Teach Menses India by Myna Mahila

Sexual and Reproductive Health (SRH) is the right of every woman. SRH refers to the ability of individuals to make informed decisions about their sexual and reproductive lives and to access high-quality healthcare services to support those decisions. The core aspects to SRH includes menstrual hygiene, sexually transmitted infections, gender-based violence and maternal mortality. Each one of these are larger issues and need focussed attention. The ability to access essential health services is also a part of enabling SRH. Sadly even though the young generation are a huge part of the low and middle income countries such as India, their requirements for the SRH are more often overlooked, especially those living in slums. Women still face barriers to accessing SRH services due to factors such as stigma, discrimination, and lack of access to quality healthcare services. It is essential that we work towards eliminating these barriers and ensuring that all women have access to the comprehensive SRH services they need to lead healthy and fulfilling lives.
Even though India has made huge strides in ensuring SRH through its National Family Planning Programme and Rashtriya Kishor Swasthya Karyakram (National Adolescent Health Programme), there are critical gaps in meeting Sexual and Reproductive Health outcomes. There is a huge gap in terms of knowledge about their health, bias among health providers and social stigma that deters the ability of the girls and women to protect and foster their own SRH needs.

Through the Teach Menses India Intervention, Myna Mahila Foundation intends to provide a

holistic one-stop solution to problems related to education, adoption and accessibility regarding sexual reproductive health, by addressing the barriers for it in a systematic manner. TMI will be delivered via two channels: (1) Physical Training Sessions in colleges and high schools where trained school staff would lead class sessions around the students’ health and gender attitudes. (2) Online through a mobile digital health application, “TMI App” where Myna Didi will lead a curriculum, and provide personalized support via female doctors.

Impact Goals for next year

 ● Access to a quality and affordable menstrual product. Beneficiaries are able to easily, comfortably, and regularly access and use a higher quality menstrual product. Factors such as cost, distance/geography, education, economic status, literacy-levels, product maintenance, and unfamiliarity with the product type will not pose a problem in adoption
● Access to quality and appropriate SRH education. Beneficiaries users are able to easily and comfortably access and understand higher quality SRH education. This includes ensuring that factors such as distance/geography, language/dialect, educational and economic status, and literacy-levels do not pose barriers to access or comprehension.
● Increased acceptance by girls and boys that menstruation is normal and healthy. Improved understanding and attitudes by girls and boys on the basics of menstruation and its importance as an indicator of a healthy reproductive system. This also includes a reduction in negative social norms and taboos surrounding menstruation found at the societal-level.
● Increased girls’ participation and attendance during her years of education . Young girls have increased participation and engagement in the classroom due to increased confidence in the reliability of the menstrual product they are using. Improved product security may enhance girls’ abilities to engage with teachers and peers in classroom activities by reducing fears about blood stains on their clothing.
● Increased utilization of Access to health services. Since the girls now know the importance of taking care of their own sexual and reproductive health and will also be able to identify signs and symptoms incase of any deviance due to the health education session, they will not hesitate to book an appointment with the doctor/counselor according to their need thereby enabling them to treat themselves at an early stage.

Suhani Jalota, CEO & Founder –Suhani has researched and designed implementation strategies in urban slum and rural communities on projects ranging from adolescent girl health, water and sanitation, and social protection policies. Suhani holds a degree in Economics and Global Health from Duke University, is a Forbes 30 under 30 recipient and a Queen's young leader 2017. Since 2011, she has been working on community- led solutions in slums. With Myna Mahila Foundation, her responsibility is that of scaling, monitoring operations, strategizing marketing, fostering partnerships with other organizations, and working with donors.

Sweta Kanavaje, Associate Director- Sweta is a Ph.D candidate at Mumbai University and holds a Masters degree in Social Work. Sweta's expertise lies in program planning and management. She has worked in the development sector for more than a decade. She guides Research vertical at Myna Mahila Foundation and along with that provides support to both Health and Employ verticals to streamline programs, monitoring and evaluation.
Dr. Shraddha Kale Kapile, Senior Program Manager for Health vertical - Shraddha has completed her Bachelor of Dental Surgery from Nashik University of Health Sciences and Masters of Social Work from Nirmala Niketan College of Social Work, Mumbai. Though being a Dentist by profession, she always had a passion to do something for the society at the ground level and wished to do it in a more professional way. Hence, she took a two year Masters degree course for Social Work. She believes that ‘Precaution is better than Cure and for precaution Awareness is necessary!’ She now prepares the content for various social impact programs such as Myna Digital (App + IVRS), Myna Champions and other interventions including Teach Menses India and also conducts sessions. She also trains the Myna training team who work with Dr. Shraddha to lead sessions. (50+ team members)

We have reached out to 1.5million girls and women with access to health education, products and services in Mumbai, India’s urban slums.

