From the time we’re children, we’re constantly told that health is wealth. Yet, when it comes to menstrual hygiene, the popular adage falls apart, and an uncomfortable silence takes its place.
This silence is the reason why so many young girls in India are unaware of what their bodies undergo at menarche. It’s why we can’t seem to ask for pads and tampons without whispering at the chemist’s. And it’s also why a 12-14.5% goods and services tax (GST) on sanitary napkins has gone unchallenged for so long. Yes, we have begun to break that silence, but universal access to sexual and reproductive health-care services is still scarce. Especially when it comes to marginalised groups, like sex workers.
“Menstruation is still a taboo in our country,” says Dr Smarajit Jana, a founder and chief advisor of Durbar Mahila Samanwaya Committee (DMSC), a Kolkata-based sex workers’ collective. Talking about the challenges faced by sex workers in accessing products like pads and tampons, he says, “We cannot talk openly. Even shop owners cannot talk very openly; they have to go very close to the compound and whisper to them ‘What do you want to buy’, and then put it in a black bag.”
For many sex workers, however, even purchasing that pad can be a luxury. As per studies conducted by DMSC, Dr Jana says that around 40% of sex workers still use cloth, instead of sanitary napkins.
“In the redlight district cloth doesn’t dry properly,” he adds. Obviously, using damp, unclean cloth comes with its own consequences. Yeast infections and vaginitis are common, but they pale in comparison to long-term problems like pelvic inflammatory disease, or sexually transmitted infections like trichomoniasis that some women suffer from.
According to the United Nations, only half of all women in developing regions like India receive the recommended amount of health care they need. In the case of sex workers, even information about health care is absent.
“Pehle pehle toh hum kapda use karte the, kyunki jaankari nahi tha (Initially, we would use cloth, because we didn’t know better),” says Bharati Dey, Secretary of DMSC. “Har sal, hum har area mein meeting kartein hain, menstrual hygiene pe (Now every year, we conduct meetings on menstrual hygiene in different places).” Such programmes have really changed things for the better, but unfortunately, efforts like these are few and far between in India.
Speaking to YKA, social worker Aysha Mahmood says: “Many projects concentrate on educating them about safe sex and their rights. But my feeling is that sanitation and hygienic living on the whole has not yet been made easy for them.”
That’s not all. Things become doubly complicated for sex workers, since they are marginalised by the law as well. Mahmood worked for 4 years in women’s prisons in India as a psychiatric counsellor, and a point person for the Kerala State AIDS Control Society. In these prisons, she says, more than half the inmates were sex workers. Conditions were bad, she explains, as they were not provided sanitary napkins or underwear, that the appointed doctor was hardly ever available, and lady doctors even less. In fact, for the last few years, Mahmood and her friends have spent Women’s Day distributing sanitary pads in these prisons.
This isn’t to say that those who stay under the police’s radar have it easier. In the trade, one’s health is quite literally their wealth. If you want to continue seeing clients and earning money, you have to be in a condition to do it. Dey talks about how, previously, HIV intervention programmes were able to increase the use of condoms. “Vaise hi menstrual hygiene campaigning ke baad sanitary pads ka use badh gaya hai (Similarly, after campaigning for menstrual hygiene, the use of sanitary pads has increased).”
Dr Jana adds that, “Non-specific STIs are very high among the community, even after 15 years of our HIV intervention programme. So explaining to sex workers how and why they should have hygienic practices is important.”
But just how achievable is that? After all, sanitary pads are so heavily taxed. Dr Jana says that for low-income category sex workers, it’s an economic burden. And like so many people across the country, he favours a withdrawal of the tax on condoms and sanitary napkins. There is of course much more that needs to be done, and this is where the issue ties up with the country’s dismal reality of sanitation. Only 60.4% of people have access to toilets. Hand-washing facility with soap and water are also rare. And all of this combined poses massive obstacles to good menstrual health.
As a signatory to the United Nations Sustainable Development Agenda, India has a duty to ensure good health and wellbeing for all its citizens – especially sex workers and other marginalised groups. Reducing mortality and sickness caused by unsafe sanitation and lack of hygiene is a non-negotiable. We need national strategies and programmes on reproductive health care, and we need to empower people to ask for them.The government must incorporate menstruation in its efforts to achieve adequate and equitable sanitation and hygiene for all. To achieve all this by 2030, as part of our commitment to the agenda, we must work extra hard to do right by those vulnerable situations.