Swavalamban a P R O J E C T O N C R E a T I N G M E N S T R U a L L I T E R a T E C O M M U N I T I E S

U N I T E D S I S T E R S F O U N D A T I O N SWAVALAMBAN A P R O J E C T O N C R E A T I N G M E N S T R U A L L I T E R A T E C O M M U N I T I E S

Report on Final Outcomes

Project Location TODAPUR GAS GODOWNS, NEW DELHI CONTENTS

I. INTRODUCTION Page 1- 11 IV. SUSTAINING THE CHANGE Page 25-30 Founder's Note Social Impact Analysis Stakeholder Organisations USF Change Agents Executive Summary Project Background Logo & Objectives Methodology

V OTHERS Page 30-35 II UNDERSTANDING THE ISSUE Page 11-21 Way forward Social Mobilisation Activities Core Team *Nukkad Natak Stakeholders *Painting of the Meeting Place & Public Toilets Project Glimpses *Poster Campaign Personal Interactions & Survey

III ADDRESSING THE ISSUE Page 21 - 25 Body & Mind Pinkathon Technical Sessions Production & Distribution Medical Screenings Other Social Initiatives

FOUNDER'S NOTE

The Indian Society has deemed several aspects of human physicality as taboos especially issues related to women bodies. As a result of this societies silence over decades on women health issues, diseases like breast cancer, cervical cancer, sexual infections etc are on the rise. These taboos & cultural factors created an obstacle for women to a free discussion on certain physical ailments with their family members, which eventually might lead to a delay in accessing the required health care. In 2012 United Sisters Foundation decided to break the silence on breast cancer by empowering women. Our intention was not just creating awareness but also to get more and more women to adopt a fitter lifestyle for themselves and their families. From the past 5 years, we expanded our awareness to 8 cities & sensitized lakhs of women to freely talk about it. After the success of breast cancer awareness, USF has decided to focus on creating awareness of menstrual health & hygiene practices through breaking taboos. Though our country is progressing technologically & scientifically, it is very unfortunate to see a large number of adolescent girls and women are still weighed down unfounded and unscientific beliefs about menstruation. Our focus through the Swavalamban project is to empower women and adolescent girls to be change makers in their own community. We feel we will be able to bring change by actively engaging them in conversations, understand their doubts & provide technical knowledge. USF will also work towards providing opportunities for their mental & physical development.

Let’s join hands to make this world better for everyone. MILIND SOMAN Actor & Model, Founder - United Sisters Foundation STAKEHOLDER ORGANISATIONS

UNITED SISTERS FOUNDATION United Sisters Foundation (USF), not for profit organization spreads awareness of the importance of an active lifestyle for the women and health issues that put women’s lives at risk. Founded in 2014, founded by Mr Milind Soman and Ms Reema Sanghavi, USF has been instrumental in bringing a major shift in women’s health and fitness through India’s biggest women run, Pinkathon. This India’s top-rated running event aimed to create awareness on breast cancer is now spread across 11 plus cities, engage lakhs of women & families directly. Pinkathon supported several underprivileged women with cancer to get better treatment & facilitated hundreds of free breast screenings.

SONALIKA SOCIAL DEVELOPMENT SOCIETY Sonalika International tractors Ltd. is the youngest and the 3rd largest tractor maker in India. Its world’s number one integrated tractor manufacturing plant at Hoshiarpur has a capacity to produce 3 lakh units per annum. The company produces technologically superior tractors in a range from 20HP to 120HP and is recognized in both domestic as well as international markets as a formidable player. The company has earned the trust of over 7 lakh customers in more than 80 countries in just 2 decades which is a remarkable feat. Sonalika ITL has been recently felicitated by The Economic Times publication as ‘The Iconic Brand of India’.

DELHI POLICE The Delhi Police (DP) is the Law enforcement agency for the National Capital Territory of Delhi (NCT). It does not have jurisdiction over the adjoining areas of the National Capital Region. The head of the Delhi Police Department is designated as Police Commissioner of New Delhi. In 2015, sanctioned strength of DP was 84,536 (including I.R. Battalions making it one of the largest metropolitan police forces in the world.They come under the jurisdiction of the Ministry of Home Affairs (MHA), Government of India and not the Government of Delhi. [4]:para7.5. The headquarters are located at Indraprastha Estate, New Delhi.

