A woman’s menstrual health is at the centre of her well-being. At the same time, it is also of great importance to the well-being of her family as well. Greater emphasis on menstrual issues means improved health for India’s women, which automatically translates into a rise in education, employment, income and development.

On 15August 2020, Prime Minister Narendra Modi became the first Prime Minister of our country to address menstrual health as not just a problem affecting women, but as a matter of public health. A much neglected but necessary part of public health, his remarks gave renewed impetus to our healthcare system to focus on this issue. In light of those remarks, it is imperative to take a look at the condition of women, government efforts in this regard, as well as what can be done by the state and the people to improve the status of menstrual health in our country.

The Core Issue

India has more than 355 million menstruating women. Out of this, only 36 per cent use sanitary napkins. 71 per cent of adolescent girls remain unaware of menstruation until their first menstrual cycle. In fact, their first sighting of blood accompanied by pain and other physical symptoms causes them to believe that they are either dying or have caught some horrible infection.

The stigma surrounding menstruation has led to women falling behind; the impact is visible on their health as well as education. Unhygienic practices and carelessness can lead to cervical cancer, reproductive tract infections, Hepatitis B infection, yeast infections and urinary tract infection. More serious illnesses like TSS can lead to death. Almost 23 million girls drop out of school annually as they lack awareness as well as access to hygiene, bathrooms, sanitary napkins.

There are also wide disparities between the condition of women in urban and rural areas. Sanitary napkins are still a luxury for many women, especially in rural areas. The accessibility to menstrual hygiene products is correlated to one’s income.

Current Situation

While in the last decade, our policymakers have started focusing on menstruation and related issues, the improvement is not praiseworthy. In 2011, menstrual hygiene scheme was launched under the National Health Mission (NHM) to promote menstrual hygiene amongst girls of 10-19 years. In 2014, Rashtriya Kishore Swasthya Karyakram (RKSK) was launched to educate adolescent girls about menstruation and increase their accessibility to sanitary pads. State governments have also launched their own schemes.

In Uttar Pradesh, Rajasthan, Maharashtra, Odisha, Chhattisgarh, Andhra Pradesh and Kerala, state governments distribute free sanitary napkins in schools. In Bihar, adolescent girls are given Rs 300 under the Kishori Swasthya Yojana to buy sanitary pads. In fact, the Bihar government offers two days of menstrual leave to its female employees every month — women can take their days off on any days of the month with no justification. Towards the end of last year, Andhra Pradesh state government launched a scheme whereby monthly awareness classes will be taken for students studying in classes VII to XII.

Despite these efforts, the improvement was marginal, and the disparities were highlighted further in the Covid-19 pandemic. As business supply chains were affected globally, accessibility to pads was also hit. We are also faced with questions about management of menstrual hygiene for frontline workers, as well as hospitalised/quarantined women. Our healthcare infrastructure lacks the ability to take care of these needs.

Current Market Scenario

Presently, premium disposable pads have the largest market share in our country. Sales in 2015 alone amounted to Rs 19 billion. For a lot of girls from low socio-economic backgrounds, disposable pads seem like a symbol of empowerment; they guarantee freedom of movement and a carefree life. In fact, rural areas accounted for 32 per cent of the total sales in 2014.However, homemade reusable pads are not far behind. 88 per cent of women use them due to personal preference/familiarity/lack of access to commercial disposable pads.

Additionally, low cost, good quality disposable pads manufactured categorically for low-income households are now making their way to our market. Small-scale innovators as well as imports from countries like China, Ukraine and Malaysia have boosted availability.

Suggestions And Strategy

A strategy based on mobilising the reach of rural communities will be effective. People possessing local influence and decision-making powers should be sensitised. Communication drives through social media/radio/telephone/messaging services to reiterate the need for menstrual hygiene and culling the stigma is of prime importance.

Many private players have started filling up the market vacuum of affordable menstrual products. A partnership between the state and the private entities is a good idea, especially with the current government bringing private players in many sectors of our economy. Currently, we have two major global players in our market — Procter & Gamble and Johnson & Johnson.

