MENSTRUAL HYGIENE IN INDIA: QUESTIONING THE SANITARY NAPKIN POLICY

India is a country where only 58 % of menstruating women have been exposed to safe and hygienic methods of menstrual protection. The remaining face the risk of severe health vulnerabilities arising out of using many homegrown alternatives such as hay, dried leaves, old rugs. This discrepancy in the choices of menstrual products varies according to different criteria’s such as areas of residence, lifestyles, income group, etc.Such a difference in user preferences is directly linked with the risk of contracting infections. For instance, poor menstrual hygiene has caused a 70% increase in incidences of reproductive tract infections.

While discourse on menstrual hygiene is gaining recognition all over the world; mere pontification in this regard will not suffice. There is a need for aconcrete policy on menstrual hygiene.

Taboo surrounding menstruation

One of the foremost reasons for such a dismal state of menstrual hygiene in India is the social taboo surrounding menstruation. A survey reports that 70% of the mothers in India consider menstruation “dirty” thereby attaching a notion of impurity to this biological function. Menstruating women are considered to be “impure”. Such a line thinking  gives birth to a host of restrictions imposed on menstruating women such as isolation from certain areas in the house (especially the prayer room), preventing attendance from (public) functions, prohibiting touching plants, etc. This is one of the primary reasons why the discourse of menstruation is so hushed up/tabooed and hence issues of menstrual hygiene have been neglected to a large extent.

While it is a matter of common knowledge that women are excluded from participating in religious festivals and social ceremonies, a study reported in the Down to Earth reveals that close to 23% girls drop out of school upon reaching puberty. This can have serious repercussions on the financial and personal autonomy of these girls and can affect their prospects of becoming workers.

Of late, movies such as ‘Padman’ and documentaries like ‘Period.’ have hit the screens and media streaming services like Netflix.Movies are a great way of spreading social messages due to their ability to seep through to a large section of society; be it urban or rural audience.It can help dilute the stigma attached to periods and is indeed great way of normalization of the discourse on menstruation.

Management of menstrual hygiene in India

The foremost attempt at securing basics of sanitation was brought up in an interesting decision by the Supreme Court in Environmental and Consumer Protect Fund v. Delhi Administration & Ors[1], where it ordered all government schools to ensure separate washrooms for girls were built in order to improve sanitation. Asserting the importance of the same, the Court made the following observation: “Empirical researches indicated that wherever toilet facilities are not provided in schools, parents do not send their children (particularly girls) to school which is violative of the right to free and compulsory education of children as guaranteed under Article 21-A of the Constitution.”By invoking Article 21 of the Constitution of India, the Court placed a high bar for the government schools of each state. Disobedience by government schools in providing toilets for female and male students will now translate into a violation of the Right to Life of the children and is subject to direct scrutiny by the Courts under Article 32 (for Supreme Court) and Article 226 (for High Courts) of the Indian Constitution. Thus, the Courts by this decision took note of the increase in drop out rates of girls due to their periods, and gave this decision to limit the same.

Subsequently, The Government launched the ‘Rashtriya Kishor Swasthya Karyakram’ in 2014. It aims to ensure holistic health development of adolescents. One of the schemes introduced under this program is the National Menstrual Hygiene Scheme. The object of this scheme is to promote menstrual hygiene among adolescent girls in rural areas. It strives to do so by two methods: a. procure and supply sanitary napkins in certain districts by way of a competitive bidding process in the State level, and b. In the remaining districts, the government trained self- help groups to make sanitary napkins.The distribution of sanitary napkins under this scheme’s brand ‘Freedays’ takes place at a subsidized rate of Rs. 6 for a pack of 6 napkins.An Accredited Social Health Activist (ASHA) is appointed for this reason who goes to schools, Anganwadi Centers as well as door to door to sell these sanitary napkins. As an incentive, the ASHA gets to retain Rs. 1 from the sale proceeds and a free pack of sanitary napkins. The scheme has fixed the upper limit of support from government to procure sanitary napkins with Menstrual Hygiene Management Scheme funds is Rs. 12. It was initially launched in 112 districts in 17 States and is to be extended on a pro rata basis based on uptake of the product.

However, there are certain short falls in this policy. A study conducted by Post Graduate Institute of Medical Education and Research in 2018 indicates that even though 80% of the adolescents in rural are as know about  sanitary napkins, merely 30% of them actually use it. This scheme is also plagued with issues of irregular and inadequate supplies of sanitary napkins as well as “insufficient subsidy” and supply of sanitary napkins to the ASHAs involved, according to the same study. Additional loopholes in this policy are that it remains silent on how it aims to impart training on how to use and dispose sanitary napkins after usage.The rural women to whom sanitary napkins are distributed to are being introduced to a product that is not conventionally used. Thus, they need to be given proper training on its usage such as; on how to wear it, in what frequency it has to be changed in to avoid the risk of contracting infections, and proper disposal mechanisms. This could be one of the reasons as to why only 30% of these women use sanitary napkins in rural India, despite it being projected as the dominant product of menstrual hygiene right from the school level.One of the reasons for this could be that the women to whom it was being distributed to have engrained in themselves a particular absorbent that is used by everyone in their village and  community that they have been using since their menarche. Bringing a new product may make it alien to them, as something they are not able to relate to and were thus uncomfortable with the same. This lack of comfort may be resolved only by proper sensitization that normalizes the product, and specifies the need to discontinue current practices in a manner that can be comprehended by the rural population.

