New Delhi: Using a hygienic method to manage periods is important for women’s health and personal hygiene. The National Family Health Survey considers locally prepared napkins, sanitary napkins, tampons, and menstrual cups to be hygienic methods of protection. In India, 64.4 per cent of women aged 15-24 use sanitary napkins, 49.6 per cent use cloth, 15 per cent use locally prepared napkins and only 0.3 per cent use menstrual cups. As per the report, it is important to note that the respondents may report multiple methods so the sum of people using a hygienic method may exceed 100 per cent. Overall, 77.6 per cent of women in this age group use a hygienic method of menstrual protection, states the national report of NFHS-5 released by Union Health Minister Dr Mansukh Mandaviya on May 5.
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Banega Swasth India team spoke to experts to understand how safe it is to use cloth during menstruation. Dr. Arundati Muralidharan, Menstrual Health Alliance India said,
As per NFHS’ definition of hygienic methods of protection, cloth is unsafe but I consider cloth to be a menstrual product as well – that can be used hygienically with information and support. If you use a sanitary pad for 10 hours and do not practice personal hygiene, you can get a rash and an infection, and you can feel uncomfortable. For me, it is the hygienic use of a menstrual product that is safe and that product could be a sanitary pad, clean cloth pad, or menstrual cup. When you say cloth, there are stitched pads, unstitched pads, homemade pads, readymade pads, not just rags. We have options now.
Further interpreting NFHS data, Dr. Muralidharan said that the percentage of menstruators using a cloth indicates a potential to promote a basket of menstrual products among them. These menstrual products range from a regular sanitary napkin to compostable pad, different types of cloth pads, menstrual cups and tampons.
Riya Thakur, Senior Specialist – Youth and Adolescence at Population Foundation of India said,
Cloth pads can be safe to use as long as they are used hygienically. Cloth pads must be washed properly, dried under sunlight, and stored in dry and sterile places. When menstrual and personal hygiene is not practised, it can lead to infection. For proper menstrual hygiene management, women also require privacy to change materials, and access to proper disposal mechanisms. India needs menstrual hygiene literacy to combat these challenges as well as access to clean and functional toilets and disposal mechanisms.
Dr. Rahul Manchanda, Gynae Endoscopic Surgeon at Pushpawati Singhania Hospital and Research Institute (PSRI Hospital) said, using a cloth is not the best option considering the hygiene factor. He said,
If the same cloth is used repetitively and not washed properly, it can cause a lot of infections, eventually Septicemia or Toxic Shock Syndrome. Blood as it is a great breeding ground for infections. Also, the cloth being used should be good for your skin. Synthetics can cause irritation, infection and allergy. If one has to use a cloth, it should be clean and cotton.
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Additional findings of the latest National Family Health Survey (NFHS-5):
The NFHS-5 shows a direct link between education, wealth and hygienic methods of menstrual protection. Only 43.5% of women aged between 15-24 years with no schooling use hygienic method. On the other hand, 90.3% with 12 or more years of schooling use hygienic method.
Schooling is linked with socio-economic status, so greater schooling can mean greater exposure to information, perhaps more financial resources in some instances. Many government schemes actively provide pads in schools, especially for girls from class 7 onward. This can explain why girls who stayed on in school had access to pads, said Ms Muralidharan.
Women in the highest wealth quintile are almost twice as likely to use a hygienic method as women in the lowest wealth quintile (95.1% versus 53.6%).
Further explaining the link between education and wealth and the usage of hygienic products, Dr. Muralidharan said,
The more educated you are, there is a certain kind of exposure that you have to sanitary pads. The higher your income status and your family’s income status, you are going to probably purchase sanitary pads because you think that is the product that’s also because you have received limited information on other products. But, in big metro cities like Delhi, Mumbai, and Bengaluru, you see middle income and higher income women using menstrual cups some of which are really expensive. In rural areas, several NGOs are supporting cup use with very promising results. Income and education are not the only factors – awareness, access to and support for alternative products play a critical role in uptake.
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Similarly, women living in urban areas are more likely to use a hygienic method (89.6%) than women living in rural areas (72.6%). Talking about the same, Ms Thakur said,
Women’s social location often determines their access to proper menstrual hygiene. Improving menstrual hygiene requires investment in girls’ education, alongside extensive social and behavior change communication campaigns to change social norms and behaviours.
In terms of states with the lowest percentage of women using hygienic methods of menstrual protection are Bihar (59%), Madhya Pradesh (61%), and Meghalaya (65%). The best performing states are Southern states and UTs – Puducherry (99.1%), Andaman and Nicobar Islands (98.8%) and Tamil Nadu (98.4%).
Considering a wide variety of options of menstrual hygiene products, what is preventing the adoption of these and what can be done to improve the access? Dr. Muralidharan said,
One is awareness. The perception is that girls and women in rural areas should have access to sanitary napkins because they can’t use cloth properly or they won’t use cups. So we do not introduce a basket of products to them. My experience and learnings from the field suggests that If we create awareness, provide support and access to a basket of menstrual products, and discuss with them the benefits and challenges of these product options for their bodies and contexts – girls and women will choose and we will be surprised by the choice. Quality products, accessible products and choice are critical for menstrual health and hygiene.
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NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.