At 22, Anchal Srivastava from Lucknow is a rare millennial working on a simple but arduous task of changing the menstrual hygiene habits of Indian women. As a management student studying in Rajasthan, Anchal started a campaign on campus on how to use a sanitary pad. In a girls’ college, some of her classmates found it strange, at times even embarrassed by her conversations with the women labourers on campus on how they “managed” their periods. Do they use clothes? Have they heard of sanitary pads? Do they know of menstruation related infections? Most women confided to Anchal about their apprehensions in using pads.
Some said they would get pregnant if a man saw their disposed-of pads, others thought it was too “dirty”, and those who wanted to use them were deprived because they were unaffordable and, worse, inaccessible. In the face of these barriers, many women ended up stuffing their undergarments with sand, leaves or ashes during their monthly periods.
For Anchal, it was a personal experience of her mother’s ovarian cancer, which started as a vaginal infection, that inspired her to take up the taboo regarding menstruation in the country. “After her recovery from cancer, my mother told me and my sister about the dos and don’ts of menstrual hygiene management. It’s not just the story of my mother but of millions of other women in India suffering from the same cause and I wanted to bring about a change in menstrual hygiene management; as it’s a matter of dignity for every woman,” Anchal told ET Magazine.
For Indian women, menstruation is much more than biological; it is one more way of perpetuating gender discrimination. Superstitions and cultural taboos associated with periods have persisted at the cost of women’s health and safety, which is yet to be penalised under law, unlike in certain countries like Nepal that criminalise discriminatory practices related to menstruation.
It took a landmark and complicated tax reform, the good and services tax (GST), to restart the conversation around menstrual hygiene in the country.
Question of Quality
The debate around “pad tax” is an old albeit crucial issue. However, in all their earnestness in addressing the importance of sanitary pads in improving women’s health, the rights groups have missed a crucial point that is not about taxation but about product categorisation. Sanitary pads are put under “miscellaneous items” — the same category in which pencils, towels and crayons are also placed. An essential commodity and hygiene product should ideally come under “health”.
“India is one of the countries with the highest rates of cervical cancer (it accounts for almost 23% of all cancers in Indian women, with only breast cancer being higher at 27%). Studies show a direct link between HPV infections (cause for cervical cancer) and poor menstrual health, so I want to lobby to the government to treat this as a drug or a medical device so that it is well regulated,” explains Sahil Dharia, founder of Soothe Healthcare, one of the new entrants in the low-cost sanitary napkin manufacturing space. “It is idiotic that such an essential product does not have stringent quality checks,” he adds.
Dharia, whose Paree brand is reaching out to the low-cost mass market segment, feels that many companies are claiming to sell biodegradable or reusable pads, which is completely “trash talk”. And in the absence of any quality checks, as in the case of a drug, these companies are allowed to flourish. In most regulated drug markets, feminine hygiene products like sanitary pads or tampons have to pass their drug regulator’s muster.
For example, the US Food and Drug Administration regulates this segment as a “medical device”, which means companies have to follow a bare minimum quality muster regarding the quality of the cotton, the use of gel, perfume, among others. In the Indian context, it is ideally the Drug Controller General of India who should be ensuring that Indian women have access to quality sanitary pads; such products should also be put under the National List of Essential Medicines, which could control the price as is the case in some medicines.
“The taxation per se is not something that is going to hurt companies as there is enough leeway to claim input credit,” says Suhani Mohan, cofounder of Saral Design, a Mumbai-based manufacturer of low-cost sanitary pads. Saral is looking at reaching out to those women whom large MNCs like Procter & Gamble and Johnson & Johnson, the market leaders, don’t address. Mohan adds that even under the current government’s procurement system of sanitary pads in national health programmes, the quality requirement for tenders is outdated. “The quality certification for manufacturers still refers to a 1980 guideline; we have moved so much ahead of that.”
Nearly 80% of Indian women do not use sanitary pads. This is when countries like Indonesia, Thailand and China have managed to reach over 50% penetration in this space. In China the manufacturing boom in the late ’90s resulted in an explosion of domestic manufacturers who flooded the market with new brands, vast distribution networks and targeted marketing campaigns that replaced the traditionally habit of cloth usage.
A tax expert from a global consultancy firm says that the current debate on “pad tax” is shrill and misplaced. “Even if sanitary napkins are considered a medicine they will be taxed as in current GST (drugs attract a 12% rate). What we need are slabs,” says the indirect tax expert who advises MNCs like P&G and J&J. “Tax and health policy should be intertwined; when one wing of the government is promoting the use of sanitary pads by giving it free to schoolgirls, you cannot have another wing that adopts a regressive tax practice.” The GST Council, for its part, displayed fine balancing when it came to imposing cess on cigarettes and pan masala, keeping in mind the health ministry’s initiative to discourage the use of these products, but the same principle was not applied to sanitary pads. Irked by the outrage, the government has defended its move stating that the current rate actually is lower than what the companies would have paid otherwise.
