State’s cup plan will flop if the approach is wrong, caution activists

ASHAs and mothers must be trained in the usage of menstrual cups before enlisting the girls for the pilot, feel activists

The government of Karnataka launched a pilot project in Chamarajnagar and Dakshina Kannada districts by distributing menstrual cups to eight girls at BR Hills in Chamarajnagar district on July 6. Conversations with activists and beneficiaries highlight the need for better planning and approach in the pilot programme.

Ranjitha J, a BCom first-year student in a Kollegal college, was one of the eight beneficiaries to whom the cups were given on July 6. Her mother Shashikala J works as a junior primary health officer in a Primary Health Centre (PHC) in Gumballi. She told DH that before Covid, a Bengaluru-based NGO that partners with the PHC, conducted two short offline and online trainings on menstrual cups for Anganwadi staff and Accredited Social Health Activists (ASHA).

Apart from this intervention, there has been no other awareness programme from the government on menstrual cups. The frontline workers working in the area themselves are unaware of how the menstrual cup practically works.

One of the ASHAs who spoke to DH said that they and women in the community don’t feel confident about using cups yet, so more practical face-to-face trainings are necessary. Sanitary pads and cloth pads are the most used method in the communities living in and around BR Hills.

Catching them young

Ranjitha said that though a video was shown and celebrities spoke about cup usage in the programme, she needs to check online and try it out. No one in the community, including her mother, knows enough about it to use it confidently, she said. DH also spoke to a couple of other beneficiaries who shared similar views.

The token distribution of cups took place in BR Hills, but the pilot is going to be in Yelandur taluk, on 150 girl students from schools and colleges. This area has seen no intervention in terms of Information, Education and Communication (IEC) about the programme so far. Puttur in Dakshina Kannada district is another taluk chosen for the pilot where cups will be distributed to 50 more girl students as part of the pilot.

Explaining the rationale behind choosing these two taluks for the pilot, Randeep Dev, Commissioner of Health and Family Welfare, said: “The plan is to introduce menstrual cups in one easy acceptance and one difficult area like tribal area.” Also, one highly educated district for which Puttur was chosen and one tribal area, ie, Yelandur.

Why the age group 16-18? Randip informed that the Shuchi program, under which the pilot was launched, covers the age group 10-18, and the 16-18 age group is suitable for menstrual cups. “Early adolescent girls may not be appropriate for pilot interventions and menstrual cups are recommended only after 16 years and not before that,” he added.

Welcome step, but...

C Mahadev is working for the last 20 years with the tribal community in Chamarajanagar district as the president of Zilla Budakattu Girijana Abhivruddhi Sangha. He said this was a novel and welcome initiative for the tribal community in the area that is unaware of this option that would save money spent on pads. However, he said the women in the community were not roped in or spoken to before the programme, though 400-500 tribal women participated in the pilot launch programme.
Sindhu Naik, based in Bengaluru, is a volunteer with the ‘Green the Red’ campaign that advocates sustainable menstruation involving cups, cloth pads and period panties. She says that while it's encouraging to see that the government is looking at sustainable alternatives in menstrual hygiene products, it would work better if the programme was targeting women. Frontline workers such as ASHA, Anganwadi workers, teachers and community workers should be educated first. “Even better if it’s a mother-daughter programme. Since it’s an intimate subject, and since the cup is new, it is better if women educate their children about it.”

“The removal of the cup from the body is a tricky issue. Lack of practice or lack of knowledge on tips to remove it, and incorrect usage can result in pain and problems, and it can affect the very acceptance of cups. Adapting to a cup involves a learning curve, and it cannot be thrust on girls. They should be given a choice of cups or cloth pads. There needs to be somebody to handhold the young girls,” she says while vouching for the eco-friendliness and pocket-friendliness of cups. She also raises concerns about the monitoring mechanism for the usage of cups during the pilot.

Dr Meenakshi Bharath, a gynaecologist and a trainer with the Green the Red campaign, calls it a “no-rash, no-trash no-cash programme” highlighting the economic, health and environmental benefits of the cups. However, she says, “we recommend that mothers and teachers also be brought on board and given access to the awareness and menstrual cup. Once they understand the benefits, it will end the ‘period poverty’ where women do not have money to buy sanitary pads every month. It’s a win-win situation for all.”

Meenakshi also addresses the unsaid apprehension among women. “There is no question of girls losing virginity with the cups. The hymen already has a hole without which period blood will not come out. But for a young girl to know her body parts, someone must guide her. That’s why mothers should try it out first and then handhold the child.”

Megha, a scientist and a cup user based in Bengaluru, says the step is progressive. However, since the cups are a relatively new phenomenon in India, she says she is not sure how it works with the anatomy of a 16-18-year-old. Also, between the uses, the cup needs to be sanitised, for which access to clean water and toilets is a must. Her third concern is the social acceptability of the culture of cups which involves inserting something into one’s body, for which strong mentoring in a way girls feel confident about it is required.

Dr Sylvia Karpagam, a public health expert, highlights many practical problems: "Unless there is a good facility to wash and change the cups, it will either overflow or can lead to reproductive tract infections. If the cups are left for too long in the absence of a facility to change them hygienically, the blood doesn’t clot unlike with a pad. Fresh blood can flow out during certain movements. Removing the cup and inserting requires some skill. Removing the cup can cause blood to spill if not done carefully. Sometimes the cup can even fall into the commode."

"Unless government schools in rural areas are equipped with good toilets and water facilities, which they are mostly not, sanitary pads are a better option. It is also culturally more acceptable," she adds.

The department hopeful

The Health Department agrees with the observation of volunteers. Randip told DH: “Not only to adolescents, but we plan to introduce cups to their mothers as well and train them, along with guidance for both. ASHAs and Community Health Officers (from health and wellness centres) will be involved in the programme for further monitoring and guidance to beneficiaries.”

Dr Veena, Deputy Director of Rashtriya Kishor Swasthya Karyakrama in the state, said that parents and teachers will be roped in, and orientations will be conducted. The health department will make sure the schools and colleges chosen for the pilot have access to clean water and toilets.

Randip said the final programme depends on the response from both the pilot areas which will contribute to specific approaches. The pilot project is supposed to be completed in six months.