Nahid Dipa: The woman putting menstrual cups on the map in Bangladesh

It was early 2018 when development worker Nahid Dipa faced a very complicated health issue. Her menstrual flow saw a sudden surge following her first pregnancy.

As a working woman who had to spend long hours outside the home, the situation was gradually becoming very difficult to handle – in spite of having access to the best sanitary napkins in the country. 

"The discomfort I was going through wouldn't just go away, even if I changed my pads every three or four hours. So, I was desperately looking for an alternative solution," Dipa told The Business Standard.

In the meantime, her husband AFM Nazmul Alam, a public health researcher with whom Dipa co-founded the social innovation lab "Mumble," went to Uganda to attend a conference on reproductive health. There, Alam noticed that some women were using a special device made of silicone on their menstruation days. 

Upon his return, the couple embarked on a journey of exploring medical research papers about the device. Called a menstrual cup, the couple found that it was a "very convenient and effective alternative to traditional sanitary napkins."

So, Dipa asked her brother residing in the United States to buy and send her a cup. And, ever since, she has been using the menstrual cup on a regular basis. 

"It took me nearly five months to adapt to it. But once I did, I began to feel I had finally gotten my hands on the 'lifesaver' I had always craved for during my periods," said Dipa.

As a communication manager of an NGO who had previous experience working in the media as a journalist and news presenter for nine years, she thought the menstrual cup was something too good to keep to herself only.

"So, I started talking about it with my friends and close relatives first. Then, after a few months, I took a giant step by opening the Facebook group 'Menstrual Cup by Mumble' as a women-only platform to spread awareness about menstrual hygiene and advocate the benefits of menstrual cups."

At one point, she also kickstarted the public page named "Roop Mohol" to sell authentic menstrual cups approved by the US Food and Drug Administration (FDA).

This is how Dipa – who completed her M.Sc in Physics from Jahangirnagar University in 2008 and did a second Master's in Communication from the University of Liberal Arts Bangladesh (ULAB) in 2016 – became one of the leading menstrual hygiene activists, as well as the pioneer of menstrual cup usage in Bangladesh. 

What is a menstrual cup?

A menstrual cup is mainly a small, flexible funnel-shaped cup made of either silicone or latex rubber that menstruating girls and women can insert into their vaginas to collect period fluid.

The biggest advantage of a menstrual cup lies in its convenient use. Instead of absorbing the flow, it collects the blood; and is capable of holding more blood than other conventional methods.

Depending on an individual's flow, a person can wear a cup for up to 12 hours. "Sometimes while using it, you wouldn't even feel like there's something inside your body, let alone feel bothered by the flow," shares Dipa.

The process of keeping a menstrual cup clean and germ-free is also very simple. It just needs to be sterilised in boiling water before and after every menstrual cycle. Also, during the cycle, one should empty the cup when it is full and then rinse it with clean water.  

According to a systematic review published in the world-renowned medical journal The Lancet in 2019, "Menstrual cups can be an acceptable and safe option for menstrual hygiene in high-income, low-income, and middle-income countries." However, the review also added that "there are 199 brands of menstrual cups available in 99 countries but awareness is low."

Menstrual cups are not a new invention. The first menstrual cup, made from rubber, was invented in 1937 by an American woman named Leona Chalmers. 

Why is the menstrual cup important for Bangladesh?

Bangladesh, as a country, still has a long way to go in achieving proper menstrual hygiene. 

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. And according to another 2018 study by the World Bank, 77% of Bangladeshi women have no proper access to appropriate menstrual materials.

So, evidently, the lion's share of menstruating women in Bangladesh are still in the dark, and at risk of deadly infections caused by the menstrual flow.

The biggest reason behind the low rate of sanitary pad use could be attributed to their high price, which surpasses most women's affordability. 

"Even if one buys the cheapest sanitary napkin available in the market, which is around Tk70-80 [per packet], she will need two packets every month, and throughout the year she will have to spend nearly Tk 2,000," said Dipa, adding, "Most low-income, marginalised women in our country cannot afford to spend this much amount on menstrual hygiene."

However, thanks to the durability of one menstrual cup, and its comparatively less price if the total usable time is taken into consideration, it can be a better alternative to sanitary napkins. 

"Right now, we sell FDA-approved menstrual cups starting from Tk 2,000. Though a cup can last up to 10 years – let's say it will run for five years. Even then, it will cost you one-fifth of the cheapest sanitary napkin. 

Besides, you will not need to use anything else like soap, panties etc. alongside it," reasoned Dipa. 

Menstrual cups as an alternative to sanitary napkins have great environmental benefits as well. 

"A single pad contains the plastic equivalent of three polybags. So, it takes 500-800 years to decompose. That means, even the first sanitary napkin produced in world history is yet to get decomposed," explained Dipa.

By using a menstrual cup, such environmental hazards could be reduced manifold.

Menstrual cup usage in Bangladesh

Currently, menstrual cups are not available in the country's physical pharmacies. Buyers can only order them online.

Since opening the group "Menstrual Cup by Mumble" in November 2018, Dipa has so far sold nearly 6,000 menstrual cups through her page "Roop Mohol." But as there are no locally-produced menstrual cup brands in Bangladesh, she has to import them from abroad. 

Right now, there are menstrual cups from two different brands available in Dipa's online shop. Among them, one is Safecup, which is made in the US and marketed in India. This is sold at Tk 2,000. 

The other is OrganiCup, made in Germany and marketed in Denmark. This is sold at Tk 2,700. 

"When I brought the first lot of menstrual cups, paying with my own credit card, I got only 17 orders from my group," says Dipa. 

"Now even girls aged 13-14, as well as women from Satkhira's saltwater region and Chittagong Hill Tracts, order menstrual cups from me, as I kept writing about the benefits of it based on latest research papers," she adds. 

Apart from Facebook, Dipa – as a freelance journalist now – has also written extensively on the topic in some of the country's leading media outlets. 

Owing to Dipa's campaign, the overall usage of menstrual cups substantially increased, but most people are opting for cheap Chinese brands available on different online marketplaces. "Many Facebook pages and online marketplaces sell menstrual cups starting from Tk 300. But those are mostly unauthorised Chinese products without FDA approval.

"It is highly recommended to not use those products as they could lead to life-threatening infection," warned Dipa. 

Dipa also believes that the price of a menstrual cup could be brought down to under Tk1,000 if it was produced locally. "I think the plastic companies have the capacity to start producing menstrual cups in Bangladesh. All they will need is medical-grade silicone to make that happen," Dipa explained. 

Why aren't menstrual cups becoming more popular?

In April 2021, one post from Dr Tanni Barua, MD (Psychiatry) at the National Institution of Mental Health, became viral on Facebook. In her post, she described the benefits of menstrual cups while also debunking myths and misconceptions surrounding them. Those misconceptions are detrimental to increasing the popularity of menstrual cups in the country. 

"The silliest of them is that one could lose her virginity, should she insert a menstrual cup inside her vagina," Dr Barua told The Business Standard. 

"There are a few others, including that only married women could use menstrual cups, or that it could make one's vagina loose. Some also fear that the cup could be lost inside their body. All these are baseless, and shouldn't be given any importance whatsoever," added Dr Barua. 

Unfortunately, according to Dr Barua, most specialist gynecologists in the country are yet to be aware of the details about menstrual cups, let alone recommend them to their patients. 

Apparently, the claim has some solid ground. When contacted, several Dhaka-based specialist gynecologists said that they had heard good things about menstrual cups, but hadn't learnt the details of it. 

"Until doctors start to recommend it in person, menstrual cups will not become widely popular among the common people," believes Dr Barua.