DISCLAIMER DISCLAIMER ADDRESS: The United Sisters Foundation prepared this report on the outcomes and proceedings of recently concluded UNITED SISTERS FOUNDATION CSR Project in partnership with Sonalika Social Development Society. This report prepared by a team of 402 Opulence, 4th Floor, 6th Road, Above Dena Bank, consultants and researchers outlines menstrual health management challenges, perceptions and solutions. The Near Santacruz station, report is for knowledge dissemination only & the content is subject to copyright. Santacruz (E) Mumbai – 400055 COPYRIGHT @2017 EXECUTIVE SUMMARY INTRODUCTION Menstrual hygiene management (MHM) is an important issue that affects adolescent girls and premenopausal women on a monthly basis. However, Menstrual hygiene practices vary worldwide and depend on the individual’s socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. Around the world, women developed their own personal strategies to cope with menstruation. Most of these practices are based on the myths that they have been hearing from their elders. Often these myths/ methods are unhygienic and inconvenient particularly due to unclean water, and social taboos and restrictions of drying clothes indoors, away from sunlight and open air. To be able to dispel myths and solve the menstrual hygiene issues, society must first be able to identify the root cause. Women & Men should be able to discuss this out openly & freely. As a result, adolescent girls will develop the knowledge about menstruation and hygienic habits that are essential. This knowledge will not only give young girls & women the confidence to talk freely about the subject without getting embarrassed but also help them to ably manage it.

METHODOLOGY United Sisters Foundation conducted a 6 months pilot project at the Todapur Gas Godowns Slums in New Delhi. The project was focused on 5 major areas - Education, Health, Environment, Economic and Empowerment. The project initiated with social mobilization activities by conducting street theatres and social infrastructure beautification to create awareness followed by one on one interviews at the village on menstrual hygiene management among adolescent girls and women. Assessment of knowledge on adolescent girls and women followed by an orientation on the issue was done. 3rd phase was more focused on the mental and physical health. Approx 300 women and girls were made to participate in the Delhi Pinkathon. Specialized training was conducted with doctors and experts on MHM management and other preventive issues. Training on making cloth pads was given. As an end of the project, a medical screening camp was held & change agents were appointed.

FINDINGS 80% women in Todapur gas godowns don’t have access to the toilet. They wake up in the midnight to take bath. Menstrual health management was poor in this kind of situation among the large proportion of women The pilot intervention helped to improve knowledge of the Todapur women & girls to an extent Before the orientation. 73% of the women & girls were not aware of menstruation. But after the orientation, remarkable response and changes in their perception was observed A noticeable change & increase in the knowledge of menstruation was observed

CONCLUSION Conclusion This initiative has definitely helped the women in understanding menstrual health management and changed their perception. During the end of the project, people were more open to discussing menstruation and they were even willing to discuss in public. Few issues came up during the campaign were lack of toilet facilities, which is essential for MHM. This needs to be addressed in future. MENSTRUAL HYGIENE A Basic Necessity to Human Health Issue

In many developing countries, women & girls encounter difficulties in managing hygiene during menstruation. Menstrual Health Management is more challenging in urban slums & rural areas due to lack of Water, Sanitation and hygiene (WASH) facilities. Almost every woman and girl (from menarche to menopause) will menstruate on average every 28 days for about 5 days. Though it is a completely normal biological process, menstruation is still associated with silence, myths, taboos and even stigma. Women and girls all over the world over face numerous challenges in managing their menstruation, which is considered to be ‘impure’ and ‘dirty’

Together, these challenges related to social stigma, lack of knowledge, education, cultural practices, beliefs and lack of sanitation facilities may result in women and girls being denied basic human rights and can turn a simple biological fact into a barrier to gender equality. Realizing the human rights to water and sanitation for women and girls is an important issue for MHM, it is important to create safe, sufficient, accessible WASH facilities for personal and domestic use so that it provides privacy and ensures the dignity of women & adolescent girls.

As a community, we must ensure that menstrual hygiene management and education are incorporated more into water, sanitation, and hygiene (WASH), education, and sexual and reproductive health programs. Doing so can boost the confidence of women and girls in managing their menstrual hygiene.

Project Swavalamban initiated in Todapur Gas Godowns with an objective of creating awareness about effective menstrual health management in women & adolescent girls. However our approach was not just to create awareness, but also to find out the other health & social concerns that are affecting women & adolescent physical & mental development & also to address the issues related to education, knowledge and WASH facilities.

71% of girls in India 70% of women & 27% world’s cervical 355 million There are 63 million reported adolescent girls in cancer deaths are menstruating women adolescent girls living in having no knowledge of India do not have accounted in India due and girls in India homes without toilets menstruation before access to proper to poor menstrual their first period menstrual hygiene hygiene. products

Source: Menstrual Hygiene Awareness Day /Fact sheets Source: Menstrual Health Management day IT'S TIME TO BREAK THE SILENCE Source : Menstrual Hygiene Awareness Day/Fact sheets PROJECT BACKGROUND

Todapur Gas Godowns is one of the slums in Delhi adjacent to the Traffic Headquarters. The village has over 2,500 houses, mostly occupied by people running dairies or working as auto rickshaw drivers. "The living condition of the slum dwellers was pathetic and toddlers were seen playing in the huge garbage dump. Due to the poor socio-economic conditions, many young and adolescent children were vulnerable and prone to crime. Most of them were drug addicts and use to get involved in street crimes like snatching, theft, robbery, etc, to meet their needs. Women & Girls were worst affected by lack of hygiene and sanitation facilities.

