of adolescent girls in educational institutions.
“An adolescent girl is an asset and the future of a community and her health should be a priority,” she said.
Poor water and sanitation facilities in schools, inadequate puberty education and lack of hygienic items makes girls feel menstruation as a shameful and an uncomfortable experience.
Dr Syed Masooma Rizvi, a professor at the LD Maternity Hospital said she had visited some villages where she found that there was no concept of menstrual hygiene.
“The incidence of Pelbic Inflammatory Disease (PID) is more prevalent among the women in villages. PID has long term effects like infertility and it destroys life of a girl,” said Rizvi, who has worked in the field of menstrual hygiene.
“If there is no access to sanitary pads, it’s better to use clean cloth or cotton. It is not about using a pad. The question is, ‘Do women change it on time?’” she said.
The maternity hospital has an adolescent clinic and some adolescent girls come there to seek treatment.
“Not many girls come to the clinic. Most girls don’t have the information or the working of our society is such that menstruation is considered not important,” she said.
Few years back when the clinic was started, the doctors suggested setting it up at a distance from the maternity hospital, which was not done.
“When a girl is seen in a maternity hospital, people look at her with suspicion, which is unfortunate,” said Rizvi.
She said girls visit private hospitals with complaints about menstrual hygiene and avoid going to government hospitals.
Rizvi said the clinic receives puberty menstruation patients from across the Valley and some of them are admitted.
“Their condition is very bad. In some cases, they suffer excessive blood loss at home. Their hemoglobin level gets down and we do the blood transfusions, which should not happen,” she said.
Rizvi said in remote areas like Bandipora, Baramulla, Kupwara, Handwara, even if people were aware, they do not have economic stability to afford sanitary napkins.
At some places there have been changes but a lot needs to be done, as per the doctors.
“Overnight change is impossible. We must have dispensaries at schools and other public places,” she said.
Rizvi also admitted that the problem was more worrisome.
“Ours is a conservative society and there are ill notions among the people toward girls. Some people say a girl who develops menstruation is impure and she can’t enter the kitchen,” she said.
The doctors also argued that since Kashmir was a patriarchal society, women face inequalities, putting them in trouble.
A study conducted in 2019 in GMC Srinagar on Female Multipurpose Health Workers (FMPHW) of Ramzaan Institute of Paramedical Sciences in Srinagar aimed to assess the effectiveness of structured teaching programme that found FMPHWs were having moderate level of knowledge in pre-test regarding menstrual hygiene.
It suggested education of students.
Shabnam (name changed), a Srinagar-based freelance journalist, said even girls were criticised for talking about their periods with their close friends.
“I have a friend in my neighbourhood. Few months back she posted on Facebook about her period and then the boys would tease her for the same,” she said.