INDIA GENERATES AN ESTIMATED 13 TONNES OF MENSTRUAL WASTE ANNUALLY IN THE FORM OF 12.3 BILLION DISPOSED SANITARY PADS, A STUDY FOUND
Posters of the film Padman, with Akshay Kumar clutching a sanitary pad like a Wimbledon Trophy have made the sanitary napkin far more visible than ever before. While it remains to be seen whether the movie will stop chemists across India from handing sanitary napkins to women without first wrapping them in a newspaper or a black polythene bag, urban women have moved on to using more convenient products to deal with their monthly period.
For 26-year-old Purvi Gupta, using a menstrual cup was a life-changing experience. “When I first used the cup last year, I realised I almost forgot I was having my period. It works best at night when I can sleep without worrying about staining,” she said.
It lowers the risk of rashes too. “I had read about it but products like menstrual cups and menstrual panties were not readily available in India a few years ago. Now you can choose from a wide range of products on online retail websites, with good quality cups costing as little as ₹ 200 to ₹300,” said Gupta. In India, nearly 58 per cent of women between the ages of 15 and 24 used hygienic methods of menstrual protection, found National Family Health Survey (NFHS) 2015-16. “This means around 42 per cent of the women were still using unhygienic methods, which lead to infections. Our first aim is to ensure women use hygienic products and since disposable sanitary pads are the cheapest and the most readily available, most organisations promote their use,” said Dr Surbhi Singh, a Delhi-based gynaecologist who runs a non-profit organisation called Sacchi Saheli to promote menstrual awareness and health among adolescents.
Of the people who use hygienic menstrual protection, 42 per cent use commercially available sanitary napkins, according to the NFHS data.
Disposable sanitary pads, which contain chemicals, gels and plastic sheets to make them more absorbent and leakproof, create a lot of waste that is poorly managed. India generates an estimated 13 tonnes of menstrual waste annually in the form of 12.3 billion disposed sanitary pads, according to a report by PATH, Water Aid and Water Supply and Sanitation Collaborative Council.
“This is just an estimate. If 121 million women in India use two pads for four days a month, one billion pads are discarded every month,” said Arundhati Muralidharan, who works in the policy team of Wateraid India. “To manage menstrual waste and promote menstrual hygiene, people can opt for reusable products,” said Muralidharan, who uses cloth pads to lower her carbon footprint.
Priyanka Jain, 32, the founder of the Hygiene and You website dedicated to promoting the use of sustainable menstrual products, first used a cup when she was in sanitary pads tillill ththen. The only proproblem em was I couldn’t go swimming. So I started looking for alternatives and discovered menstrual cups on Google,” she said.
Three years ago, she thought of promoting it in India. “I realised that most people had the same set of queries, so I started the website that answers 15 or 20 basic queries and creates awareness through articles and videos,” she said.
She switched to cloth pads when she introduced it on her website. “I needed to try it first to persuade people to use it. Cloth pads are easily washable, much more comfortable than the disposable sanitary napkins, does not cause rash and does not smell awful,” she said. Now, she has a line of cloth pads too.
“In the last year or so, more and more people have moved to these sustainable options, but it is still a minuscule percentage,” she said. Using cloth, say gynaecologists, is not the best solution. “The ph of the vagina becomes alkaline during the menstrual cycle and cannot stop bacterial growth as effectively as the acidic vaginal fluid. This means that if it is not cleaned properly, the cloth can become a source of infection,” said Dr Jyotsna Suri, professor of gynaecology, Safdarjung hospital.
“The cloth pads have to be washed and dried in the sun, and I don’t see many women doing that,” said Dr Singh.
Many women don’t like products that need to be inserted. “From the years of experience, I have learned that women in India are not comfortable with manipulating something in their genitalia. They do not like products that have to be inserted, especially before marriage. This is the reason tampons never took off in India and why menstrual cups are difficult to promote,” said Dr Suri.
Commercial products like silicone cups, padded panties, cloth and jute pads are alternatives that cost more than the ubiquitous pad. “In the longer run, the reusable products are economical, but for the poor, it is impossible for many to shell out ₹ 300 to ₹1,000 in one go. A pack of pads for ₹25 is affordable,” said Dr Singh.
