The coronavirus pandemic has triggered what has been described as a “sanitary pad disaster” in India. Priya, a 14-year-old schoolgirl, considers herself fortunate: her mother and father can nonetheless afford pads. However a number of of her mates must go with out. In some components of India, colleges are a vital a part of the provision chain, offering a pack of pads to women every month. With them closed, together with different provide chain points, as few as 15% of women had entry to sanitary pads throughout the lockdown.
This isn’t solely the case in India. Girls in Fiji, the US, UK and different components of the world have additionally reported extreme provide shortages and hiked up costs for disposable menstrual merchandise.
However in India, the place I’ve spent a lot of the previous couple of years researching how girls select to handle their durations, shortages are notably extreme. The state of affairs escalated shortly as India went into an sudden and full lockdown on March 24. This put an instantaneous cease to the month-to-month provide of pads that hundreds of thousands of adolescent ladies obtained through their colleges. The manufacturing of sanitary pads additionally got here to a screeching halt for seven days, which result in stockouts in a number of places.
Pads have been reclassified as important objects eligible for provide chain operations on March 30 however even now provides haven’t resumed to regular ranges in lots of locations. Safa India, an NGO I work with, is busy educating girls make fabric pads at residence. And a number of other massive charities, like KGNMT, have began distributing reusable pad kits to susceptible girls.
Girls in India primarily use disposable pads or conventional fabric to handle their durations. The previous decade has seen the federal government campaigning onerous for girls to make use of disposable pads, placing throughout the message that disposable pads are the one hygienic technique to handle menstruation. They did so to encourage girls to transition away from using conventional fabric, which was seen as tough to take care of hygienically. However little has been completed to create consciousness of different, cheaper, extra sustainable alternate options, resembling menstrual cups and reusable pads.
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I got down to examine this – to search out out what Indian girls learn about their choices to handle durations, and whether or not giving them extra info would change their strategy. I discovered that their data about different obtainable choices to handle durations is severely missing, and that giving girls extra info created extra demand for sustainable merchandise like menstrual cups and reusable pads – merchandise that may have been impervious to the shortages many ladies skilled below lockdown.
Good menstrual hygiene is a lot extra than simply entry to sanitary merchandise – water, bogs and equitable gender norms additionally matter – however they’re important within the administration of durations and present practises are removed from sustainable.
Menstrual historical past
However first, how did disposable pads come to dominate the Indian market?
Disposable sanitary pads and tampons could appear indispensable in the present day however they’ve been round for fewer than 100 years. Till the flip of the 20th century, girls merely bled into their garments or, the place they might afford it, formed scraps of fabric or different absorbents like bark or hay right into a pad or tampon-like object.
Industrial disposable pads first made an look in 1921, when Kotex invented cellucotton, a super-absorbent materials used as medical bandaging throughout the first world battle. Nurses began to make use of it as sanitary pads, whereas some feminine athletes gravitated in direction of the concept of utilizing them as tampons. These concepts caught and the period of disposable menstrual merchandise started. As extra girls joined the workforce, demand for disposables began to extend within the US and UK and by the tip of the second world battle, this alteration in behavior was totally established.
Advertising and marketing campaigns helped additional this demand by leaning closely into the concept that utilizing disposables freed girls from the “oppressive outdated methods”, making them “fashionable and environment friendly”. After all, the revenue incentives have been appreciable. Disposables locked girls right into a cycle of month-to-month purchases that may final for a number of a long time.
The technological advances in versatile plastics over the 1960s and 70s quickly noticed disposable sanitary pads and tampons develop into extra leakproof and person pleasant as plastic backsheets and plastic applicators have been launched into their designs. As these merchandise grew to become extra environment friendly in “hiding” menstrual blood and lady’s “disgrace”, their attraction and ubiquity elevated.
