Mass Community Health Teaching in Accham, Nepal – Sunita showing how to make a cloth pad. Image from Flickr by Possible. CC BY 2.0

In many cultures and societies around the world, there is a stigma attached to menstruation. Girls in developing countries miss up to one week of school or work every month due to lack of sanitary products, inadequate facilities and shame associated with periods.

Shortcomings in education and poor hygiene during menstruation can also lead to discomfort, rashes and infections.

But in Bangladesh, India and Nepal, various efforts are underway to help make sanitary napkins affordable and available to the country's women.

The message spreads in Bangladesh

In Bangladesh, the available sanitary napkins on the market are costly. Foreign manufactured ones cost more than 120 Bangladeshi taka (US $1.50) as there is a 60% supplementary tax imposed on the imports.

But a locally manufactured brand called Joya, which costs 60 taka (US $0.75) for eight pads, falls short, according to blogger and activist Marzia Prova:

“জয়া” র এত প্রচারণা দেখে, “দেশি জিনিষ ব্যবহার করব না মানে” টাইপ ভাব নিয়ে জয়া ব্যবহার করলাম। [..] ইউজ করতে গিয়ে দেখি প্যাডের আঠা জাস্ট একটু খানি। প্যান্টির সঙ্গে ঠিক ভাবে এটাচড থাকে না। যেকোনো মুহূর্তে পড়ে যাবার সম্ভাবনা থাকে । তারপর উপরের কভার ভীষণ খসখসে, আমার তিনদিনের মাথায় জঙ্ঘায় লাল র‍্যাশ উঠে পড়ে। [..]

ভাবা যায়, দেশের পিরিয়ড হওয়া নারীর সংখ্যা ৫ কোটির ও বেশী। অথচ এই দেশে “মেইড ইন বাংলাদেশ” স্যানিটারি ন্যাপকিনের সংখ্যা মাত্র দুইটা নিদেনপক্ষে তিনটা, এবং তার একটাও মানসম্মত নয়, কোনদিক থেকেও ! এটা আসলে কার উদাসীনতা ! দেশের সর্বস্তরের নারীদের স্যানিটারি ন্যাপকিন ব্যবহারের প্রতি আগ্রহ তৈরি লক্ষে প্রচারণা চালান হয়, অথচ দামে এবং মানে দেশের একটা প্যাডও ভাল নাই। সব শ্রেণীর মেয়েদের কাছে প্যাড পৌঁছে দিতে কি আসলে কেউই প্রকৃতপক্ষে আগ্রহী নয়?

After watching the much hyped advertisements I started using “Joya” with the zeal I reserve for local products. [..] I saw that the adhesive in that pad is inadequate. So it does not stick to the undergarment and is prone to be displaced. Its cover is very rough, I got rash on my thigh in just three days.

Can you believe, in our country there may be 50 million menstruating women. But only two or three female sanitary products are “made in Bangladesh” and their quality is not up to mark! Whose negligence is it? We see campaigns across the country to increase awareness among women to use hygienic sanitary pads, but there is no affordable and good quality pad in the country. It seems nobody is interested to provide affordable or free pads to every women in this country.

But there are people who are doing something about it. Girls in a drop-in-centre (shelter home) in Dhaka, run by an NGO called Oporajeyo Bangladesh, are making their own pads by hand with a cost of only 4.50 taka (US $0.06).

The organisation provides shelter for these girls with violent or tragic pasts, trains and rehabilitates them for school or work in different garments factories or beauty parlours. In an interview with Feminism Bangla, a feminist blog, the organisation's executive director Wahida Banu explained her dream of commercialising the product:

অপরাজেয় বাংলাদেশ পথশিশুদের নিয়ে কাজ করে। আমরা এখানে প্রত্যেক শিশুকে রিপ্রডাক্টিভ হেলথ, এইচআইভি প্রভৃতি নিয়ে সেমিনার করি, ক্লাস করি, শিক্ষা দেই। বলি ৩ থেকে ৬ ঘণ্টা পর পর প্যাড বদলানোর কথা। এরাই যখন মেইন্সট্রিম স্কুলে যায়, তখন নিজেরাই সে স্কুলে বাচ্চাদের এই বিষয়ে ধারণা দেয়, যেটা টিচাররা পর্যন্ত এড়িয়ে যায়। [..]

