Ata Tuzi Pali

Menstrual health is an important determinant and outcome of sexual and reproductive health and rights. While the Menstrual Hygiene Management (MHM) has gathered momentum both globally and nationally; in many cultures today, it is still greatly stigmatized and treated as something shameful or dirty. The continued silence around menstruation, combined with limited access to information at home and in schools results in millions of girls having very little knowledge about what is happening to their bodies when they menstruate, and how to deal with it. This is often accompanied by a lack of sanitary products, services, and facilities to adequately manage the monthly occurrence.

A study of adolescent girls was conducted in Rural Maharashtra (1) to understand their current menstrual hygiene says that the provision of reproductive health services, health education, counseling and awareness in rural areas and schools and availability of water and sanitation facilities in rural areas are absolutely essential.

 A report published by MoFHW, Govt of India (2) says that we have to break the taboos, silence and the stigma around this normal physiological phenomenon by running a sustained social and behavior change communication, implement the policies and programmes and health system that is sensitive and comfortable with addressing the issue.

 According to a study carried out in Central Karnataka (3) showed that only 38% of the girls changed the menstrual absorbents every six hours. Also, symptoms of Reproductive Tract Infection (RTI) were found to be high among adolescent girls who did not do proper cleaning and drying of cloth they are using as absorbent & those not maintaining hygiene of genitalia.

 While the need of educating girls, women and even boys on menstrual health is an intuitive one globally, many studies conducted at National and International level call attention to action. 

Sources - 

(1) Indian Journal of Gender Studies 28(1) 127–137, 2021) 

(2) MoFHW, Govt of India (Menstrual Health in India - An update) 

(3) National journal of community medicine

Ata Tuzi Pali (A Marathi name, means 'Now its your turn' in English) is an educational game designed with a purpose of learning, understanding the various aspects of Menstrual Health like 'PMS and Menstruation, Promoting Good personal hygiene Habits, Breaking Misunderstandings and Taboos & Nutrition and Exercise' in a fun way.

Ata Tuzi Pali revolves around one of the dimension of the challenge 'Improve the SRH outcomes of young people and address root cause barriers to SRHR care..'

• This game is an educational, making it a perfect fit for school or college students to play and understand the menstrual health in creative way.
• This game can act as a support tool for the Menstrual Health Educator beginners who want to build the capacities of youth in various institutions, in the communities. 
• It can also be used as an 'Information-Education-Communication (IEC) material' for the organizations or individuals who are already conducting awareness sessions, training programs on menstrual hygiene management at various levels. 

While the game has not been used at larger scale, it was tested immediately after its creation. adolescent girls in schools and communities, doctors, working professionals from various sectors, homemakers, social development professionals, community mobilizers did the trial of this game and shared some valuable feedback for improvement. The game was then modified as per the suggestions of the users and is still in revolving process.

The game addresses information needs of target population, especially adolescent girls and young women regarding various aspects of menstrual health. While conducting one to one sessions with them, it has been observed that they either have a little information about the subject or they have heard half things from someone and have been following them and also sharing it with others. For instance, many feel that the menstrual blood is nothing but a bad blood coming out of the body OR soaking a used cloth or cloth pad in hot water will clean the absorbent completely etc.

The game speaks about four important aspects of menstrual health and focuses on giving scientific information, promoting personal hygiene habits, eating whatever available at home the right way and taking out some time for self care. This simple yet important information may give a positive insight towards menstrual health and small changes in their daily routine may bring long term positive change in their lives and it will be passed on from one generation to another.

A few discussions and meetings with communities and with few nonprofit organizations working in communities in Maharashtra India have been conducted to understand the information needs of the beneficiaries.

The game was though designed before these meetings; it was later tested with adolescent girls living in communities and few employees of nonprofit organizations working in communities. Their valuable feedback like using simple words, using pictures wherever possible, changing color scheme was noted and then incorporated in the game for improvisation.

Though the game has not been used at larger community level, it is also made with a thought that capacity of some local adolescent girls or young women from community can be built and they can further educate the other beneficiaries with the help of this game. 

The game has been tried and tested with below population - 

Adolescent girls in schools - 10 numbers

Adolescent girls in communities - 10 numbers

Doctors, working professionals from various sectors, homemakers, social development professionals, community mobilizers - 20 numbers

10 copies of the game have been purchased by individuals and organizations working in the field of menstrual health and we expect they use it with their beneficiaries and share a valuable feedback for improvement.

Below approach was thought while gamifying the menstrual health information -

1. Games or game based activities are often seen in schools, colleges, trainings, workshops or even in family get together. Playing a game is something that interests people from all age groups and people enjoy it a lot. 