Many of the preliminary marketplace for disposables was restricted to the west. However within the 1980s a number of the bigger firms, recognising the market’s huge potential, began promoting disposables to girls in growing international locations. They obtained a substantial increase when in early to mid-2000s considerations across the menstrual well being of women and girls in these international locations noticed a swift public coverage push for the take up of sanitary pads. Public well being initiatives throughout many of those international locations started to distribute subsidised or free disposable pads. Pads have been largely most well-liked over tampons due to the patriarchal taboos in opposition to vaginal insertion that prevail in lots of cultures.
As demand for disposable merchandise has risen, so have the considerations over the sustainability of those merchandise. With round 2 billion women and girls of menstruating age, the potential world menstrual waste burden might be important certainly. The UK alone generates 200,000 tonnes of menstrual waste yearly. A lot of this waste leads to landfills or within the oceans the place the plastic and different non-compostable materials in these merchandise takes lots of of years to decompose.
And that’s to not point out the provision chain points that disposable merchandise heighten.
Sustainable alternate options
Even earlier than COVID-19 imposed urgency round this challenge, rising environmental consciousness of menstrual waste resulted in a rise in a spread of dependable and sustainable sanitary merchandise obtainable to girls. Whereas small-scale improvements have existed for some time, these alternate options solely took off within the early 2000s when huge producers resembling GladRags and Mooncup entered the market. The 2 predominant sustainable product strains on supply are reusable fabric pads and the menstrual cup. The low lifecycle value of those merchandise additionally make them a less expensive different to disposables. For instance, menstrual cups are estimated to have lower than 1.5% of the environmental impression of disposables at 10% of the fee.
Fabric pads mimic what girls used traditionally and so are simple to undertake. Some have a foldable form that doesn’t resemble a pad when drying, like Lilypads. Some, like Safepad, have an antimicrobial high layer for improved hygiene. They sometimes final for 12 to 24 months. Most are biodegradable. Lifecycle prices are considerably decrease than disposable pads and they’re simpler to handle when in comparison with conventional fabric, though hygienic use nonetheless requires dedication to washing and drying. Round 12% of ladies within the UK are estimated to make use of reusable fabric pads. Ranges of “interval pants” are additionally now available on the market: underwear that absorbs menstrual blood and may then be washed usually and reused.
Menstrual cups, in the meantime, are versatile bell-shaped receptacles that acquire blood (somewhat than take up) and want insertion like tampons. In 2001, essentially the most recognisable model, Mooncup, began utilizing medical grade silicone – a non-porous materials immune to micro organism – in its manufacturing. A single silicone cup can reportedly final for as much as ten years and are extremely popular) amongst customers. This clearly has big implications for waste administration. In 2018, the worldwide menstrual cups market was estimated at US$1.2 billion and is predicted to succeed in US$1.89 billion by 2026.
Though the markets for these merchandise are rising, a lot of the main target of those firms has been on the west (echoing the preliminary phases for disposable pads). However clearly these merchandise promise a lot for girls in poorer areas of the world as a result of they’re a less expensive and environmentally pleasant different to disposable pads.
India’s menstrual well being
I needed to learn the way a lot consciousness there’s of such merchandise past the west, and the way standard they might seemingly be in the event that they have been obtainable. India is residence to 20% of the world’s menstruating women and girls and was an excellent place to search for solutions. Regardless of the prevalent cultural norms that stop girls from overtly speaking about durations, round 300 girls from ten slum dwellings within the metropolis of Hyderabad agreed to speak to my group and take part in our experiment.
Round 80% of the ladies we talked to throughout our fieldwork used disposable pads, and none of them have been conscious of the extra sustainable choices.
That is unsurprising. Since 2011, the Indian authorities has campaigned for girls to make use of them. This coverage objective might be traced again to the NGO Plan India reported that simply 12% of Indian girls may entry sanitary pads. This raised considerations across the challenges girls utilizing conventional options might be dealing with in sustaining their menstrual hygiene and private dignity. Conventional fabric is seen as unhygienic. Whereas fabric is a hygienic menstrual answer, it requires satisfactory washing and drying, which is tough to realize in a rustic the place taboos about menstrual blood are prevalent.
