While such a criticism seems to have some merit at face value, to get to a realistic picture of this move by the government, as well as understand the ground conditions and various issues surrounding menstruation and sanitary hygiene, Nithin Sridhar, Editor of IndiaFacts conducted a brief interview of Sinu Joseph.
She is an Engineer by qualification, who chose to work in the social space. She has travelled extensively across rural India interacting with more than 17000 adolescent girls and women to really understand their practices and problems pertaining to menstruation, first hand. She is the Managing Trustee at Mythri Speaks.
Nithin Sridhar: With GST coming into the force, there has been some criticism of the government for placing sanitary pads under “non-essential” section and taxing it at 12%. In an article published recently in CNN, Ira Trivedi has criticized that while the government placed sindhoor, bangles, etc. under “essentials” and hence exempt from taxes, the sanitary pads have been placed under non-essentials under GST and hence subjected to taxes. What are your views regarding this?
Sinu Joseph: A sensible discussion on comparing Sindoor-Bangles-Bindi (which are not taxed) Vs. Sanitary Napkins (taxed at 12%) requires us to look at who is being benefited by the GST rates and how.
First, let us look at the women’s items, which are not being taxed – the Sindoor, Bangles and Bindi. While modern feminists look at these items as signs of oppression being promoted by a patriarchal society, the reality is that even if you taxed these items at 28%, which is the highest slab, the women who use it would in no way discontinue it. Do you think women who wear the Sindoor do so because men force them to? Or do you think they will suddenly stop wearing it just because it is taxed more? Of course not. These are cultural symbols, which women carry with pride. Such items are entirely demand and consumer driven. Moreover, in most cases, the manufacturers of such items are small local traders and not mega corporates. So, keeping in mind the manufacturer who is a small time local entrepreneur as well as the huge demand for such products, it has rightly been exempted from taxes.
Now, let’s look at Sanitary Napkins. The latest National Family Health Survey (NFHS) 2015-16 report shows that the use of Sanitary Napkins among Indian women is 48.5% in rural, 77.5% in urban and 57.6% total. (Source: http://rchiips.org/nfhs/factsheet_NFHS-4.shtml). In India, three international brands occupy two-thirds of the market share: Procter and Gamble (P&G), Johnson & Johnson (J&J), and Kimberly-Clark (KCC). Today, 95% of India’s sanitary napkin market share goes to international companies like P&G and Johnson & Johnson. Feminine sanitary products account for a significant proportion of the Indian disposable hygiene market. According to Euromonitor, the Indian feminine hygiene product market has reached 22.21 billion Rupee ($340 million) and is expected to reach 34.68 billion Rupee ($522 million) in 2020. (Source:http://www.nonwovens-industry.com/issues/2017-03/view_features/the-indian-hygiene-market-exhibits-huge-potential/).
From the above, it is evident that Sanitary Napkins are essentially a supply driven commodity. And the manufacturers are large corporates. Over the last few years, I have been approached by four Sanitary Napkin manufacturers and three menstrual cup manufacturers with the same objective – help us enter the rural Indian market. With Sanitary Napkin supplies getting less popular in developed countries where tampons and cups are more popular, markets like India become a necessity for them to sustain. If you look at the top Sanitary Napkin brand sold in India, and look at the same product sold in developed countries, you will find that it is a poorer quality product that is sold in India. So what feminists are essentially fighting for is to help the corporates dump their supplies in India. In the name of CSR, feminism and social enterprise, Sanitary Napkins have been pushed into the Indian market by NGOs and international charitable organizations on behalf of the corporate manufacturers. Now, why should the government ease business for these foreign corporate enterprises?
It is a big myth that women who do not use Sanitary Napkins do so because they cannot afford it. In all my interactions with more than 17000 rural girls and women across India, the main reason why women use cloth is because they “prefer” it. It is softer, non-allergic, familiar and does not litter the environment. So why do the social engineering by dumping Sanitary Pads on them?
Removing the tax on Sanitary Napkins assuming it will get more women to use these products will have the same effect as increasing the tax on alcohol and cigarettes thinking people will stop using these. It would make no difference to the consumer. But in the case of Sanitary Pad manufacturers, it would really multiply their billions. The real question is, why are the feminists becoming the mouth piece of large corporates by pushing for removal of taxes for Sanitary Napkins?