Our main target audience is women who live in vulnerable areas, such as slums. These women

often work as homemakers or daily wage workers and are unlikely to prioritize their own health, particularly in regards to sexual reproductive health, as it is still considered a taboo topic in many Indian families. To help address this issue, we are offering a three-fold solution.

 The first part of our solution involves teaching these women about sexual reproductive health by providing access to education. We will target girls in these vulnerable areas to break away from the culture of silence and increase their knowledge base, helping them to better understand their own bodies and reproductive systems. We will also support both girls and boys to address myths, taboos, restrictive perceptions and social norms surrounding sexual reproductive health.
The second part of our solution is to encourage the adoption of hygiene and quality sexual reproductive health products, while ensuring affordability. Through our Adopt concept, we aim to provide these women with access to affordable hygiene products. By generating revenue from the sale of these products, we will also ensure financial stability for our proposed solution. Our goal is to create a habit of using hygiene products, as we believe that if a woman adopts these products and becomes accustomed to using them, she is more likely to continue using them.
The third part of our solution involves ensuring that women have access to critical health decisions through their smartphones, by exposing them to the services provided by the TMI App. By offering education, affordable hygiene products, and access to health services, we believe that we can help improve the overall sexual reproductive health of women living in vulnerable areas, such as slums.

Sexual and Reproductive Health (SRH) is the right of every woman. Sexual Reproductive Health is also the most stigmatized topic for vulnerable communities. Over 3.4 million women in India have a desire to avoid pregnancy - of which 94% are married women (Murro et al.). In India, 71% of girls report not knowing about menstruation before their first period (Rehman). Furthermore, 70% of women in India say their families cannot afford sanitary pads (FSG). Moreover, 23 million girls drop out of school annually due to lack of proper menstrual hygiene.

Through the Teach Menses India Intervention, Myna Mahila Foundation intends to provide a
holistic one-stop solution to problems related to education, adoption and accessibility regarding sexual reproductive health, by addressing the barriers for it in a systematic manner. TMI will be delivered via two channels: (1) Physical Training Sessions in colleges and high schools where trained school staff would lead class sessions around the students’ health and gender attitudes. (2) Online through a mobile digital health application, “TMI App” where Myna Didi will lead a curriculum, and provide personalized support via female doctors.
This will ensure Knowledge, Adoption and Accessibility about Sexual Reproductive Health for girls at an early age to make informed decisions. The goal of the intervention is as follows:

 ● Teach: To bring about a change in knowledge, attitude and practices in terms of SRH by providing access to education
○ Target girls in the areas of intervention break away from the culture of silence.
○ Increase their knowledge base to understand their own body and reproduction
system
○ Support girls and boys to address myths, taboos, restrictive perceptions and social norms.
● Adopt: Encouraging the adoption of hygiene and quality SRH products and not compromising the affordability of the products and services.
● Access: Ensuring that women are able to control their critical health decisions through their smartphones by exposing them to the services provided by TMI App
The innovation in the solution is as follows:
- There have hardly been any interventions which focus on three core aspects of the SRH - Knowledge, Adoption and Accessibility
- There have not been any interventions in the space of Sexual Reproductive Health which have been delivered in the hybrid mode - physical trainings and virtual setups
- The sustainability of the program lies in the fact that the on-boarded girls will be engaged till the end of their lifetime through TMI App
- The training sessions are not only for SRH - but also to ensure mental health hence the sessions include the topics such as Importance of Mental Health, Importance of Nutrition, Importance of Exercise and Role of Mental Health Counsellor

