JAMMU: In the Kargil Colony of Jammu's Narwal area, Rohingya refugee families live in makeshift tents under harsh conditions. Najma (34), Jannat (35), and Aamina Khatoon (65) share one such tent, where health struggles are constant.
Two among them have recently undergone surgeries for uterine complications, a proportion that reflects the broader crisis within their community.
"If you look at ten women in our community, at least eight are ill, and four have undergone operations. Unhygienic menstrual practices are a major reason. Back home, we managed better, but here we struggle even to eat," says Jannat.
Aamina Khatoon recounts her own ordeal. Operated on after three months of untreated illness, she still needs to visit the hospital but cannot afford transport. Medicines are a further burden she has no means to meet.
A Layered Crisis
For many women like Rumana, early marriage and poverty have compounded the health crisis. Married at 12 and now a mother of four, she recently underwent surgery for a reproductive health issue. In the ward, her mind was not on her own recovery but on her children.
She goes on: "I was mentally disturbed. My husband works as a daily wage labourer, so we can feed our children at night. I was anxious that if something happened to me, where would my four children go?”
In hindsight, she blames it on lack of awareness and menstrual hygiene. “All this happened due to a lack of awareness. If I had somehow managed proper menstrual hygiene, the situation might have been better," she adds.
Rumana did not know what sanitary pads were until she saw advertisements on her mobile phone and received products through an NGO distribution drive. Affording them regularly remains a challenge.
What is striking, and significant, is that the women of Kargil Colony are beginning to draw the link between menstrual hygiene and their reproductive health. This is not awareness that came from the government, from doctors, or from outreach workers. It is a conclusion they have arrived at through lived suffering.
Rumana says plainly that had she known about proper menstrual hygiene; her surgery might have been avoided.
Jannat identifies 'unhygienic menstrual practices' as a major reason for the scale of illness around her.
And younger women like Nandini (26) are now actively trying to spread awareness within the community and save money to purchase hygiene products. They are not driven by a government or any NGO programme, but by watching what happens when hygiene is absent.
"Due to a lack of education, our community continues to suffer. Health should be a priority, particularly for women. Ignorance around menstrual hygiene worsens our condition. If the government takes effective steps to raise awareness, it will significantly help," Nandini says.
This emerging self-awareness is fragile. It exists without medical guidance, without women doctors who have ever visited the camp, and without the financial means to act on what the women now understand. Awareness without access changes little.
Tradition, Taboo, and Tribals
The crisis is not confined to Rohingya refugees. Among tribal communities migrating along the Mughal Road, traditional practices still dominate menstrual care. Many women continue using cloth, citing cultural norms, inaccessibility of medical stores, and social taboos that prevent them from asking men to purchase hygiene products.
“We have always used clean cloth and never faced major health issues. It is a natural process, not a disease,” 59-years-old Rehti said. However, she acknowledges that younger women are becoming more aware of modern hygiene methods.
This is further validated by the younger women around her, reflecting a generational shift in awareness of menstrual hygiene even as there is severe lack of access.
"There is no privacy, medical stores are far away, and we cannot ask men to buy these products due to social taboos. Still, things are slowly changing with awareness," says Shahnaza, a 29-year-old woman from a nomadic tribe along the Mughal Road.
For a migrant worker in Jammu, Kali Puniria (58), the barrier is economic: "We struggle to feed our children. Spending money on pads feels like a luxury."
Across communities - refugees, tribals, economic migrants - the pattern is the same: survival takes precedence over hygiene, and hygiene debt results in illness.
A Systemic Failure
Dr Marya, a gynaecologist serving at a district hospital, while speaking to Kashmir Times, acknowledged that a majority of women seeking treatment are facing multiple complications due to poor menstrual hygiene.
She added that young girls who are educated and aware of sanitary pads and hygiene practices are comparatively better protected.
Referring to Gujjar, Bakerwal, migrant, and economically weaker women, she stated that many suffer from a range of ailments, particularly multiple reproductive health issues, including cervicitis, uterine infections, and pyometra.
However, due to unhygienic menstrual conditions, many are now falling into the category of women who are unable to conceive, and cesarean surgeries have become common. She emphasized that a lack of awareness about maintaining menstrual hygiene is a major contributing factor.
She also referred to a case where treatment took nearly a year, and the patient had to be shifted to SMHS Hospital due to severe infection and discharge of pus. She noted that such women often suffer from.
A senior official in J&K's Department of Health, speaking on condition of anonymity, acknowledged that hundreds of women are suffering from ailments tied to poor menstrual hygiene. While the government has made sanitary pads available at health centres for Rs 2, the official conceded that these facilities are not being utilised properly, pointing to a deep gap in ground-level awareness.
ASHA workers do make efforts to reach marginalised communities, the official noted, but acknowledged a significant gap remains at the community level.
Jannat's observation cuts through the official language: "No female doctor has ever visited us." Or, as Najma says, "If we start counting our problems, the counting may end, but our problems never will."
The Supreme Court, in Dr Jaya Thakur vs. Government of India & Ors., recognised menstrual health as a fundamental right under Article 21 - the right to life, dignity, and self-respect. The judgment acknowledged the barriers preventing women and girls from accessing menstrual hygiene and the consequences that follow.
For the women of Kargil Colony, the nomadic tribals, or the migrant workers in their slums, that constitutional language is distant. What is immediate is the cost of transport to a hospital they cannot afford, the price of medicines they cannot pay, and the knowledge that a piece of cloth used in place of a pad can have consequences for their health.
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