To reduce the crime rates and to improve the living conditions in Todapur, Delhi Police has taken up " Integrated Slum development project' in association with several corporates and NGO's. The project focused majorly on women and children development by improving infrastructure, facilities & also sensitisation programmes on health & hygiene.

Swavalamban project initiated as part of the slum development by United Sisters Foundation in association with Sonalika Social Development Society, with an exclusive focus on Menstrual Hygiene Management among women & adolescent girls. ABOUT SWAVALAMBAN

United Sisters Foundation along with Sonalika ITL launched a project ‘Swabalamban’ ( means power within) with a primary objective of creating awareness about women’s health and hygiene, sustainable menstruation practices, and cancer awareness along with self-examination workshop.The project “Swabalamban” committed towards women’s hygiene, health will Identify, train, educate and empower women from weaker sections who would act as catalysts in bringing behavioural change that impacts their living conditions & improves their health & wellness.

Mr. Deepak Mittal, MD, Sonalika ITL with Mr. Milind Soman, Founder, United Sisters Foundation at the CSR advisory committee meeting 2017 held in New Delhi. LOGO DESCRIPTION Swa means self, Avalamban means owning responsibility. Swavalamban means adherence to one’s self-using the power within. The posture represents inner peace, which is a core objective of Swavalamban. It conveys conscious effort to channelling inner potential for self-sustainability. Flower in hand represents inner blossom. Bud above the head represents the willingness to learn and grow. A strand of hair circles, in the end, represents various thoughts, which flow in harmony. The logo painted in warm colours – Red, Orange and Yellow, light blue representing life, positivity and strength.

OBJECTIVES The main objective of the project was to promote adolescent girls’ rights to reproductive health through Menstrual Hygiene Management.

Specific Objectives *To raise awareness of menstrual hygiene management *To raise knowledge of MHM practices and To develop skills in preparing affordable, reusable, environmentally friendly, hygienic, sanitary napkins

The swavalamban project was an initiative just not to create awareness on menstrual awareness but also to understand the traits, address individual challenges, clarify doubts, touch lives, education on the preventive methods and create a positive image of the menstruation. METHODOLOGY PHASE 1 PHASE II PHASE III

UNDERSTANDING ADDRESSING SUSTAINING THE ISSUE THE ISSUE THE CHANGE

Physical & Mental Health Identifying Change Agents Social Mobilisation Activities Sports Events - Pinkathon Participation *Training * Street Theatres, Body & Mind workshops *Empowerment * Painting of Social infrastructure, Motivational classes * Posters Suggestions & Recommendations to Stakeholders Menstrual Health Management United Sisters Foundation One to one conversations with * Expert Workshops Sonalika CSR Women & Adolescent girls to understand the * Skill Development Delhi Police following; * Menstruation myths Other Health Issues *Current practices on MHM * Doctor Appointments *Challenges *Medical Screenings * Other Social Issues indirectly affect MHM

Social issues & Infrastructure Changes

Partner Engagement, Volunteer Engagement, Response & feedback analysis, Social media engagement & other ongoing activities P H A S E I : U N D E R S T A N D I N G T H E I S S U E

SOCIAL MOBILISATION The Swavalamban project isn’t a target driven exercise but a means to spread a sense of belongingness to one’s own self through her body. In the first phase of the project, we focused on social mobilization activities and personal interactions which will result in creating a positive working environment to achieve desired results.

The conditions of work at Todapur would not be very conducive to the intent and the matter that we are dealing with has been silenced throughout history. To bring up a conversation which has been a taboo due to the stigmas attached to menstrual health was not only challenging but also empowering for the beneficiaries and the society at large. Initially, interns were taken aback at the sight of vulnerabilities that nestled right at the heart of the capital city.

We started with an initial visit to the village on the 14th August 2017 in order to plan out the wall painting that was to be carried out as a part of the Independence Day Celebrations next day. It was a part of the social mobilisation campaign to mark the first official visit of Swavalamban to the field. An immigrant Bihari population thrives in conditions one could never imagine. This however served as a motivating factor for them to step forward and work towards empowerment making an attempt to create awareness about the plethora of myths and misinformation that surround around one’s menstrual health.

