Understanding infrastructural needs for perimenopausal women

Learnings from a workshop at CEPT University, India, on the needs of perimenopausal women and its impact on the WASH sector

By Mayank Pandey and Rachana Kansagra, Masters in Urban Infrastructure students, CEPT University

This is a reflection on learnings from a workshop on needs of perimenopausal women and its relevance for the water and sanitation hygiene (WASH) sector. The workshop was conducted at the Faculty of Planning, CEPT University, Ahmedabad with students of Masters in Urban Infrastructure in February 2023. The workshop was led by Dr Amita Bhakta and Gargi Mishra

Figure 1: Dr Amita Bhakta and Gargi Mishra conducting the workshop on needs of perimenopausal women and its relevance for the water and sanitation hygiene (WASH) sector

What did we do in the workshop?

The half-day workshop was a learning experience about the perimenopausal period in a woman’s life, and the associated experiences from interviews done by Dr Amita in her research, and a dialogue amongst us about its implications in the urban infrastructure and WASH sector.

The workshop was conducted in a planned way, with discussion around findings of Dr Amita’s research and exploration by participation in dialogues among students in groups around open questions at specific intervals between the presentations.

The workshop started with a fundamental understanding of what the perimenopausal period is in a woman’s life cycle, followed by a deeper understanding of types of knowledge in a society, categorized in a matrix of known/unknown to self against known/unknown to others, and where does perimenopausal knowledge lies within this matrix. We engaged in a focused group discussion to further understand the aspects of hidden knowledge. This opened our eyes to several cases from our lives in our society that fall within this category of hidden knowledge, and developed a better understanding of types of knowledge as categorized in this workshop.

Figure 2: Matrix – Hidden knowledge, Johari window
Source: http://www.amita-bhakta-hidden-wash.net/

This was followed by a quick analysis of how less literature exists in the scientific community around this issue, leading to an inquiry of why it is so. Dr Amita then introduced her feminist approach to research via questionnaires, oral history documentation, ethnography, PhotoVoice documentation and participatory mapping to arrive at WASH needs of perimenopausal women and how to address them through vignette methods of research.

Subsequently, from the research conducted by Dr Amita, we discussed the observations shared by women going through the perimenopausal period and their needs with respect to the WASH sector.

What did we learn which was unique?

Most of us had not even heard of the term ‘perimenopause’. Most of us were familiar with menopause, but not with the phase preceding it and the changes a woman’s body goes through during this period.

Through the tool of interview recordings integrated into the session, we were able to ‘hear’ the women from different parts of the world about their experiences and their needs during this period. The experiences included hot flashes, night sweats, joint pain, bone density loss, mood swings, irregular heavy blood flow during periods and weakness. There were also concerns of vaginal and urinary tract infection and bladder infection risk. We learnt that the duration of the perimenopausal period was over a few years.

The workshop also highlighted, through PhotoVoice, several pain points of perimenopausal women apart from the bodily experiences, due to existing practices and patterns of life due to the nature of perimenopausal needs being a hidden knowledge in society. These included difficulty in squatting position while using the toilet, need of increased reliability for access to toilets and assistance in extreme cases, coping with changes in use of products to manage the symptoms of perimenopausal period, need of access to effective menstrual hygiene materials and their safe disposal facilities, need of washing and drying of clothes infected with sanitary waste and of bathing up to 3 times a day to manage the symptoms in a private sanitation facility and need for 24-hour  access to water as perimenopausal women need to drink a lot of water to make up for the lost water due to sweating.

The workshop highlighted different Infrastructural needs during the perimenopause. These included the need of stools to sit and bath in the bathroom, the need of higher platforms in bathing areas to manage laundry, need of closed drainage, need for safe disposal of sanitary waste, and in underdeveloped countries, need of secure access at night to community toilets by perimenopausal women. In underdeveloped countries, for example, in Ghana, financial stability of poor women was also found to be a hindering factor in management of symptoms around the perimenopausal period.

Finally the workshop concluded with a discussion around what policy level measures can be taken to address the unmet needs of perimenopausal women in our society.

What are the larger implications, what to take away from this?

After the session, Prof. Mona Iyer, Dean of Faculty of Planning, joined the class outside on the steps of the faculty for a debrief of the workshop. The discussion led us to understand the importance of studying such delicate and hidden subjects, as needs of perimenopausal, in the overall academic spectrum.

Figure 3: Post session photograph of the group with Prof. Mona Iyer, Dean – Faculty of Planning, CEPT University

We realized that India being a developing country, suffering from poor sanitation facilities, is struggling to meet even basic sanitation requirements for a large portion of its population. In this context, the government has launched pan India level – Swachh Bharat Mission to meet the most basic sanitation needs of the population. A country where achieving basic sanitation facilities has become a national level challenge, it seems obvious that hidden knowledge such as the needs of perimenopausal women remains largely untouched, which is a neglected topic globally as well, as indicated in Dr Amita’s research.

Another key observation from this workshop is that the knowledge around perimenopausal symptoms and their management remains hidden and is transferred from generation to generation among the women. An interesting observation was also that in the layout of a traditional house in a village in North India, we see the internal parts of the house to be resided mostly by the women, where entry of men is restricted. In these areas, we see a source of water and access to the cooking area in close proximity, indicating that there has been an awareness regarding the needs of perimenopausal women among the women of the family, translated down to the layout and planning of services within a traditional house, all the while keeping the men out of this realm, physically as well as socially.

Figure 4 – Layout of a traditional house in a village in North India – showing the response to needs of women (including perimenopausal needs) reflected in location of amenities like kitchen(rasoi) and source of water and sanitation within close proximity to areas acquired predominantly by women and children of the family.
Source – primary study by Mayank Pandey (2013)

As more and more urbanization is happening in our cities, the issues of sanitary hygiene do not remain confined to individual residences, but have inevitably become city level issues, due to centralized wastewater management systems. Thus, unsafe management of menstrual waste from individual residences potentially pose the risk of creating a health hazard at a wider level, just like unsafe management of sewerage can pose risk of spreading of diseases in the city. This creates a need for the WASH sector to pay attention to this situation as well. Hence it becomes important to prioritize the inclusion of needs of perimenopausal women in the planning of infrastructure of our cities.

Acknowledgement

We would like to especially thank Prof. Mona Iyer and Siddh Doshi, for facilitating the setting up of this workshop.