Going with the flow: A handbook on menstrual management & hygiene for women with disabilities

Going-With-The- Flow- book

Updated 28 September 2015 Activist, counsellor and innovator and writer Abha Khetarpal’s recent book ‘Going With The Flow’, is a book on menstrual management and hygiene for women with disabilities which includes information and tips for parents, caregivers and doctors with pictorial presentations. Following is a write up by the author on the book

By Abha Khetarpal
Across the world’s largest democracy, millions of women still are held back by shame around their most basic sanitary needs. According to World Health Organization, India accounts for 27 percent of the world’s cervical cancer deaths. The incidence rate here is almost twice the global average, and doctors say that the basic reason behind this is poor menstrual hygiene.

The number of women with disabilities in reproductive age in India is approximately around 35 to 40 million. Gynecologic health care of women with disabilities has to be a comprehensive one. They are as likely sexually active as other teenagers or women without disabilities but are at greater risk for forced sexual encounters. They are more likely to live in poverty, due to lack of education and employment. They need appropriate education on hygiene, contraception, sexually transmitted infections, and abuse prevention measures.

All this made me write ‘Going With The Flow’, a handbook on Menstrual Management & Hygiene for Women with Disabilities as written or educational material catering to such needs is all together missing in our country. The management part of the book includes the how menstruation can increase difficulties for women with different kinds of disabilities. It contains information about various absorbent materials that can be used and how to use them, when to change them, how to keep clean, what kind of food to eat and what kind of exercises that can be done by girls with disabilities during the time of periods. It also contains tips for mothers, caregivers and even doctors. The book, in its various chapters uses pictorial presentations so that girls who are visual learners may understand the matter easily. The E-book version of the book is accessible for girls with visual impairment. I have written it in Hindi also as I want more and more girls and women to benefit from reading this book. Soon its audio book will also be available with us.

What I believe is that with the ongoing ‘Swachh Bharat Abhiyaan’ and ‘Beti Bachao Campaign’, the need to focus on the health and needs of girls and teens with disabilities becomes all the more imperative

Menstruation in India has always been accompanied by myths and taboos and adolescent girls find it difficult to even discuss the issue with parents or elders in the family. For a woman with disability it becomes all the more difficult. Being a counsellor for persons with disabilities and I being a woman with disability myself, I could very well understand and relate to plight of other women and girls who go through this phenomena every month.

Depending on the level of disability, some girls are able to cope with menstruation and some are not. Although adolescence is a healthy period of life, adolescents who have disability are often less informed, less experienced, and less comfortable accessing reproductive health information and services and the challenges accentuate for them. Pubertal development and the subsequent onset of menses are the beginning of a significant change for many adolescents. This may even be more for a teen with developmental disability (DD), for whom life it-self is challenging, and mental and physical health is often in a delicate balance.

Unfortunately we have a culture of silence that surrounds the topic of menstruation and related issue. As a result, young girls with disabilities lack appropriate and sufficient information regarding menstrual hygiene. This may result in incorrect and unhealthy behaviour during their menstrual period. Also, many mothers lack correct information and skills to communicate about menstrual hygiene which they pass on to their children, leading to false attitudes, beliefs and practices in this regard.

Menstrual Hygiene has remained a taboo subject – stigmatized just like disability

Learning about hygiene during menstruation is a vital aspect of health education otherwise they have a risk of acquiring infections and ailments that may persist into adult life. It is paradoxical that various conventions and linked action plans, elaborate on women’s sexual and reproductive rights but menstruation remains as one of the most stigmatized, silent and socially constructed. I found that there is a complete neglect of menstruation management and hygiene and its implications for the dignity, health and safety of women with disabilities.

About the Author

Abha Khetarpal has been providing free online counselling to persons with disabilities regarding career and vocational decision making, personality development and confidence building through her community based website www.crossthehurdles.org . She being a polio survivor and a wheelchair user has constantly been fighting for the rights of persons with disabilities. She always tries to focus on the empowerment of women with disabilities and was one of four protagonists in the 61st National Films Award winning documentary, ‘Accsex’.The bookShe developed Cross the Hurdles Mobile Application which is the first ever mobile application to provide information to persons with disabilities for which she has won NCPEDP Mphasis Universal Design Award 2015.
She has authored handbooks, namely, ‘Tax Concessions and Exemptions for the People with Disabilities in India’, ‘Keeping You Abreast’ for Women with Disabilities for their breast cancer self examination and awareness and ‘Going With The Flow’ on Menstrual Management and Hygiene for Women with Disabilities in accessible formats like audio books, Braille books, print version and screen reader versions both in English and Hindi. She runs an accessible e-magazine by the name of Cross the Hurdles E-Magazine where people with disabilities can contribute their write ups. She provides free individual domain names to artists, sportspersons and writers with disabilities to showcase their talents and expertise under Cross the Hurdles Web Network.

Her numerous papers and articles have been published in various national and international journals.

Excerpts from both English and Hindi books
Menstrual management refers to range of strategies that women with disabilities can use during menstruation so that she is comfortable with her menstrual flow and is able to manage her periods with dignity, privacy and hygienically. Management of menstruation can be one of the more difficult self care tasks for disabled women….
….Women with disabilities, for whom menstruation is a challenge, must be taught adjustment to position and modification in panty, tampon or pads. They can be provided with aids, such as use of mirrors or knee spreaders so that changing pads or tampons becomes less troublesome for them. If they are able to manage menstruation themselves and take care of their hygiene in privacy or with little help life would completely become different for them.
मासिक धर्म प्रबंधन में वो युक्तियाँ या उपाय हैं जिनकी सहायता से नि:शक्त महिलाओं के लिए मासिक धर्म को सहज बनाया जा सकता है. इनकी मदद से वह मासिक धर्म प्रवाह को सहजता और स्वच्छता पूर्वक, गरिमा और गोपनीयता के साथ इस दिनों को बिताने में सक्षम हो सकती हैं. नहीं तो नि:शक्त युवतियों और महिलाओं के लिए मासिक धर्म के दौरान अपनी खुद की देखभाल करना अत्यंत कष्टदायी साबित हो सकता है.
निःशक्त महिलाओं के लिए मासिक धर्म एक चुनौती है. इन महिलाओं को पैंटी, तंपन या पैड की स्थिति में संशोधन या लगाने-निकालने करने के लिए आसान तरीका सिखाया जाना चाहिए. अगर वह मासिक धर्म के दौरान खुद को संभालने में सक्षम हो पातीं हैं और गोपनीयता रख पातीं हैं तब ज़रूरत है स्वछता पर ध्यान देने की

The book is available in English as well as in Hindi in the form of print version and as well as an accessible e-book.

For women with disabilities, the book is free of cost.

This book can be bought here

Also available on Google Play.

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