NS: The menstruation hygiene debate in India has often focussed on the spread of usage of sanitary pads. Reports, Opeds, etc. have often quoted that only 12% of women in India can afford sanitary pads and the rest i.e. 88% depend on scraps of cloth, newspaper, ash, wood shavings, dried leaves, hay or even cow dung. The argument is that these stats show how low the awareness about menstruation hygiene in India is. But, as an activist who is working in this sector for many years and having first hand ground experience, you have expressed your reservations about these statistics. Can you shed some light on how these statistics were arrived and why you disagree with them?
SJ: Majority of the time, the articles published on menstruation are poorly researched, if at all researched. To understand the actual penetration of Sanitary Napkins in the Indian market, we need to look at research papers or national surveys, which the public has access to. The A.C. Neilsen & Plan India 2011 study, which apparently says that only 12% menstruating women in India use Sanitary Pads, is not even a published study. Till date, I haven’t found a single journalist, researcher or NGO who quoted this study to be actually possessing a copy of it. To verify the authenticity of this study, last year we (Mythri Speaks Trust) reached out to the Society for Menstrual Cycle Research (Boston) & WASH to see if they had access to this study. SMCR said that despite their best efforts, all they could get was a presentation (.ppt format) from the NGO Plan India. WASH, the organization responsible for bringing Menstrual Hygiene Management (MHM) to India, now says that this study is “problematic”. So this study has been taken off SMCR, WASH and the National Guidelines on MHM because of its questionable nature. Therefore, any reference to it should not even be taken seriously, let alone use it for debates and discussions on menstruation.
The most reliable survey in this regard is the latest National Family Health Survey (NFHS) 2015-16 report, which shows that the use of Sanitary Napkins among Indian women is 48.5% in rural, 77.5% in urban and 57.6% total. This is what we need to refer to, if we are to have sensible discussions on this issue.
I would like to add that in all my interactions with rural women across 9 states in India, which included Bihar, Jharkhand, Assam, Meghalaya, Nagaland, Manipur, Karnataka, Kerala and Maharashtra, nowhere have I found women using hay, mud, cow-dung and all the other nonsense that is written about. Nor do we find any evidence of usage of such items in published research papers on menstrual hygiene in India (we studied over 100 published researches). So it is obvious that such information has no basis in the reality of the situation in India. It is unfortunate to note how low we can go just to sell a product.
NS: Can you briefly share a realistic assesement about menstruation hygiene situation in India? What problems does young girls face, both in urban and rural areas? What level of awareness is prevalent among them?
SJ: The first thing we need to understand is that menstrual blood is not a bodily waste which can cause “hygiene” problems. In fact, the menstrual blood is the most potent bodily fluid given that it contains highly regenerative stem cells from the endometrium. So much so, that now Menstrual Blood Banking (similar to umbilical cord banking) is gaining popularity. The stem cells from menstrual blood are capable of curing complex diseases and this is a new area of research.
The second thing we need to know is that none of the menstrual disorders have any connection to menstrual hygiene. Whether it is Dysmenorrhea (period pain), Menorrhagia (Heavy Menstrual Bleeding), Amenorrhea (absence of periods), PCOD or Endometriosis – none have anything to do with what product you use during menstruation. It is such a wonder how so much hype has been created around “Menstrual Hygiene” when it is not even a real issue. The closest we can come to theorising a problem due to poor menstrual hygiene is bacterial vaginosis / RTI. However, here again there is no evidence of any existing research, which can prove beyond doubt that this is due to poor hygiene. A study by London School of Hygiene & Tropical Medicine, which looked at 14 articles to understand possible correlations between MHM and RTI found that there was no association between confirmed bacterial vaginosis (typically characterised by excessive white discharge) and MHM. It also mentions that “The body of evidence to support the link between poor MHM and other health outcomes (secondary infertility, urinary tract infections and anaemia) is weak and contradictory.” The study concludes by stating that “It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear.”
So then what problems do adolescent girls face when it comes to menstrual hygiene? The answer is the same whether it is an adolescent girl from rural India, urban India or even from a “developed” country – the fear of staining and the embarrassment that goes with it. Internationally, Chella Quint, a period positive activist has spoken about how the biggest menstrual issue reported in schools in UK is the fear of leaking. So you see, we are the same universally and our problems too are not greatly different. In this case, the solution lies in normalising conversations around menstruation and staining, so that young girls do not hesitate to take the needed toilet breaks during their period.
