Menstrual hygiene management in India: Still a long way to go

The Oscars have brought global attention to menstruation once again, emphasising how deeply entrenched social norms about menstruation restrict girls’ freedom and affect their health. One solution offered was sanitary pads.

Lauding sanitary pads as the solution to menstrual health and hygiene is not new. The film Pad Man played a pivotal role in spurring conversations around periods and positioning sanitary pads as the saviour.

In this article, we acknowledge sanitary pads as a hygienic option for millions of girls and women to manage their periods. However, we present important considerations about the blind promotion of sanitary pads that have a bearing on the health of the young girls and women we want to serve.

A critical aspect of hygienic management is the use of safe or hygienic materials to capture or absorb menstrual blood, including sanitary pads or clean cloth. The latest National Family and Health Survey 4 found that 58 per cent of young Indian women (15-24 years) use a hygienic method of protection (mostly sanitary pads), a significant increase from the 12 per cent using pads in 2010 (as reported by the Plan and AC Nielsen study). This is, no doubt, a consequence of greater attention to menstrual hygiene management (MHM) over the past few years in India.

Corporates have expanded their product range and market reach. Several government and non-government programmes have promoted menstrual hygiene through health awareness schemes and free or subsidised distribution of sanitary pads.

Small-scale sanitary pad manufacturing units have been supported to make low-cost pads more easily available, while generating income for women. And, entrepreneurs, driven by quality, health or environmental concerns over regular sanitary pads, have innovated with a range of menstrual products introducing reusable cloth pads, menstrual cups, and “eco-friendly” or compostable sanitary pads. Over the past year in India, several state governments have announced schemes

Critical questions

Greater availability of sanitary pads raises some critical questions for us to ponder: 1) Are all available sanitary pads of good quality? 2) Do girls and women have sufficient knowledge about the product they are using? 3) What happens to sanitary pads once they are used and thrown?

The goal of MHM initiatives is to ensure that girls and women are able to manage their periods in a hygienic manner and experience health, education and other related benefits. To actualise this goal, we need efforts directed at awareness and education about menstruation and menstrual hygiene, and access to safe products, and responsive water, sanitation and hygiene (WASH) infrastructure.

While some of these issues are being addressed by many programmes, we must turn our attention to understanding the menstrual hygiene product landscape and waste management issues. Without this comprehensive approach, good menstrual health and hygiene will not be possible.

Let’s go back to the questions posed above:

Are all sanitary pads of good quality? The Bureau of Indian Standards set out standards for disposable sanitary pads (IS 5405), but these are not enforced. As a result, sanitary pads are more widely available through different channels, but their quality varies greatly.

While research on this issue is limited, anecdotal evidence suggest that poor quality pads do not provide the kind of absorption and leakage protection and hygiene standards as promised. Further, hygienic use is equated with sanitary pad use, whereas hygienic use calls for much more including regular changing of pads and personal hygiene practices.

Do girls and women have sufficient knowledge about the products used? The simple answer is “no”. The popular messaging around sanitary pads (For example, super absorbent, 12-hour protection, scents to mask unseemly odours) obscures the importance of hygienic use, a critical pillar of MHM.

Informed choice is important in the context of women’s reproductive and sexual health, and is applicable to menstrual hygiene as well. Informed choice means that women and girls have comprehensive information about menstrual hygiene products available (including their advantages and disadvantages, hygienic use, and disposal), and are equipped to make a choice about what they want to use given their needs, and the socio-economic contexts in which they live and experience menstruation. 

A girl may still choose sanitary pads, but does so with greater understanding of how she should use it. Informed choice provides options for girls and women to use other materials — for instance, reusable cloth pads, in a safe and hygienic manner. A cloth pad user may continue to use home-made pads, ensuring that she washes, dries and stores them properly to minimise infections. She may also change the type of cloth pad used, opting for new designs and variants that offer greater leakage protection and can be washed and dried more easily.

What happens to sanitary pads once they are used and thrown? Widespread sanitary pad promotion has overlooked disposal. This issue is concerning for two inter-related reasons. First, when girls lack access to disposal facilities, they tend to use a hygienic/safe product in an unhygienic manner — they often extend its use beyond the recommended time (sometimes using a single pad for a whole day). When this happens, it places the girl at increased risk for infection, and has critical health implications.

Second, discarding sanitary pads is concerning as we do not have feasible and scalable solutions for managing this waste safely, having implications for girls and women, as well as for the environment.

Research indicates that pads are typically thrown in the open and in water bodies, and field experiences suggests that used materials are also discarded in toilets and in incinerators. The use of incinerators is particularly concerning. While they offer an immediate and convenient way of dealing with waste, most incinerators in India do not adhere to emission norms set by the Central Pollution Control Board. Because of inefficient combustion, these small-scale incinerators release toxic fumes into the immediate environment — potentially affecting the health of girls.

For sanitary pads that enter the solid waste stream, environmentalists are concerned with the volume of pads in the environment (though it is less compared to other types of plastic and non-organic waste). This waste takes years to breakdown posing a concern for long-term management.   

Efforts to promote sanitary pads are important, but must emphasise choice, and address the issue holistically by looking at how waste also affects use and health. 

The author is a founder member of the Menstrual Hygiene Alliance of India who works on research and advocacy on menstrual hygiene management