Background

Mubarakchak is a small village in Munger District of Bihar. It has recently been declared as a model village by Bihar Administration owing to its people’s commitment to the total sanitation movement. Sanitation has physical, cultural and economical implications on the masses but lack of information and infrastructure often leads to ignorance, poor health and contaminated surroundings in the rural areas.

There is a strong connection between gender and sanitation in rural India as sanitation issues among women and girls are influenced by inequitable gender norms that put them at greater risk of experiencing violence and multiple health vulnerabilities. This led to the inception of a unique programme called Making Periods Normal Programme which has played a vital role in helping the residents of Mubarakchak accomplish this feat. Making Periods Normal or MPN began its journey in two districts of Bihar- Munger and Bhagalpur and is led by 4 awareness partners – Restless Developers, SEWA, BVHA and Pratham and distributor partner, Dharma Life.

Making Periods Normal

Making Periods Normal is a unique initiative to reach out to women and adolescent girls in rural Bihar who need structures and mechanisms in place to meet their menstrual needs. Most of these women either lack information about menstruation & menstrual products or have no access to toilets or are faced with unclean lavatory facilities. Over past years, studies and research have proved that Menstrual Hygiene Management is no longer an individual’s issue but a severe developmental concern. Low awareness, lack of infrastructure and economic means along with various myths and taboos associated with their menstrual health, many women are subjected to cultural discrimination, exposed to dangerous health risks, and lose out on economic and educational opportunities.

Total Sanitation Campaign  

In order to accelerate sanitation coverage in rural areas and to bring about an overall improvement in the   general quality of life in these areas, with the broader goal to eradicate the practice of open defecation, a comprehensive programme called ‘Total Sanitation Campaign’ was launched by Government of India to cover all households with water and sanitation facilities and promote hygiene behaviour for overall improvement of health and sanitation in rural areas. The programme is demand-driven and people-centered based on the principle “From low to No subsidy”. A nominal subsidy in the form of incentive is given to the rural poor households for construction of toilets.  The Scheme lays strong emphasis on Information, Education and Communication (IEC), capacity building and hygiene education for effective behaviour change, with the involvement of PRIs, Community Based Organizations (CBOs), NGOs, etc. The Scheme has now been renamed as ‘Nirmal Bharat Abiyan’ (NBA)

Strategy

Making Periods Normal is a unique intervention in more ways than one. Firstly, an end-to-end holistic action plan has been put into action which includes construction of toilets, awareness regarding female hygiene, availability of sanitary napkins, etc. Secondly, various agencies coming together, each with its own set of expertise and working towards a common end objective is a unique approach in itself. Also, community involvement and stakeholder participation has been an integral part of the implementation. To develop Mubarakchak as a model village, following targets were identified and worked upon.

 

The programme is financed with a grant from the Dutch Postcode Lottery (NPL) and each partner has a critical role in Mubarakchak’s success story.

 

• Restless Development & Pratham work with the adolescents attending school and out of school youth to create awareness about menstrual hygiene and encourage them to use toilets at home and schools.
• BVHA targets the men, women and PRIs in the village to help them identify the sanitation issues in the village, build their capacities to take up task of toilet construction in the village.
• Dharma Life’s specific goal is to make sanitary pads available by creating a viable business model with female entrepreneurs selling and distributing sanitary pads.
• SEWA Bharat contributes towards the advocacy challenges related to the issue of sanitation and female hygiene.

Implementation

1. Sensitization Drive – The first stage of the programme was a sensitization drive across the village. The residents were briefly informed about the objectives of the programme. This was also an opportunity for all the partners to know the village and its people better. This was followed by the Donor Visit in Mubarakchak where in all partners discussed their plan of action, timelines and strategy for implementation.
2. PRI Involvement – Subsequently, regular meetings with PRI members about the program and its positive effects on the health and hygiene condition of the village took place. PRI involvement, commitment and dedication were the key to the success of this programme. A household survey was conducted in the village to understand the needs of the village better. It was observed that less than 50% of HHs has a functional toilet at home.

