Riddle us this: What is frequent, inevitable, completely natural and affects over half the world population and yet frowned upon and completely ignored by society? Menstruation. And all related issues and connotations. The M word, (for menstruation or mahavari in Hindi) has long been stigmatised in our vocabulary and society. It is not a topic considered suitable for polite conversations. The stigma and socio-cultural norms around menstruation and menstrual hygiene in India violate and impact several human rights, including but not limited to right to human dignity, right to equality, bodily integrity, health, privacy and right to freedom from inhumane and degrading treatment from abuse and violence.
Beware the monthly monster: Menstruation and social stigma in India
It’s time to break the silence and talk about periods. Most of the social stigmas come from misinformation and misconceptions due to lack of awareness. In India, women on their periods are considered impure, dirty, or unclean. The furore that ensued in the wake of the contentious Sabrimala Judgement goes to show that the ‘unclean’ image of women of menstruating ages is still prevalent and widely accepted in pockets of India. Women are not allowed to pray, cook, serve food or drinking water, or bathe/shower during their periods. In rural India, often women are required to sleep alone or away from other family members; as in Nepal, some parts of India also practice the tradition of chaupadi or their own iteration of it. Such arrangements present risks of their own including snake bites and rape.
Persisting stigma around periods also means that the ‘hardware’ or menstrual products are not easily available or accessible. Most of the times, the pads are stacked at the rear end of pharmacy and local stores. The shop keeper will probably hand you a packet of pad after wrapping in layers of newspaper and sliding it in a black plastic bag as if it were a contraband which could land both the seller and the consumer in deep shame. Where sanitary products are unavailable, women rely on cloth pieces, mud, dung, leaves, etc which pose obvious risks to their health.
Menstruation and Women’s Participation in the Economy
Taboos around menstrual and sexual health of women affects women’s contribution to an economy. This conversation then becomes even more pertinent in India, which ranks as the third worst nation in Asia for gender equality. Lack of menstrual products and sanitary infrastructure to ensure hygiene during periods also mean that most girls, especially in rural India, drop out of schools when they start menstruating. This is where the exclusion and vicious cycle of inequality begins.
The issue of menstrual hygiene goes deeper than which sanitary products are being used. The sanitary infrastructure also matters. Women on their period are forced to travel long distances to change their pads due to lack of women’s toilets with proper locks on them. Women in rural India are particularly disadvantaged due to lack of infrastructure, and end up either dropping out, or taking 5 days of leave per month on an average. If the woman is a day labourer or farm worker who receives wages for work per day, she loses out around a quarter of her monthly earnings.
Menstrual Hygiene and Women’s Health
Additionally, 70% of all reproductive diseases in India were caused by poor menstrual health, which also affects maternal mortality rate and cervical cancer rate. According to the World Health Organization, India accounts for 27 percent of the world’s cervical cancer deaths. The incidence rate there is almost twice the global average and doctors studying the disease believe poor menstrual hygiene is partly to blame. The homespun ‘solutions’ or home-sewn cloth pads raise the risk of vaginal infections that suppress the reproductive tract’s natural defenses. A weaker immune response can compromise the body’s ability to fight the sexually transmitted human papillomavirus, the microbial cause of most cervical cancers.
Unhygienic ‘period’ practices that persist in our society further expose women to infections such as Staphylococcus Aureus and may even lead to Toxic Shock Syndrome, which may further cause shock, renal failure or even death. Up until recently, the Government of India levied taxes on the sanitary napkins, which made pads expensive and therefore limited their distribution.
In the absence of sanitary napkins, women are often forced to use homemade pads made out of cloth (this tends to be any cloth they can spare or find). Due to stigma around periods, most women must wash these homemade pads at night and hide it away to dry. Cloth pads are actually environmentally friendly, however, they must be dried in sunlight as the UV rays sterilise it. When cleaned without detergent or disinfectant, and dried in dark and damp corners of the house, these cloth made pads are more prone to develop bacteria and fungus which can affect the health of the user. In urban India, 43%-88% of girls use reusable cloth during menstruation, yet they are often washed without soap or clean water.
Menstrual Waste Management
When discussing the issue of menstrual hygiene, we must also consider disposal, waste management and the impact on environment. The choice of absorbents varies among rural and urban women and girls, depending on personal choice, cultural acceptability, economic status, and availability in local market. In rural areas the most preferred sanitary products are reusable cloth pads, and in urban areas women prefer to use commercial sanitary pads. It must be pointed out that the adhesive wings and perforated plastic layers on a disposable sanitary napkin are not biodegradable and may take up to 800 years to decompose. For the deodorised sanitary products, chemicals used in bleaching such as organochlorines, tend to disturb the soil and microflora and take longer to decompose. It is estimated that each woman will generate 125-150 kgs of sanitary waste in her lifetime. That is over 108,000 tonnes of menstrual waste a year in India.
Most often, the sanitary waste either ends up in landfills or water bodies. Sanitary products soaked with blood of an infected women/girl may contain hepatitis and HIV viruses which retain their infectivity in soil and live up to six months in soil. The clogged drainage with napkins has to be unblocked and cleaned manually by conservancy workers with their bare hands without proper protection and tools. This exposes the workers to harmful chemicals and pathogens. Incineration is a better technique to dispose of menstrual waste but burning of pads releases harmful gasses that affects health and environment. Burning of inorganic material at low temperature releases dioxins which are toxic and carcinogenic in nature.
It’s Time for Action
The theme of Menstrual Hygiene Day 2019—It’s Time for Action—not only emphasizes the urgency of this public health and environmental issue, but also highlights the transformative power of improved menstrual hygiene. It empowers the world’s women and girls and unlock their economic and educational opportunities. Mr. Arunachalam Muruganatham, in finding a solution, designed a low cost machine to manufacture sanitary napkins. He has a unique business model, where he helps women in rural areas to set up their own manufacturing unit. Since inception, he has supplied machines to 1300 villages in 23 states in India.
There are various things that can be done at individual, organisational, local and national level to educate the masses on menstrual hygiene issues:
- Sex education in schools with course on menstrual health, hygiene, disposal and waste management;
- Talk about the issues openly, break the taboo, thereby increasing access to sanitary products for women;
- Include men in the conversations, as family, friends and political representatives, it is absolutely imperative to make men understand and see the value in investing in sanitary products and infrastructure;
- Educate girls about menstruation, sanitary products and appropriate disposal methods, including that the used pads should be disposed by wrapping in paper instead of plastic as that increases the duration of decomposition;
- Switch to more environment friendly sanitary products such as the menstrual cups or the cloth pads and spread information about their safe and hygienic use;
- Promote the development of sanitary infrastructure in your local municipality and surrounding areas such as toilets with adequate plumbing, water facilities and proper locks; and
- Encourage government level policies to ensure that companies manufacturing sanitary products should disclose the information on the pads regarding the chemical composition of the pads, so that appropriate technologies could be used for their disposal and treatment.