আমার মেয়েগুলো ক্লাসে যাচ্ছে, ফ্রেন্ডদের বলছে, ওরা আগ্রহ পাচ্ছে। এখন এসে বলছে ওদের ফ্রেন্ডরাও প্যাড চায়। [..] অনেকের কাছে অফার পেয়েছি এক টন তুলা, বা এক টন ইলাস্টিক তারা কিনে দিতে প্রস্তুত। লটে যখন তুলা বা ইলাস্টিক কেনা হবে তখন প্যাডের দাম আরও কমে যাবে। মরার আগে বাংলাদেশে আমি ৪ থেকে ৫ টাকার প্যাড করেই যাব।

Oporajeyo Bangladesh works with street kids. We teach every kid about reproductive health, HIV, etc. We tell them to change pads every three to six hours. When they go to mainstream school, they communicate this knowledge to other children, even the teachers don't teach them this. [..]

Our girls are telling their friends in their class, and they are also interested. So they come to us saying that their friends want the pads. We got an offer from others, who are eager to help with purchasing the raw materials in lot — 1 tonne of cotton or 1 tonne of elastic rubbers. When we can buy them in lots, the cost will be lower. I want to produce sanitary pads costing 4 or 5 taka before I die.

A ‘revolution’ in India and Nepal

In Nepal, there are a number of menstrual pad projects that train local women to sew menstrual pad kits. A huge problem in using the traditional methods is to wash the menstrual rags for reuse and dry them in an hygienic way without much exposure. Students at the Art Center College of Design in California have built one low-cost, easy-to-use tool to wash and dry reusable sanitary cloths.

And in India, Arunachalam Muruganantham, a school dropout from a poor family in southern India turned social entrepreneur, has ‘revolutionised‘ menstrual health for rural women by inventing a simple machine to make cheap sanitary pads. His machines have been installed in more than 1,300 villages in 23 of the 29 states of India. A manual machine costs around 75,000 Indian rupees (US $1100) and can provide employment for 10 people. The machine can produce up to 250 pads a day, which cost about 2.5 rupees (US $0.04) each.

According to a 2011 survey by AC Nielsen, only 12% of India's 355 million menstruating women — compared to 88% in Japan, 64% in China and nearly 100% in Singapore and Japan — use sanitary napkins, with 70% of women saying their family can't afford to buy them. The rest resort to unhygienic alternatives like non-sanitised clothes with cotton, sometimes combined with ashes and husk sand.

Muruganantham, who was recognised in 2014 among Time Magazine’s 100 Most Influential People in the World, shared in a TED talk how he began his movement for sanitary napkins in India.

His machine was reportedly replicated in Jordan to help Syrian refugees.

The impact on the environment

Inspired by Muruganantham, more and more social enterprises have been launched in India to manufacture cheaper sanitary pads. However, there are also the critics who say that focusing on sanitary pads and ignoring traditional cloths used for menstrual hygiene isn't sustainable. Sinu Joseph, a menstrual health educator from India, comments:

The hypocrisy is such that while foreign organizations are promoting the need to introduce sanitary napkins in India by saying that 88% of Indian women are using cloth, in their own country they are promoting reusable cloth pads and menstrual cups, citing environmental reasons. If that is the case, then India is far ahead of the rest of the world in being environment friendly. [..]

What we do need is a simple solution of providing information in schools and communities on maintaining menstrual hygiene, be it with cloth or pads. And leave it to women to decide what they wish to use.

Then there is the question of disposing the pads. The thought of hygienic disposal of sanitary napkins got Kathy Walkling into the business of making biodegradable cloth pads as part of the Indian all woman group Ecofemme that produces and exports fair-trade cloth sanitary napkins from India to 14 countries in the world. Other organisations in India have started producing cheap compostable pads like Azadi pad and Anandi pad.

Menstrual health and hygiene isn’t merely a women’s issue. If a large number of the population is being held back because of a problem which is often ignored then it affects the whole population. If only the policy makers could recognise and accept this truth.