In spite of their immense importance in ensuring menstrual hygiene among women and adolescent girls, the use of sanitary napkins is still sparse in Bangladesh, the biggest barrier to using the product being affordability.
Industry insiders have attributed the high prices of sanitary napkins to excessive duties on the import of their raw materials i.e. high-absorbent air-laid paper, silicone release paper, and adhesive tape.
The government has levied a flat 25% import duty on these items. On top of this, a 3% regulatory duty has been imposed on the import of silicone release paper, and a 10% supplementary duty and 3% regulatory duty have been in place on the import of adhesive tape, they said.
In a bid to promote menstrual hygiene, the government has continued to offer VAT exemption facilities on locally produced sanitary napkins since the fiscal 2019-20. Even then, sanitary pads are still pricey in the local market, which is why ordinary women cannot afford them.
Against this backdrop, Anjan Chowdhury, managing director of Square Toiletries Limited, last week wrote a letter to Commerce Minister Tipu Munshi, requesting him to reduce tariffs on the import of raw materials for sanitary napkins.
According to Square Toiletries, 97% of women who do not use sanitary napkins suffer from cervical infections, which can lead to infertility and even life-threatening diseases such as cancer.
"Inadequate menstrual protection makes adolescent girls miss at least three days of school in a month. On the other hand, girls and women working in garment factories cannot go to work seven days a month during their periods, which is hampering the industry," says the company.
Quamrul Hassan, business director at ACI Limited, told TBS that the size of the domestic sanitary napkin market, which currently stands at around Tk500 crore, has been growing at an annual rate of about 20%.
According to the National Hygiene Survey 2018 conducted by the Bangladesh Bureau of Statistics, some 29% of menstruating women in the country use sanitary pads, up from 14% in 2014.
Despite the rise, however, the rate of growth remains slow.
While the use of pads is higher among urban adolescents, thanks to awareness, the rate is much lower among urban adults and rural girls and women, the survey report says, adding that women resorting to shocking alternatives such as unsanitised cloth, cotton, and tissue paper during periods are falling into health risks.
Sanitary pads of various local and foreign brands, including StaySafe, Monalisa, Joya, Senora, Stayfree, Freedom, Whisper, Savlon, are available in the market. The price of one pack of these pads ranges between Tk100 and Tk300. For most poor and low-income women, it is not possible to spend Tk100 on period management every month. So they use old cloth even if it involves risks.
Arafat Akhter, 22, works as a nurse in a private clinic in Rangpur city on a salary of Tk5,000. With that money, she has to meet her living expenses and also support her family. Therefore, despite being aware of the risk factors, she is forced to use pieces of old cloth during her periods.
"Spending Tk100 on sanitary pads during periods is a kind of luxury for us. There are three other menstruating women aged 15-49 in my family, including my mother, sister, and sister-in-law. Everyone uses pieces of cloth during their periods," Arafat Akhter told TBS.
Sormindo Nilormi, associate professor of economics at Jahangirnagar University, stressed the need for making sanitary napkins affordable to ordinary people. "The price of one pack of good quality sanitary pads is over Tk100. It is not possible for a woman without income of her own to spend Tk100 for her menstrual protection. In many cases, mothers do not want to put their children at risk. So, even if they themselves use pieces of old cloth, they give their girls pads. It is not that the mothers do not want to use pads. They just cannot afford them," she said.
"Besides, it is rather easy for an urban woman to buy pads from a shop, but the case is different for a rural woman as she has little scope to go to the market to buy a pad for herself. And it is not as simple as that – her husband or son will not buy it for her," observed Sormindo Nilormi.
According to the National Hygiene Survey 2018, 50% of adolescent girls and 64% of women used old clothes for menstrual hygiene management. The use of disposable pads was more likely among adolescents (43%) compared to women (29%).
Less than 20% of schoolgirls who used old cloth followed the recommended cleaning and drying practices. Only 23% of schoolgirls had access to improved toilets with soap and water, and a place to dispose of used menstrual hygiene materials at school, the survey found.
Nilormi said since the use of sanitary pads is related to health protection, the government may provide those who go to schools and colleges with one pack of pads every month for free.
Speaking on the risks of using unsanitised cloth, Dr Sabikun Nahar, gynaecologist at Dhaka Medical College Hospital, told TBS that women who do not use sanitary napkins during periods have various problems, including infections and septic due to using unhygienic cloth. Usually, poor women in rural areas use the same cloth repeatedly and do not dry it in the sun, which is why they get different types of vaginal infections.
Dr Sabikun Nahar also observed that now school-going children are very much aware, so the rate of using pads by them is increasing.
"However, the rate of use of pads is much lower among adults and rural women. Most of the patients who come to us with cervical cancer have never heard of sanitary pads. Infection is responsible for cervical cancer. So, cleanliness is important during menstruation."
The National Hygiene Survey 2018 data show that about 8% of women and 6% of adolescent girls reported discomfort such as itching, irritation, redness, swelling or lumps-related health problems. About 5% of women and 4% of adolescents reported smelly discharge or unusual discharge. A higher proportion of adolescents (28%) reported having pain in the lower abdomen compared to women (15%).
Today, 28 May, is Menstrual Hygiene Day. The theme of the day this year is "Making menstruation a normal fact of life by 2030", which aims to contribute to achieving an overarching goal – to build a world by 2030 where no one is held back because they menstruate.