MHM Issues through the Eyes of State, District & Block Level Stakeholders of the Public System in the State of Bihar, India

Abstract

Menstrual Hygiene Management (MHM) is an active component of Adolescent health initiative of the Rashtriya Kishori Swasthya Karyakram (RKSK) of the National Health Mission (NHM) of all the 18 Empowered Action Group states where NHM is operational since the introduction of National Rural Health Mission (NRHM) in 2005 (GoI, 2014). The current study relates to the state of Bihar where the MHM is operational through the NHM. After a year of RKSK, the MHM guidelines of India was developed in 2015 (GoI,2015).

MHM is defined as ‘women & adolescent girls are using clean menstrual management materials to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstrual period, using soap & water for washing the body as required & having access to facilities to dispose of used menstrual management materials (WHO/UNICEF JMP, 2012).

Globally, at least 500 million women & girls lack proper access to menstrual hygiene facilities. Several factors influence difficult experiences with menstruation, including inadequate facilities & materials, menstrual pain, fear of disclosure & inadequate knowledge about the menstrual cycle (World Bank, 2018).

Women & girls typically wash & change menstrual materials at home. They use sanitation facilities that are not safe, clean or private & frequently lack water or soap that relatively few facilities meet all these criteria. Access to appropriate materials & the type of material used also varies widely across countries (WHO & UNICEF, 2019).

The global MHM day started in 2014 when the German based NGO WASH united co-ordinated the menstrual hygiene day as the overall global co-ordinator. The global day was decided to be the 28^th of May every year as the menstrual cycle is of 28-day duration & usually lasts for 5 days. That’s how it is 28^th day of the 5^th month of every year (Wikipedia, 2014). Similarly, on these lines, the RKSK program was also launched in India in the year 2014 (GoI, 2014).

The objective of the current study was to collect & aggregate qualitative data through involvement of stakeholders like schools & community of Gaya, Purnia & Sitamarhi districts of the state of Bihar to reflect on issues of MHM. The study was a step towards the process of developing a roll out map of MHM related issues at the state & district level.

Focus Group Discussions (FGD) were held for community members & school students for Sitamarhi district where they had come to the district level for the discussions. Similarly, FGDs were conducted at school level & community level stakeholders of Gaya & Purnia districts.  FGD protocols were used as research tools to conduct FGDs for the participants of the purposively selected schools & community.