Mira Bai (name changed) contracted polio when she was very young. Disability alongside stigma has made her monthly menstrual experience challenging and traumatic. But when disposable sanitary pads were introduced, it enabled her to have a comfortable menstrual experience. “I no longer need to wait for others to leave the house so that I can wash the cloth which I use during periods. For me even washing my clothes is a difficult task".
Anuka devi (name changed) has been using cloth to manage her periods from the beginning. When disposables were introduced, she did not feel comfortable using it. “I face problems disposing of them and I don’t want to invest in pads when I can stitch my own pads now."
India has made considerable progress in ensuring accessibility to menstrual products. However, the journey towards menstrual equity is not one to be solved with product-based interventions alone. The issue of period (menstrual) poverty sheds light on the intersection of gender inequality and human rights. Women’s and girls’ experiences are often informed by the unavailability of water and soap, lack of private spaces to wash or clean, the problem of solid waste management, lack of accountability on product manufacturers for materials they use in their products and deep-rooted shame and stigma, all compounded by lack of education about reproductive health.
In the vortex of such complicated issues, what suffers most is women's agency in choosing which products are most comfortable to use and easiest to dispose. In March, on the occasion of Commission of the Status of Women and the 25-year review of the Beijing Declaration and Platform for Action, the Global Menstrual Health & Hygiene Collective highlighted the importance of being able to make informed choices on menstrual products and having access to health services and wash facilities as the key for achieving comprehensive and inclusive menstrual health.
Indeed, the focus of narratives and interventions should therefore be on health and sanitation, rather than which product is best. A report by UNFPA emphasizes how the best product is context specific. “In all circumstances, the choice of menstrual product must be acceptable to the people using them". For example, Washing and drying cloth pads, no matter how beautiful the print of the cloth, is not possible in contexts where there is not only lack of water but also lack of personal bathroom space to wash, or dry out wearables properly. In humid regions, they are difficult to dry completely, and can prove to be more detrimental to health. Menstrual cups have become a game changer for many, but also present a similar problem in many contexts where there is scarcity of water, space and deep-rooted stigma which takes years to unlearn.
Similarly, one-time-use sanitary pads for have been marketed, rather misguidedly as more sanitary than cloth—the truth is that using cloth is unhygienic only if not washed and dried properly. Disposable pads are expensive to buy. There is evidence that women use them for long hours, which is a health hazard. The humble cloth that women use and then discreetly dispose has often been needlessly vilified.
The right to choice and agency should be at the centre of achieving menstrual equity. It is high time that we take concrete steps to ensure women have a dignified menstrual experience.
Firstly, government and organizations working on distributing menstrual products must offer a basket of choices and provide unbiased information on usage, disposal, cost, and environmental impact. These options should range from disposable pads to washable cloth to menstrual cups. A case study in Kenya showed girls' preferences were varied within the same community and many wanted to choose among multiple menstrual health products or even to combine multiple products. This is true across the world.
Secondly, mandatory printing of materials used should be mentioned on the packaging and including this information in awareness sessions to enable women to make informed choices. Many disposable pads that claim to be fully bio-degradable are not, or compost only when certain disposal conditions are fully met, which is not practicable for a vast majority of women.
Thirdly, corporates should conduct a thorough needs-assessment before deploying funds for providing access to menstrual products. They should partner with grassroots organisations and take advice to streamline their donation/marketing efforts. Manufacturers of menstrual products must make a clear distinction between marketing and advocacy.
It is also important to recognise the onus is on governments and large corporations for the acute waste management problem. While we are caught in a fraught discussion around plastic generated by menstrual waste, large corporates and industries responsible for an overwhelming percentage of that waste continue to go largely unpunished. Individual choices matter most, but not when larger forces remain inexorable in the face of changing realities.
The rights-based pro-choice approach in the distribution of menstrual products will not only shed light on issues such as clean water, soap, private space for bathing and washing, but also put focus on women's health, rights, dignity and agency, by opening up space to talk about women's bodies and experiences, comforts and challenges, aches and pains.
A dignified menstrual experience should not be the privilege of a few, but a right for every woman. This starts when they are provided with a range of products with accurate information and a non-judgmental approach to respect their choices. Menstruating women from under-resourced communities have as much right to choose their menstrual product, rather than be at the receiving end of donations, with decisions made by donors.
Monalisa Padhee and Swarnima Bhattacharya are, respectively, program head of the women wellness initiative at Barefoot College International, and founder of TheaCare, a health coaching and consultation platform for women.
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