Prime Minister Narendra Modi’s address on Independence Day this year touched on an important public health issue: menstruation. Modi said, “Through 6,000 Jan aushadhi kendras, about 5 crore women were provided sanitary pads at one rupee (each).” It’s a powerful statement from the prime minister addressing an issue for millions of people in the country, and which is a big positive step towards recognising menstruation as an important health, education and gender equality problem.
However, Modi’s few sentences during his 90-minute speech only glanced at a much larger issue.
In India, a significant proportion of girls and women have no access to basic sanitary products and use ash, banana leaves, husk, sand and/or unsanitised cloth for menstrual hygiene. Among young women aged 15-24 years, 62% use cloth for menstrual protection. In Bihar, Uttar Pradesh and Chhattisgarh, approximately 81% of women still use cloth during menstruation. Only 48% from rural areas and 78% from urban areas use sanitary pads. Others resort to unhygienic menstrual management methods. The use of such methods for a long time can lead to serious health consequences, so governments push girls and women to use sanitary napkins, a more hygienic alternative.
Accusations of poor implementation
The Centre, in association with the Department of Pharmaceuticals, launched the Jan Aushadhi Suvidha sanitary napkin in 2018 through more than 6,300 Pradhan Mantri Bhartiya Janaushadhi Pariyojna kendras across the country. These oxo-biodegradable pads were sold at a minimum price of Rs 2.50 per pad, and were later subsidised to Re 1. With the motto of ‘health, hygiene, and convenience’, this scheme garnered much attention and applause, but at the expense of eliding issues of sustainable menstrual health. The scheme later faced backlash for its poor implementation, inadequate advertising, irregular supply and lack of communication.
Similarly, in 2018, the Maharashtra government launched the ASMITA scheme but without a pre-run pilot test. The pads were later found to be too small, with low absorbing capacity, leading to the scheme’s failure. Subsequently, women switched from using cloth to mediocre sanitary pads as well as developed a negative attitude towards state-backed sanitary pads and products in general. Women also lost their autonomy over the choice of absorbents and were limited for choice. As the world was taking steps towards sustainable menstruation, we walked in the opposite direction.
Research has shown that low-cost sanitary pads don’t solve the myriad issues related to traditional menstrual practices, and is more like band-aid on a deadly wound. Menstrual health and hygiene reach well beyond the distribution of pads, to encompass broader systemic issues like knowledge, availability, safety and affordability of materials, informed and congenial professionals, referral and access to health services, sanitation and washing facilities, positive social norms, safe and hygienic disposal, advocacy and policy.
When they start menstruating, most girls are unaware of the changes their body is going through, about menstruation being a biological process, and what they can do to manage it. Studies have shown around 40% of adolescent girls skip school when they menstruate, due to the use of bad absorbents used, lack of privacy in schools or restrictions imposed on them. School management and teachers must be aware of menstrual hygiene practices, to ensure adequate support for those who need it, in their formative years of developing hygiene behaviour. Moreover, creating supportive spaces involving adolescent boys and men through open dialogues will enable them to understand the importance of menstrual hygiene management. Such engagements could prompt changes in social norms, myths and taboos associated with menstruation and improve overall gender equality.
Focus is on handing products, not safe disposal
The government tends to focus more on handing sanitary products and ignores educating people on how to safely dispose them, which is a major concern in a country like India. Oxo-biodegradable pads, when compared with other commercial ones, are said to be eco-friendly, but their safety and modes of disposal are still questionable. Menstrual cups are a cheaper, more sustainable and more eco-friendly alternative but they haven’t been actively promoted and hardly find space in India’s policy discussions on menstruation. Instead of providing sanitary pads to everyone, the strategy must focus on educating and empowering people who menstruate, to choose from the various safe options available to them.
The country’s menstruation discourse is currently women-centric. Transgender men and people with other gender identities also menstruate. The current focus on menstrual hygiene excludes these marginalised groups. Though we have scraped Section 377, the pain of menstruation is more than just physical for transgender people. Safety concerns and a lack of access to menstrual products are some of the vital issues gender-nonconforming people face. The corresponding state schemes must shift their focus from ‘women-alone’ to ‘people with periods’ to be more inclusive.
Moreover, the distribution of sanitary napkins without addressing a plethora of other socio-economic, cultural and policy constraints only leads to the formation of myopic, knee-jerk policies. Menstrual management requires a multi-faceted approach. Behaviour modification and ensuring access to menstrual hygiene materials are important measures, but at the same time inclusion, sustainability, and autonomy must guide such measures.
Anuja Sankhe and Parvani Laad, are MPh students at the School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai. M. Sivakami is a professor and chairperson of the Centre for Health and Social Sciences, School of Health Systems Studies, TISS. All authors are studying the issue of menstrual health and hygiene in India.