Congress MP Shashi Tharoor recently raised a parliamentary question during the monsoon Lok Sabha session, regarding the government’s efforts to provide facilities for menstrual care to girls and women. The Union minister for health and family welfare Harsh Vardhan, in his response, drew attention to the Ministry of Health and Family Welfare’s scheme to provide subsidised sanitary pads through the centrally sponsored Menstrual Hygiene Scheme under the Rashtriya Kishor Swasthya Karyakram.
Vardhan further pointed out that efforts were underway in several states to provide sanitary pads to adolescent girls in schools. While the past couple of years have brought unprecedented and much-needed attention to menstrual hygiene, the focus continues to be skewed. The 2017 Bollywood blockbuster movie Pad Man and its promotional events were unequivocal in their support for sanitary pads to ease women’s suffering and isolation during menstruation.
In December 2017, the National Family and Health Survey 4 (2015-16) highlighted that only 57.6% of young women aged between 15 and 24 used a hygienic method of protection during menstruation. Since 2018, several state governments have launched schemes for the free distribution of sanitary pads in schools, namely – Odisha’s Khushi Scheme (2018), Andhra Pradesh’s Raksha Scheme (2018), Chhattisgarh’s Suchita (2017), Maharashtra’s Asmita Scheme (2018), Kerala’s She Pad scheme (2017).
These actions are well-intentioned and have brought national attention to a topic hitherto taboo. However, the narrative surrounding menstrual hygiene is focused primarily on the distribution and use of sanitary pads. Disposable sanitary pads (of good quality) are undoubtedly a safe and hygienic option for managing menstruation, yet their singular promotion is problematic.
It diverts the conversation from a comprehensive education around the physiology of menstruation, hygienic practices, and restrictive social norms to the use of a particular type of menstrual hygiene product. The installation of sanitary pad vending machines in toilets, for instance, can mask the importance of safe water and sanitation facilities to enable girls and women to practice hygiene in schools, homes and workplaces during their periods. Further, the emphasis on disposable sanitary pads fundamentally undermines the right of a girl or woman to choose a menstrual hygiene product that best suits her needs, context, personal preference and ability to pay.
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The promotion of disposable sanitary pads in India as the primary hygienic option may be the result of some evidence – anecdotal and research-based – that the use of old cloth causes infections, and that alternative products – like menstrual cups – are unsuitable for India.
The use of unhygienic cloth – old rags or cloth that has not been thoroughly washed and dried, and stored appropriately – is unsafe, but the use of a clean cotton cloth is not harmful per se when maintained well and used properly, according to experts and organisations promoting cloth use and sustainable menstruation.
A recently published global study by van Eijk and colleagues in The Lancet on menstrual cups brings to the forefront, the importance of menstrual hygiene education and efforts to foster positive norms around women’s bodily functions, and the viability of alternative or reusable products to promote menstrual hygiene.
India now has many small and medium scale innovators introducing alternative menstrual hygiene products, like reusable pads made of various textiles and menstrual cups, into the market. Ecofemme, Uger Pads, Safe Pad, and Saafkins are examples of reusable sanitary pads brands. The introduction of reusable cloth pads, albeit among small sections – in urban and rural areas – has created greater awareness about hygienic use and proper maintenance of these products, and debunked deeply held norms around menstrual blood and notions of impurity.
Along with reusable cloth pads, menstrual cups also offer another affordable and environment friendly alternative. She Cups, Boondh, Soch and Stonesoup Wings are examples of brands of menstrual cups marketed by Indian retailers. Menstrual cups are made of medical-grade silicone, can be used for five or more years, and cost much less over the reproductive life cycle of a woman than the cheapest available disposable pads.
A body of research sheds light on the acceptability and feasibility of cups. The recent global review ascertained the acceptability and feasibility of menstrual cups as a viable menstrual hygiene management (MHM) alternative.
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One small study of married women in Gujarat and anecdotal evidence from MHM interventions across the country indicate potential demand for menstrual cups among some segments of girls and women. However, deeper research and exploration is required to understand its acceptability across different contexts, especially given that taboos related to vaginal insertion and an uninformed linkage with virginity in several low and middle-income countries, persist.
More research is also needed to identify the information, guidance and supportive eco-system that would be needed to ensure the hygienic use of menstrual cups. Unhygienic practices may lead to a higher risk of reproductive tract infections as the product is vaginally inserted. While the global review states menstrual cups as safe, trials specific to India are needed to generate data on safety in different contexts and for the inclusion of menstrual cups in any public health programme at scale.
In essence, a stronger push is required to expedite such research efforts and also ensure that MHM programmes offer comprehensive information to girls and women as well as people around them. The asymmetric focus on disposable sanitary pads also needs to be corrected to ensure girls and women are offered an informed choice, rather than pushing the rigid interests of any particular type of product or industry.
Tanya Mahajan is the Senior Consultant at Development Solutions and Arundati Muralidharan is Manager-Policy at WaterAid India. The authors are also the founding members of Menstrual Health Alliance India, a collaborative of organisations working on menstrual health and hygiene in India.