“Menstrual blood is the only source of blood that is not traumatically induced. Yet in modern society, this is the most hidden blood, the one so rarely spoken of and almost never seen, except privately by women.”

– Judy Grahn

Throughout our society there is a common lack of knowledge about menstruation. There are also a lack of resources needed for proper hygiene during times of menstruation. These factors lead to a lack of understanding about what the menstruation process actually is. Fear is developed over the topic of menstruation because of the various misconceptions that surround it. Advertisements and commercials are greatly impacted by the high levels of fear and stigma attached to the menstruation. This causes them to lack anything relevant to real life experiences and often encourage secrecy around menstruating. Ways this is conveyed include, emphasizing no leakage and using liquids that aren’t red to display blood. With all these social media influences, there is a consistent level of menstruation taboo because people are being exposed and primed to think that menstruation should be kept secret and they are often led to believe the opposite of what real life women experience during menstruation. The taboo around menstruation continues due to the absense of education, realistic promotion and resources.

Research indicates that these menstrual taboos have negative effects on women, specifically their likelihood to self-objectify. One article looked into the menstrual knowledge and taboo advertisements and their effects on self-objectification. The researchers found that the lower level of menstrual knowledge a woman had the more likely they were to self objectify. They also found that women with negative attitudes toward menstruation were more likely to self objectify than those with positive attitudes.

Menstrual hygiene still continues to be amongst the most challenging developmental issues that women face today, especially in the developing countries like India, the mindsets, customs and institutional biases prevent women from getting the menstrual health care they need.

Let us have a look on the problems of using sanitary napkins in general :

Physical aspect

1. The pads are scented which can cause infections in vagina.
2. The skin around the vagina is thin with numerous blood vessels and chemicals can directly enter the bloodstream from the
3. Prolonged contact with SAPs has been also linked with skin reactions such as rashes.
4. Synthetic and plastic restricts air flow and traps heat and dampness, causing yeast and bacteria growth in the vaginal area.

The environmental aspect

According to Solid Waste Management(SWM) rules, sanitary pads waste comes under the category of Domestic Hazardous Waste.

As the use of sanitary pads increases, so does the amount of sanitary waste generated. The primary concern, for now, is how these pads are disposed of and their impact on the environment.

According to a joint report by Water Aid India and the Menstrual Hygiene Alliance of India, depending on the materials used in the manufacture of the sanitary pads, it could take up to 800 years to decompose a single sanitary napkin.

Right now there is no separate way prescribed to dispose of them. So, out it goes with all the household garbage. This causes serious health issues for the waste pickers when they segregate the waste; exposing them to infection-causing microbes, leading to diseases like Hepatitis, E.coli infection, Salmonella infection, Typhoid, etc. Recently, the Red Dot Campaign was launched in Pune which encouraged women to throw sanitary pads in a ‘red dot marked’ packet, so that they could be easily identified and segregated.

The used pads are then finally moved to landfills on the outskirts of the city, where they stay for hundreds of years. SAPs are petroleum-based materials that do not degrade easily. Let’s just say, a pad used by a woman will not be decomposed in her lifetime or her kids or their kids. Now, imagine the extent of plastic pollution we are creating/have created, especially when one pad is said to be equivalent to 4 plastic bags. Every sanitary napkin carries two grams of non-biodegradable plastic. Multiply that with an average of 8-10 pads per menstruating women every month and let that sink in.

According to the National Family Health Survey (NFHS) 2015-16 report, around 48% rural women use sanitary napkin while in urban areas the percentage is around 77%. Recent data provided by Menstrual Health Alliance India states that menstrual waste collected across the country, primarily consisting of sanitary napkins which is disposed of as routine waste along with other household garbage, is 45%.

According to the Municipal Solid Waste (Management and Handling) Rules, 2,000 soiled napkins and blood-soaked cotton are disposed of after segregation into biodegradable and non-biodegradable components. However, the Bio-Medical Waste (Management and Handling) Rules, 1998, says that items contaminated with blood and body fluids, including cotton, dressings, soiled plaster casts, lines and bedding, are bio-medical waste and should be incinerated, autoclaved or microwaved to destroy pathogens. The longer used pads are kept in the open and kept in contact with air, the more they are prone towards becoming pathogenic.

Now, throwing light on the problems of using sanitary napkins specifically in India :

Genital hygiene

The study found an urgent need for intensive health education on genital hygiene. According to the Census of India 2011, more than 41% of the households do not have bathrooms and of those that do, 16% of the rooms did not have a roof.

Because of the poor conditions of the bathroom or lack of proper toilet facilities, women in rural areas do not have the privacy to wash their genitals.

Poor genital hygiene has been found to be an important factor for the development of dysplasia and cervical cancer, and the use of pads made from reused cloth increases that risk, studies have shown.

