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HEALTH-INDIA: On the Rag Amidst Riches

Ranjit Devraj

NEW DELHI, May 28 2009 (IPS) - For millions of Indian women the colloquial phrase 'going on the rag' can literally mean that, or using just about anything available to stay dry during menstrual periods for lack of access to modern sanitary pads.

Teaching women in Muzaffarpur, Bihar state, to make sanitary napkins Credit: Goonj

Teaching women in Muzaffarpur, Bihar state, to make sanitary napkins Credit: Goonj

At 50 rupees (one US dollar) per pack of five, sanitary napkins are an unaffordable item in the monthly budget of most families in India's impoverished rural areas and urban slums. And like other issues concerning women this too remains unaddressed or is glossed over by gender programmes.

Anshu K. Gupta, founder-director of the non-governmental organisation (NGO) 'Goonj', is convinced that ensuring ready access to sanitary pads can be a major intervention impacting on a range of development goals – from providing better reproductive health care to women to reducing the high rate of girls dropping out of school at puberty.

About three years ago Goonj launched a simple solution to a basic issue. It consisted of collecting old cotton sheets and discarded clothing, cutting them up into strips to be washed and sterilised and packed for distribution at a nominal price or for free to menstruating women.

''We priced each packet of five strips at 3 rupees, which is a fraction of what a packet of regular, branded napkins cost, but distributed most of our stocks free because the main idea is to sensitise the public to a nationwide problem,'' Gupta told IPS during an interview.

Gupta said one aim is to make the lack of access to sanitary pads a subject that can be ''discussed at the dining table''. He referred to the many taboos that surround menstruation in this deeply conservative country which, in many remote areas, dictate that women having their periods be banished to the cowshed. Goonj took on this complex challenge by directly pushing their packets of sterile cotton pads along with hygiene messages in backward states like Bihar or else partnering established grassroots NGOs such as the well-known Spandan Samaj Sewa Committee that is active in central Madhya Pradesh's Khandwa district.

''Typically, women in the villages we visit shy away from the packets we hold out to them,'' said Spandan's director Seema Prakash over the phone from Khandwa. ''But soon we are able to win their confidence and get them to participate in discussions on personal hygiene, especially during those crucial five days of each month.''

What Prakash and her husband Michael consider most valuable was the feedback from the women they met and interacted with in poverty ridden Khandwa. ''Many were glad just to be able to use sterile, absorbent material instead of dirty rags or non-absorbent synthetic material,'' they said.

Prakash said that a surprise development was that Goonj's packets of multi-hued, handmade, sanitary napkins began gaining popularity among relatively better off groups, such as student nurses, because of their cheapness as compared to the branded varieties.

''We are now talking to officials of the union women and child development (WCD) ministry to subsidise the costs of handling and transportation from Goonj's offices in New Delhi to Khandwa so that we can get these packets to as many women as possible at zero cost to them,'' said Michael.

Since the WCD ministry was allocated 72 billion rupees (1.04 billion dollars) in the union budget for the fiscal year 2008-2009 that ended in March, Prakash thinks it can easily afford to cough up a subsidy. On Goonj's part every effort is being made to cut costs to the bone. ''This includes teaching women to wash and dry the napkins in the sun so that they can be safely reused, and this way our napkins are also more environmentally friendly than the costly disposables,'' Gupta said. For Gupta the most important goal is to save women from serious health complications that arise from using dirty rags or other material that may carry pathogens. ''Because menstruation is considered 'polluting' activity women across India think that it is appropriate to use the dirtiest rags in the house, even those that have been used to wipe floors.''

Gupta said it is not unusual to find two or three women in a household using the same piece of cloth or drying it in a secluded spot away from sterilising sunshine just to ensure that it is kept out of sight.

Goonj's records, developed from interactions with thousands of women, show an abnormally high incidence of irritations, infections and poor pelvic health among lower income groups. ''There is evidence enough to link the many cases of cervical cancer that we see with poor personal hygiene,'' he said.

Medical experts agree. Dr. Meenakshi Sharma, a city gynaecologist, told IPS that because menstrual blood provides an ideal medium for bacteria to breed extra hygiene precautions need to be taken. There is also an increased risk of fungal (yeast or candida) infections during menstrual periods because of changing acidic/alkaline balance in the vagina, she said.

Sharma said the fact is that even women from affluent backgrounds who use costly brands of sanitary napkins, tampons and panty liners regularly came into the clinic with infections. ''So what to speak of impoverished women in rural areas and slums who have little or no access to medical care?''

In her experience, said Sharma, women from whatever background tend to lack basic information such as the value of washing locally with mild vinegar as protection from yeast or other infections, which not only cause irritation and discomfort but can lead to pelvic inflammation and worse.

''There is a real need for the government or NGOs to reach out to large numbers of women and help them so that they can help themselves,'' she said.

''It is all very well to give lectures and run programmes on reproductive health, infant mortality and maternity care, but maybe they should start by giving women in this country a few pieces of clean cloth as a good first step,'' Gupta said. ''I know of a woman in Uttar Pradesh [state] who died of tetanus after injuring herself on metal hooks that had not been removed from a rag.'' Gupta said it was astonishing but true that literature on gender mainstreaming in such an area as water and sanitation is often silent on related issues like menstrual management or environmentally safe disposal of sanitary napkins.

Development initiatives, he said, do recognise that a lack of latrines is a major reason for the high rate of girls dropping out of school, but stop short of going into specifics like menstrual management in toilet design or the need to raise awareness among boys. ''There is irony in the fact that massive amounts of money are available for the marketing of branded sanitary napkins, going by the number of advertisements shown during commercial breaks,'' commented Dr. Sharma.

''Surely some of that money could be easily channelised into meeting the basic menstrual needs of the majority of women in this country.''

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