 

 

1. Gram Sabha – All implementation partners participated in the Gram Sabha on 26^th Jan’16 and explained the objectives of the MPN Programme. The alliance partners further discussed the Action Plan to work on the Total Sanitation Objectives and focus on the end objective of building a model village with mutual support.

Community members discussed their apprehensions and doubts and pledged their support towards a Clean & Healthy Mubarakchak.

1. MPN Steering Committee – Finally a MPN Steering Committee was formed with representation from the alliance partners, PRI members, community members and women from the village.
   1. DDC, Munger pledged his full support to the cause and promised cent percent facilitation from the administration.
   2. Role of Dharma Life Entrepreneur – DLE in Mubarakchak, Shabhreen Shakeel has also been actively involved in sensitizing the girls and women in her village about menstrual hygiene. She has become the point person for all MPN queries amongst women, in addition to becoming an entrepreneur who is supplying women the sanitary napkins thus taking care of the availability and accessibility issues related to female hygiene.

Problems Identified

The working area (Munger) is an under developed district of Bihar with very poor social, economic and health indicators. Along with other health problems, the menstrual health and hygiene related complications are very common in the area. Thus, based on community and PRI interaction, following problems were identified under the two broad categories:

• Sanitation Challenges
  • General lack of awareness amongst the masses in Mubarakchak was a major cause for poor sanitation condition there.
  • Men, specially the older folk in the village who were used to defecating in open were never convinced with the idea of wet toilets in every household.
  • Convincing the School and Aanganwadi administration to build new toilets and ensuring that the existing ones are clean was also a big roadblock.
  • Finally lack of funds amongst rural families to construct toilets was a major hindrance in the success of NPN Programme.
  • Gender inequality in household financial decision making was an important constraint against toilet construction.

In response to the shame and fear associated with OD, women were restricting their mobility and adopting risky practices such as inadequate food and water intake for long hours to avoid the need to urinate or defecate. This lack of adequate nutrition along with poor sanitation and hygiene practices worsens the situation for pregnant women and lead to poor pregnancy outcomes leading to maternal and child under-nutrition

• Female Hygiene
  • In India even mere mention of the topic has been a taboo in the past and even to this date the cultural and social influences appear to be a hurdle for advancement of knowledge on the subject
  • During the household survey, various girls accepted that they miss school on their period days as they are embarrassed too face others. Few girls dropped out of schools because they miss their final exams due to periods.
  • Lack of Access and Availability of Sanitary Napkins is also a critical issue in villages. The chemist shops were generally manned by a male thus making the encounter very uncomfortable for the Indian rural women
  • Women silently suffer with health challenges such as infections, discharge, etc because of using unsafe methods to absorb menstrual blood like rags, ash, etc.

 Action Plan

All the MPN alliance partners have implemented the model village plan in a Mission Mode   at Mubarakchak. With clear targets in mind, following steps were taken to ensure that each of the set objectives is met.

Sensitization Drive was the most critical portion of the programme.  Generating awareness amongst the rural masses by all the partners in various capacities helped to build a consensus amongst the community members who whole heartedly participated in the programme, constructed toilets and started buying  sanitary napkins. Pratham and Restless Development worked with young minds whereas SEWA and BVHA worked with the PRI members and other stakeholders to bring about this difference. Dharma Life Entrepreneur sensitized the women folk and young girl s in the village at Aanganvadi  centres and ensured the last mile delivery of female hygiene products.

Easy and smooth flow of funds for toilet construction was ensured by the partners. The Centre State contribution under Nirmal Bharat Abhiyan is as mentioned below. The partners coordinated with the local authorities to ensure that the toilet construction in households isn’t stalled because of lack of funds.

