Millions of women in India dread the time when they go for their menstruation cycle. The shining economy and rocketing clout of India is just one side of the story. The AC Neilsen report undertaken with the help of Plan India on ‘Sanitary Protection: Every Woman’s Health Right’ in 2010 painted a rather grim picture of menstrual hygiene of Indian women. The report claims that only 12% out of the 355 million women have access to sanitary napkins. As per this study, 98% gynecologists’ use sanitary napkins, but their patients have their own good reasons to avoid them. Gynecologist Dr. Abha Sharma feels that awareness has increased but still there are patients that use cloth and face vaginal and urinary tract infections. At times it is good economics that play on the woman’s mind. As Meera Das, 35, a mother of two, feels that with some spare money in her hands, she may also opt for the napkin but in her house only one has that luxury. Her 14 year old daughter uses a napkin, but that too only when she ventures outside. In her native village also, women choose old rags.

A. Muruganandam, apparently the first man to wear a sanitary napkin, who started what he calls a ‘white revolution’ by making and distributing cheaper sanitary napkin, has an equally sordid tale. Muruganandam, who later founded Jayaashree Industries to help the cause of menstruating women, talks about the day when he saw the cloth his educated wife was using during menstruation and noticed that the cloth was so dirty that he could not even wipe his scooter with it! When he told her to use a sanitary napkin instead, his wife snapped at him saying that if all the women in the house started using sanitary napkins then the family will have to cut down on the milk budget!

Not much different is the study put forward by the Pardada Pardadi NGO in Anoopshehar, Uttar Pradesh. Renuka, the spokesperson of this NGO elaborates that many girls have to drop out of their schools when they enter puberty. The AC Neilsen report puts the dropout numbers at a staggering 23 percent. The research undertaken by the Pardada Pardadi showed that the inability of pubescent girls in handling their periods due to non-availability of material or knowledge lead to their desertion of schools. ‘And expensive sanitary napkins are not an option for many women in India and other parts of the developing world,’ Renuka quips. People at many places do not even understand what a sanitary napkin is or what it does. ‘The awareness is so low, that when I went out and asked for a sanitary napkin from a chemist, he wrapped it in a brown paper. The chemist and others sniggered; they thought it was something unwanted like a condom!’ recounts Muruganandam. Accessibility and reach-ability is also a roadblock. A woman that has to travel miles to fetch one pitcher of water has little time to go and buy a sanitary napkin and add another mile to her arduous regimen. Like the case of Harpyaari Devi, 70, a matriarch with 2 daughter-in-laws and 3 pubescent granddaughters, says that in her village no one would buy these packets as there is not a single shop selling them. Her daughter in laws, have found a better way of handling the issue; they do not venture out when they are in their periods and use cotton or rags. They even lose out on daily wages as a result, but what can be done?

But is it only rural India that is plagued by this menstrual apathy? Unfortunately, the answer is no. Even in some Urban and semi- urban areas the situation is similar. Amitabh Kumar, head of the media division of Centre for Social Research says that in the educational and medical camps that they organize, they often have to educate women about the usage of sanitary napkins and at times have to dissuade myths that pull women away from napkins. He says, that in most cases women argue, that cotton is better than the fabric and using fabric can cause diseases. Some even claim that sanitary napkins are made of recycled plastics. So how can they be any good? He feels that India is as good as sub-Saharan Africa in context of menstrual hygiene. Not a rosy picture indeed.

Issues that worsen the situation

There are various mores and practices that wreck an Indian woman’s life. Like, the patriarchal nature of Indian society and skewed sex ratio makes menstruation a taboo topic. It is rarely discussed as the society takes the coming of period as the time of sexual awakening in a woman and wishes to put a lid on it. The end result is that women try to curb topics related to menstruation; hence, health and hygiene are both lost. In fact, as Muruganandam puts it that ‘90% of Indian men are unaware that women undergo menstruation! Even educated men and government officials are unaware what a sanitary napkin is.’ The issue, taboo, just like drugs, is shunned. ‘Even the wives and sisters feel ashamed to talk about it with husbands or brothers’. He says, in many tribal north-east states, women use leaves, sand and even ash to absorb menstrual blood.

The absence of sexual knowledge is also a big dampener. Amitabh of CSR says, ‘sexual awareness and education is very limited and no doctor or teacher is there to help girls with basic information.’ Even Neeraj Goyal, General Marketing Manager of Johnson & Johnson India Ltd finds taboos and societal attitude as one of the biggest challenge that is faced by Indian women. As per him, ‘it is more to do with the stigma associated with it and contributes to gender inequality. So when girls enter puberty they stay at home or drop out of school completely.’

Then there is the problem of affordability. In a big country like India, with the female population of many millions living in abject poverty, the cost plays a major factor. As Muruganandam tells of a peculiar issue he has observed; he says that women try to save money by using unhygienic means but in actuality they end up paying about Rs200-500($3-$10) to a doctor at regular intervals. Desperate women even resort to removal of uterus at an early age to stop cost escalation.

But then, is a cheaper sanitary napkin a game-changer? ‘May be for the poorest and marginal folks’, says Neeraj Kumar, ‘but then why is it that in urban India where the cost is not a big issue the usage is just 57%?’ In a country where fairness cream sells more than a hygienic product like sanitary napkins, maybe there is something more than what meets the eye. And then ‘How cheap is REALLY cheap?’ He may have a point here, but Muruganandam blames this on the perception that advertising of sanitary napkin conveys and the monopolistic hold of big corporate on this sector. In the advertisement of this product, he elaborates, comfort is highlighted not hygiene.

The basic sanitary infrastructure is also lacking in India. Such lopsided is the scenario that there are more mobile phones than toilets. And then there is another angle, like if a fairness cream reaches more household then, maybe it is more widely available than a sanitary napkin?

The way forward

The situation has improved, though not up to a desirable level. Governments, NGOs and corporations are pulling loose strings. The public-private partnership between government and corporations has changed the lives of millions of girls. Like Johnson & Johnson’s Stayfree Woman for Change initiative has already touched approximately 2.6 million girls and women. Along with UNICEF it has started a program to reach out to 5 lakh girls in the period of next three years in remote parts of Bihar and Jharkhand. Government of India has also woken up to the seriousness of the issue after all a booming economy like India cannot afford to keep half of its workforce at home. The government has started multiple projects like Kishori Shakti Yojna (10-18 years) and several others. Rs150 crore have already been earmarked for the KSY scheme to provide cheaper sanitary napkins to pubescent girls. It is an extension of an already existing Adolescent Girl scheme that aims to provide napkins at a subsidized rate. But subsidy is not the only way out. There are novel measures too, like Muruganandam’s decentralized mode of making and delivery. He says ‘eliminating men’ from the chain and having more woman to woman contact would take the sanitary napkin to even remotest parts of India. His unique model makes it easier to make a sanitary napkin at home and women can barter it for eatables and other goods as it is cheaper than most other napkins.

Targeting girls at school would be even better as at school they would be even easier to convince. And as Neeraj Kumar puts it, once you convert one woman, it is easier to convert others close to her. Imparting education to women about hygiene and changing mindsets of people are also equally important. Gender equality and better school curriculum must be taken up with determination. Better sanitation facilities, better infrastructure and sexual education at school level could change fate of millions of Indian women and girls. But then, is India ready to tackle this challenge?