Poverty reasons

Many people below the poverty line cannot afford the sanitary napkins. Homeless people, mendicants are deprived of the facility of using sanitary napkins. Though many government schemes are introduced to give free supply of sanitary pads in rural areas. Still there are people who use piece of cloth, rags, ash, or husk.

Lack of Sanitary Napkins and Adequate Facilities

In a city, availing a sanitary napkin for a woman aware of menstrual hygiene is a normalised process. Not only are sanitary napkins available in pharmacies and grocery stores in cities, they are commercialised via advertisements so that they are treated as any other product. In rural areas, sanitary napkins are found with difficulty. Most girls rely on home-grown or other readily available material, the latter often being unhygienic and unsanitary. Only 2 to 3 per cent women in rural India are estimated to use sanitary napkins. The lack of demand results in storekeepers not stocking up on sanitary pads. This results in women resorting to unhygienic practices during their menstrual cycle, such as filling up old socks with sand and tying them around waists to absorb menstrual blood, or taking up old pieces of cloth and using them to absorb blood. Such methods increase chances of infection and hinder the day-to-day task of a woman on her period.

Superstitions & Lack of Awareness

Lack of awareness makes for a major problem in India’s menstrual hygiene scenario. Indian Council for Medical Research’s 2011-12 report stated that only 38 per cent menstruating girls in India spoke to their mothers about menstruation. Many mothers were themselves

unaware what menstruation was, how it was to be explained to a teenager and what practices could be considered as menstrual hygiene management. Schools were not very helpful either as schools in rural areas refrained from discussing menstrual hygiene. A 2015 survey by the Ministry of Education found that in 63% schools in villages, teachers never discussed menstruation and how to deal with it in a hygienic manner.

There are also many superstitions regarding menstruation which stops woman from using sanitary napkins.

Lack of penetration & poor quality

India has one of the lowest levels of penetration of sanitary pad usage in the world. At 20%, India lags behind Thailand, Indonesia and China, all of which have over 50% usage. Social norms, cultural taboos and superstitions associated with menstruation have meant that Indian women continue to rely on unhygienic practices.

The quality of napkins used in a government scheme which was to promote menstrual hygiene was poor in Odisha, Rajasthan and Kerala. This means that they had a low absorption rate or inadequate dimensions that increased the likelihood of leakage. Sanitary napkins reportedly ran out of stock in Arunachal Pradesh, Bihar, Jammu and Kashmir, and Maharashtra. However, a satisfactory uptake of sanitary napkins was noted in Bihar, Jharkhand, Odisha, Jammu and Kashmir, Andhra Pradesh, Maharashtra and Gujarat, according to the 10th common review mission (CRM), an annual progress report published by the National Health Mission (NHM) in 2016.

The uptake of sanitary napkins under the scheme was low in Himachal Pradesh and Odisha due to mediocre quality. Delhi was reported to have faced an irregular supply of sanitary napkins, as per the ninth CRM report in 2015. Moreover, no sanitary napkins were distributed in Chhattisgarh in that particular period, revealed a 2015 Comptroller Auditor General (CAG).

From a ban on advertisements on sanitary napkins in 1990, to a full-fledged feature film, PadMan, on a low-cost sanitary napkin entrepreneur in 2018, India has indeed come a long way. It was eight years back in 2010, when the Ministry of Health and Family Welfare launched the Freeday Pad Scheme, a pilot project to provide sanitary napkins at subsidised rates for rural girls. The scheme was launched in 152 districts across 20 states and sanitary napkins were sold to adolescent girls at the rate of Rs. 6 per pack of six napkins by Accredited Social Health Activists (ASHAs). The estimated cost for the entire scheme was Rs 70 crore.

A year later, the Union government launched the SABLA scheme across 2015 districts in the country. The scheme aimed at improving health conditions for adolescent girls with menstrual hygiene as an important component. Two years later, under the then ongoing Nirmal Bharat Abhiyan, focus on menstrual hygiene was added as a key component of the sanitation mission. In 2014, the Union government launched the Rashtriya Kishor Swashthya Karyakram, aimed at improving the health and hygiene of an estimated 243 million adolescents. Menstrual hygiene was also included as an integral part of the programme.

Under the ongoing Swachh Bharat Abhiyan, menstrual hygiene has been given high importance. The Swachh Bharat (Gramin) guidelines explicitly state that funds allocated for information, education and communication (IEC) maybe spent on bettering awareness on menstrual hygiene in villages. Adequate knowledge of menstrual hygiene and development of local sanitary napkin manufacturing units is encouraged by Swachh Bharat Mission (rural) and self-help groups are to help in propagating such efforts.

Many Government schemes are introducing, which each passing day people are becoming more conscious about the menstrual hygiene. We can now see a ray of hope.