Youth leaders for the NGO Jatan Sansthan's youth program

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(The RAND Blog)

August 22, 2014

Women's Menstrual Hygiene in India: The Health and Environmental Implications

Youth leaders for the NGO Jatan Sansthan’s youth program, in Rajsamand, a town in Rajasthan, India

Photo by Mahlet Woldetsadik/RAND

by Mahlet Atakilt Woldetsadik

According to India's 2011 census, 89 percent of the nation's rural population lives in households that lack toilets. This absence of proper sanitation presents public health challenges and affects Indian women disproportionately.

An estimated 355 million Indian women and girls must find ways to cope with monthly menstrual hygiene. Most of these women either have no access to toilets or are faced with unclean lavatory facilities. Moreover, they usually wait until nighttime before using public toilets or fields, which exposes them to various forms of physical attacks.

A majority of rural women in India employ clothes and rags for feminine hygiene. These materials might predispose women to reproductive tract infections since it may be difficult for them to keep their used napkins clean and free of harmful bacteria. Washing reusable feminine products with soap and drying them in sunlight may be difficult due to lack of water, private facilities, and cultural taboos associated with menstruation.

While commercially available sanitary napkins provide a possible alternative, only 12 percent of Indian women can afford this option. The average woman also is estimated to throw away 125-150 kg of tampons, pads and applicators in her lifetime. This amounts to 433 million such products per month to be discarded in India, experts estimate. However, most of these products end up in landfills or sewage systems because waste pickers are reluctant to separate the soiled sanitary pads by hand and prepare them for burning as is required under the Indian government's Municipal Solid Waste Management and Handling Rules.

SWaCH, a self-governing organization that provides waste management services to citizens of Pune in west India, recently brought attention to the issue of waste pickers' exposure to infections and other health hazards due to handling feminine hygiene discards. They highlighted the lack of disposable bags for each used sanitary pad, making its disposal hazardous to both those who handle waste and the environment. Disposable sanitary napkins are seen littering dry riverbeds, roadsides, and streets.

After multiple unsuccessful attempts to reach the products' manufacturers to see if they would help address the issue, the organization initiated a “send it back” campaign. Activists sent boxes of used sanitary napkins to major producers, including Johnson & Johnson, and Procter & Gamble. Although the activists got to meet with key stakeholders, an action plan is still pending. In the meantime, SWaCH has made an effort to produce and sell small, yellow plastic bags with strings for an affordable price.

Meantime, Indian grassroots nongovernmental organizations have responded in other ways to the growing use of disposable sanitary products and its environmental impact.

In Southern Rajasthan, advocates are pressing for environmentally friendly sanitary products. Organizations such as Jatan Sansthan are mobilizing local women to produce and use affordable, reusable sanitary pads. These types of initiatives can provide sustainable solutions and stimulate the local economy by creating jobs for women. The community awareness campaigns have been targeted at both men and women to break down taboos associated with menstruation.

In the state of Tamil Nadu, UNICEF (PDF) has developed an affordable incinerator that uses firewood to handle sanitary napkin waste at schools, where students may be pressed for time or seek the greater convenience of commercial products. Latrines are equipped with special wells where sanitary napkins are composted. Although this has its own challenges — female students are reluctant to be seen walking into these designated toilets — it is still a viable solution for now.

These are worthy first steps, but many challenges remain in the effort to improve hygiene options for Indian women.


Mahlet Woldetsadik is an assistant policy analyst at RAND and a Ph.D. candidate at the Pardee RAND Graduate School. This blog was written for the Pardee Initiative for Global Human Progress.