When Neelam started her period, she thought she was dying like her mother

The subject of periods and menstruation is even more taboo for India's girls than defecation - many have no idea what is happening when the bleeding starts.

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

Neelam, a 14-year-old schoolgirl from Madhya Pradesh, India.
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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

***

Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.