Menstrual hygiene management is core to women’s health, self-confidence and ability to work. With Project “Pravah”, Shahi is providing menstrual health and hygiene training and awareness and easy access to low-cost, high-quality sanitary products to its women employees. This blog post is written from the experience of the OD field team that designed the project.

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Why menstrual hygiene management (MHM)?

Even though MHM is core to women’s health, self-confidence and ability to work, it is a taboo topic that is not talked about openly in India. In a country where the female labor force participation is abysmally low, Shahi’s factories like other garment factories, are rare spaces where you see more women than men. Every factory is legally mandated to have a dispensary stocked with sanitary pads. However in a single factory with over 3000 women, on average only 200 pads are being used every month. The numbers don’t add up.

This led us to wonder:
How are 70,000 women in our factories affected by and managing menstrual health?

To understand this gap better, in 2018, we designed and conducted Focus Group Discussions (FGDs) with around 180 women across five factories in Shahi North, to talk about various aspects of menstruation — myths and taboos, health and hygiene, products and practices, and its impact on work. It was not without its challenges. Socio-cultural barriers around menstruation over the years in India, have led to a culture of uncomfortable silence on discussing periods, especially at the workplace. To facilitate discussion, we tried to create a  “safe space” for women to talk about menstruation by sharing our personal anecdotes and experiences. We conducted similar discussions with other factory stakeholders including supervisors, HR and medical staff.

To supplement our findings, in 2019, Good Business Lab (GBL), a labor innovation start-up incubated at Shahi, also conducted a quantitative baseline survey with 260 randomly selected women in two of these factories on topics including their perception of menstruation, sanitary products, barriers to using pads, and mental health during menstruation.

What did we learn from our research?

Most women did not know about menstruation at menarche (first period). They thought that they had hurt themselves or contracted a serious disease. This is in line with a study conducted by UNICEF in 2013 in Jharkhand with 1200 girls, which found that 70% of girls felt completely unprepared for their first menstruation and 51% felt scared at menarche.

They talked about several myths and taboos related to menstruation that continue to persist. For instance, in some places women are not allowed to enter the temple or kitchen, and are kept away from other family members because they are considered “impure”. These unscientific attitudes and misconceptions that women are “contaminated” lead to poor awareness of their reproductive system, adversely affecting their health and social lives. For example, in the UNICEF study, when shown a body map of the female reproductive system and asked to identify the source of menstrual bleeding, only around a quarter of the girls and their mothers could correctly identify the source as the uterus.

Back at  Shahi, we found that most women are aware of and say they use sanitary napkins. However, at the same time, there is rampant usage of scrap or waste fabric from the factory during menstruation. In GBL’s baseline survey, 60% of women said they use cloth instead of pads at work or other times, such as in cases of emergency or when they forget to bring a pad. Other reasons identified in the FGDs, for the use of cloth include, lack of awareness about the availability of pads, ease of access to waste cloth in the production line, opportunity cost of going to the dispensary (loss of productive time), and embarrassment in telling their supervisor (usually male). This is deeply concerning because studies have revealed non-use of hygienic methods during menstruation to be a contributing factor for reproductive health morbidity among women besides genital and reproductive tract infections. The baseline survey also found cost to be a prohibitive factor – 40% of women who don’t use pads find them to be too expensive, and 65% of them said they would buy them if they were cheaper.

The insights from the FGDs, baseline survey, and secondary studies on menstrual hygiene indicated two clear problems to solve:

1. There is a stigma around menstruation leading to misconceptions, misinformation and lack of knowledge about the physiological process
2. Women use unhygienic methods during menstruation which is bad for their health

Collective insights from the FGDs and the surveys were used to design a holistic MHM intervention in two Shahi factories (A5 and A7) as a pilot.

How did we design the intervention?

We realized quickly that just providing sanitary products at the workplace will not be not enough. To tackle this issue at its roots, we needed to design interventions that:

• Systematically destigmatize and normalize the chatter around menstruation
• Go above and beyond simply providing sanitary products in the factory dispensary

Only then can we expect things to change. Thus, our project objective is to create a comfortable and supportive work environment for women by providing menstrual health and hygiene training and awareness to all stakeholders, and easy access to low-cost, high-quality sanitary products to all women.

Two factories (A5 and A7) with 800 women were selected to pilot the project. Taking support from our long-time partners, Breakthrough (a women’s rights non-profit), we designed a campaign on MHM called “Pravah” meaning “Flow” in English with a strong tagline translating to “No stigma. No shame. Soar with this new aim.”  To improve access, affordability and awareness, we developed a multi-pronged approach:

• A three-hour awareness session for women with:
  • Informational and sensitization training around menstrual health and hygiene
  • Screening of “Padman” – a national-award winning Bollywood movie, based on the true story of a social entrepreneur who creates a low-cost pad-making machine
  • Video message from popular Bollywood actress Sonam Kapoor encouraging women to break the silence on menstruation
• Biometric-enabled vending machines in women’s toilets have been installed, stocked with highly subsidized sanitary napkins. This helps women overcome barriers identified in the research – high cost, loss of productive time by visiting the dispensary, and embarrassment in informing the supervisor. More than that, the vending machine gives a woman independence in availing sanitary pads in a comfortable environment without any interference of a third person.

We recognize that just talking to women and changing their mindsets is not enough – we need to talk about MHM with all stakeholders in the factory. So we conducted training sessions with the medical staff, HR team, factory management and male supervisors in the two factories.

Where are we now?

The training and awareness sessions have been completed, and the biometric-enabled vending machines are running in the factories since October 1, 2019.

Within one month of launching the service, 353 women have availed the facility in one factory with around 550 women. That’s a utilization rate of 65%. Results from our knowledge tests – before (pre) and after (post) training show a drastic change in how women perceive menstruation. Before the training, 81% of women said that menstrual blood is dirty or impure; after the training, this number came down to 12%. While this shows that there is still room for improvement, we can see that women’s mindsets are changing.

Earlier we had problems in accessing sanitary napkins and their safe disposal. I am happy that Shahi has given us this facility in the toilets through sanitary napkin vending machines. The napkins are affordable and accessible to all the women employees of the factory. A safe disposal mechanism has also increased the hygiene level in the toilets

– Archana Singh, Checker, working in Shahi for the past 8 years.

That is not all, GBL will be studying the impact of this intervention on workplace outcomes such as attendance and productivity. True to GBL’s ethos, this is an effort towards creating a business case for investing in workers’ health. They will conduct an endline survey in January 2020 to once again map changes in women’s perception of menstruation, menstrual products, organizational commitment, and mental health. The results from their study, and our experience with the implementation of the pilot, will inform a Shahi-wide MHM strategy.

We must also acknowledge an inherent problem with disposable pads –  they are most often non-biodegradable and pad producers don’t fully disclose the materials that have gone into making the pad. Thus, we are conducting a  feasibility study in our factories in South India to explore alternatives such as menstrual cups and reusable cloth pads. We are also looking for biodegradable disposable pads that are not only safe but also don’t compromise on cost and quality.

Our co-creation process has just begun, and in that spirit, we invite more stakeholders to get involved in this dialogue so that we can, together, create a scalable, effective and sustainable MHM solution for women in factories around the world.

For more information about the project or collaborations, please email us at od@shahi.co.in