Impact Goals for next year

 ● Access to a quality and affordable menstrual product. Beneficiaries are able to easily, comfortably, and regularly access and use a higher quality menstrual product. Factors such as cost, distance/geography, education, economic status, literacy-levels, product maintenance, and unfamiliarity with the product type will not pose a problem in adoption
● Access to quality and appropriate SRH education. Beneficiaries users are able to easily and comfortably access and understand higher quality SRH education. This includes ensuring that factors such as distance/geography, language/dialect, educational and economic status, and literacy-levels do not pose barriers to access or comprehension.
● Increased acceptance by girls and boys that menstruation is normal and healthy. Improved understanding and attitudes by girls and boys on the basics of menstruation and its importance as an indicator of a healthy reproductive system. This also includes a reduction in negative social norms and taboos surrounding menstruation found at the societal-level.
● Increased girls’ participation and attendance during her years of education . Young girls have increased participation and engagement in the classroom due to increased confidence in the reliability of the menstrual product they are using. Improved product security may enhance girls’ abilities to engage with teachers and peers in classroom activities by reducing fears about blood stains on their clothing.
● Increased utilization of Access to health services. Since the girls now know the importance of taking care of their own sexual and reproductive health and will also be able to identify signs and symptoms incase of any deviance due to the health education session, they will not hesitate to book an appointment with the doctor/counselor according to their need thereby enabling them to treat themselves at an early stage.
Impact Goals for next five years
● Improved educational engagement. Improved educational engagement can enhance the academic success and confidence of girls in addition to strengthening their college -based social networks. Ultimately this may impact their grade progression and graduation completion rates.
● Improved population health. Girls’ education improves population level health outcomes, such as by reducing fertility rates, increasing contraceptive usage, reducing the

 risk of becoming infected with HIV/AIDs and other sexually transmitted diseases, and positively impacts the health of girls’ future families, such as increasing children’s vaccine rates.
● Improved engagement by girls and women in society through the diminishment of taboos and social restrictions. Girls may experience an increased capacity and confidence managing their activities of daily living during their monthly menstruation, including reduced menstrual related stress, improved ability to engage in college, and decreased social segregation from community, religious and household activities.
● Gender Equality: Promoting SRH is an important way to protect girls' dignity, privacy, bodily integrity, and, as a result, their self efficacy. Awareness of SRH contributes to the creation of a nondiscriminatory and gender-equal environment in which female voices are heard, girls have choices about their future, and women have opportunities to become leaders and managers.

This initiative is directly linked to two different UN SDGs - Goal 3 Ensure healthy lives and promote well-being for all at all ages and Goal 5 Achieve gender equality and empower all women and girls. Hence in the short run we will be measuring the impact of the intervention on bringing about an attitudinal change on gender stereotypes and shed light on gender inclusivity. This will be a qualitative survey and will help the participants in understanding the gender stereotypes and unlearn the myths related to the topic. The intervention will also promote Menstrual Hygiene Management, thus helping out the participants to break the vicious circle of myths, taboos and stigma around MHM. The intervention will provide access to one stop solution, thus helping in increased knowledge on Health, Increased access to services and Increased access to hygienic and affordable products. Participants will be sensitized to know the importance of physical, mental and social health and also the importance of eating healthy and nutritious food along with exercise and its effect on the aging process. As a result of this intervention, girls health seeking behavior on SRH becomes her self regulatory behavior and thereby her overall health is improved

Due to the prioritization of the girl’s health, it is expected that the school dropouts due to Menstrual problems will reduce drastically. They would be able to continue their education, seek better employment opportunities and thus become financially independent - a catalyst for gender equality

Our technology is the Teach Menses India App, which is a mobile application providing holistic one-stop solution to the beneficiaries from the vulnerable communities who do not even have a confidante with whom they can share their Sexual Reproductive Health related issues, let alone visiting a doctor. Given this in purview, we wanted to design a mobile application which will help them discuss their problems without any hesitation.

Furthermore, during the ideation phase, the pandemic struck, and the need to launch the app became more prominent. The number of calls on the Myna helpline increased three-fold since the confusion and consciousness set in during the pandemic for women in the most low-income patriarchal families. Most concerns were related to SRH, especially MHM-related queries, which could have been fatal in many cases. With the intention to provide door-to-door services for women who become prone to sexual diseases without proper care, sanitation, and health products. Myna’s effort was to bring them into mainstream health care as a part of Universal Health Coverage. Based on this, the Myna Health App was designed with three motives:
● Promote Awareness: The Myna Health App was designed to promote awareness amongst women about the biology of their well-being and their social and psychological well-being. In the M-Health App, various short animated videos make them aware of the health aspects focussing on physical health and mental health
● Provide Doctor Consultations: Most women in the areas that Myna focused on were either unaware of the doctors in and around their areas or too shy to approach them by themselves, usually relying on the male family members. M-Health App eliminates any such need and ensures that booking doctor’s appointments for these women is just a click away. Furthermore, if the women are too shy to even step out of their homes, M-health App has a feature of private chat to give them anonymity to disclose their problems and take corrective action towards their well-being.
● Provide door-to-door health products: Even today, when one accesses a sanitary napkin from a medical shop, the first thing that they do is wrap it in a newspaper before passing it on to the customer. This is the kind of stigma that women face for their SRH. Hence, M-Health App has a feature where women can place orders for essential healthcare products at the App to receive them at their doorstep.

