By Anupreeta Chatterjee

Understanding the Menstrual Health Crisis faced by Female Refugees during COVID’19 Pandemic

Menstruation is often seen as a private matter, even though it is a matter of public health due to stringent social norms and taboos associated with it, it is not perceived as such. Although the Ministry of Health and Family Welfare introduced a scheme for promotion of menstrual hygiene among adolescent girls in rural areas to increase awareness among them. It emphasized on menstrual hygiene, increasing accessibility to high quality sanitary napkins and ensuring safe disposal of these used napkins in an eco-friendly manner. The issue is also pertinent in urban settings. FSG report claims that there are around 355 million menstruating girls and women in India, but they face significant barriers when it comes to menstrual hygiene management. The report also revealed that 88% of women in India use homemade products including, old cloth, rags, ash, etc. due to personal preference, lack of access to quality sanitary napkins or menstrual products, and lack of sufficient information pertaining to pads and other menstrual products is also rampant. While working with Sachhi Saheli, an NGO-based in Delhi working in schools and Anganwadi centres to increase awareness among adolescent girls and women about menstrual health and hygiene, I realised that most girls were not aware of what menstruation is, before their first period. Most girls had a negative self-image about their menstruating bodies as they felt that their menstrual blood is dirty. Such was the situation of menstrual hygiene management when the pandemic did not exist. 

Now, the situation has worsened with the government induced migrant crisis in the wake of the all India lock down to arrest the spread of COVID-19. It would be difficult to bring out narratives of refugees as their vulnerabilities are not often taken into consideration. Their existence is nullified and governments often ignore them. It is important to address such issues but it seems the government is unwilling to have discussions centered around citizenship issues and they do not want youth to engage in discussions pertaining to crucial issues of citizenry. Thus, this essay would try to bring out menstrual health issues faced by female refugees while the world seems to fight COVID-19. Most of the narratives would be derived from secondary sources including, newspaper articles, opinion articles published by various organisations including, UNFPA, Indian Bar Association, etc. 

India’s Refugee Policy 

In India, the provisions of the Constitution regulate law pertaining to citizenship or nationality. Articles 5 to 11 in Part II of the Constitution of India state provisions relevant to citizenship. In India, humanitarian matters of rehabilitation of refugees and providing safety and security to them along with fulfilling their basic needs is often influenced by national security. While law and order is a state subject under the Indian Constitution, but international relations and borders are under the purview of the Central Government. Thus, various agencies of both state and central governments have to deal with matters affecting refugees as far as law enforcement is considered. All policies are laid down by the Central Government but the state government is more responsible for handling the problems of refugees. State governments must focus on addressing humanitarian issues faced by refugees without compromising on national security. The government should realise that a person becomes a refugee due to adverse situations they face in their native lands. They do not have any other option left other than fleeing from human rights violations, socio-economic and political insecurity, generalized violence, civil war, etc. 

Article 1 Paragraph 2 of the 1951 United Nations Convention defined refugee as:

“a person who owing to well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his/her nationality and is unable or, owing to such fear, unwilling to avail himself/herself of the protection of that country.”

In India, there is no separate law which addresses the issues of refugees. In absence of a specific law, all existing laws including, The Criminal Procedure Code, The Indian Penal Code, etc. apply to refugees as well. Even though India is not a signatory to the 1951 Convention on refugees and 1967 Protocol, India is a signatory to a number of United Nations and World Conventions on human rights. India has also voted affirmatively to adopt Universal Declaration of Human Rights which protects rights of all persons even if they are non-citizens. Thus, India must focus on creating policies and laws which address problems faced by refugees. 

COVID-19 Pandemic and its impact on refugees in India 

The majority of refugees registered with UNHCR, the UN Refugee Agency in India belong from Myanmar and Afghanistan with smaller groups of refugees coming from countries like Yemen, Syria, Somalia and other African countries. UNHCR along with its local partners has provided food packages to 9000 refugee families. Even UNHCR is facing funding problems so as to support vulnerable refugees, asylum seekers, host communities with rations, cash support and sanitary napkins for girls and women. UNHCR claimed that refugees and asylum seekers have access to healthcare but testing centres are asking for proof of address so they are providing supporting letters to refugees who are not having formal rental agreements. UNHCR has played a significant role by issuing an advisory to the government stating that the government should take care of the needs of immigrants and integrate them in their national schemes as their needs remain unmet because they do not have a status. 

Refugees who are single women have been evicted by landlords as they are unable to pay the rent. These women cannot even go to the police and seek help due to their tenuous status. Some of them are facing sexual assaults and are easy targets because they do not have access to legal protection systems. Thus, female refugees are facing a lot of violence at every stage. Female refugees do not have the right to access reproductive healthcare currently as their access to health care was routed through UNHCR’s partners who owned their own healthcare facilities. For that, partners would come to one centre and refugees would come and access them in that centre. Now, due to lockdown the centre has been closed. Refugees can go to hospitals run by the government but they are not visiting hospitals due to the few of contracting COVID-19.

The Central Government has set up hunger centres and initiated a migrant mapping protocol so that migrants are able to access relief measures. The Supreme Court of India also issued an order stating that basic facilities, minimum wages to workers, access to testing in private labs should be provided to migrant labourers. Despite the efforts put in by the government, refugees are struggling as they are excluded by mainstream systems as UNHCR has reported that refugees are excluded from policies. Government has released many advisories but nothing has been done to address concerns of refugees due to lack of clarity pertaining to their legal status and lack of government documentation. 