Adecade ago, condom promotion as part of HIV prevention campaigns was so ubiquitous that the moral police started counter-campaigns alleging it destroyed the nation’s culture and heritage. It didn’t. What it did was lower HIV infections from an estimated 5.1 million in 2003 to 2.1 million in 2017.
With annual new infections hovering around 80,000 over the past five years, complacency set in with a visible shift to other priority health programmes. The budget outlay for the National AIDS and STD Control Programme stagnated and HIV awareness hoardings were replaced with campaigns promoting immunisation, contraception and tuberculosis prevention and treatment.
India’s overall health budget increased by ₹5,437 crore – an 11 per cent increase over 2017–to ₹52,800 in 2018, the outlay for AIDS went up by ₹ 100 crore, from ₹ 2,000 crore in 2017 to ₹ 2,100 crore in 2018.
It’s not enough. India’s large population base of 1.32 billion makes it home to the world’s third largest HIV population of 2.1 million, after South Africa (7.1 million) and Nigeria (3.2 million), even though as percentage of the population, infection levels are low. Adult HIV prevalence in India is 0.28 per cent, compared to South Africa’s 18.9 per cent, shows UNAIDS data for 2017.
The majority of the budget allocation for HIV and AIDS is spent on counselling, testing and antiretroviral therapy (ART), which is given free to treat everyone who tests positive for HIV. There’s little money left for information, education and communication programmes that are central to prevention and lowering stigma. The high number of people who tested positive for HIV in Unnao in Uttar Pradesh over the past few months has put the spotlight on the threat of undetected cases in some districts of states like Uttar Pradesh, which have a low overall prevalence compared to the national average of 0.28 per cent.
While HIV prevalence is falling in traditional high-prevalence states such as Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu and Telangana, new pockets of infection have emerged in Uttar Pradesh, Gujarat, Bihar, Delhi, Chhattisgarh Rajasthan, Odisha and Jharkhand, shows the National AIDS Control Organisation’s (NACO) biennial HIV Sentinel Surveillance 2016-17.
Of the 14 sites with more than two per cent prevalence, five were in Bihar, Chhattisgarh, Odisha, Rajasthan and Uttar Pradesh, while one-third of the 56 sites with more than one per cent prevalence were in Bihar, Chhattisgarh, Delhi, Gujarat, Jharkhand, Odisha, Rajasthan and Uttar Pradesh.
Treating and suppressing HIV viral load not just lowers symptoms and keeps people living with HIV disease-free, but also makes their chances of infecting others negligible. While there is no study for
India, using ART to treat HIV can add 10 years to life and gives a 20-year-old who starts treatment a “near normal’ life expectancy of 67 years in Europe and North America, found an analysis of 18 studies of more than 88,500 people, reported The Lancet HIV in August 2017.
A study to compare life expectancies of people with HIV at age 20 showed those with the infection were 13 years behind healthy persons, found a US study in 2016. The effect of HIV on life expectancy is almost comparable with people who have
uncontrolled diabetes. This information, however, has clearly not trickled down to Unnao, Premgunj village, from where 50 of the 58 confirmed HIV cases have been reported, and which has been labelled an “AIDS village”. People from the village have been ostracised and are being shunned by former friends and extended families, who want to have nothing to do with people they believe are “tainted” with HIV because of its association with unsafe commercial sex work and injecting drug use. No one seems to know that getting treated can keep them healthy and symptom free. The unlicensed medical practitioner accused of spreading the infection by using contaminated needles is guilty of quackery, but is highly unlikely to have been the cause of the high HIV prevalence in the village. Giving intradermal injections is unlikely to have caused an infection that spreads through body fluids such as blood, breast milk, semen and vaginal fluids through direct contact or through the use of an infected syringe or needle.
In India, unprotected sex with an infected person and injecting drug use are the leading causes of new infection, and not touching, saliva, tears, sweat, sharing toilets, sharing meals or insect bites. If prevention and ART is not used to contain infection in districts like Unnao, stigma will remain and India will not be able to shake loose the threat of an HIV resurgence.
I was 19 and had used only disposable sanitary pads till then. The only problem was I couldn’t go swimming. So I started looking for alternatives and discovered menstrual cups on Google.