It is crucial that our team members complement each other well and bring a variety of skillsets and perspectives to the table. We ensure diversity from top down in our cultural and economic differences. Further, we encourage perspectives to be heard in bottom up order. During team debriefs, people working most closely with workers speak first and they are given the most air time. We constantly relate back to our values during the meetings every time there seems to be diversions, and we regularly engage in open and honest dialogue (including mistakes/failure). If our team believes in diversity and inclusivity themselves, we would be equitable in recruiting workers of different ethnicities and cultures for Myna. We provide training to be unbiased in the recruitment process to ensure we are not discriminating. For instance, our Muslim coordinators visit Hindu homes to speak about the job, and vice versa. When our diverse team talks to each other so openly and freely about their lives, others around them tend to open up as well.

Finally, we need to invest a lot more in leadership development of our team members, providing them with mentorship to grow more confident of themselves and their team.

Our main target audience is women who live in vulnerable areas, such as slums. These women

often work as homemakers or daily wage workers and are unlikely to prioritize their own health, particularly in regards to sexual reproductive health, as it is still considered a taboo topic in many Indian families. To help address this issue, we are offering a three-fold solution.

 The first part of our solution involves teaching these women about sexual reproductive health by providing access to education. We will target girls in these vulnerable areas to break away from the culture of silence and increase their knowledge base, helping them to better understand their own bodies and reproductive systems. We will also support both girls and boys to address myths, taboos, restrictive perceptions and social norms surrounding sexual reproductive health.
The second part of our solution is to encourage the adoption of hygiene and quality sexual reproductive health products, while ensuring affordability. Through our Adopt concept, we aim to provide these women with access to affordable hygiene products. By generating revenue from the sale of these products, we will also ensure financial stability for our proposed solution. Our goal is to create a habit of using hygiene products, as we believe that if a woman adopts these products and becomes accustomed to using them, she is more likely to continue using them.
The third part of our solution involves ensuring that women have access to critical health decisions through their smartphones, by exposing them to the services provided by the TMI App. By offering education, affordable hygiene products, and access to health services, we believe that we can help improve the overall sexual reproductive health of women living in vulnerable areas, such as slums.

The mobile application is expected to experience exponential growth in adoption. The application building and development will be done in three phases.

Phase 1 will focus on building the necessary tools and setting up an in-house team, as well as covering hosting charges, one-time maintenance costs, and one-time configuration costs. This phase is estimated to take approximately 200 days, and the total cost for this phase will be $108,500.
Phase 2 will concentrate on engagement and implementing marketing strategies. The estimated cost for this phase will be $54,300. During this phase, the count of beneficiaries is expected to double.
In the final phase, engagements will be increased four-fold, and live app data will be monitored. The estimated cost for this phase will be $87,200.

 The total cost for the deployment of the mobile application will be $250,000. The total outreach will be 250,000 girls across the slums of Maharashtra, India.
As for generating revenues, a hybrid approach will be adopted. The intervention aligns with many international and national welfare schemes, and functional welfare bodies will be approached to obtain grants and donations. In addition to this, revenue will be generated from doctor consultations, online orders, collaborations with ed-tech companies for skill development courses, and advertisements, among other sources.

The grant received from Bharat Petroleum Corporation Limited in 2022 for the Sponsor a Girl Program in schools and colleges, amounted to ₹ 2,200,000. We initiated 2600 beneficiaries through community mobilization, conducted Physical Health Core Sessions with 1300 beneficiaries and onboarding 1300 beneficiaries on M - Health as a part of Sustainability. This program initiated three phases of change - the individual, peer and community level. This level of change was aimed to move from the cognitive, physical, psycho-social to the independent stage.