These considerations led the federal government of India to design nationwide tips and techniques for the adoption of excellent hygiene. Above all, it favoured free or discounted distribution of disposable sanitary pads. This was seen as a tangible use of taxpayers’ cash. It was additionally simple to piggyback on the advertising success of personal firms that had already created public consciousness and aspiration for pads.
Low cost industrial variants, authorities efforts and personal philanthropy mixed to trigger a fast surge in demand for sanitary pads. In lower than 5 years, 2015-16’s Nationwide Household Well being Survey reported pad customers to have quintupled to 58%, with rural customers at 48% and concrete customers at 78%. In the meantime, public menstrual well being campaigns stay completely silent on different reusable choices.
© Supriya, Creator offered
The opposite 20% of the ladies we spoke to used conventional fabric, however the aspiration to change to pad for the promised consolation and comfort was excessive. Affordability of pads was the principle barrier to switching. We got here throughout circumstances the place girls have been ready to surrender necessities to have the ability to purchase pads or purchased pads for his or her daughters however not for themselves.
Many ladies, each fabric and pad customers, take into account fabric to be unhygienic. On the root of this perception are the myths and taboos that restrict girls’s means to clean and dry fabric in a hygienic manner. Many do not need entry to non-public washing amenities and select to not dry fabric below open daylight for the humiliation of being seen by male family members and outsiders. Girls are inclined to dry their menstrual fabric indoors, hid in closets and hidden below mattresses. Such practices render the material unhygienic and contribute to the idea that fabric is inferior to pad. However we additionally discovered unhygienic practices among the many pad customers – it was widespread follow to make use of the identical pad for the entire day or to apply it to two consecutive days if the movement was gentle.
The overall tradition of silence round durations meant that girls didn’t really feel snug in search of info from higher knowledgeable folks (well being employees, lecturers) and ended up believing what they’re instructed by girls within the household and mates. Though it was widespread for girls to have had some education and for youthful ladies to have studied in school with some attending college, we discovered that formal schooling made little distinction to beliefs about menstrual merchandise. A university pupil who participated in our examine instructed us that “fabric was dangerous as a result of my aunt’s buddy grew to become infertile due to it”.
What occurs to the used pads?
The overwhelming majority of the ladies in our examine threw their pads out with routine waste. Additionally it is widespread to see dirty pads floating in open streams and gutters subsequent to dwellings. In focus group discussions, girls instructed us about how they discarded dirty pads within the waterways near their houses because it was essentially the most handy manner of disposing it. Members of their late twenties instructed us:
We’ve got an enormous river behind us, the pad will simply movement away with it.
I wrap it [used pad] in a plastic bag, earlier than throwing it within the river, how can I throw it identical to that?
A lot of the moist waste sifting in India is completed by sanitation employees manually. We spoke to some sanitation employees concerned on this work. Considered one of them, talking about his expertise with sifting used sanitary pads from different waste, instructed us: “Once I deal with this mess, I really feel my life is cursed.”
The plight of sanitation employees and the rising considerations round sanitary waste in cities has led the federal government to fee small-scale incinerators for colleges, hospitals and authorities places of work. These efforts are being scaled up regardless of excessive emissions related to use of such incinerators.
Whereas there isn’t a concerted public effort in direction of informing girls about sustainable alternate options, there are a number of small initiatives. Notably noteworthy is the menstrual cup initiative by the federal government of Kerala. Launched in 2019, the Thinkal undertaking distributed 5,000 menstrual cups freed from cost to girls from the municipality of Alappuzha. The concept emerged out of the devastation attributable to floods in 2018, the place girls within the reduction camps confronted an enormous drawback with the disposal of their sanitary pads.
Different initiatives, primarily by small personal enterprises, have give you a wide range of improvements like Uger’s and EcoFemme’s variations of reusable fabric pads, additionally educating girls make their very own pads and Anandi’s compostable pad which wants deep burial and is therefore higher suited to rural areas. However with out the backing of presidency coverage and funding, these efforts stay small and sporadic and have little total impression on data and shopper behaviour.