However, domestic players are now entering the market as there is great business potential for these brands. The government can provide incentives, exemptions, and concessions to such business entities which will encourage them to manufacture cheaper pads. Another argument in favour of private-public tie-ups is variation in goods. When it comes to bodily functions, one size does not fit all. Government schemes can only do so much, but private entities can bring out variety, which will fulfill the purpose.

An odd but workable comparison can be done to the mid-day meal scheme: just as children were incentivised to attend school because they were promised free meals, adolescent girls can be encouraged to not drop out/skip school due to menstruation through provision of pads. However, this will only be partially successful as these schools often lack basic hygiene, bathroom, soap, and water. Thus, focus should also be on renewing infrastructure. Installation of pad vending machines in public places, workplaces, educational institutions, as well as anganwadi centres and childcare centres for rural areas will be a small step which goes a long way towards successfully implementing such a scheme.

Jan Aushadhi Suvidha scheme by the Centre, provides sanitary napkins at Re 1. Unobstructed flow of sanitary napkins and proper advertising through this scheme should be the main aim. Most women are still unaware about the existence of such a scheme. They cannot be beneficiaries of a programme they do not know exists. In addition to provision of pads, proper training must be imparted to those involved in distribution drives and campaigns. Important aspects such as: how to use, frequency of changing, proper disposal, etc, should be addressed. However, the scheme can only be called successful if the government can ensure last mile delivery of these products.

Promotion of environment-friendly products amongst the well-to-do is also essential. Pads take millions of years to degrade, owing to all the plastic they are made up of. However, expensive reusable cloth pads and menstrual cups have recently started getting more attention. While these products are not convenient for rural women as they require even greater levels of hygiene than simple sanitary napkins, promoting them amongst the urban, richer class of women will bring down the use of plastic pads by a huge margin, which, in turn, will take care of the environmental concerns.

Monetary Implications And Suggestions

Last year, Scotland made all menstrual products free. This sparked concerns amongst legislators about the annual costs being too high for the government to bear. It goes without saying that this is a far bigger concern in India, considering our population and its distribution. Last year, after Prime Minister Modi’s address, people had similar questions; one official had said, “The monthly usage of sanitary napkins in India stands at 500 crore units. Based on the actual cost of production of each pad, the cost of the project would be around Rs 12,000 crore per annum.” Of course, these are all big numbers, and are costs the government of India cannot undertake. However, involving the market will be a fair strategy.

Encouraging corporate entities to take responsibilities of selected rural zones and fulfil their corporate social responsibility, partnerships with private manufacturers, tie-ups with NGOs, merging of central and state schemes, are few of the ways the government looked at last year — and they can prove to be very effective. They can also promise proper implementation of the abovementioned strategies.

In July last year, female teachers in Uttar Pradesh demanded three days of ‘menstrual leave’ every month, citing the example of their neighbour Bihar. The Uttar Pradesh Women Teachers’ Association cited reasons such as extreme physical symptoms, as well as lack of basic amenities at the workplace. Private entities such as Zomato have also started granting a select number of days as ‘menstrual leave’. In the recent years, as the conversation around menstruation gains momentum, the demand for an effective policy catering to this biological phenomenon has been cropping up from every corner of the country.

India’s menstrual health problem is due to lack of three things: awareness, goods and facilities. This leads to poor reproductive health, hampered education and environmental issues. Educating one woman is equivalent to educating 10, as we often turn to our mothers, sisters, friends for guidance.

Investing in MHM will lead to triple returns — on education, income, environment. A woman staying in school will delay marriage and childbirth, which can add about $100 million to India’s gross domestic product (GDP).With a prioritisation of this sector by the government, investment by private players will also increase.

There is no doubt that with the right steps, we can empower more and more women to take responsibility for their health, education and income. Empowerment of even one individual can aid the country’s economy by leaps and bounds. There is no reason why we should not invest more in almost 360 million women.

Rashtriya Kishore Swasthya Karyakram

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