Image Credit: Economic Times

A close reading of Menstrual Health indicator in NFHS-5

The National Family Health Survey was released this week by the Ministry of Health and Family Welfare. This is the fifth National Family Health Survey (NFHS) after the last one was released in 2015–16. The survey includes an extensive analysis of 131 indicators related to family, contraception, sex. One of the indicators covered is usage of safe and hygienic menstrual protection methods.

The NFHS-5 shows a positive indicator trend with 77% women in the country using hygienic period products. Puducherry has shown a 99.1% usage of safe and hygienic products making it the best performing UT.

With 98.6% safe and hygienic usage of menstrual protection Tamil Nadu is one of the best performing states in the category. To understand these trends, we would need to understand parameters on which the assessments are made. Below are a few points that one should look at while reading the NFHS-5 factsheet.

1. The definition of the indicators: Bihar which is one of the worst performing states with only a 58.8% cumulative usage has also shown a remarkable 90% improvement. The improvement can also be seen in Madhya Pradesh and Odisha numbers. Though if we look at the measurement definitions closely, there is a caveat that is visible. The definition of safe and hygienic menstrual protection as mentioned in the survey is- “Locally prepared napkins, sanitary napkins, tampons, and menstrual cups are considered to be hygienic methods of protection.” The definition for hygienic appears to be unclear. Research suggests that there are questions related to sterilization and quality of locally prepared napkins (Garg et. al., 2012). These authors also see a need of monitoring the quality of napkins on a regular basis, otherwise it would defy the basic purpose of introducing sanitary napkins. It is even said that this age-old practice of using cloths and locally prepared napkins among women increases the risk of spreading of reproductive tract infections among women (Goyal, 2016). Thus, the given improvements in the system are definitely laudable but we must accept these numbers with a pinch of salt.
2. The inclusion of a wider age cohort: Currently, the factsheet only includes data for women and girls in the age group of 15–24 years. The indicator is covered under the theme of women-empowerment where the overall age bracket is between 15–49 years. A wider age cohort will provide a holistic understanding of the landscape. Currently, the statistic is only limited to a very young cohort whereas, the age window for menstruation is between 12–50 years (Sinha et. al., 2020).
3. The inclusion of access to awareness: One of the major elements missing in this jigsaw puzzle is the inclusion of menstrual awareness indicators on the NFHS. Studies suggest that 71% of girls in India are unaware of menstruation before menarche (Dasra, 2012). A research done by Project Baala in 2020 shows that only 50% (total women surveyed 364) of the entire sample in a Delhi based study had access to MHM digital resources during the pandemic (Bawa et. al., 2020). This shows that access is not just limited to safe period products but also menstruation related knowledge, attitude and practice change along with it. With Pandemic plaguing us for approximately two years now, data like this makes us reconsider the situation on ground.

Hence, while celebrating our feat with indicators, we mustn’t forget that there is definitely a lot more to achieve. With the incorporation of an indicator on menstrual hygiene in NFHS 4 and NFHS 5 the government has indeed taken a step in the right direction. But let us also bear in mind that a 360 degree intervention and data collection is a necessity for a deeper insight into reality.

About the Author: Uttara S is the Strategy and Research Lead at Project Baala. She is a development practitioner and has worked at grassroot organisations in different parts of the country, she has research and implementation experience in Women’s Health issues. She is believed to be 80 years old with an abundance of knowledge and experiences across multiple sectors and topics.