As we conducted undergraduate research on ‘myths and realities associated with menstruation and the usage of sanitary napkins among the urban poor of Ahmedabad’, we realized that the product that we had set out to promote was not the ideal menstrual product for women’s health or the environment. The plastic-based sanitary pads that were most commonly available posed the risk of fungal and other infections, allergies, and inflammation to the women using them. Each pad contained 2 grams of non-biodegradable plastic, which when accumulated over a period of time and geographical area, added significantly to the crisis the environment is facing currently. While trying to solve the problem of unhygienic menstrual management, are we actually creating or adding to a bigger waste management issue and other potential health risks? Are the female sanitary hygiene behemoths doing the same?
Menstruation has always been a taboo in India but during the past decade, efforts by NGOs, new-age start-ups, mainstream Bollywood (with movies like Phullu and Padman) and different sections of the government have resulted in a definite increase in awareness and dialogue around menstruation and menstrual hygiene management (MHM) in the country. The rate of sanitary pad usage, a statistic often quoted as a testament to the fact, has risen from a mere 12% in 2011 – according to a study conducted by AC Nielsen and PLAN India – to 42% in 2015-16 – according to the latest National Family Health Survey (NFHS-4) conducted by the Ministry of Health and Family Welfare. However, such statistics raise more questions than they answer if one takes a closer look.
Does using sanitary napkins imply hygienic use?
Sanitary napkins are often equated with hygienic use. The Survey cited above also considers 58% women (including 12% who use locally prepared napkins) as ones using a “hygienic” method of menstrual protection. UNICEF, however, includes changing the menstrual management material in privacy as often as required, using soap and water to clean the body, and having access to safe disposal apart from just using clean menstrual management material, in its definition of MHM. This means that using a clean cloth and washing and drying it properly is actually hygienic, while using a sanitary pad but not changing it regularly and/or disposing of it improperly is not. In fact, the ubiquitous product’s demand or need did not exist in India until recently. It was created by MNCs such as Johnson & Johnson, P&G, and Kotex over the last one and a half centuries, first among the European and Anglo-Indian population and then among the “modern Indian women”. Under the garb of words like “hygiene”, “cleanliness” and “comfort”, the early advertisements brought to the forefront Victorian ethics of controlling the markers of sexuality. Aggressive ad campaigns were published to convert younger generations from cloth users to pad users. Schools, doctors’ clinics, free samples, door-to-door sales and even home-delivery helplines were used to promote and cut across societal distinctions and break through taboos. While these behemoths have been trying to discredit cloth pads for decades, cloth pads are not actually unsafe. The process of them not being washed and dried properly is the biggest cause of infections, because today, in the areas where waste cloth is used, it is disposed of discreetly and hygienic practices are not followed due to the stigma associated with menstruation and menstrual blood and a lack of hygienic living conditions. As consumers and producers grow more conscious of their health and the environmental impact of the products they use, cloth pads are making a revolutionary comeback as the eco-positive and healthy alternative to plastic-based pads.
While research in this area is limited, anecdotal evidence suggests that due to the lack of private washrooms, disposal facilities, affordability, or awareness of MHM, and the stigma associated with purchasing sanitary napkins at chemist shops, women often end up adopting unhygienic practices such as prolonged use and improper disposal. Such practices have implications on the health of these women as well as the environment.
What happens to used sanitary napkins?
In India, the number of women in the reproductive age group (15–49 years) is more than 31 crores according to the Census conducted in 2011. An individual uses approximately 11,000 disposable pads and/or tampons in a lifetime. According to a joint report by Water Aid India and the Menstrual Hygiene Alliance of India, this results in 12 billion waste pads in India with each pad taking an estimated 800 years to decompose. Lack of awareness, lack of proper washrooms with disposal facilities, as well the shame associated around menstruation cause women to flush pads down the toilet which clogs the sanitation system. Throwing used pads along with other solid waste creates further problems as menstrual waste can turn pathogenic if exposed to air for long durations and releases toxins if burnt instead.
How reliable are the government programs around menstrual products and practices?
Like most policy areas, MHM has seen some hits and many misses. Around November 2016, Delhi Government discontinued its 2011 program to provide government-run schools with free sanitary napkins. This led school principals to go back to the practice of asking menstruating girls to not attend school during that time of the month, as described by a Hindustan Times article. State elections such as the one held in Karnataka in 2018, following the much talked about release of the movie Padman, saw the ruling party promise free pads to students of government colleges if voted back to power and the lead opposition promising to fix the price at 1 rupee (around 1 US cent) per pad if voted to power. However, women saw these as “election gimmicks” according to a Reuters article as the center, at the time, levied the same tax on sanitary pads as it did on luxury items (the tax was dropped after strong protests by activists, actors and the like).
However, there are laudable instances of government initiatives as well. The gram panchayat (village council) of Muhamma in Kerala, for instance, distributed reusable pads and menstrual cups to the women of the village in December last year. However, it remains to be seen if the village can live up to its claim of being a synthetic pad-free village for the foreseeable future.
Earlier, SWaCH, an organization advocating for dignity and health of waste pickers, launched The Red Dot campaign in association with Pune Municipal Corporation. The campaign urged residents to mark sanitary waste with a red dot so as to indicate to the waste pickers that it is not to be opened. It became viral on social media and resulted in 50% adoption (among the residents of a sample survey conducted).
While there is no denying the fact that awareness of sanitary napkins has increased drastically in the recent past, there is still a long way to go as far as issues such as spreading awareness about eco-friendly products and holistic MHM practices, fighting the stigma by including boys and men in the conversation, and developing and implementing a nationwide disposal system are concerned.
Disclaimer - This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements.
ProactiveForHer is a digital clinic for women, offering accessible, personalised, and confidential healthcare solutions. We offer out-patient care, diagnostic services and programs for various health concerns of Indian women, across their lifetime - from puberty to pregnancy to menopause. To know more on the sexual and reproductive health of women, visit https://www.proactiveforher.com/