The policy also remains silent on the reason for endorsing sanitary napkins specifically as the product for menstrual hygiene among all alternatives. It fails to give the reason as to why it found this particular product more efficient, economical or appropriate to serve the purpose of menstrual hygiene in India. There is a universalization created in usage of sanitary napkins at large, be it in the form of an adolescent welfare scheme or even practices of the State. For example, it is a prominent practice to distribute sanitary napkins as a freebie during elections as a “goodwill gesture”.In the 2019 General Assembly Elections, the Election Commission itself adopted a strategy of to incentivize women to come out and vote by distributing sanitary napkins. Such a move by the State is problematic as it is endorsing one specific product which is being distributed at a platform that women use to exercise their political autonomy for voting.Ironically though, such an incentivization deprives a female voter to choose the product which she wishes to use for her menstrual hygiene. The government needs to realize that by merely distributing sanitary napkins, neither does it ensure its usage, nor will it create awareness on menstrual hygiene. It can lead to a host of problems such as infections due to improper usage, clogging due to improper disposal, and may have larger Anthropocene impacts that this product might have. The same has been discussed in greater detail in the next section.

Disposal Issues

A report indicates that India generates approximately 12.3 billion disposable sanitary napkins every year. The landfills are getting accumulated by this kind of hazardous waste.The disposal of these pads, mainly undertaken by incinerators produces harmful emissions which in turn harm the environment because of air pollution.

Sanitary napkins come with a lot of added instructions with regards to its disposal. The Solid Waste Management (SMW) Rules mandates that every waste generated must be segregated into: wet, dry and domestic waste and that sanitary napkins should be properly wrapped and classified into the dry waste category and ought to be handed over separately. Such guidelines however are seldom adhered to on the ground level; leading to clogging of drains, contamination, etc. The Ministry of drinking water and sanitation has recorded that out of the total sanitary napkins used in India, 28% of it is thrown with regular waste, 28% are disposed of in the open, 33 % are buried and the rest are burnt openly.All the above-mentioned modes of disposal invariably lead to environmental degradation.Sanitary napkins can take close to hundreds of years to biodegrade and burning them releases harmful toxins that harm the environment.

Thus, even though sanitary napkins are being distributed, training with respect to how it is to be used; how often it is to be used has not been imparted.

Composting sanitary napkins is another common practice. This is limited only to a select category of biodegradable sanitary napkins. It however, requires adequate segregation of waste, which is missing in India, as established above. Thus, the tussle between environmental risks in both incinerators as well as landfills is highly problematic.

Sustainable Alternative

A whole range of sustainable alternatives to sanitary napkins exists and if subsidized can go a long way in improving the menstrual health among the women in India. For instance, Eco Femme, an initiative that seeks to empower rural women by beginning a small-scale production of an organic washable (reusable) product for menstruation. Though these reusable pads are sold at a price of Rs. 200 each, the government can either subsidizing such products or begin production of such eco-friendly menstrual products and sell it. Further, this also tackles the problem of irregular supply as they are reusable products. Compostable pads are also produced by aakar (Anandi pads), Saathi Pads, and sakhi (vatsalya). The per cycle cost to customer is Rs. 96 and above. It is more economically viable since it is a one-time investment. The women may also prefer such a reusable product as it is similar (but more hygienic) to their existing practices of using clothes as absorbents.

Apart from this, a device called the menstrual cup is also a sustainable and re-useable sanitary product which could be introduced on a trial basis  in certain districts.Brands such as She Cup, Silky Cup, Moon Cup, Luna Cup, produce menstrual cups in India and it is available in the market for a per cycle cost to the consumers at Rs. 85 and above.

Since the demand for such a product is from a very limited section of the society, its prices are inflexible compared to non-compostable products. Thus, the government should consider subsidizing such eco friendly products. Proper training however is an imperative for usage of this product. The same can be done by teachers in schools or specially appointed adolescent councilors.

Thus, while having a menstrual hygiene policy subsidizing menstrual products is good; such a policy should not be restricted to sanitary napkins. Having established the intricacies pertaining to sanitary napkins as well the disposal problems it entails, it certainly is not the most economically viable and environment friendly option.Moreover, women come from different social and economic backgrounds and have different reservations over a specific product based on their monthly experiences. Imposing a particular product horizontally across women as a policy is denying them of their comfort and autonomy. They ought to be entitled to make awell-informed choice with respect to the wide variety of options available to them. This, in turn,guarantees  proper usage of the product; for instance, despite knowing of the existence of sanitary napkins, a woman may choose to use cloth pads in the right way that helps her to minimize the risks for infection.

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REFERENCES 

[1](2010) 15 SCC 261.

ABOUT THE AUTHOR

Raagini is a third-year law student at National Academy of Legal Studies and Research (NALSAR), Hyderabad.

In content picture credit: sbmgcg.in