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 dad and mom can nonetheless afford pads. However a number of of her associates must go with out. In some elements of India, faculties are a important a part of the provision chain, offering a pack of pads to ladies every month. With them closed, together with different provide chain points, as few as 15% of ladies had entry to sanitary pads throughout the lockdown.
This isn’t solely the case in India. Girls in Fiji, the US, UK and different elements 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 ladies select to handle their intervals, shortages are notably extreme. The scenario escalated rapidly 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 acquired through their faculties. 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 had been reclassified as important gadgets 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 ladies make fabric pads at residence. And several other massive charities, like KGNMT, have began distributing reusable pad kits to susceptible ladies.
Girls in India primarily use disposable pads or conventional fabric to handle their intervals. The previous decade has seen the federal government campaigning arduous for ladies to make use of disposable pads, placing throughout the message that disposable pads are the one hygienic strategy to handle menstruation. They did so to encourage ladies to transition away from the usage of conventional fabric, which was seen as troublesome to keep up hygienically. However little has been finished to create consciousness of different, cheaper, extra sustainable options, reminiscent of menstrual cups and reusable pads.
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I got down to examine this – to seek out out what Indian ladies find out about their choices to handle intervals, and whether or not giving them extra data would change their method. I discovered that their data about different obtainable choices to handle intervals is severely missing, and that giving ladies extra data created extra demand for sustainable merchandise like menstrual cups and reusable pads – merchandise that will have been impervious to the shortages many ladies skilled underneath lockdown.
Good menstrual hygiene is a lot extra than simply entry to sanitary merchandise – water, bathrooms and equitable gender norms additionally matter – however they’re important within the administration of intervals 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 at present however they’ve been round for fewer than 100 years. Till the flip of the 20th century, ladies merely bled into their garments or, the place they might afford it, formed scraps of material or different absorbents like bark or hay right into a pad or tampon-like object.
Business 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 the direction of the thought of utilizing them as tampons. These concepts caught and the period of disposable menstrual merchandise started. As extra ladies joined the workforce, demand for disposables began to extend within the US and UK and by the top of the second world battle, this alteration in behavior was absolutely established.
Advertising and marketing campaigns helped additional this demand by leaning closely into the concept that utilizing disposables freed ladies from the “oppressive previous methods”, making them “fashionable and environment friendly”. After all, the revenue incentives had been appreciable. Disposables locked ladies right into a cycle of month-to-month purchases that will 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 turn out to be extra leakproof and consumer pleasant as plastic backsheets and plastic applicators had been launched into their designs. As these merchandise turned extra environment friendly in “hiding” menstrual blood and girl’s “disgrace”, their enchantment and ubiquity elevated.
A lot of the preliminary marketplace for disposables was restricted to the west. However within the 1980s among the bigger firms, recognising the market’s huge potential, began promoting disposables to ladies in creating nations. They acquired a substantial increase when in early to mid-2000s considerations across the menstrual well being of women and girls in these nations noticed a swift public coverage push for the take up of sanitary pads. Public well being initiatives throughout many of those nations started to distribute subsidised or free disposable pads. Pads had been largely most popular 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 will be important certainly. The UK alone generates 200,000 tonnes of menstrual waste yearly. A lot of this waste results in 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.
Even earlier than COVID-19 imposed urgency round this concern, rising environmental consciousness of menstrual waste resulted in a rise in a variety of dependable and sustainable sanitary merchandise obtainable to ladies. Whereas small-scale improvements have existed for some time, these options solely took off within the early 2000s when massive producers reminiscent of GladRags and Mooncup entered the market. The 2 fundamental 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 various to disposables. For instance, menstrual cups are estimated to have lower than 1.5% of the environmental affect of disposables at 10% of the price.
Fabric pads mimic what ladies 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 prime 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 girls within the UK are estimated to make use of reusable fabric pads. Ranges of “interval pants” are additionally now in the marketplace: underwear that absorbs menstrual blood and might then be washed usually and reused.
Menstrual cups, in the meantime, are versatile bell-shaped receptacles that accumulate blood (relatively than soak up) and wish 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 very talked-about) 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 achieve US$1.89 billion by 2026.
Though the markets for these merchandise are rising, a lot of the main focus of those firms has been on the west (echoing the preliminary phases for disposable pads). However clearly these merchandise promise a lot for ladies in poorer areas of the world as a result of they’re a less expensive and environmentally pleasant various to disposable pads.
India’s menstrual well being
I wished to learn the way a lot consciousness there’s of such merchandise past the west, and the way standard they might doubtless be in the event that they had been obtainable. India is residence to 20% of the world’s menstruating women and girls and was a superb place to search for solutions. Regardless of the prevalent cultural norms that forestall ladies from brazenly speaking about intervals, round 300 ladies from ten slum dwellings within the metropolis of Hyderabad agreed to speak to my crew and take part in our experiment.
Round 80% of the ladies we talked to throughout our fieldwork used disposable pads, and none of them had been conscious of the extra sustainable choices.
That is unsurprising. Since 2011, the Indian authorities has campaigned for ladies to make use of them. This coverage purpose will be traced again to the NGO Plan India reported that simply 12% of Indian ladies may entry sanitary pads. This raised considerations across the challenges ladies utilizing conventional options may very well be dealing with in sustaining their menstrual hygiene and private dignity. Conventional fabric is seen as unhygienic. Whereas fabric is a hygienic menstrual resolution, it requires ample washing and drying, which is troublesome to attain in a rustic the place taboos about menstrual blood are prevalent.
