Menstrual Hygiene Management: Making it Economical

Aranyak Saikia

Dr Dhritishna Kalita

A significant proportion of girls and women in India are expected to be suffering from ‘period poverty’. The term is used to describe a situation where women are unable to access menstrual hygiene and sanitary products due to financial constraints. While the UN estimates that globally around 1.2 billion women lack access to sanitary products, precise estimates from India do not exist. Data from the recent National Family and Health Survey (NFHS)- IV (2015-2016) show that 42% Indian women in the ages 15 to 24 years use sanitary napkins, 62% use cloth, and 16% use locally prepared napkins. Thus, one can safely assume that more than 50% of women suffer from some form of period poverty in India. Not just financial constraints, prevalence of misconceptions about menstruation, lack of proper education about the management of a menstrual period, social isolation, and absence of proper sanitary services are collectively responsible for making periods a harrowing event for women in Indian villages.

As the World Bank notes, many girls drop out of school in their adolescence as they are unable to safely manage their periods. This affects their employment opportunities in the future. Further, the associated deprivation of education is not just restricted to that girl, it affects the entire community. When a girl goes to school, she marries later, has fewer children and is less likely to experience sexual violence. With every extra year of a girl’s secondary education, per capita income of the country increases by 0.3% every year. Some studies also note the reduction in incidence of crime in the community.

At the same time, unhygienic practices during menses can predispose women to a variety of infectious conditions of the urinary and genital tracts. This further affects the earning potential of families through a loss of productivity and higher health expenditures. Thus, there are significant economic impacts of the absence of adequate menstrual hygiene management in society.

It is in this context that menstrual hygiene management has acquired significance both from an economic and social perspective. Not only does it boost economic activities and earnings potential of households, it is an important means for uplifting the health, dignity and condition of women in India. Menstrual hygiene management (MHM) has been defined by UNICEF as the set of activities that allow “women and adolescent girls to use a clean material to absorb or collect menstrual blood, and this material can be changed in privacy as often as necessary for the duration of the menstrual period.”

One of the important components of MHM is the sanitary napkin. However, sanitary napkins are not very popular in rural areas owing to lack of availability, absence of proper disposal methods and the pricing. Women prefer the use of cloth as an absorbent which is washed and reused. Washing them without soap and drying them indoors due to social taboos makes them a rather unhygienic alternative to disposable sanitary napkins.

The other important component is WASH (water, sanitation and hygiene). It involves a plethora of activities including clean water supply, construction of separate toilets for girls and boys in schools, and information, education and communication (IEC) campaigns to spread awareness on hygiene in general and menstrual hygiene in particular.

In recent years, policymakers, economists and public health experts have looked at innovative ways to promote MHM among the public. Behavioural economics has been used to ‘nudge’ people, especially women, into talking about menstrual issues and using sanitary products like napkins and tampons. Steps have been taken to reduce the financial burden of menstrual hygiene products. While the GST Council slashed the tax on sanitary napkins, the government of India has recently introduced biodegradable Suvidha pads priced at Re. 1.00 per pad. At the same time, start-ups and incubators are using technology to make these products cost-effective, improve inventory management and make them easily accessible. While still at a nascent stage, there is tremendous potential in this sector to make MHM effective among the masses. This, therefore, calls for further government incentives to spur up these start-ups.

The National Health Mission (NHM) has a component on menstrual hygiene, while the Swacch Bharat Abhiyan (SBA) and SarvaShikhaAbhiyan (SSA) have similar components relating to construction of separate girls’ toilets and IEC campaigns. However, instead of operating in separate silos, these schemes can be integrated into a single scheme operating under comprehensive menstrual hygiene management guidelines. The various components under the present schemes can be incorporated to form the National Menstrual Health Mission (NMHM), with a style of campaigning similar to the SBA and SSA. Randomised Control Trials (RCTs) and other statistical tools can be used to evaluate the impact of the Mission, and improve outcomes. The Mission should include different stakeholders, including women’s rights activists, economists, health officials and law enforcement agencies.

Concerted efforts need to be made to eliminate the notion of menstruation as being a ‘problem’ – and this is to be undertaken both by the government and the individual. While the current steps are in the right direction, the suggestions given above can further give an impetus to making menstruation a more comfortable experience for women. Proper menstrual hygiene management is nothing short of a giant leap in empowering women in our society.