The wall painting event on Independence Day turned out just as planned. Everyone, ranging from toddlers to older men of the village, helped beautify the “Chabutra” that they associate with religious practices. The outer walls of the toilet complex were our canvas to raise consciousness about sanitation and personal hygiene. The members of Kalakriti, the Fine Arts Society of Hansraj College, chose traditional animal motifs from the “Madhubani” form of art. This was a deliberate gesture to create a sense of cultural connection with the inhabitants of the village who have migrated from Bihar wherein the art form originated. . Social Mobilisation Activities by Swavalamban Volunteers - Paintings & Street Theatres P H A S E I : U N D E R S T A N D I N G T H E I S S U E

PERSONAL INTERACTIONS & SURVEY

To solve any issues, we need to first find the root cause is. Before addressing the challenges related to Menstrual Health Management, a survey was conducted at Todapur Slum. 200 plus women & adolescent girls were interviewed through a customized questionnaire. Survey objectives:

• Understanding myths • Understating of current MHM practices & challenges • Willingness survey to take up menstrual hygiene practices • Willingness survey to participate in the health & wellness activities • Willingness to attend the technical sessions and workshops • Willingness survey to be change agents • Estimation of demand for the medical screenings & other training programs

The survey questions were designed into 4 groups: General Information, Menstrual Hygiene Management, Other Health Issues & Social Concerns. It was a 360-degree approach to understand challenges that directly & indirectly affect women’s health & therefore it helps planning in addressing the issue. U N D E R S T A N D I N G W O M E N I S S U E S T H R O U G H 1.) UNDERSTANDING C O N V E R S A T I O N S MENSTRUAL MYTHS

One on one conversations on menstrual myths and taboos being practiced and then disseminating knowledge towards denouncing these superstitions leading to unsafe practice

2.) UNDERSTANDING MENSTRUAL CHALLENGES

Understanding of the challenges that the women being faced in terms of sanitation facilities

3.) AWARENESS ON BASIC SAFE SANITARY PRACTICES Basic awareness on sanitary practices, safe disposal of pads, maintaining daily cleanliness etc

4.) UNDERSTANDING OF OTHER HEALTH ISSUES 4 Understanding of other issues related to health and wellbeing of women Survey Results - General Information

Out of the 200 women & adolescent girls interviewed, most of them i.e 57% belong to the age group of 16-30 years and the least (2%) fall in the range of 45 years. 71% of the women subjects are married, out of which 32% bear three children followed by 23% bearing only two children. It is also observed that a higher proportion of women bear six children (16%) compared to those with a single child (13%), which reflects poor family planning. With only 23% of the total women employed, the rest primarily engage a) age group themselves with household chores like filling water, cooking food, cleaning etc.

b) employement c) No of children d) Marital Status Survey Results - Understanding Health Issues & Available Medical facilities

HEALTH PROBLEMS Around 28% of the women who were interviewed do not suffer from any major health issues. Around 48% women face problems related to menstruation. These include irregular menstruation, white discharge, body pain and reproductive tract infections. There are other issues faced by a number of women like joint pain, back pain and other skeletal issues which can be related to reproductive health. Certain cases which need particular attention are those related to complication in sterilisation, use of Intra Uterine Devices, and lack of spacing between children.

AVAILABLE MEDICAL OPTIONS Most of the women visit the nearby hospital in case of some serious health problem. b) Pre-menstrual awareness Lady Hardinge, Gurunanak, and Gangaram hospital are located in the vicinity. There are other small clinics in Inderpuri. Hardly any women contact the ASHA worker in case of any health issue which reflects the poor accessibility of immediate healthcare advice. This could be one of the reasons why most women neglect issues like fever, menstruation-related pain and irregularity. The taboo associated with menstruation could inhibit talking about it with a male doctor or even an unknown female doctor. In such a situation the ASHA worker can work as a helpful mediator and advisor. 1% of those interviewed do not take any action in case of a healthcare problem. While 22% buy medicines from a medical shop without consulting a doctor. This reflects the lack of awareness about the repercussions such carelessness can have on an individual’s health and often such actions lead to increase in the severity of a health issue and other side effects. Survey Results - Assessment of Menstrual Knowledge Majority (86%) of the women attained menarche in the age range of 10-15 years. 80% of the women were unaware of menstruation due to which a large proportion was scared when they first menstruated. a) age of menarche For the 20% who were aware of menstruation, the mother played the most significant role in 40% of the cases followed by school, which made 20% of the young girls aware. Very few of subjects had some idea about the science behind menstruation. While the other had their own notions, 63% had no idea whatsoever. Lack of education, awareness, communication and poor teaching in schools amount to the results shown. b) Pre-menstrual awareness

c) First Reaction d) Why do we menstruate? c) Who informed? Survey Results - Understanding MHM Practices & Issues