These considerations led the federal government of India to design nationwide pointers and methods 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 business variants, authorities efforts and personal philanthropy mixed to trigger a speedy 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, Writer supplied
The opposite 20% of the ladies we spoke to used conventional fabric, however the aspiration to modify 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 ladies had 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, contemplate fabric to be unhygienic. On the root of this perception are the myths and taboos that restrict ladies’s capability to scrub and dry fabric in a hygienic method. Many shouldn’t have entry to non-public washing services and select to not dry fabric underneath 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 underneath mattresses. Such practices render the material unhygienic and contribute to the assumption 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 move was mild.
The final tradition of silence round intervals meant that ladies didn’t really feel snug in search of data from higher knowledgeable folks (well being employees, lecturers) and ended up believing what they’re instructed by ladies within the household and associates. Though it was widespread for ladies to have had some education and for youthful ladies to have studied in faculty with some attending college, we discovered that formal schooling made little distinction to beliefs about menstrual merchandise. A university scholar who participated in our examine instructed us that “fabric was dangerous as a result of my aunt’s pal turned 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. It is usually widespread to see dirty pads floating in open streams and gutters subsequent to dwellings. In focus group discussions, ladies instructed us about how they discarded dirty pads within the waterways near their houses because it was essentially the most handy method of disposing it. Individuals of their late twenties instructed us:
We’ve got an enormous river behind us, the pad will simply move away with it.
I wrap it [used pad] in a plastic bag, earlier than throwing it within the river, how can I throw it similar to that?
A lot of the moist waste sifting in India is finished by sanitation employees manually. We spoke to some sanitation employees concerned on this work. Certainly 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 faculties, hospitals and authorities places of work. These efforts are being scaled up regardless of excessive emissions related to use of such incinerators.
Whereas there is no such thing as a concerted public effort in the direction of informing ladies about sustainable options, there are a number of small initiatives. Significantly noteworthy is the menstrual cup initiative by the federal government of Kerala. Launched in 2019, the Thinkal challenge distributed 5,000 menstrual cups freed from cost to ladies from the municipality of Alappuzha. The concept emerged out of the devastation brought on by floods in 2018, the place ladies within the reduction camps confronted a large drawback with the disposal of their sanitary pads.
Different initiatives, primarily by small personal enterprises, have give you quite a lot of improvements like Uger’s and EcoFemme’s variations of reusable fabric pads, additionally educating ladies 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 general affect on data and shopper behaviour.
The ladies who spoke to us throughout the fieldwork received their data on menstrual merchandise from TV adverts and billboards. Apart from conventional fabric and disposable pads, little was recognized about different menstrual merchandise. Not one of the ladies had heard of commercially made reusable fabric pads or of menstrual cups.
We wished to seek out out whether or not ladies’s selection of menstrual merchandise would change in the event that they knew extra about different options to hygienically handle their intervals.
We determined to check this query with ladies from our examine. We started by giving ladies full and unbiased data on your entire vary of menstrual options, together with compostable and conventional disposable pads, reusable fabric pads, tampons and menstrual cups. For every menstrual product they had been knowledgeable of the professionals and cons, together with prices, hygienic use and implications for waste administration. Then, among the ladies got a provide of disposable pads, others got a provide of reusable fabric pads and the remainder got nothing.
We additionally wished to check menstrual cups, however deep-seated patriarchal taboos in opposition to vaginal insertion meant that we couldn’t safe approval from accomplice organisations in India who had been frightened about group acceptance. Whereas we had been upset at this, it additionally firmed up our resolve to grasp the function of knowledgeable selection in ladies’s preferences for menstrual merchandise.
We adopted up with 277 ladies to seek 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% enhance general. However the fabric and the knowledge solely teams noticed a a lot larger enhance (37%) when in comparison with the group that acquired disposable pads (9%).
This means that receiving disposable pads might have strengthened the unique perception that “pad is finest”, inflicting ladies within the pad group to disregard the knowledge given about various menstrual supplies. It is usually doable that these ladies valued the comfort supplied by disposables over different merchandise.
A number of ladies within the fabric and knowledge teams expressed an curiosity in studying extra about options to pads, particularly about menstrual cups, as little was recognized about these, and gave strategies on how data may very well 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 recommend that, regardless of the taboos related to vaginal insertion in India, ladies 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 price 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 world provide chains, with shortages in sanitary pad provides rising as a specific concern.
The menstrual product panorama has developed significantly in the previous couple of years and new sustainable improvements proceed to emerge. But when ladies 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 method. The silence round options continues largely due to social taboos surrounding menstruation which makes discussing speaking about it troublesome for everybody concerned.
The dominance of disposable pads, in the meantime, is pushed by firms motivated by earnings and this hegemony continues as policymakers, group stakeholders and ladies watch in silence, not understanding the true value of pads or of the provision of options. The one strategy to reverse ladies and public well being initiatives selecting disposable pads is to supply full and unbiased data on the total vary of menstrual supplies.
Regardless of the final warning connected to research with small pattern sizes, our outcomes recommend that as a coverage software, knowledgeable selection has the potential to steer the menstrual product market in a sustainable route. If given complete data on all obtainable menstrual merchandise, ladies are doubtless to select that considers not solely prices to themselves and their well being but in addition prices to the atmosphere. Enhance in demand for a variety of merchandise, together with sustainable options, is prone to incentivise the markets into enhancing 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 girl in each scenario, pandemic or not, has the power to hygienically and sustainably handle her intervals.
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