As an organization working on menstrual health, we do not promote, sell or help distribute any menstrual product. Over the years, others working on this issue have often asked us about what products would be suitable for the rural Indian women. So, here is our take on what one needs to keep in mind while considering products for women and girls in rural India. This information is based on our extensive travels, survey and conversations with at least 15,000 girls and women across 8 States in India.
- Cloth used for absorbing menstrual flow is the product that majority of rural girls and women prefer. Note that we say prefer for very specific reasons. Across India, among the thousands of women we surveyed and interacted with, majority of them use cloth because they prefer it. The reasons have little to do with affordability or accessibility to other products. Cloth users feel that it is more comfortable when compared to a sanitary napkin. Unlike sanitary napkins, most women are very familiar with cloth and change it more frequently than they would a sanitary napkin, resulting in better hygiene. Besides, in humid regions of the country, sanitary napkins crumble easily and hence a cotton cloth is preferred. Several women also expressed environmental concerns on disposing sanitary napkins in their villages and therefore preferred reusable cloth. In some villages in Karnataka, women told us that they can now purchase a red cloth called “Date Batte” (Date refers to periods, and Batte means cloth) from the grocery shops. This is a soft cloth, quite suitable for menstrual blood absorption.
We would recommend that usage of loose cloth is not discouraged unless there is clear evidence of rashes or other discomfort due to usage of cloth. In cases where women might complain of rashes, we must enquire about the type of cloth they use, the frequency of changing, the method of washing, drying and storing cloth. Knowledge on proper use can be given if we find that some of the practices might be causing problems.
- In recent years, some organizations have begun selling / distributing cloth pads. These cloth pads are designed to resemble sanitary napkins and yet be reusable for environmental reasons.
Any reusable product should be such that it can be properly washed and sanitized. Loose cloth is sanitized by exposing it to sunlight. However, cloth pads which are usually stitched on all sides cannot be opened up and dried properly. So the inner layers may never fully be exposed to sunlight. This could result in bacterial infections due to improper drying. So unless the cloth pads can be fully opened and dried in sunlight, we do not recommend its use.
Commercial Sanitary Napkins
A significant percentage of school going girls and women in rural India are naturally turning to use of disposal sanitary napkins for its ease of use and disposal. However, most girls and women are ill-informed on the frequency of changing sanitary napkins. With advertisements of leading sanitary napkin companies stating 12 hour and more protection, we found a great majority of pad users changing the product only once or twice a day. If a pad (or even a cloth) is not changed 3-4 times a day, it might lead to bacterial infections. Hence, imparting this knowledge is essential for those who are using sanitary napkins.
Locally made Sanitary Napkins
Small scale sanitary napkin manufacturing units are currently trending. Such units promote the idea of locally manufactured low cost sanitary napkins as well as generating employment opportunities. Naturally, many new organizations and well meaning individuals are drawn to this idea. Having worked closely with such units and having distributed their products, we would not vouch for either the product quality or for the employment promises. The product quality is usually worse than the cheapest available commercial pad – for ex., the pad doesn’t last more than an hour, the glue won’t come off, the machine frequently breaks down, the raw materials are difficult to access, the material inside clumps and when the pad doesn’t come off properly, it rips apart messily. After a few uses, women and girls have blamed us for dumping a low quality product on them and refused to accept any more free pads. So there go the employment opportunities!
But the more worrisome aspect is that basic hygiene standards and sanitization of the product are not followed in the small-scale manufacturing units. Very often the standards and tests prescribed by the Bureau of Indian Standards for Sanitary Napkins (check the link here and attachment at the end of this document) are not even assessed. So we would recommend that all necessary assessments and tests are conducted before manufacturing or distributing such products, for those who wish to take this risk.
Tampons & Menstrual Cups
While these products might offer greater comfort to some women and lesser environmental damage, we would think hard before enforcing it on rural women. Most girls and women in villages do a lot of physical work with their hands – tilling the land, sowing seeds, harvesting crops, milking and bathing cattle, feeding animals, etc. As a result their hands are not the most clean and usually carry germs/bacteria. With products like tampons and menstrual cups which require insertion of the product into the vagina using hands, it is necessary that high levels of hygiene and cleanliness is maintained. The practicality of women paying attention to hand hygiene in the midst of all the work they do is to be seriously considered, before promoting such products.
We have come across quite a few women in villages and urban slums who do not use any of the above products and bleed freely. Shocked?
Had these women been part of the movements around menstrual activism, they might have been looked at as heroic in rejecting unnatural methods of absorbing blood which was meant to flow freely. However, since they are rural women who don’t use facebook, the tendency is to generally feel shocked and sorry for them. Before we hyperventilate and start “educating” them on practices of the learned women, let us try and understand how they actually manage their period.
Most of the women who did not use a product said that they did not feel the need for it as the bleeding was not very heavy. Whether this is their perception or the reality is a different matter. The women who bleed freely sometimes wear two undergarments. Some of them use two underskirts and keep wiping the trickling blood with the skirts. Some of them innovatively lift the ends of the skirt and tuck them on the hips of the opposite side – this way there is more cloth to absorb the flowing blood. Quite a few women, do not wear undergarments as they find it very uncomfortable and complained of rashes when they use it. Come to think of it, unless they have access to high quality cotton undergarments and can change it often, they are probably better off without it. These women work hard, sweat constantly and their vaginal region is better off when it is aired rather than closed. In cases where we found that women had rashes or other difficulty, we recommended use of cloth for absorbing the blood. In other cases, we just let it be after giving them information about use of cloth and pads.
Poor hygiene might result in rashes and bacterial infection could cause a problem with white discharge. However, most menstrual disorders like dysmennorhea, mennorhagia, PCOS, endometriosis, ammenorhea, etc have no proven connection to poor hygiene. With every product, there is a possible chance of bacterial infection if not used correctly. Dismissing a product or promoting another is no guarantee of preventing rashes and infection. Instead, knowledge on the right way of using a product needs to be shared.
Therefore, we would invite you to keep an open mind when you come across methods that are different from what you are familiar with. Let us remember that the focus is on whether or not women are being affected by the method they follow. There is no meaning in forcing women to change practices just for the sake of social engineering.
Note: the IS5405 specifications for Sanitary Napkins can be read below: