Lack of sanitary pad usage has become a public health issue for women in India. Only 12% of menstruating women in India use sanitary pads when on their period . The other 88 percent of women resort to stuffing their undergarments with various unhygienic objects such as unsanitized cloth, ashes, husk sand, and others . Something as simple as a pad is something that many women take for granted in America. However, in India the lack of affordability and access to sanitary pads combined with pervasive stigma related to periods has had a detrimental effect on the reproductive health of many women.
Negative attitudes related to periods has been a common occurrence in India and is even perpetuated in Indian culture and society. For an example, various religions practiced in India deem a woman “dirty” when on their period and they are forbidden to enter temple  . Additionally, many teenage girls skip school the week of their period in order to avoid embarrassment from their classmates, thus contributing to the 23% dropout rate for girls once they start menstruating . This culture that implicitly and explicitly degrades women because of a natural bodily phenomenon obstructs most forms of reproductive health education and conversation about healthy menstruation habits. When Economic Times in India tried to interview students from a girls college to ask them about their perception of periods and sanitary pads, they all were too ashamed to speak about it and expressed their apprehensions about using pads  . Many of them specified that when they are on their period, they feel dirty and would be scared if their family members saw disposed pads in the trash can  . The lack of understanding how pads are used in addition to the long standing culture of not using them are major barriers in pad usage. To resolve this taboo against sanitary pads, better implementation of health education in Indian schools is needed to teach girls how their own bodies work and how sanitary pads are hygienically used.
On top of the stigma related to periods and sanitary pads, the extortionate pad tax and unavailability of pads in a majority of Indian villages adds to the barriers between women and using sanitary pads. In India, a steep 12% tax is placed on all sanitary pads, known as the Pad Tax  . In the United States, there is no particular tax for feminine products, making it more affordable and accessible for people of all socioeconomic statuses . The primary reason for this large difference in taxes between India and the US is that the US places feminine products in the Medical Devices tax category while India has them in the Miscellaneous category along with items such as crayons, towels, pencils and etc  . This tax category represents the imbalance of the societal and governmental importance of sanitary pads in the US versus India.
Women living in rural Indian villages often have to walk 20 minutes in the scorching heat to gain access to sanitary pads  . Even then, many store owners wrap the sanitary pads in newspapers to hide the identity of the taboo product. This arduous process of purchasing something so essential to female reproductive health is representative of the stigma associated with periods in Indian society.
The health impact of using unhygienic replacements of sanitary pads is detrimental to many Indian women. Various studies have revealed a direct relationship between HPV infections and poor menstrual health . Additionally, India is one of the countries with the highest rates of cervical cancer, accounting for 23% of all cancers among Indian women. Women that do not use sanitary pads are also at 70% percent more risk for the development of Reproductive Tract Infection (RTI) . Gynecologist Dr. Malvika Sabharwal from Jeewan Mala Hospital in India states that “Unhygienic practices could lead to ascending infections — bacteria entering the urinary tract or uterus from outside” and indicated that simply using a sanitary feminine products could significantly reduce the risk of infection . Societal stigma and cultural practices surrounding periods in India has led to adverse health effects for many Indian women.
Arunachalam Muruganantham, now known as the “Pad Man” of India, noticed the unhygienic cloth his wife was using during periods in place of a pad in the late 1990’s and decided to attack the issue of the lack of pad usage in India. In 2000, he extensively started researching how US manufacturers produce sanitary pads in order to inspire his own design of pad production . Coming from a below poverty line family and having no formal education, Muruganantham was shocked when he found that the US used multimillion dollar machinery to produce something so simple . Letting his passion for engineering and the cause drive him, after multiple years, he was able to produce machinery, costing only $950, in his own home which is comparable to the ones used by large manufacturers  .
His first prototype of the sanitary pad was made out of cotton. When he asked his wife and several medical college students to test the product, they thought he was a crazy pervert and denied his request . The stigma surrounding periods was so prominent in his village that they shunned him for just wanting to help women in his community. His last resort was using the pad himself. He tied a football bladder full of animal blood to his waist and attached a pipe to it which traveled to the pad he wore in his undergarments . When he would bike, walk or have any motion, the pressure on the football blader would cause secretion of blood into the pad, similar to when a woman is on her period. Sadly, after all this effort, his prototype failed the test as it did not absorb the blood as he expected. However, after more research, Muruganantham was able to make a revamped prototype out of cellulose and found it to work perfectly .
When Muruganantham’s machinery and sanitary pads proved to be effective, he started employing local women to run the machines and create the product. The simplicity of his apparatus allowed even the most uneducated individuals to work to create pads with some simple training. This form of employment at the grassroots level has led to many women becoming financially independent and has allowed them to advocate for the importance of reproductive health and pad usage . Muruganantham’s model to create jobs and sell pads for cheap in local villages has implemented a larger sanitary pad revolution in India. As his project became more popular, he started to collaborate with the Indus World School of Business College and a Students in Free Enterprise from Britain’s Sheffield University . Their monetary contributions to Muruganantham’s project has created a financially sustainable venture that is able to fund all the workers . Now, he travels a 22 days out of the month in order to set up operations of his sanitary pad machines all over the world. Over 110 countries are accessing his machinery at the moment and with only four women working, one operation can produce 800 to 1,100 pads in one day  .
Arunachalam Muruganantham is an inspiration to all people fighting for greater pad usage in India. His model of employing local women and selling the pads in villages addresses the issue right at its root. It breaks the barriers of affordability and access of sanitary pads while also promoting greater advocacy and conversation about reproductive and menstrual hygiene.
In fact, on February 12th, 2018, a bollywood movie “Pad Man” was released that tells Muruganantham’s story as he tries to revolutionize production of sanitary pads for women in his community .. This movie has brought light to an issue that went unnoticed for so many years and has challenged the social stigmas around periods in Indian society. Additionally, it recently inspired a social media challenge among the most famous Indian celebrities in which they posted pictures of themselves holding a pad and tagged other celebrities to challenge them to do the same . This has been successful in destigmatizing a reproductive process that happens to all women and has ignited an increase in public health campaigns showing the importance of wide spread pad usage.
Breaking free from stereotypical stigmas regarding menstruation in India is the first step in resolving the lack of sanitary pad usage. This, on its own, will dismantle issues of affordability and access. Arunachalam Muruganantham in his TED talk challenges Indian society in his broken English by stating “So I classify the people into three: uneducated, little educated, surplus educated. Little educated, done this. Surplus educated, what are you going to do for the society?”  “This” being the sanitary pad revolution that has caught fire all throughout India.
Edited by: Soyi Sarkar