• 57.6% of those interviewed use only sanitary napkins to contain their menstrual flow while 18% use both cloth and sanitary napkins. Around 38% of the women use only cloth. • When asked as to why they preferred sanitary napkins, around 66% of them stated that they found it more convenient and safe from leakage, 20% believe it is cleaner, the rest said light or heavy flow was the reason they used sanitary napkins. • Around 15% of those interviewed received sanitary napkins from school, while 76% spent around 50-100 rupees per month on sanitary napkins. • Almost 85% of those who use sanitary napkins dispose of them off in a nearby area after wrapping in a newspaper while 11% of them throw them directly. • 55% of the women are aware of the consequences that waste generated by sanitary napkins has on the environment and also their own health. They also agree to the fact that it adds to their expenses but they don’t have any viable alternative and this is the most convenient option for them. • When told about cloth pads and menstrual cups as alternatives, around 82% of the women agreed to use cloth pads and see if it suits their need, while only around 5% agreed to try menstrual cups. • Of those who use cloth, around 78% do not reuse the cloth and dispose of it. Only about 15% of them washed the cloth either outside their house with other clothes or in a separate pit and then dried it indoors often behind a door or some other place. • Majority of the women (around 76%) indicated that their mothers and grandmothers used cloth, while the rest of them were unaware of what they used.

• When asked about the major issues that these women face, around 69% of them stated as stomach and body ache during menstruation as the main problem. • Although 76% of those interviewed use public toilets only 31% think of it as a problem as far as menstruation is concerned. Around 30% of the women defecate in the open(i.e. in the nearby jungle) which presents a major environmental and personal health problem. • Around 11% of them stated that they faced problems in washing the cloth that they used during menstruation. This can be related to the lack of space and water. But this does not deter them from bathing daily and all the women who were interviewed bathe every day even if it’s in the open. • 5% stated difficulty in discussing menstruation with family as an issue and 3% said that not being allowed to enter kitchen during menstruation caused inconvenience. • When asked about how their family treated them while they were menstruating around 92% said that besides not being allowed to enter the temple and touching achar(pickles) their family members treated them absolutely normally. In fact, they hardly discussed menstruation with anyone. • Around 6.7% women are not allowed to enter the kitchen while they are menstruating. Interactions with Women & Girls by Swavalamban Project Team P H A S E 2 - A D D R E S S I N G T H E I S S U E Issues Directly & Indirectly affecting women's health

CHALLENGES IDENTIFIED HOW DID WE TACKLE THEM ON GROUND?

MENSTRUAL AWARENESS TRAINING STAKEHOLDERS * Cultural Taboos * Training and Briefing project volunteers so that they * Girls were not being educated about the Puberty themselves * Mothers hesitant to discuss menstruation with their daughters understand and speak to the women and educate them.

MENTAL & PHYSICAL HEALTH MOBILIZING COMMUNITIES * Stress due to the lack of toilets and sanitation facilities * Making women and men understand the issue. * Domestic violence * Involving Pradhan's ( village heads) in the initiative. * Domestic abuse Lack of employment for women ** Making the women participate in Pinkathon And many more..

MENSTRUAL HEALTH & HYGIENE CREATING AWARENESS * Lack of toilet facilities for women to take bath. Women & Girls * Technical Sessions by Expert Doctor in Todapur wake up in odd hours to take bath in open. * Conducting a Medical Camp * Lack of sufficient water & long queue at the public water pump CREATING PEER LEADERS * Lack of wash areas and disposal areas for their clothes. * Identifying few women leaders and asking them to drive the change OTHEHR iSgOhC IkAiLn eIStSiUcE eSn ergy Alcohol / Drug addiction among adults & children No definite volume LEVERAGING GOVT SCHEMES Huge garbage dump and open defecation spreading diseases No definite shape * Involving law and order team to tackle the issue Increase in the school dropouts due to alcohol addiction * Informing and working with other stakeholders in providing Lack of sports facilities for the mental & physical health of sports infrastructure children. Lack of social infrastructure Children getting into street crimes due to lack of engagement Todapur Slum P H A S E 2 - A D D R E S S I N G T H E I S S U E MENTAL & PHYSICAL HEALTH Emerging pieces of evidence and reports from recent studies have demonstrated that the poor sanitation & inadequate access to water is linked to psychosocial stress, among women in slums. In Todapur, which is a non-Government notified slum, we noticed that sanitation- related psychosocial stress (SRPS) due to poor sanitation facilities.

We explored daily sanitation practices of adolescent girls and women and identified stress factors encountered during sanitation. Several women came forward and said that their stress is due to the daily sanitation issues like defecation, urination, menstruation, bathing, post- defecation cleaning, carrying water, and changing clothes. 75% of the women & adolescent girls take bath outside their home in the odd hours. This makes them sleep deprived. It was also noticed that the women and girls being vulnerable to domestic violence, children getting into drugs and alcohol. Overall, sanitation behaviours that were most restricted (i.e., menstruation) were the most stressful.

