A village woman in the hills of Noney in Manipur carries a cane basket ‘Kah’ on her head, collects vegetables and fruits from her farm or forest to sell in the main market on National Highway 37 and earns a petty income to support her family. Women walk long distances for their livelihood activities, to visit the hospital, school, market or medical store. The number of households having their own private car or two-wheeler is less. There is no facility of public transport in this hill district of Manipur which has a population of close to 37,000 barring a few private autos that run on the highway but no commendable transportation linking villages located up in the hills to the main market, the district headquarters or health facilities. Additionally, the condition of roads, in areas where people have no other means but to walk, is exceptionally bad with sharp stones and rocks and not a sign of tar topping anywhere. The private transport available only for a little patch on the main road offers no significant relief to women.
‘Breaking the Silence’, a global campaign works on raising awareness on menstruation and best hygiene practices in remote parts of India. It interacted with several women in its outreach program in Noney District with an objective of understanding barriers here. A woman complained of pain in the neck, back and legs from carrying a full basket for long distances on foot. The Medical Officer at the Primary Health Centre pointed out that majority of the OPD cases are dominated by women, though the exact underlying reason is not ascertained. Most of the medical complaints among women patients are related to excessive physical activity like back pain, knee pain and joint pain. White discharge and itchiness are common hygiene related complaints.
From the many interactions with community, health and medical personnel, there is reason to believe that lack of public transportation in Noney is affecting the health and morbidity of women, limiting their access to opportunity and income, medical facilities and emergency services, rendering undue stress from this forced hardship and affecting their productivity.
In times of delivery, it becomes very difficult for families of pregnant women to rush her to the PHC. While the Health Department advocates for an institutional delivery, if there is no transportation and good roads, how can such goals be achieved? In other parts of India, the state governments run call centre-based ambulance services, toll-free helplines 108 and 102 to provide free ambulance pick up and drop service to pregnant women linking public healthcare to the remotest villages of India under the National Health Mission and Department of Health and Family Welfare. 108 ambulance service aims to reach patients in rural parts within 40 minutes and bring them to the nearest health facility. Even sanitary pads distributed in government hospitals after a delivery and by ASHAs to girls and women in villages are not known in this region, nor are similar government relief policies visible.
Villages do not have medical stores and little shops selling few essential household items do not sell sanitary napkins. Sanitary napkins are only found in the medical stores and pharmacies numbering less than ten, located in the main market. Mostly girls and women come to buy these sanitary napkins, so the pharmacist wraps it in a newspaper to help shy customers. The most popular brands are Stayfree for its low cost and Whisper for its absorbency and anti-leak technology. Few Chinese brands are also popular including Magnetic Energy Anion Sanitary Napkins and AiRiz Active Oxygen and Negative Ion Soft Cotton Sanitary Napkins. Though priced much higher than Indian brands (close to Rs.200 per pack), the foreign manufacturers claim to provide relief from menstrual cramps, infections, itchiness and foul smell. The government needs to have mechanisms to verify how safe these products are and promote affordable and safe products only.
Without good transportation mechanism, access to sanitary materials and medical consultation and treatment are limited considerably. Mechanisms to assess and ensure the safety, affordability, accessibility and availability of sanitary napkins and materials in the market needs to be in place so girls and women are not exposed to danger and other medical complications from poor quality products and can buy and use sanitary napkins with ease.
Awareness of other sanitary materials other than cloth and pads like tampons, menstrual cups, eco-friendly bio-degradable sanitary pads or reusable cloth pads is low. The biology of menstruation and correlation to vitality, health and ability to give birth is not understood by a majority of girls and women. Girls and women seek clarity on diet during periods for reducing weakness or menstrual cramps, they ask us not taking a bath or washing hair during periods was scientific and good for health, or for a remedy for itchiness and skin infections.
The most common complaints we’ve head from them are itchiness, irregular periods, low volume blood flow during menstruation, menstrual cramps and skin infections. The cause of skin infection is due a lack of personal hygiene and ignorance. These problems are seldom shared with mothers or teachers and the extent of silence is so profound that young girls seek medical solutions in pharmacies and with quacks, and rarely with adults known to them.
A trained nurse, Amona Kamei who runs Gaza Pharmacy in Noney bazaar, shares her observation that young girls do not even have basic hygiene knowledge of taking bath daily, using soap to wash hands and that wearing washed and clean undergarments can go a long way in avoiding skin infections. Another pharmacist, S.K Aneiliu, runs Highway Medical and advocates for frequent sanitary napkin change to avoid infections to buyers.
A stream running through the village.
What is most ironic is the water scarcity experienced by the community in Noney, despite receiving high rainfall and having rivers like Ijei (Agah in Rongmei/Kabui dialect), Iril(Aling in Rongmei dialect) and Leimatak(Apin in Rongmei dialect). Households do not receive tap water and there are no significant water reservoirs. People connect pipes to brooks which bring water either to a common point in the village for the entire habitation or to a few homes, since this is a private arrangement to secure water and not by the government. Additionally, this water is untreated and does not offer uninterrupted supply when brooks dry up in the lean season. The electricity supply is erratic and power cuts last not less than a week. The impact of this on productivity, small-scale industry and the quality of life is obvious.
70 years of independence and yet, a tribal community in northeastern region of India still awaits water supply, electricity, roads and transportation in Noney district in Manipur.
Left on its own to find a way, the tribal community composed of the Kabui tribe, Chiru, Kuki and Inpuimei has found solace in the Church which plays an important part in not just spiritual growth of its people but offers humanitarian service in education, health, relief, youth and women empowerment and infrastructure. Besides that, the ancestors and elderly still guide community decisions with their age-old wisdom. An old woman from a remote village Rangkhung(Langkhong) Part-1 said, “I can identify which tribe a person, be it a woman or a man, comes from by their smell. Each has its own diet and smell.”
In the hill district of Noney where several tribal communities live, that which has experienced decades of armed conflict but is naturally endowed, menstrual hygiene is possible only if the government of Manipur makes pucca roads connecting villages to district headquarters, organizes public transport like minibuses or autos, builds water reservoirs and water treatment and distribution mechanisms, hydel projects in either Noney or Tamenglong to address electricity deficit, assesses the affordability and quality of available sanitary napkins and encourages safe products for its young girls and women.
Noney(Longmai) khou gong louna kagan gansak aniu goi le bam incham louna aniu tong rianra khatni kalam thai lou the. Thuanku the.
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Note: This article was published in the People's Chronicle the largest English newspaper in Manipur state in India and Youth Ki Awaaz India's largest youth platform and was developed as a recommendation to the Government of India and Government of Manipur from the field experience of Breaking the Silence, a campaign focused on educating girls and women on menstrual hygiene and health.