India: Changing the tone on menstruation

The manifold disadvantages and discrimination continue to plague women in many parts of the world. Women are still regarded to be objects of repression in various countries especially India.  Despite stringent laws for the protection of women, they continue to be the victims of violence and harassment. Be it in terms of access to education, access to equal economic opportunity or even access to basic health care services, women continue to face discrimination from laws, social norms or customs linked to stereotypes mostly in rural areas.

Image source: Medical Daily

Among these, one of the least talked about aspect remains women’s access to menstrual health care. Menarche is the beginning of a woman’s journey to motherhood. But in India, especially rural India, rather than celebrating, it is considered a taboo to even discuss it. Superstitions and cultural taboos associated with periods have persisted at the cost of women’s health and safety. Practices of not letting menstruating women enter places of worship or fetch water in rural areas as that would impure the sources are still prevalent. Most of the women in rural areas use unhygienic products such as wood shavings, sand, ash or dirty cloth. Many women stuffed their undergarments with sand, leaves or ashes during their monthly periods because there was lack awareness or sanitary napkins were unaffordable or even worse they were inaccessible. This in turn results in women suffering from numerous episodes of vaginal infections which often lead to reproductive tract infection and a host of other diseases. Lack of sanitary products also causes girls to stay home from school and keeps women out of the informal labour workforce.

Challenges:
Limited access and acceptance in India comes coupled with the issue of disposal. Disposal of sanitary products is another important issue, both from a waste management and a cultural perspective. Even under the current government’s procurement system of sanitary pads in national health programs, the quality requirement for tenders is outdated.

Inadequate sanitation facilities act as a hindrance to growth and impact. Women find it difficult to replace napkins or wash in privacy given the lack of proper and clean toilets. All these act as impediments.  Studies have shown girls lack water, soap, privacy, and space to change adequate time to manage their menses comfortably, safely, and with dignity and hygienic sanitary products and sometimes underwear.

As per the latest National Family Health Survey (NFHS-4), 2015-16, rural Madhya Pradesh fares the worst in the country in menstrual health management, with only 26.4 per cent of women between the ages of 15 and 24 using hygienic methods. There is extreme reluctance among girls and their families to approach health centers for any sort of counselling or medical help.

The 12% GST on sanitary napkins have spurred heated debates and widespread anger among various sections of the society. This has led to mass participation and demonstrations against the current government’s move. But activists often miss out that is not about taxation rather about the product categorization. Sanitary pads are put under “miscellaneous items” (the same category in which pencils and crayons are also placed). An essential commodity and hygiene product like sanitary pad should ideally come under “health”.

Again, lack of good menstrual hygiene practices cannot be replaced by a non-biodegradable disposable product, that is, sanitary pads made of plastic. Tampons and menstrual cups carry with them the skepticism of inserting foreign material in the body.

Action Taken by Government and Policy Makers:

Governments have begun to address menstrual hygiene as a key issue in women’s health and education. International organizations such as the World Bank, UNESCO, UNICEF, the World Health Organization (WHO), and others have started including menstrual hygiene management, including the provision of sanitary products, in their research and support to governments.

The “MHM in Ten” initiative was organized by Columbia University and the United Nations Children’s Fund (UNICEF) in New York City in October 2014 to systematically map out a ten-year agenda for overcoming the menstrual hygiene management (MHM)-related barriers facing schoolgirls.

Governments are being encouraged to subsidize pads and even distributing them for free amongst girl children of various schools in rural areas. The Indian government in 2010 started the Menstrual Hygiene Scheme under which highly subsidized sanitary napkins are given to girls in rural areas below the poverty line. The state governments too followed similar initiatives. Scheme for promotion of menstrual hygiene has rolled out in 17 states in 1092 blocks through Central supply of ‘Freedays’ sanitary napkins.

Possible solutions/changes- 

For Indian women, menstruation is much more than biological; it is a way of perpetuating gender discrimination. Many girls receive factually incorrect or no guidance prior to menarche about the normal physiological process of menstruation or its management. This in turn results in numerous misconceptions about their own fertility, creating vulnerability to adolescent pregnancy. Lack of scientific understanding about menstruation, rampant myths and misconceptions coupled with limited or no access to hygienic menstrual products result in some of the biggest problems crippling the women in rural India. Combining menstrual hygiene education and the sale of sanitary products allow addressing the cultural taboos and misconceptions, eventually leading to the breaking of gendered stereotypes.