2. Playing games also engages people and makes them concentrate on what they are playing.

3. While a person may hesitate or take time to open up and speak about menstruation in a group discussion or in sessions, the game by its rule makes it compulsory for a participant to read the content on the cards.  

4. Playing games creates memories. While there are multiple nonprofit organizations working in the schools and communities, this approach of conducting a session through games may remain in the minds of beneficiaries rather than just listening to the sessions.

The game can be used by both menstruators as well as non menstruators since it's a knowledge tool. The game is simplified in such a way that it can be used by a diverse population in terms of  gender, class, caste, religion. While it can be used by a highly educated population, a person with basic reading skills can also use this game. 

The games are available at present in English, Hindi and Marathi. If the users and implementers find this tool useful then the games could be easily translated in more languages and could be reached out to more number of beneficiaries.

In India, there are few App based games available on menstrual health. This game could be one of its indoor board games and can be played in any geographical area (Where Hindi, English, Marathi is known) since it does not need any technology or network.

The impact goals are based on below Sustainable Development goals - 

SDG 3 (3.7) – Good Health and Well Being 

If women and girls lack access to a­ffordable, hygienic menstrual products, they often use old rags, cloths or other unhygienic materials. This can lead to reproductive tract infections (RTIs) and other health conditions.

The game can support overcoming the above issue by creating awareness among diverse population on menstrual hygiene management. It can also help in creating a safe space for beneficiaries to talk about their issues and address them on time.

SDG 4 (4.5) – Quality Education 

Girls in developing countries miss up to 5 days of school per month when they menstruate. In a study from Nepal, 41% of girls reported missing school during their menstruation.

The game can support overcoming the above issue by creating awareness among adolescents, their parents and teachers on menstrual hygiene management. It will make them understand the importance of menstruation in their lives, different ways to manage their periods effectively so that they do not miss the schools during periods and make periods normalize. The game can also be used to build the capacity of teachers to teach about these issues with comfort.

SDG 5 (5.1, 5.6) – Gender Equality 

Taboos and myths related to menstruation often portray women and girls as inferior to men and boys.

The game can support overcoming the above issue by creating awareness among diverse population on menstrual hygiene management. It will help in creating a safe space for beneficiaries to talk about periods openly and start treating it normally. It will also help in addressing taboos and promote positive social norms around menstruation.

Theory of change for this solution could be explained as follows - 

Namita is a menstrual health educator freelancer. She works on multiple projects with various organizations who has their own teams.  As a freelancer, she works on her own in collaboration with other organization.

Have been working on the design, development and improvisation of these games from last six months.

The game Ata Tuzi Pali can be used by both menstruators as well as non menstruators since it's a knowledge tool and hence can reach out to larger population. 

The game is simplified in such a way that it can be used by a diverse population in terms of  gender, class, caste, religion. While it can be used by a highly educated population, a person with basic reading skills can also use this game. 

The game is at present available in English, Hindi and Marathi hence can be used by large amount of population and also has a wide scope to get it translated in more languages to increase the reach.

While Namita works as a freelancer, she conducted multiple trainings with different sets of trainees, community mobilizers working with parents of waste pickers residing in slums, community coordinators working with tribal population in tribal areas, teachers from government schools etc. Namita has also been a part of research study where she got to interact with many physically and mentally challenged girls and women living, studying and working in residential schools and vocational training centers. 

Namita has been actively participating in various gender sensitization workshops to develop a broader approach towards the community and reach a more diverse population in near future.

While doing assignments for other organizations, Namita has consciously ensured that the organizations she worked or works with, believe in equality and hence does not tolerate any differential/preferential treatment amongst fellow employees including discriminating gender preferences, and/or creating or promoting an atmosphere of differential economic/social status.

The organizations she was/is associated with, works with a diverse population in terms of gender, class, caste, religion, language and ensure qualitative work throughout all the above factors.

The proposed business model for the game is an integrated one where the game can be sold to organizations, individuals working on the menstrual health projects in schools, colleges, other institutions, communities etc with diverse population. This will act as a funding mechanism to sustain the product and expand/enhance the scope of improvisation in future.

The organizations working on menstrual health projects will have an additional tool to implement the project on the ground.  

At present, Namita is working as a freelancer and hence she has invested some money from her pocket for the design and development of the games. Few copies of the games have been sold to non profits and individuals and some part of the invested amount has been recovered. 

Since the solution is at pilot stage, we have not approached any funding agency for any funds. We are in the process of collecting the feedback about the game from the buyers and if the scope of expansion is positive, then we may approach individuals or organizations to support the printing, outreach, impact evaluation of the solution.