Managing menstruation with dignity: Worries, stress and mental health in two water-scarce urban communities in India

Figures & data

Table 1. List of participants in India.

Interviewee #	Age	Marital Status	Neighborhood	Religion
1	28	Married	TN	Hindu
2	37	Married	TN	Hindu
3	35–36	Married	TN	Hindu
4	39	Married	TN	Hindu
5	21	Married	TN	Hindu
6	21	Married	TN	Hindu
7	37	Married	TN	Hindu
8	20–21	Married	BH	Muslim
9	27	Married	BH	Muslim
10	38–39	Married	BH	Muslim
11	37	Married	BH	Muslim
12	28–29	Married	BH	Muslim
13	37	Married	BH	Muslim
14	35	Married	BH	Muslim
15	19	Married	BH	Muslim
16	25	Married	BH	Muslim
17	19	Unmarried	BH	Muslim
18	20	Married	BH	Muslim
19	18	Unmarried	BH	Muslim
20	19	Unmarried	BH	Muslim

Table 2. Examples of codes applied in analysis.

Code name	Code exemplar	Code definition
Responsibility and ideal cleanliness	XINT: How do you think a responsible woman will maintain her cleanliness and hygiene during menstruation? XRESP: I think … the right way is to bath early in morning … should use pad … should change pad in 2–3 hours … then when it is a waste … it should be covered in a paper and then should be thrown in the dustbin.	Describes what is the perception of a responsible woman [jimmedar], during menstruation. Women describe how ‘responsible’ or ‘proper’ [uchit ] women deal with menstruation and maintain cleanliness in ideal way.
Personal dignity during menstruation	XRESP: In our village, I used cloths, used to wash it and dry it … [I would dry them] inside only … outside, the sun used to be there, but inside nobody would see it … I used to be very scared … I avoided sitting with Father or others … [because] what if I leave a stain … So, if Father used to sit out, I would remain inside … what if stains are visible to him or my brother?! I would be ashamed and that’s why avoided going out. Now, when I use pad, no worries … I can go anywhere. XINT: How do you dispose it? XRESP: I cover it in a paper and throw in a dustbin.	How women describe their CONDUCT (rather than emotions/feelings) about menstruation; the lengths they go to in order to manage menstruation so as to maintain dignity [izzat]. This code will overlap with the responsible women and loss of dignity codes.
Hierarchy of needs and menstruation management amidst water scarcity	XINT: How can a responsible woman manage her menstrual conduct? What all she needs? XRESP: she [a woman] should clean herself properly, she needs sanitary pad, water, should change pad frequently. XRESP: so you can imagine, how difficult it is to keep clean, still we try to store water and use it for cleaning and hygiene needs … but during menstruation, we need water. XRESP: When water is not there, I borrow some from the neighbour and then clean myself	Women rank the need for various items including water to manage menstruation; includes talking about lack of water, and strategies to manage water – storage and/or re-allocation etc.
Loss of dignity (felt humiliation, shame and worry)	XRESP: It’s difficult to go out … there can be leakage … it can stain before others … they can see … it can be so embarrassing. XRESP: if someone sees that she [a woman] has got stains on cloth … they will say – ‘see what a disgust … how she is living … everyone will laugh … it’s easy for others to laugh … only one in trouble can understand it … others just laugh and make fun.	Describes how women answer protocol question about humiliation [beizzatti ] and menstruation. This includes respondents’ account of emotions like worry and shame likely from the loss of perceived dignity. This code will likely overlap with expressed stress.
Expressed stress, frustration, anger	XRESP: I feel troubled … but very angry also … due to lack of water, I can’t do household chores properly … face problem in bathing also … It’s difficult to wash cloths also … If we do not wash cloths then [there is trouble].	Describes multiple negative emotions women EXPERIENCE with regard to a lack of water during menstruation.

Figure 1. Summarised framework linking household water insecurity with loss of dignity and adverse mental health outcomes for women.