 

Schools receive Rs 150/- per adolescent girl as her hygiene expenditure. Under MPN, this fund was capitalized directly via schools. The DLE directly supplied the sanitary napkins to the school in return of the menstrual hygiene funds.

 

Several follow up meetings and awareness sessions were conducted to ensure that residents of Mubarakchak continue with the right and appropriate sanitation habits. Behaviour Change has been a key driver towards the Mubarakchal success story.

Outcomes – post intervention situation

• Mubarakchak village has attained a 100 % awareness status where men, women and adolescents in the village have understood the relevance of a clean open defecation free village and significance of menstrual health management for a woman’s social, physical and cultural well being.
• The toilets are not just built but they are being used and this behaviour change is the most significant impact of this programme. Women are no more putting their safety and dignity at risk by using open washrooms or toilets.
• Mubarakchak has also achieved the 100% wet toilets mark where every household and public building has a functional toilet in them with proper water arrangement and sewage system, thus, mitigating the risk of water pollution and other health concerns.
• Clean & Safe Drinking Water is another immediate and direct result of the Total Sanitation Campaign in Mubarakchak.
• All women are sensitized and use sanitary napkins regularly during their periods. The easy and doorstep availability in addition to a woman salesperson have worked wonders in the village. Training and awareness workshops in schools have also encouraged adolescent girls to freely talk about their menstrual doubts and adopt sanitary napkins as a way of life.
• Ultimately, it is important that MHM is prioritised by all stakeholders and the hesitation associated with talking about the subject goes away. Mubarakcha team has been able to fight the social stigma and myths associated with this natural process.

Lessons Learnt

• The project was designed in a way such that each partner brought with itself a set of expertise to work on this programme The conflux of all the five key partners paved a powerful movement to drive change around Menstrual Hygiene Management and Total Sanitation Campaign.

It is often observed that several Ministries/Organizations work with different means towards a common goal. But this leads to dissipation of time, efforts and energy. MPN Programme demonstrated that convergence can be a very powerful tool in this regard.

• Sporadic interventions aren’t enough in the field of health and hygiene. Construction of toilets i.e. just the infrastructure is not enough. Similarly, given the sensitive nature of the subject, education about MHM is also rarely or intermittently imparted in schools. A continuos hand holding support of the community is critical to bring about the necessary behaviour change.
• Importance of demand-driven approaches to sanitation giving better results has been proven with the Mubarakchak success story. PRI consultation and involvement along with community brain storming sessions would ensure community involvement and commitment towards the end objective.
• Role of a female DLE as the last mile distributor of female hygiene products was also an interesting feature in this intervention. Right from answering the doubts of adolescent girls to helping women embrace the new change, she is able to help them all. Unlike the male dominated chemist shops, women feel far more comfortable in buying from a female counterpart thus, solving the accessibility issue.
• Programme Customization is the key to success of Mubarakchak village sanitation campaign. Stakeholder consultation, community involvement and PRI support is essential for any grass root level developmental intervention as one size fits all policy doesn’t work in rural India.
• Sensitization of men and adolescent boys by BVHA and Restless Development also led to gender sensitization towards sanitation goals.

Challenges

People of Mubarakchak along with alliance partners have taken some worthy first steps, but many challenges remain in the effort to improve hygiene options for Indian women.

• Firstly proper sanitary pad disposal would be a big challenge as this would otherwise lead to contamination of water resources or end up as breeding ground for infection or bacteria. Low cost bio-degradable sanitary napkins or installation of incinerators in the village would be a few solutions in this regard.
• Lack of baseline data in Mubarakchak village is another challenge to establish the achievements of the intervention.
• Feasibility of replication & upsacling the Mubarakchal model is also a concern. 5 partners bringing in their expertise towards a common goal won’t be easy to replicate and would thus, need another model for implementation.
• Maintaining the robust distribution network would also be crucial to ensure that there is no going back to old means and methods of menstrual hygiene management.