Menstrual Hygiene Management (MHM) guidelines of the government concentrate on spreading awareness and removing the taboo around menstruation. The majority of existing efforts aimed at addressing MHM have emerged from the WASH (Water, Sanitation and Hygiene) community, yet the WASH sector alone cannot advance the MHM agenda in schools. Including menstrual hygiene in national sanitation and hygiene strategies and school health policies is an important step toward improving awareness of feminine hygiene products.

India has one of the lowest levels of penetration of sanitary pad usage in the world. More startups are wanted to address the issue of affordability and accessibility. A bunch of local ventures is looking to build viable feminine care businesses. Saral Design, founded by four IIT Bombay graduates, is one such company. By using the ASHA workers in rural India, Saral is establishing a door-to-door sales network. Their objective is to tap on the areas where inaccessibility is an issue. These women took on the role of ambassadors of menstrual health in their villages where they are seeking first-time converts. Soothe Healthcare is another venture to receive funding from Vini Healthcare and are reaching out to the mass market with their brand Paree.

Vatsalya Foundation developed sanitary pad manufacturing unit that were hygienic and low cost using wood pulp to absorb menstrual flow. They further involved the Sakhi Mandals (Women Self Help Groups) to increase women participation. This also allowed for viable livelihood options. Project Baala decided on manufacturing environment friendly sanitary pads to be distributed in the villages. The pad is made of three layers of cloth stitched together, is reusable and can be used for a period of 1.5 to 2 years. They conduct workshops too in order to create awareness among public, especially women.

Manufacturing of sanitary napkins in rural areas using local products widens reach and reduces cost too. Women’s involvement in this value chain at every step also ensure production and selling of pads themselves. Women’s productivity at home and work rises with their access to menstrual health care.  Some models, such as Aakar Innovation, Azadi produce compostable products which disintegrate quickly. This helps in addressing the environmental issues. It is also important to ensure toilet with running water facility and proper pad disposal facilities are available to the women and girls.

It is crucial to build collaboration and strengthen research capacity across countries and regions of the world on menstrual health management and indentify or foster new menstrual hygiene experts and actors. As far as taxation is concerned, tax and health policy should be intertwined. The policies should ensure impact of tax on less affluent consumers is lower, keeping in mind social and economic objective. It is important to make sanitary napkins a health product. The proper access to menstrual health care is important to ensure high rate of girl student drop outs. The importance of proper quality check is equally essential.

Women are not always comfortable buying napkins from the pharmaceutical shops due to the prevalent taboos and cultural norms. A simple change in a lifestyle habit can often change social indicators. Providing sanitary napkin is one aspect of it, we need to look at the issue through a larger lens of access, awareness and affordability. It is important thus to go beyond the problem in providing sanitary napkin. There are communities even today who believe menstruation is a curse to girls and a health problem. Good menstrual hygiene practices needs to be talked about and discussed in the open for the sake of economic and environmental sustainability and health. It is also vital to bring global and local expertise together in order to coordinate progress and share outcomes.

Men too need to be involved in this process. Many issues like proper functioning toilets, access to safe private spaces and clean water need to be ensured, even at the household level, to allow the rural women a decent shot at having a healthy reproductive life and beyond. Menstrual health management is crucial for educational and health reasons. There is a need for greater representation of government representatives, youth voices, and sanitary napkin manufacturers to address this.

Shreya Mukhopadhyay

Shreya Mukhopadhyay

Intern at InPRA
Shreya is a final year undergraduate of the Political Science, International Relations department, from Jadavpur University.
She has previously interned at organizations like OneWorld Women Network, Child Rights and You, and Daricha Foundation.
Shreya takes active interest in Model United Nations simulation and has done research related to gender rights.
She is a firm believer of gender parity and passionate about working in this field.
Shreya Mukhopadhyay

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