Is a sanitary pad enough?

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Suchita Shah

Suchita Shah

Suchita is a family doctor, public health consultant and primary care tutor at Oxford University who has an MPH from Harvard and an MPhil in International Relations from Cambridge University. She has a diverse range of interests, including global primary care, health systems, medical education, digital health, and the nexus between health, law, and policy. She has been a physician in the UK National Health Service for many years and also has extensive experience working abroad. She loves travel, literature, writing, and the arts, and contributes regular blogs to the British Medical Journal.

In a timely lead-up to International Women’s Day on Saturday, this  almost incredible story, about an uneducated South Indian man inventing a low-cost technology to make sanitary pads more widely available to rural women, has been doing the social media rounds.

Earlier in the week, I had declared to my friends that it was ‘utterly wonderful’. And it is, indeed, remarkable in many ways: a man, Arunachalam Muruganantham, recognises a problem faced by women. Against seemingly insurmountable odds, he finds a solution to it. He gives up patent rights over a product that could make him a fortune. He also swims against popular prejudice, for a time alienating even his own wife and mother. All to better the lives of others. In short, this is a tale of successful grassroots innovation, with a happy ending, and a distinct two-finger salute to corporate greed. Bravo.

Re-reading the article, however, I paused to think a bit. And this really is just a thought-out-loud, rather than an immutable opinion – a thought by no means intended to diminish the inevitable warm glow that comes from reading such a story, but rather to consider the wider context and implications of a seemingly impeccably tidy narrative.

One paragraph reads “[t]here are still many taboos around menstruation in India. Women can’t visit temples or public places, they’re not allowed to cook or touch the water supply – essentially they are considered untouchable.”

Many religions – throughout the world, not just in India – consider a woman to be ‘impure’ if she is menstruating; she is expected, among other things, to rest, not to enter places of worship, or to prepare food. If you have ever had the misfortune of experiencing heavy and painful periods, you will know how it can be – horrible, messy, debilitating even. For many women with menorrhagia and dysmenorrhea, such as those I see regularly in my clinical practice, single protection (i.e. just a pad) isn’t enough and a day in bed is all they want. In many parts of the developing world, where I have also found myself, painkillers are largely unavailable, manual work is the norm and the needs of the family or community usually outweigh those of the individual.

I wonder, then, whether in this context you might not welcome some – albeit enforced – respite from the arduous grind of daily life. I am obviously not condoning the vilification or enforced seclusion of menstruating women but, writing as a woman who grew up surrounded by some of these religious and cultural orthodoxies, I think that knowing which battle to fight first is key. Things are never black and white. Women in patriarchal societies are often dismissed as helpless victims, rather than credited for their strength and resourcefulness in navigating complex power politics.

But here’s the line that made me pause. Regarding the state of Bihar: “Here, women often have to walk for miles to fetch water, something they can’t do when they are menstruating – so families suffer.”

What is the implication here? By focusing on the pragmatic, bottom-up solution perhaps we are at risk of ignoring the elephant in the room, i.e. why, in 21st century India, anyone (menstruating or not) should have to walk miles to fetch water. Will the kind of ‘enablement’ implied here allow the Indian state, caught in a maelstrom of economic growth, to abrogate its responsibility to provide clean, accessible water – a basic human right – to all its citizens?

Slate magazine recently ran the headline ‘The man who made the period safe for the women of India’. A disposable sanitary pad is undoubtedly more hygienic than a reused dirty rag. However, if you don’t have a waste disposal and collection system, or running water, or soap, or somewhere to carry out your ablutions safely, or basic knowledge about menstruation – all the things many of us take for granted – then will it alter women’s lives as radically as this story seems to suggest? Are we being falsely enticed by technology and ‘things’ over meaningful and lasting systemic change? Or is the technology itself a welcome precursor, or adjunct, to such change?

People are beginning to debate these kinds of questions, and this is where those three dreaded words, Monitoring and Evaluation, become pivotal. There are some studies evaluating outcomes of sanitary pad interventions, mostly relating to educational attainment in African schoolgirls. 1 In India the potential reach of Mr Muruganantham’s invention holds promise for a more rigorous evaluation method, such as a cluster randomised controlled trial. Whether the low cost sanitary pad will bring about lasting change and command acceptance from those whose lives it will affect remains to be seen. I sincerely hope so.

Thanks to Nimalan Arinaminpathy and Aparna Nair for their comments on this article.

1. For example, see Montgomery et. al. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0048274