As part of the Swavalamban project, United Sisters Foundation provided an opportunity for the 300 plus women and girls to participate in Pinkathon, India’s biggest women run that was held in Delhi. Despite a cultural festival on the same day, almost 85% of the registered women turned up to the run at 04.00 am in the morning. It is first of its kind in Todapur that women stepped out to participate in a sporting event.

In many countries, it has been recognized that sport can be a force to amplify women's voices against several issues related to gender discrimination, human rights etc. Women in sport defy the misperception that they are weak or incapable. Every time they clear a hurdle or kick a ball, demonstrating not only physical strength but also leadership and strategic thinking, they take a step towards changing their own situations. There is good evidence that participation in sports can help break-down gender stereotypes, improve girls’ and women’s self-esteem and contribute to the development of leadership skills. Our idea through making women of Todapur participate in Pinkathon was to show them that there is a bigger world waiting and they can be change makers. Several girls said they were motivated to participate in sports and they would like to come back to run.

Smt Anita Roy, Addl DCP West interacting with women during the trail run Milind Soman encouraging en elderly woman to Run

250 women & Girls from Todapur Village Participation in Pinkathon, Delhi on September 17, 2017 P H A S E 2 - A D D R E S S I N G T H E I S S U E TECHNICAL SESSIONS

Team Swavalamban engaged with approximately 450 women, of varying age groups, over a period of 5 months to further the cause of female health and hygiene. A myriad of concepts was introduced to the women and several relevant matters were touched upon, using a bevvy of tools, techniques, programs and activities.

The team of volunteers was fortunate to have guidance and support from experts in various fields like health, medicine, social work and so on. The project was kick- started by collecting exhaustive surveys of the total women population (above 12 years old) of Todapur slum. Based on the findings the activities and sessions were carefully designed to meet the needs of the subject population.

EXPERT DOCTORS / TRAINERS

Dr. Mansi Dhingra, MS OBG Dr. Kiran Kukreja Dr. Sonu Agarwal Dr. Laxmi Krishnan Dr. Surbhi Singh Priyanka Jain EXPERT TEAM AND DOCTORS

Dr. Mansi Dhingra, MS OBG Dr Sonu Agarwal Dr Kiran Kukreja To spread awareness regarding the biological mechanism To focus on puberty, menstrual health & hygiene. To focus on menstrual health, pregnancy and underlying menstruation and pregnancy. contraception.

Priyanka Jain Dr Surbhi Singh Dr. Laxmi Krishnan, SPOWAC; President SOCH; Sustainable Menstruation Gynaecologist; Sacchi Saheli To reassess the menstrual “Do’s and Don’t’s” in an To conduct a workshop about the To primarily focus on making the adolescent girls aware of effort to move beyond the social stigma attached to production of Cloth Pads and to spread menarche, good and bad touch along with hygiene and menstruation. awareness about the benefits of Menstrual sanitation. Cups. Session 1 : Know about menstruation & puberty

Through a focused group discussion, Dr Mansi Dhingra & Dr Sonu Agarwal have initiated first technical session about the Puberty & Menstrual Cycle. objectives of the session include;

1. Helping the group members to know the physical and psychological changes during puberty and menstruation 2. Medical concerns during menstruation and how to handle it. 3. Steps to maintain hygiene during the menstruation The program was duly supported by the Swavalamban Volunteers and project coordinators. The discussions fulfilled diverse objectives for the above enablers, by citing their own personal experiences. Girls and women have completely opened up on their perspectives, views on menstruation.

The session covered growth and development, stages, growth pattern, physical and psychological changes happening in the body, puberty, and menstruation and importance of reproductive organs. Interactive lecture, with visual aids on the topics, group discussion and individual doubt clarification.

Session 2: Menstrual Health & Hygiene

One of the major challenges for menstrual hygiene in Todapur was lack of sufficient toilets and water. The women shared difficulties of using public toilets in the odd hours. The session conducted by Dr. Surbhi Singh emphasized on hygiene management practices with limited facilities. Women were educated on the importance of safe sanitary practices, washing the genital area with water after each use and also after urination.

They were also informed on the need of changing sanitary napkins or cloth pads regularly after 4 to 5 hours to avoid any leakage, odour and The girls & women especially who goes to school were given key instructions towards menstrual management were carrying a piece of clean cloth or napkins for change when visiting out. This will ensure better handling of periods and avoid embarrassment. Session 3 : Reproductory & Pregnancy

Despite medical advance and technological progress, good health and well-being continue to baffle a large majority of world’s population a number of births affect on maternal mortality rate (MMR) and infant mortality rate (IMR) in India every year 8% girl become the mother who is below 19 years of age. Son gets frequently and promptly treatment than a daughter. Abortion is a serious problem even government made law Indian food first serve to male in the family then it serves to female. Sometimes this leads to malnutrition. Early pregnancy is a cause of maternal mortality because 50% of Indian girls married less than the legal age of marriage. It was noticed due to lack of knowledge and education Todapur women had children at a young age and without gap from child to child. Session headed by Dr Kiran Kukreja had addressed the issues related to; * To avoid Unwanted, Unplanned pregnancies * Nutrition during the pregnancy * Regular medical consult * Importance of being happy and healthy

Session 4: Physical & Mental fitness

One of the sessions was exclusively conducted about awareness on breaking menstrual taboos. Women were also educated on the importance of asking for necessary facilities instead of maintaining silence. Attendees were also told to take bathe at least once in a day with warm water, which can reduce pain, especially for the adolescent girls. Women and girls were encouraged to participate in sports activities, taking small walks and being physically active.

