Period poverty, defined as the lack of accessibility or affordability of menstrual products and educational material, is a public health issue worldwide. Disparities in menstrual health and awareness are greatest in low to middle-income countries like India. At least 70% of Indian girls do not know what a period is when they first experience it. Moreover, only 36% of menstruators use sanitary pads, and over 20 million girls drop out of school annually due to a lack of products to manage menstruation. Period poverty is closely linked to education, politics, economics, health, and social norms. Innovations and solutions to this pervasive issue must be accessible, sustainable, and equitable across demographics.
Rural and underserved communities in India require more than donations of menstrual products; menstruation remains a bodily process mired in shame and taboos. Cultural and religious norms and myths prevent girls and women from realizing their potential and prospering and hinder them from further education and future economic opportunities. While girls and women menstruate, their communities view them as “dirty” and “impure” and bar them from specific public and private spaces. While pad distribution programs help increase access to period products, menstrual hygiene management (MHM) remains taboo, perpetuating harmful practices and stigmas. In addition to increased access, the societal and educational barriers to menstrual equity also need to be addressed.
Pad-making machines have a positive educational, social, and economic impact on period poverty. A low-cost version of the industrial machines that produce pads, these meat-grinder-like mechanisms tear boards of cellulose into fluffy cotton, which is then compressed and layered, attached to a film, and wrapped in cloth. In a country where old clothes, rags, and even newspapers are used instead of sanitary pads, these pad machines offer a solution that decreases stigma by welcoming open conversations and sexual and reproductive health while increasing education and access.
This was precisely the mission of Action India, a grassroots NGO that installed a manual pad machine in Kathikhera, a rural village in Hapur, India with the help of The Pad Project, a non-profit organization with the mission of ending period poverty and stigma surrounding menstruation. With a population of almost 3,000 people, 50% of whom are female, Kathikhera desperately needed a solution to period poverty. Documented in the Academy-Award-winning film Period. End of Sentence., this village had no access to pads for generations, forcing girls and women to use makeshift materials to manage their periods. The lack of MHM in Kathikhera forced girls to drop out of school and resulted in health complications. Once a pad-making machine was installed in their village, women learned to operate it and sell their pads throughout their community, allowing many of them to earn their own income for the first time in their lives. Moreover, the machines sparked discussion on menstruation and sexual health within the community.
Following the lives of several women, Period. End of Sentence. shows how this single pad machine created a successful micro-economy, helped women earn respect from their husbands and brothers, and started conversations about MHM and sexual and reproductive health. With the ability to produce 600 pads daily, the local women decided to make their own brand of pads, called Fly; one 8-pad box sells for 30 Indian rupees (roughly 0.40 USD), making them accessible to the community. Employing seven women as of 2019, the machine is operated six days a week and gives each woman a monthly salary of $35 through the support of Action India and the Pad Project. The marketing of these pads also involves demonstrations and workshops for young girls and women to learn how to properly use and change them. Moreover, the workshops teach what a period physiologically entails and have increased the percentage of pad users in the village to 70% while including men in the conversations around menstrual and reproductive health.
The Indian government has continuously neglected MHM, a clear consequence of government leadership being primarily made up of men. In 2017, a 12% tax was imposed on pads, deeming them a non-essential item under the Goods and Services Tax. It was removed a year later due to the efforts of activists but serves as a reminder that MHM remains unacknowledged as an essential part of healthcare.
India has achieved small victories for menstrual health recently, including Prime Minister Narendra Modi openly speaking on the issue and the release of a commercially successful Bollywood film on the topic. In 2011, a government initiative called the National Health Mission launched the Menstrual Hygiene Scheme to provide adolescent girls in rural areas with pads. Despite these strides, India still faces several challenges to MHM, including family acceptance, lack of sexual education in schools, poor menstrual hygiene product quality, and the disposal of pads. However, despite the growing public discourse around menstruation and some companies implementing their own menstrual leave policies, Parliament has struck down proposed bills that strive for increased access to menstrual products, leaving the issue up to each of India’s 28 states.
Kathikera is just one example of how a pad-making machine in a rural village can give girls and women access to resources they need to care for their health. With sustainable solutions and policies, girls will no longer be forced to drop out of school. Women will not have to worry about bleeding through their clothes. While menstrual equity will take time to be achieved, investing in these machines can be a step in the right direction. With at least $36,000 as the overall cost for each machine, organizations and governments can improve essential health services and simultaneously empower women, create economic opportunities, and uplift communities.