The ladies who spoke to us throughout the fieldwork bought their info on menstrual merchandise from TV adverts and billboards. Apart from conventional fabric and disposable pads, little was identified about different menstrual merchandise. Not one of the girls had heard of commercially made reusable fabric pads or of menstrual cups.
We needed to search out out whether or not girls’s selection of menstrual merchandise would change in the event that they knew extra about different alternate options to hygienically handle their durations.
We determined to check this query with girls from our examine. We started by giving girls full and unbiased info on your complete vary of menstrual alternate options, together with compostable and conventional disposable pads, reusable fabric pads, tampons and menstrual cups. For every menstrual product they have been knowledgeable of the professionals and cons, together with prices, hygienic use and implications for waste administration. Then, a number of the girls got a provide of disposable pads, others got a provide of reusable fabric pads and the remainder got nothing.
We additionally needed to check menstrual cups, however deep-seated patriarchal taboos in opposition to vaginal insertion meant that we couldn’t safe approval from associate organisations in India who have been nervous about group acceptance. Whereas we have been upset at this, it additionally firmed up our resolve to grasp the function of knowledgeable selection in girls’s preferences for menstrual merchandise.
We adopted up with 277 girls to search out out about modifications of their attitudes and preferences for menstrual merchandise. Data of menstrual supplies and understanding of hygienic use was up considerably throughout all teams. Desire for sustainable menstrual supplies additionally went up in all teams, with a 24% improve total. However the fabric and the knowledge solely teams noticed a a lot better improve (37%) when in comparison with the group that obtained disposable pads (9%).
This implies that receiving disposable pads could have strengthened the unique perception that “pad is finest”, inflicting girls within the pad group to disregard the knowledge given about different menstrual supplies. Additionally it is attainable that these girls valued the comfort supplied by disposables over different merchandise.
A number of girls within the fabric and data teams expressed an curiosity in studying extra about alternate options to pads, particularly about menstrual cups, as little was identified about these, and gave solutions on how info might be shared:
Somebody ought to inform us no? Such group discussions, lecturers, authorities … they’ll put posters.
I really feel I may use a menstrual cup.
These testimonials counsel that, regardless of the taboos related to vaginal insertion in India, girls are keen to experiment with such merchandise. The outcomes of Kerala’s cup trial will inform the way forward for this product in India and are value watching out for.
The way forward for menstrual supplies
What does this imply for the way forward for menstrual administration in India and elsewhere? This query is much more related now as COVID-19 exposes the vulnerabilities of worldwide provide chains, with shortages in sanitary pad provides rising as a selected concern.
The menstrual product panorama has developed significantly in the previous couple of years and new sustainable improvements proceed to emerge. But when girls have details about and entry to only disposable sanitary pads, then the demand for this alone will proceed to extend – however not essentially in an knowledgeable or hygienic manner. The silence round alternate options continues largely due to social taboos surrounding menstruation which makes discussing speaking about it tough for everybody concerned.
The dominance of disposable pads, in the meantime, is pushed by firms motivated by income and this hegemony continues as policymakers, group stakeholders and ladies watch in silence, not understanding the actual value of pads or of the supply of alternate options. The one technique to reverse girls and public well being initiatives selecting disposable pads is to offer full and unbiased info on the total vary of menstrual supplies.
Regardless of the final warning hooked up to research with small pattern sizes, our outcomes counsel that as a coverage software, knowledgeable selection has the potential to steer the menstrual product market in a sustainable course. If given complete info on all obtainable menstrual merchandise, girls are seemingly to select that considers not solely prices to themselves and their well being but additionally prices to the surroundings. Enhance in demand for a spread of merchandise, together with sustainable alternate options, is prone to incentivise the markets into bettering availability and entry to those.
Breaking the silence round menstruation is the important thing to a future the place there’s “interval fairness” – the place each lady in each state of affairs, pandemic or not, has the flexibility to hygienically and sustainably handle her durations.
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