Neelam is 14 years old. She has a narrow, pretty face. Her hair is long and black. Her uniform has been torn and repaired. Unusually for an Indian schoolgirl – at least the ones I have met – she has bare legs. Neelam goes to school in a place a dozen kilometres outside Gwalior, in Madhya Pradesh, India. I have met hundreds of schoolchildren over the years. I have attended dozens of sanitation-related training sessions in dozens of schools. I have heard dozens of hygiene-related songs that children have learned by heart and sing charmingly. I don't remember many names or individual faces. But Neelam will stay in my mind for a long time and this is why.

I have been thinking, researching, writing and talking about sanitation since 2006. Six years of shit, toilets, sewage, faeces, excrement, poop, squits, loosies, diarrhoea. I have loved it and it is a privilege, and with 2.5 billion people still without a toilet, I will keep doing it and highlighting it for as long as I am useful. Two weeks ago, I joined the Great Wash Yatra, a sanitation and hygiene themed carnival that will travel for 2,000km across rural India, from Maharashtra to Bihar, hoping to engage people about the deadliness of diarrhoea and the importance of handwashing with fun and games. I knew India’s doleful sanitation statistics already: of a population of over a billion, nearly 700 million still have no toilet, and defecate on roadsides, in bushes, wherever they can.

But until coming on the Great Wash Yatra, I had not thought hard about an aspect of sanitation that is even more taboo than talking shit: Periods. Blood. Chumming, as they say in urban India. Even so I am an expert in it; every woman is. Every woman whether in a developing or developed country, whether there is "Always" available or always no decent sanitary protection (pad, towel, or cloth) available, has stories about their menstruation. Mine: a girl sitting down under a tree at school when we were 13 or so, and her skirt rode up and the rest of us whispering “she’s started”. Another, earlier memory: a teacher at my boarding school when I was nine telling us about periods but calling them “the visitors”. A friend’s 12-year-old daughter, having her second ever period, who didn't know that she should change her sanitary pad, and who had blood-soaked socks by the end of the day. I am guessing that every woman has thought hard about wearing white trousers during their period; that every one has at least one humiliating experience of leaking through her pants, maybe onto upholstery. I have (it was in an Indian restaurant in Paris, 10 years ago, and it still profoundly embarrasses me). I have ingested probably tons of painkillers over the years; used hot-water bottles for cramps thousands of times; had to avoid high bridges during the couple of days every month when my hormones turn against me, viciously, and oblivion seems a relief from the inexplicable anger, depression that is overwhelming.

But even so, even when I was 13, I knew what periods were. I knew what to expect.

At a school near the Yatra carnival site, about 60 of Neelam’s classmates gathered in a classroom. They sat neatly on the floor, some of them on scraps of hessian bags. Unusually, they wore a mixture of uniforms. The regular school uniform was a red kurta (long tunic), white trousers, and a white dupatta (scarf). But other girls were in their own clothes, others in blue and checked outfits. They were quiet and attentive. I think they are used to outsiders coming and telling them things they are supposed to do. Wash hands. Don’t toilet outside. Be cleaner, healthier, better.

In this case, the visitor cames from the menstrual hygiene team attached to the Great Wash Yatra. They run the MHM (Menstrual Hygiene Management) lab, set up by the Water Supply and Sanitation Collaborative Council (WSSCC), where girls and women can come – no men allowed – and talk about periods, and be surveyed, and get a cloth sanitary towel kit with instructions on how to make hygienic sanitary towels from the Indian NGO. It is needed. WSSCC's facts about menstrual hygiene in India are saddening and shocking.

For instance:

Only 12 per cent of young girls and women have access to and use sanitary napkins 200 million have a poor understanding of menstrual hygiene and linked health care 23 per cent of India’s girls drop out of school after reaching puberty.

I’ll rephrase that: a quarter of the class at Neelam’s school will drop out because they don’t have a private place to change their sanitary cloths, and they will never go back.