The session addressed by Dr Lakshmi also focused on Breaking menstrual myths, superstitions and practices. The participants were addressed on key issues related to menstrual beliefs such as avoiding certain kinds of foods and pickles etc were just myths. Mothers have been encouraged to discuss actively with their daughters. Women & Girls attending technical sessions by expert doctors and trainers Session 5 : Production & Distribution of clothpads The Swavalamban project also focused on sustainable menstruation practices. Priyanka Jain, a 31-year-old Delhi-based architect, had conducted a session to spread awareness about the environmental burden that disposable sanitary napkins impose, and the alternatives. Independent research worldwide into the correlation between the environment and sanitary napkins show that an average woman goes through around 150 kg of pads and tampons in her lifetime. It also shows that the use of plastic liners in pads, and the numbers in which these pads are used, makes this a “real environmental concern”. The workshop was conducted on using safe and alternate menstrual hygiene management products. Women and girls had People many questions but most of them were the same: are menstrual cups safe, don’t reusable cloth pads cause infections? The most common was: how does one use a menstrual cup? Women were shown samples of cloth pads and menstrual cups and also how to wear them. The process of making cloth pads was also taught. All the participants enjoyed the workshop and said they learned something new, which they were never aware of.

Session 6: Medical Screenings and Self Prevention

One of the focus areas of Swavalamban was preventive care. United Sisters Foundation organized medical camp The Swavalamban project focused on preventative care. USF organizes medical camp at Todapur in partnership with The Apollo Foundation.

At medical camp, we provide basic treatment and general check up to help people be aware of their health status. A team of doctors, nurses and a lab technician who work tirelessly to see that every patient is attended to. BP check, Height, weight, BMI, and lifestyle advice. Random blood sugar was done to detect pre-diabetes and diabetes

Breast examination by a medical person and advise / demonstration of self-breast examination for all women from 20 years of age ) was done. Medical Camp conducted by Swavalamban team in association with Apollo Foundation at Todapur P H A S E 3 - S U S T A I N I N G T H E C H A N G E

SOCIAL IMPACT ANALYSIS

The Swavalamban project is mainly to bring the behavioral change and behavioral change is a long-term process.

The project was completed from the start to end as planned in terms of social mobilization, education and awareness areas. However, Todapur needs a lot more attention especially in terms of facilities.

“In addition to the menstrual awareness program, team Swavalamban also coordinated with other NGO's and Stakeholders who were working on sports and drug de-addiction programmes.

However, the primary target of education and awareness is 100% achieved as almost 80% of the Todapur women and girls have participated in the project.

Immediate impact in the areas of Education, Health, Economic, Physical & Mental awareness and empowerment observed. EDUCATION HEALTH ECONOMIC

* Approx 500 women & girls have been 1. Educating the women about the * Introduction to cloth pads and educated on the menstrual hygiene and physiology of the female reproductive menstrual cups. awareness system and its functioning. 2. Educating the * 4 technical workshops have been masses about the process of intercourse, *Guidance about how to make cloth conducted fertilization, conception, gestation and child pads with recycled cloth at home. 5. Sensitization of younger girls and older birth. And further more about * Training to setup a pad making women about matters of menstruation, “menstruation” as a process that occurs in unit & other skill development pregnancy, abortion and so on. 6. Busting the absence of fertilization. 3. Elaborately programes are being considered. myths regarding menstruation and discussed infections and diseases common encouraging open discussions about it amongst women, related to the reproductive amongst peers and family members. system and the body in general, including STDs. 4. Elucidation of methods to maintain a proper female hygiene and prevention of diseases and STDs.