Due to rampant Islamophobic political reign, Rohingyas were intentionally targeted which led to stigmatization of Rohingyas. Their needs were not taken into consideration as they were identified as a potential threat to national security and were marked for deportation by the Right-wing government. Thus, Islamophobia becomes a tool for not addressing issues faced by immigrants. It seems refugees are not meant to be treated as humans and their issues are not relevant to solving the humanitarian crisis. Yet, people talk about dharma without realizing its essence. 

Gendered Impacts of COVID-19 with special focus on Menstrual Hygiene Management 

While covering different aspects of COVID-19 impact on refugees, we must also focus on its gendered impacts. UN Refugee Agency stated that displaced women and girls are facing a greater risk of facing gender- based violence and they might be forced into survival sex or child marriage. UNHCR has recommended governments to prepare action plans for displaced women and girls. It has been reported that during lockdown, a few migrant women have been forced to give birth on streets and are relying on cloth and ash during menstruation. Even during normal times, women and girls use old cloth, rags or ash instead of sanitary pads due to lack of information and lack of access.

A case study of a 15 year old girl from Jhansi is quite disturbing wherein she stated that even when it rains, she sleeps outside, washing the clothes when the blood leaks and wears the same cloth again. This is the situation of a girl who is an Indian by birth. If female citizens of India are facing such issues during their menstruation then, female refugees residing in India might face more adverse situations because they lack even the access to proper healthcare facilities. It is important to notice improper menstrual hygiene management could lead to urinary tract infections, cervical or vaginal cancers which might lead to complex health issues pertaining to fertility issues, uterus fibroids, removal of uterus, etc. 

Adolescent girls and women among migrants including refugees are encountering enormous difficulties during lockdown. Due to the extension of lockdown, supply of sanitary pads has been affected as it was not counted among essential goods. 

Ananya Chhaochharia, the founder of Paint it Red stated that we are facing a huge health crisis due to limited production of sanitary products. The government should prioritize menstrual health and a gendered view is required to address this issue. 

On 30^th March, the Women and Child Development Ministry notified that sanitary pads should be considered as essentials but still, supply of sanitary pads has been limited due to disruption of services. Sanitary pads should be distributed for free to ensure accessibility and affordability. Women’s health should be taken into consideration and doctors should be sent to all relief sites so that women’s health is not adversely affected. Government should resume production of sanitary products and come up with alternatives to be distributed among women who are residing in relief camps. This important measure could also help female refugees to get access to sanitary pads and remain hygienic. 

Conclusion

Menstrual Hygiene Management is often not considered as important and it is the most stigmatized topic which needs to be redefined from a public health perspective. Thus, legislators should make laws or policies by keeping women in centre. Mostly, policies are not based on equity. Therefore, legislators must create a provision for sanitary napkins and incinerators in schemes like Swachh Bharat Abhiyan. It is also essential to cover environmental aspects too while considering the disposal of used pads. Sensitization is an equally important process. Therefore, only creating awareness might not lead to change in behaviour. Sensitization takes a long time and it gradually changes the mindsets of people. Accredited Social Health Activist (ASHA) workers , Anganwadi workers, Sanitation workers, public health sector workers must be sensitized so that they could spread awareness at grassroot levels. Even now, ASHA workers and Anganwadi workers should provide support to pregnant and menstruating women so as to address issues pertaining to reproductive and sexual health which could also stop child marriages which female refugees might face. ASHA workers and Anganwadi workers should be provided with safety, security and risk allowance while dealing with female refugees. On 6th of August, ASHA workers, Anganwadi workers, and other scheme workers went on a two-day strike stating that many workers died due to COVID-19 and they were not paid wages for months. Government must take initiatives to ensure safety of ASHA and Anganwadi workers by providing them Employees State Insurance (ESI) and Employees Provident Fund (EPF) for the safety of these workers working in red zones and containment areas. Menstruation is a natural process but stereotypes around menstruation underestimate women’s power to reproduce and often, their abilities are questioned when they are on periods. Therefore, it’s high time to make women and adolescent girls aware of their strength and power of menstruation as a process. It is important to reconsider production and supply of sanitary products to women living in relief camps so that they are able to practice safe menstrual hygiene management without facing any difficulties. ASHA workers can distribute sanitary pads among women. During lockdown, various NGOs also distributed sanitary pads among migrants but it is essential to take female refugees into consideration. Even the civil society organisations seem to be quite ignorant about female refugee’s issues as they are excluded from the mainstream systems. Some NGOs cater to their needs but due to lockdown, many of these organisations are facing funding issues. Thus, it is recommended that the government should create special provisions for female refugees so that they too are involved in the policies implemented by the government. 

Photography by PTI

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About the Author

Anupreeta Chatterjee is a published poet and blogger from Korba Chhatisgarh. She has pursued her post graduation from Tata Institute of Social Sciences, Hyderabad. Till date, she has published around 60 poems in various National and International Anthologies and magazines namely, Muffled Moans, Symphony of Souls, Spirit of India, The Quiet Letter, Quillopia, ParaSva, Ink Drift, Delhi Poetry Slam, Complexion Based Discrimination, etc. Currently, she is pursuing her Ph.D. in Women’s Studies from Indira Gandhi National Open University. Recently, she received special recognition from Gujarat Sahitya Academy and Motivational Strips (world’s most active writers’ forum) for her literary contributions. She was also awarded the ‘Rabindranath Tagore Award’ by Arpita Foundation, Vrindavan for her literary works, in February, 2019.