Urmila, from the MHM team, was leading the visit. It was in Hindi and I didn’t have an interpreter, so I just noted the English words that were used in and amongst:

"Gift from god"

"Body parts"

"Underkit"

"Operation"

"Bedsheet"

"Cotton"

Urmila drew a picture on the board first. Then, as she explained afterwards, she told them that menstruation was normal. It was not dirty. It was not taboo. It was not sinful. It was a part of being a woman and it was a gift from god. She asked a skinny little girl to stand up, and stood next to her to show how a woman’s body changes: the hip flaring, the breasts, the size and shape. The morphology of women. Periods are part of life.

This may be obvious to you and me. Neelam showed me why it was not obvious to her. Afterwards, Urmila and another menstrual hygiene trainer carried out an MHM survey. They methodically went through a questionnaire in a classroom, one schoolgirl after another sitting in front answering questions like: do you drop out of school when you have your period? (Yes.) What do you use when you bleed? (old cloth, sand wrapped in cloth, old saris, dirty rags). What do you do with the cloth when you have used it? (Throw it into a field and hope no one sees.) Are you restricted in any way? (Yes.) Restricted in what way? When the Indian NGO gathered a list of what menstruating women and girls are not supposed to do, it read:

See birds.

Sit on the threshold.

Go near a newborn baby.

Touch stored food.

See men before bathing.

Touch plants.

Keep flowers.

Go to the temple.

Go out at noon.

Let lizards eat leftover blood tissues.

Serve food.

Talk with boys.

The girls were shy. I don’t know if they were telling the whole truth, because only one admitted to not having a toilet, which seems improbable in deeply rural Uttar Pradesh. Then Neelam came in. I was sitting next to Urmila but saying nothing. The other girls had not looked at me or acknowledged me. But as Neelam answered Urmila’s questions, she kept looking over at me. She included me visually in the conversation. And she talked more. She was expansive, articulate. She was expressive with her hands, and so graceful. Halfway through the survey, she looked at me again and said to Urmila that she wanted to know who I was, and where I came from. In the unequal setting of visiting outsider and survey subject, this frank curiosity and presumption of equality is striking. But Neelam was confident and charming. I sat up then and listened harder and she told her story. She was clearly poor from her patched clothing. Her story was horrific. Her story is not uncommon.  

Neelam’s mother died when she was five. Her father is an agricultural labourer. He never remarried. Neelam’s elder sister tried to take over the role of the mother of the household, but it was hard, “when she was trying to cook but still crying with us.” Neelam described her mother’s cause of death as “something rotten in the breast,” so probably breast cancer. She had no close aunties or female relatives.

This August, she got stomach pains. She had eaten some street food, so she thought the pains were due to that. Nothing unusual. But the pains continued in her abdomen, for hours and hours. Finally she went to the bathroom, and there she saw blood. And she was terrified. She was truly scared, because she knew what it was. It meant that she had what her mother had, and it meant that she was dying. Really. She had reached the age of 14 without knowing that one day she would bleed and it would be normal. So there she was in the bathroom, crying with fright, enough for her sister-in-law to hear. Neelam’s brother had married recently and young: his new bride was only 19, and Neelam didn't much get on with her, because she didn't think her brother should have married so young. There was some frostiness between them. But of all the family, it was this new sister-in-law who came to the door of the bathroom and said, "What’s wrong? What is this noise?" And Neelam told her she was bleeding, and that she was dying. And her sister-in-law said, "No. You are normal. This is what happens to women. Don’t worry." Neelam’s hands were so expressive at this point, because she was saying this: "I thought I was dying like my mother, but because of that now I realise I have a mother again."

Neelam's experience is not special: when I met a group of 12-year-olds this morning at another school, not one had been told what to expect. Every single one thought they were horribly injured or worse when the blood came. Every single one thought it was entirely normal to be told that if they touched pickles while they had their period, the pickles would go rotten. Their mothers hadn’t talked to them because their mothers had not talked to them, because this normal healthy blood is unspeakable. The MHM team has heard of women who get infections from using cloth that is not properly dried, or dirty. Some end up having their uterus removed. But having met this lively, lovely girl, I bet Neelam talks to her daughters about it, so they know what to expect, so their periods are not terror and taboo, so they touch the pickles without fear.

Rose George is a journalist and writer. She tweets @rosegeorge3 [2]