Women's health

‘First day of period’ leaves are a great first step. But offices need to become more period-friendly

A policy for menstrual leave must also account for practical implications to avoid the backlash that women might face.

A digital media company in Mumbai recently declared that they would offer “first day of period leave” or FOP leave for its women employees, triggering a lively debate on social media about whether we need menstruation leave policies for all working women across the country. While the open discussion about menstruation is welcome, there is much more to be considered when it comes to ensuring women employees’ well-being, starting with making workplaces more menstruation-friendly.

Women employees of the Mumbai company that has instituted the leave policy have started a petition to be submitted to the government asking that FOP leave be made government policy. But any policy should have a broader focus than just a single day’s leave.

A large number of women in India face menstrual disorders, like irregular bleeding, heavy bleeding and menstrual pain. Stressful work environments and commutes add to the pain and discomfort. Some women resort to tinkering with their menstrual cycles by using hormonal pills, possibly without medical supervision, to avoid menstruating on days of important tasks and meetings. Unsupervised use of hormonal pills leads to a lot of health complications which may be harmful in the long term. The option of a day’s leave every month for women to rest resting during their periods is welcome. However, for a policy on menstruation leave to work, policymakers must account for practical implications to avoid the backlash that women might face.

Corporate cultures are already somewhat reluctant to accommodate the needs of pregnant women despite India’s legal requirement to do so and despite the scientific evidence that child-care benefits do not negatively affect economic performance of companies. Studies have also shown that women living in developed nations with generous child-care benefits are not able to sustain their professional status, often coming back to contract-based lower paying jobs after maternity leave. Other studies also note that extending the child-care benefits demotivates companies from hiring women altogether or result in more women in the reproductive age being fired than other categories of workers. Holistic public health policies in developed nations do not completely ensure gender parity in the workforce, India, if it chooses to implement FOP leave as policy, must ensure that such leave will not be used as an excuse to disadvantage women in their professional lives.

Not just working women

While talking about FOP leave, let us also consider the needs and problems of adolescent girls attending schools. Several studies show that girls miss out schools during their menstruation as school infrastructure and environment are not menstruation-friendly. If adult women are able to avail of FOP leave, should adolescent girls be able to do so as well?

Many studies suggest that most adolescent girls and women do not like to disclose the fact that they are menstruating due to taboos associated with it. My own study among urban and rural adolescent girls and women had instances where educated, urban women reported that they did not feel comfortable discussing menstruation with male family members or friends. Hence, it is worth considering how privacy of women employees would be protected in scenarios where supervisors are men and the employees reporting to them are women.

Employers’ responsibilities

Offering FOP leave should not absolve employers from their responsibility of creating an environment conducive to menstruation. Hence, instead of demanding just an FOP leave, a policy which is primarily focused on a menstrual leave on the first day of the periods, we should ask for a more comprehensive sustainable menstruation policy that ensures that workplaces have small rest areas, good quality toilets, the availability of good quality sanitary products, dustbins as well as medications and a doctor on call. It is possible that such comprehensive changes about office spaces – as well as schools and public spaces – may negate the need many women feel to take leave during their periods.

During her pregnancy, when Sheryl Sandberg found that parking lots allotted to pregnant women were too far away for her to walk at the Google campus, she asked the company to create parking lots for pregnant women closer to the building. Similarly, asking for period leaves can be just one part of a multi-faceted solution to addressing the necessities of menstruation in the workplace. If we do not want women to be out of office on certain days of the month, we need to create offices that can fulfill the necessities of menstruating women. That will be a lasting solution.

The writer is a PhD scholar in social epidemiology at the Indian Institute of Technology, Gandhinagar.

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.