About seven or eight years ago, I was driving to Ranikhet when I realised that I had forgotten to carry sanitary pads. No problem, I thought. I will pick up some on the way whenever the next town comes. The next town was Rampur. The first chemist shop returned a negative, as did the second. A third offered me a pack of diapers. Soon enough, I realised—much to my shock—that an essential I had always taken for granted as a city-bred person is actually a rare commodity, at least in some parts of India. I gave up after about 8-10 shops and decided to pick it up from Nainital instead.
I fervently wish much has changed in the intervening period. But as I read about the landmark Supreme Court ruling making menstrual hygiene a fundamental right, the urge to rejoice was tempered by this memory.
The other visual that kept playing in my head is the brilliant public health spot featuring Akshay Kumar, who berates a man for having money for tobacco but not for sanitary napkins for his wife. Like the husband in that advertisement, India needs to collectively shed its embarrassment in talking about 'auraton wali bimari' (women’s diseases) for meaningful conversations and interventions to happen on menstrual hygiene.
That the apex court needed to clarify this position as the country nears 80 years of independence is a red flag in itself, but there are larger concerns than feminist outrage. Much like the Swacch Bharat Abhiyan has not ended the sight of open defecation in slums of big cities, including Delhi, there can be many gaps between the pronouncement of rights and their implementation.
According to data from the National Family Health Survey 5, 77.3% Indian women use hygienic protection during their periods, which means 23% Indian women do not, which is a big number in itself. But there is more to those statistics. In Madhya Pradesh, only 60% used hygienic methods. In Rajasthan, 44% women use cloths while 74% use sanitary napkins. In Jharkhand, 52 per cent use sanitary napkins, 56 per cent use cloth. While this means that a significant section of women in both states use both methods, it also reveals a worrisome gap. Clothes are not considered hygienic protection as per NFHS, which is clear that only locally prepared napkins, sanitary napkins, tampons, and menstrual cups are considered to be hygienic methods of protection.
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In fact, the use of cloth is a well-acknowledged and documented risk for cervical cancer, a disease that claims an estimated 77,000 Indian women every year. In a 2023 article in the Journal of Cancer Research and Therapeutics, researchers from King George’s Medical College wrote: “Poor menstrual hygiene practices of using old cloth and disposal in open are significant risk factors of cervical cancer. Good MHM (menstrual hygiene management) practices should be widely publicised and implemented in the community to reduce the risk of cervical cancer.”
The lack of menstrual health hygiene also owes itself to some extent to the stigma associated with the natural bodily process. In some tribal areas of Maharashtra, menstruating women are required to leave their homes and stay in a designated room at a corner of the village called 'kurma ghar'. This is to ensure minimal contact with other family members during the days when they are “unclean”.
In many cases, the kurma ghar is a thatched hut with no toilet, with the women being forced to defecate and urinate in the open during the days when they are most vulnerable to infection. While some organisations have now come in to modernise kurma ghars and add toilets to them, there is much ground still to be covered. That is why it is important to undertake population-level sensitisation, dispel the notion of interrupted purity associated with the monthly cycle and normalise conversations about it.
Mainstreaming menstrual health
For India, mainstreaming menstrual health conversations is likely to come with collateral benefits of cervical cancer prevention, which are significant also because there has been radio silence on the issue of HPV vaccination since a widely welcomed but cryptic announcement two Budgets ago about states being “encouraged” to roll out the Human Papillomavirus (HPV) vaccine. HPV is one of the leading causes of cervical cancer. Hopes spiked when Serum Institute of India came out with its own indigenous version that comes at a fraction of the cost of the products marketed by global giants such as Merck and GlaxoSmithKline, but it has so far come to nought.
Official sources say the formal rollout of the vaccination push awaits the unveiling of an indigenous single-dose vaccine. However, a concerted effort towards universal menstrual hygiene may yield population-scale benefits since vaccination rollout, whenever it does happen, under the national programme would, at least in the initial stages, be limited to teenage girls where the returns will take a few years to manifest. Ensuring menstrual hygiene may be a relatively low-cost intervention with wider ramifications in preventing the disease in older women.
Public discourse, including political discourse, therefore needs to overcome the traditional coyness in talking about it. Conversations about menstrual hygiene have somewhat normalised in urban, educated youth, but there is a need for these conversations to happen in village panchayats and political gatherings for the idea to be effectively seeded and practised. There is a need to start early, at the school level and sensitise boys to this reality rather than keep it wrapped.
Destigmatisation is a critical element in the menstrual hygiene conversation; it cannot happen without the men.
(Abantika Ghosh is a journalist, author and public policy professional)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