“Considering that these products are used across all sections of society, the government could consider a price slab-based system with differential rates. This practice has been adopted in respect of footwear and apparel in order to ensure that the tax impact on the less affluent consumers is lower than that on more affluent sections of society. The feasibility of taxing the product in three appropriately determined price slabs at 5%, 12% and 18% should therefore be evaluated. This would enable both the social objective of promoting usage and the financial objective of tax collection to be achieved in a harmonious manner,” says MS Mani, partner, Deloitte India.
If affordability is an issue, perhaps a bigger one for many women is accessibility. Dharia of Soothe Healthcare says that a decade ago young women dropped out of school when they reached puberty and a simple intervention like a pad has turned around those statistics. In Karjat, a two-hour local train ride from South Mumbai, ET Magazine met with a group of ASHA workers who have become a direct point of purchase for the sanitary pads manufactured by Saral Design. These women took on the role of ambassadors of menstrual health in their villages where they are seeking first-time converts.
Meena Sonawane (name changed on request), 38, reached puberty when she was 13, but it was only after the birth of her granddaughter last year that she decided to try on the pads for the first time. I used to get rashes in my inner thighs because of using clothes during my periods, but with pads I don’t get those rashes anymore, she told ET Magazine. For Meena affordability is not an issue, it is the access to a pad that is a challenge. Many women in her village have to walk for at least 20 minutes to find a store that stocks sanitary napkins.
Her husband who runs a grocery store was not comfortable selling pads until a few months ago. Karjat is connected by road and rail and roughly two hours away from Mumbai and Pune, yet women are deprived of such a basic product. The government-run free schemes too are rationed, and with payment delays and supply chain issues, girls often are unable to find pads.
Dharia is hopeful. He feels that over the years parents have understood the need to keep girls in school, so this has helped in the growth of sanitary napkins, too. He reckons distribution is not the sole issue in improving access; if that was the case, the likes of Hindustan Unilever Ltd (HUL) would have succeeded in this market (a year ago, HUL announced it would divest its stake in a 21-year-old joint venture with US-headquartered Kimberly-Clark for making baby care and feminine hygiene products).
It is difficult to sell condoms and sanitary pads in India. This is a pharma category product, so women are more comfortable buying from a pharmacy; the emphasis should be on that, explains Dharia. A simple change in a lifestyle habit can often change social indicators.
It takes less than a rupee to produce a sanitary pad. That pad can actually prevent girls from dropping out of school. Does such a product with such revolutionary potential need to be taxed?
Wanted: More Startups
A bunch of local ventures is looking to build viable feminine care businesses
India has one of the lowest levels of penetration of sanitary pad usage in the world. At 20%, India lags behind Thailand, Indonesia and China, all of which have over 50% usage. Social norms, cultural taboos and superstitions associated with menstruation have meant that Indian women continue to rely on unhygienic practices.
Until few years ago, it was companies like Johnson & Johnson and Procter & Gamble that flooded the market with their popular brands of Stayfree and Whisper. But that is changing as a bunch of startups enters this space, trying to address the affordability and accessibility issue of sanitary pads. In the late ’90s, a social entrepreneur from Coimbatore in Tamil Nadu invented a machine that makes sanitary pads for less than a third of the market price of MNC brands. Almost two decades after Arunachalam Muruganathan earned the sobriquet of “Padman of India”, a clutch of startups is looking to sell low cost feminine hygiene products. The only difference? They want to make their ventures a commercial success.
Saral Design, founded by four IITBombay graduates, is one such company that’s working on both affordability and the bottom line. Rather than go head-on against the big MNCs, they are tapping unserved areas of India where accessibility of pads is an issue. By using the ASHA workers in rural India, Saral is establishing a door-to-door sales network. Another venture, Soothe Healthcare, has received funding from Darshan Patel of Vini Healthcare and are reaching out to the mass market with their brand Paree. And there’s Gujarat-based Wonder Wings that has tied up with a number of NGOs, including Blind People Association, Ahmedabad Women Action’s Group and Save the Destitute Foundation.
The entry of such local manufacturers will go a long way in increasing awareness about menstrual hygiene. Perhaps more entrepreneurs and investors are the call of the day — particularly when you realise that Bangladesh has over 40 local brands in this space.