Menstrual Hygiene, A Necessity Not A Luxury
Amita Arudpragasam
Of 4.2 million menstruating women in Sri Lanka, only 30% use disposable sanitary napkins.[1]Given the stigma surrounding menstruation, many Sri Lankans – including policy makers – are unaware of the impacts of poor menstrual hygiene management (MHM). [2]This is worrying because poor MHM poses significant health risks including urogenital infections and cervical cancer. Additionally, poor MHM may adversely impact female educational performance and female labour force participation.
The problem is not that Sri Lankan women don’t know that menstrual hygiene is important or that they don’t know how to practice better menstrual hygiene.[3]Menstrual health products, like sanitary napkins, are simply too expensive. Indeed, as noted below, the annual cost of good menstrual health management can equal the amount the average household would spend on a two-month supply of rice!
On September 19th Sri Lanka’s Finance Minister indicated that sanitary napkins would be exempted from Cess. This is good progress towards making menstrual hygiene products affordable, however eliminating border taxes won’t fully address poor MHM. By itself, this policy may only advantage a wealthy subset of Sri Lankan women. To impact lower and middle-income households, I recommend the government also exempt sanitary napkins from the Value Added Tax (VAT) and Nation Building Tax (NBT). I further recommend the government provide subsidised menstrual hygiene products to women who cannot afford them.
Health Risks
The health risks associated with poor MHM include bacterial vaginosis (BV) and urinary tract infection (UTI).[4]A 2017 hospital-based cross sectional study shows that the incidence of UTIs in Sri Lanka is increasing and that increasing resistance is likely to add a significant burden to Sri Lanka’s health budget. UTIs, while common, should not be taken lightly. If untreated, microbes can spread from the urinary tract and cause permanent damage to the kidneys.[5]Cases of BV, another health risk associated with poor MHM, reportedly doubled in Sri Lanka between 2006 and 2010.[6]Numerous studies show that women with BV may be at higher risk of early or preterm birth, loss of pregnancy, pelvic inflammatory disease and the acquisition of sexually transmitted infections.
Studies also consider poor menstrual hygiene a risk factor for cervical cancer[7]- which incidentally, is the second-most common type of cancer for Sri Lankan women.[8]According to the HPV Information Center, “current estimates indicate that every year 1721 [Sri Lankan] women are diagnosed with cervical cancer and 690 die from the disease.”
A controlled study of 486 women concludes that, compared to women using disposable pads, women who used reusable absorbent pads were more likely to have symptoms of urogenital infection or to be diagnosed with at least one urogenital infection. Gynaecologists recommend products such as disposable sanitation napkins (pads), tampons or cups for better menstrual hygiene. Because such products are intimately linked to a woman’s well-being, they are not ordinary consumer goods, but ought to be considered necessities.
Menstrual Hygiene is currently a Luxury
