The 28th GST meeting slashed off the 12% tax on sanitary products removing them from the category of ‘luxury items’. A move long overdue, this is being celebrated widely across the country. However menstrual health advocates are wary and remind that this move simply grazes the tip of this iceberg. The decision serves more as a sentimental rather than an economic or socially positive outcome. While it definitely is a victory that the product necessary for a dignified menstruation is finally recognised as an everyday necessity and not an ostentatious indulgence, this decision does not increase the accessibility, affordability or availability of these products to those in need. Quality sanitary pads are still highly priced, let alone non-biodegradable. In other words, period poverty remains an unresolved issue.
To break it down categorically
Lack of Awareness Programmes to Address Misconceptions and Taboos:
Firstly there barely exists any State led interventions with successful execution models addressing menstrual hygiene management (MHM) in a holistic manner. The work done by NGO’s while substantial and impactful is fragmented and geographically restricted as they lack the resources, funding and institutional networks to facilitate wide replication models. There are disparities in the advocacy mechanism as varying methodologies are employed with some focusing specifically on menstrual health and the others diversifying into the allied intersections of adolescence, sexual/reproductive health and nutrition. This means that the on-ground reality both in urban and rural spheres on menstrual hygiene management (MHM) is dismal. Facilitators present at the grassroots, such as Asha workers under India’s Ministry of Health and Family Welfare and school teachers directly and periodically interacting with the communities receive no training to address this issue. A recent change.org campaign reveals the sorry state of Jharkhand and petitions the government for simple MHM services such as information brochures, training mechanisms, impact auditing etc. While in 2016, the Health Department sanctioned Rs. 25 crores to promote menstrual hygiene among school girls through the distribution of free napkins, this is a partial problem solver that fails to teach the girls how to use it, how often to change, disposal process and the basic hygiene standards to be maintained.
Urgent Need to Strengthen Health Care Centres:
In rural areas, primary healthcare centres (PHC) lack specialised doctors, are ill equipped and understaffed to address menstrual irregularities or conditions such as PCOD (polycystic ovary syndrome), dysmenorrhea, heavy bleeding etc. Further, often within the urban poor and in rural areas, lack of nutritious diet both due to poor availability and information means that most adolescent girls do not receive the right quantities of vitamins and minerals required for their growing bodies. They are hence anaemic and malnourished. While healthcare centre-led programmes for providing vitamin supplements and iron tablets to adolescent girls has been initiated across some States, the implementation process is extremely poor. There is an urgent need to strengthen these first response institutions that have the greatest accessibility and interaction with the communities within their surrounding. There is also a need to sensitise medical professionals who don’t necessarily treat menstrual health problems with the same seriousness as others as this is a common physiological phenomenon.
Earlier this year, an elderly woman was suffering from Pelvic Organ Prolapse in Mahad district, Maharashtra, a common medical occurrence in rural areas due to the heavy lifting women do as a part of their daily chores. The pelvic floor muscles supporting the uterus, colon and bowel becoming weak, collapses and starts to protrude out of the vagina. Suffering for the past four years she was hesitant and embarrassed to seek medical aid both because of the stigma surrounding a female reproductive body and because the nearest PHC doctor was a male. Finally, counselling helped her gain confidence and approach a nearby city doctor. Such are the kinds of interventions that are urgently required at a wider scale.
Severe Public Health and Environmental Ramifications Through Non-Biodegradable Products
The third crucial discussion under this domain is of the waste disposal mechanism. In urban areas, 45% of the menstrual waste is disposed off in the household dustbins. This is then either sent to disposal units where rag pickers segregate them with their bare hands, in the process subjecting themselves to harmful pathogens or it is allowed along with the solid waste to enter landfills where it takes over hundreds of years to disintegrate. At present, each month India produces over 1.021 billion pads, that is 113,000 tonnes of menstrual waste annually. Many municipal bye laws have termed this waste rightly as ‘bio-medical’ which requires them to be collected separately and then disposed off in incinerators. However, there is no effective system to monitor this implementation process and hence these rules remain as dead letters on policy papers.
Under the latest amendment to ‘The Solid Waste Management Rules’, the manufacturers have been made responsible for providing disposal pouches along with sanitary products. Sadly, even two years post the enactment of this law, it remains unacknowledged. The result thus is menstrual waste being either callously dumped into the natural ecosystem or lying fallow exposed to the atmosphere posing as a health risk to the public at large.
It is hence imperative that we build stronger narratives to promote sustainable menstrual products. Cloth pads and menstrual cups are eco friendly, chemical-free and cheaper alternatives to sanitary napkins. They rate higher on consumer comfort and usability as well. It is also necessary that we break off the sensationalised media hype that terms cloth as a bad menstrual product. Dirty cloth? absolutely ; but clean, well aired cloth pads do not pose any form of health risk. Clean water and proper sanitation facilities are intersected so these must be equally propagated for successful campaigns. While rural areas lack toilets, the urban ones suffer from poor sanitation and water scarcity.
These are the concerns that urgently need to be addressed. Without this, to bleed with dignity is a far-fetched dream, a GST rate cut is a half baked solution that merely serves to temper the public outcry but fails to make practical ground impact.
The author is the Founder of a social venture that focuses on ‘menstrual hygiene and nutrition’ in India.