BODY & MIND ENVIRONMENT OTHERS

*.A huge garbage gump cleared and * Discussion about pros and cons of made into a playground by Delhi Police in *250 women & girls participated in both synthetic sanitary napkins and association with other stakeholders. the Pinkathon for the first time in cloth pads. * Children of the age group of 8 – 18 yrs their village history * Safe disposal of pads and other will be taught livelihood skills and will be * USF is considering to conduct more material has been taught. made aware of the ill effects of drug sport events like cricket match etc are * Sensitized on keeping the addiction. being considered. environment clean to avoid any * Five girls from the Gas Godown, * Sonalika & USF are working diseases. Todapur slums were given professional towards making the women training to become Fitness trainers. participate in Pinkathon every year. A huge garbage dump at the entrance of village turned as a playground for children by the Delhi Police

Open drainage to clean premises P H A S E 3 - S U S T A I N I N G T H E C H A N G E

APPOINTING CHANGE AGENTS

In business parlance, a change agent is an individual or group, who carry out the task of instigating and managing change in the organization. One of the objectives of Swavalamban was to identify influencers who can be catalysts in bringing & sustaining the change in menstrual health management. As part of the project, few women & adolescent girls were identified who can be change agents in their own community.

Roles and Responsibilities * Directly or indirectly influences change & the awareness created by Swavalamban team at Todapur * Linkage between external organisations who wants to conduct hygiene workshops/ training and the women & girls of Todapur * Stimulate, facilitate, and coordinate the change effort by constantly/actively conducting discussions & reporting them to the authorities * Actively mobilise women & girls to participate in sports, health & wellness programs * Engage & Speak to other women & girls from other slums or cities about Menstrual Hygiene Milind Soman with USF Change Agents ( Gulabi Behen) in Delhi on January 30, 2018 WWAaYy F fOoRrWwAaRrDd

Area of focus Suggested Actions Stakeholders

1. A sufficient number of toilets and wash areas for menstrual health management 2. Continue to organize follow-up workshops Menstrual Health on MHM once in 6 months with the help from Change agents 3. Delhi Police Management Continue to organize medical screenings once in 6 months 4. Sonalika SDS Garbage cleaning and open nala cleaning to prevent other diseases United Sisters Foundation and infections on regular basis 5. Distribute MHM kits for every girl child before menstruation (which can include a manual, cloth pads)

1. Prevent other men entering Todapur slum as many women Other Social complained about the issue of alcohol consumption near toilets which prevent women accessing toilets in the night 2. Organize Drug and Delhi Police Concerns alcohol de addiction programs 3. Organize sports events to engage Sonalika SDS youth and children 4. Skill development programs for women and United Sisters Foundation youth

Swavalamban 1. Engaging women & adolescent girls in sports events like Sonalika SDS Pinkathon (every year) 2. Engaging Gulabi Behen effectively in follow-up creating awareness in other slums and cities 3. Organising USF programs workshops once in 6 months on checking on MHM issues United Sisters Foundation RECOGNITIONS

Delhi Police commissioner Shri Amulya Patnaik, IPS at the Todapur Gas Godowns

Delhi Police recognized the efforts of United Sisters Foundation in project Swavalamban. Representatives of USF have been felicitated by the New Delhi Police Commissioner Shri Amulya Patnaik IPS Todapur Village Pradhan's ( Village Heads) thanking Dr. during the Integrated Community Development on October 2, 2017. Mittal & Mr. Milind Soman CORE TEAM

Vishala Reddy Vuyyala Anurupa Mitra Dr. Lopamudra Priyadarshini Project Director - Swavalamban Project Coordinator - Swavalamban CSR Head - Sonalika ITL An enterprising leader, a corporate Vishala based out of Hyderabad is a An enthusiastic & high energy-driven management professional with a dream for budding entrepreneur. She is an active Ph.D. Scholar (Women Studies), targeting for Sustainable Social Development, Lopa has 20 campaigner for liveable cities where she assignments in Teaching/Research & plus years experiences across various segments is recognized for her work in civic Development with an organization of high across the globe. She believes that “ Service of engagement and behavioral change repute.. Anurupa is a researcher in Gender Mankind is Service to God” or in Hindi “Nara communication in the areas of reclaiming Studies with nearly 3 years of experience in Seva Narayan Seva” & incorporated this belief public spaces, sustainable transportation Teaching, Educational Assessment, into the work for the betterment of society. She and community building. Her initiatives Student Relations. She is currently Pursuing has been recognized by various awards like are known to be true to the cause, Ph.D. in Women’s Studies from Centre for Odia Women of Substance 2016-2017 by The grassroots-focused and involve lakhs of Women’s Studies, School of Social Sciences, Intellect, New Delhi as honored for the constant citizens directly to solve growing urban Jawaharlal Nehru University, New Delhi. service of the society, Parampara award for the issues. educational contribution to the society. STAKEHOLDERS Initiative of Under the aegis of In association with

Community Partners Medical Partner Project Management Partner Team Trainings and Site Visits Project Team Felicitation

Milind Soman, Founder of United Sisters Foundation & Dr Deepak Mittal, Managing Director, Sonalika ITL with volunteers, experts, Todapur village heads and change agents at felicitation ceremony on January 30, 2018, New Delhi Join us in creating more menstrual literate communities.

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