NS: It has also been suggested that young girls drop out of schools in India due to poor menstruation hygiene practices and perhaps non-availability of sanitary pads. Can you shed some light on this issue?
SJ: Having functional toilets in schools is an absolute must, not just for girls. But, unnecessarily connecting it to menstrual hygiene seems more agenda driven than real. Let’s look at what existing studies reveal. Here is what we found when we studied published research on this subject – https://mythrispeaks.wordpress.com/2016/06/13/menstruation-rhetoric-research-reality/
A comparison of data owing to school absenteeism during menstruation in developing nations shows that the percentage of girls who remain absent during menstruation is around 12.1% in China, 15.6% to 24.2% in Nigeria, 24% in India and 31% in Brazil.
If the current hypothesis – that school absenteeism is due to lack of toilets or Sanitary Napkins – is true, then surely developed countries must have little or no absenteeism. However, data indicates that it is no different in developed countries as well.
Studies indicate that 17% teenagers in Canada, 21% in Washington D.C, 24% in Singapore, 26% in Australia and 38% in Texas miss school owing to menstruation.
More interesting is that the reasons for missing school have nothing to do with Sanitary Pads or Toilets; in most cases, it has to do with Dysmenorrhea (pain during menses). A study of girls having Dysmennorhea in the U.S showed that 46% miss school due to period pain.
The study by The London School of Hygiene & Tropical Medicine, which looked at 14 studies states:
“Despite the apparent acceptance in WASH policies that menstrual management affects attendance of adolescent girls at school there is very little high quality evidence associating school attendance or drop-out with menstrual management. The only published study identified found no association between provision of a menstrual cup and school attendance. An unpublished study by Scott et al found significant improvements of 9% to 14% in recorded class attendance from access to sanitary napkins and/or MHM education but full details of the study methods and results were not available at the time of the review. A systematic review into the linkages between separate toilets for girls and school attendance was inconclusive. The data were analysed without taking account of age with respect to menstruation and MHM provisions in school may have been among the influencing factors. No studies were found, which addressed provision of pain medication or other factors that may have a bearing on attendance or drop-out rates. We cannot therefore report that the current evidence indicates improved MHM improves attendance at school.”
Another important study was undertaken by American Economic Association, which conducted a randomized evaluation of Sanitary Products to school girls in Nepal. They collected daily data in Nepal on girls’ school attendance and menstrual calendars for up to a year. The study came up with two findings-
“We report two findings. First, menstruation has a very small impact on school attendance: we estimate that girls miss a total of 0.4 days in a 180 day school year. Second, improved sanitary technology has no effect on reducing this (small) gap: girls who randomly received sanitary products were no less likely to miss school during their period. We can reject (at the 1% level) the claim that better menstruation products close the attendance gap. We conclude that policies to address this issue are unlikely to result in schooling gains.”
NS: You have done extensive research on menstruation practices, the do’s and don’ts in various local communities. Though, these practices have often been branded as taboo and superstition, you have often pointed out the positive aspects of such practices and their connection to Ayurveda. Please shed light on this.
SJ: When we fail to understand menstrual practices, we end up terming them as Taboo. No matter how hard we try, we cannot successfully explain cultural practices in India, especially those pertaining to menstruation, using the lens of modern medicine. Modern medicine has only gone so far as the particle level and treatment as well as understanding of diseases happens at this level. Whereas Indian sciences have gone further in their understanding and explored subtler forces, which impact life and disease. The closest that western science has come to this is the quantum theory. However, we do not see the application of quantum science and treatment of disease in western medicine. Therefore, modern medicine really falls short in explaining our cultural practices.
To understand the reasons behind menstrual practices, we need to study the ancient sciences on the basis of which these practices were put in place. Ayurveda is neither taught in schools nor in colleges as part of the overall curriculum. So the basic understanding of the human body through Ayurveda is itself new. Unless these basics are included in our system of learning, we will continue to term our cultural practices as superstition and taboo. Those interested, can watch my TEDx talk on this subject titled “The Super Science Behind Menstrual Practices” – https://www.youtube.com/watch?v=6dI4L1B9QH0