Bebi Devi was married before her first period. Now working as a health leader (known officially as a Community Health Facilitator), Bebi teaches women and girls in local villages about menstrual hygiene and basic health care. Photo: Matthew Smeal

Bebi Devi sits in a small, noisy warehouse three stories up in an old building in Bihar, India. The warehouse—part of Bebi’s small business—is used to store, pack and distribute sanitary pads throughout the region. She is recounting her childhood and particularly the lack of knowledge girls receive about menstrual hygiene.

“I was married in my childhood,” Bebi said. “At that time, I had not got my periods.”

Being so young, Bebi remained at home with her parents, waiting for the day when she would be required to move in with her husband’s family and begin her married life in earnest. That day came three years later, when Bebi was in her mid-teens.

“The date to go to my in-laws’ house was told to me. Fifteen to 20 days were left [when] I got my period. I got a terrible stomach-ache, so I told my mother and my mother said that this happens. I was crying a lot because I felt ashamed. She told me to use a cloth.”

Bebi’s story is common. So too is the lack of knowledge about menstrual hygiene among girls in India. And with that lack of knowledge comes stigma, bullying, humiliation and isolation for women and girls when they have their period.

“We have to do something to solve the problems for young girls and women.”

It is something that Bebi has been trying to change for some time – both in terms of knowledge and the products themselves.

“I felt like when we use cloth, when we walk on the road or go the market, if the cloth gets wet, it can be very embarrassing,” Bebi said. “In Bihar there are various types of men. Some make fun or worse.”

“We have to do something to solve the problems for young girls and women.”

The original machine Bebi Devi and other health leaders used to manufacture sanitary napkins. Photo: Matthew Smeal

Some of that has been accomplished through modern communications and an increase in discussion around menstrual hygiene.

“A lot has changed, a lot has changed,” Bebi said. “TV and mobiles have increased so much, it tells everything.”

Bebi mentions that her own daughter went to school and told a friend that she used cloth whenever she got her period. Her friend told her about pads.

“At that time, I did not know about the pad,” Bebi said. “When I found out, I started keeping them in the house. I use them and my daughter uses them as well. I don’t let her use the cloth.”

“…from the beginning I had a belief in myself that I could do something.”

In 2006 at the request of her husband, Bebi took out a small loan to help with the family business. She would never have thought it would lead to something for her.

“I was married in such a family that my mother-in-law did not allow me to do anything and always found ways to keep me engaged in housework,” Bebi said.

“I couldn’t think anything about myself.”

But as the repayment process continued over the following years, Bebi’s loan officer noticed some special qualities in Bebi. He encouraged her to undergo training to become a Community Health Facilitator (CHF) – women health leaders who provide basic health education to their village and surrounding communities.

“My loan officer used to say that I am bright. So, from the beginning I had a belief in myself that I could do something,” Bebi said. “I told my loan officer that I had a very low education but will consider it.”

Finally, in 2010, Bebi enrolled in the health leader training. But, resistance and suspicion followed.

“My husband didn’t stop me, but my brother-in-law used to think that for the health leader training we had to go to bad hotels – we had hotel accommodation and food free for four days of training, so they [Bebi’s in-laws] were getting the wrong idea in their heads.”

Those ideas made their way to Bebi’s husband.

“One day, my husband told me ‘You have stopped being a wife, are you not ashamed of yourself?’ It was the third day of training and he came to check up on me. So, he came inside, they showed him all the rooms and explained to him what was happening. He got shy and left. Since then he never said anything to me.”

“By talking and building relationships, we started putting forward our agenda: talking to them about health.”

At her first health presentation, Bebi realised that the sessions were not as effective as they could be. The health leaders simply handed out information cards allowing the women to read them in their own time.

Bebi and the other health leaders correctly assumed that the women took the cards home and forget about them. They had a better idea – engagement. They asked for time.

“By talking and building relationships, we started putting forward our agenda: talking to them about health,” she said.

Health leader Poonam gives a talk about menstrual hygiene to a group of women in a village in Bihar, India. Photo: Matthew Smeal

One key health message was menstrual hygiene. But while times are changing, it remains a topic steeped in taboo and stigma.

“First people didn’t used to talk [about menstrual hygiene] but now people talk openly about it. Before people used to feel shy, we used to ask them ‘Why feel shy with us, we are women so you can share your problems with us, we may be able to help you’,” Bebi said.

“So now we talk openly about it but people from rural areas are shy. When we talk to them, they say ‘talk about something else.’”

Bebi’s interest in providing good health messages to the women of Bihar led to purchasing a machine that would make sanitary pads that were much more hygienic than the cotton cloth most women used. Despite the new machine, there were concerns that many women wouldn’t see the need for pads.

“Everyone will say ‘that we have cloth at home so why won’t we use that?’ I would explain, ‘Look sister, the cloth pad that we make at home has bacteria, germs that we can’t see.’,” Bebi said.

A health leader sells sanitary napkins to a lady in Bihar, India. Apart from teaching good health practices, the sale of basic healthcare items allow health leaders to earn a small and sustainable income. Photo: Matthew Smeal

For Bebi and her health leader colleagues, the best outcome was to provide women with health care items during the community health presentations. Not only did it allow the women to respond and purchase immediately without needing to travel into larger towns, but the health leaders themselves could earn a little money as well.

By turning their passion into a sustainable business, some health leaders have legitimised their activity to those who doubted them and have became money earners, increasing their role as decision makers within the family.

Along with pads, those health leaders sell familiar household items to ensure families and villages can maintain a clean and healthy environment – “soap, dishwashing liquid, toilet cleaner; all the products we require every day,” Bebi said.

“If we use the toilet, it is important to clean it; if we eat food, it is important to wash the dishes; if we go to the toilet then it is important to wash our hands. All the products are useful,” she said.

“Knowledge gives us information. If we don’t have knowledge, then we get sick.”

But while the knowledge surrounding menstrual hygiene is increasing and women are talking more openly about it, there is still an extraordinary way to go.

But for Bebi, it all comes down to knowledge.

“Knowledge gives us information. If we don’t have knowledge, then we get sick. If we have knowledge, only then will we be able to do some work.”