How safe are sanitary pads in India?
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New Delhi: A woman enters the store, picks up a pack or mumbles the name of the brand she wants under her breath to the storekeeper, who proceeds to wrap the product in an old newspaper and hands it to her in a black plastic bag. She pays in awkward silence before hurriedly exiting the shop.
That’s typically how a woman buys a pack of sanitary napkins in India, where the topic of menstrual hygiene is usually not discussed in genteel company, let alone in public. So how does one begin to ask questions about what goes into the making of a product that people are hesitant to even mention aloud?
Further, since sanitary napkins are classified as “medical products”, companies are not required by law to disclose what goes into their making on product packs.
There is no research to attest that sanitary napkins sold in India are safe. But the use of some chemicals in the feminine hygiene products raises questions over how safe they really are.
“It is a sanitary napkin. Its purpose is not just to absorb. Hygiene parameters of the product, of how safe they are, should be disclosed on the packets. Unfortunately, people choose sanitary napkins based on the cost, design and packaging,” said Bhawana Chanana, associate professor in the department of fabric and apparel science at Lady Irwin College, Delhi University.
“But the main consideration really should be hygiene— what’s the pH range, for instance. But women don’t ask simply because they are embarrassed and this has worked to the advantage of the manufacturers and sellers,” added Chanana, who said she has come across instances where products rejected in the US or Germany have been recycled in India.
In fact, in 2003, Ahmedabad-based Consumer Education and Research Centre tested 19 brands of sanitary napkins available in the market and found dirt and ants on some of the samples tested.
When products in the market are certified by official agencies, consumers assume they are safe. In India, sanitary pads are tested as per standards that haven’t been updated since 1980.
“On the basis of that standard, all sanitary pads will pass the tests. This needs to change; more parameters need to be added. We need to have parameters to check how safe these products are,” said Jinoj K., chief executive officer of Wager Hygiene, a maker of health and personal care products including sanitary napkins. Jinoj is also the founder of Chennai-based Centre for Hygiene Research and Development.
The Bureau of Indian Standards 1980 specifies tests that are very basic. For instance, to determine whether the absorbent fillers in the sanitary napkins are lumpy and whether the surface of the pads feels soft and comfortable enough.
However, there is no requirement to test the toxicity of ingredients.
In the US, the Food and Drug Administration guidelines recommend biocompatibility testing of napkins, appropriate for the duration and level of contact of a user with the product. The FDA guidelines also state that the approving authority is aware of risks such as adverse tissue reaction, vaginal injury and toxic shock syndrome, associated with usage of these products and recommends that companies conduct preclinical toxicology and preclinical microbiology tests.
The process involved in the making of sanitary pads in India hasn’t changed in decades. The only changes are cosmetic, said nanotechnologist Chandra Shekhar Sharma from the Indian Institute of Technology Hyderabad’s department of chemical engineering.
“No one denies the health hazards of using these commercially sold napkins. But scientifically there is much more to study before we reach a conclusion. Concerns about certain adverse effects are valid but not yet quantified,” he added.
The purpose of a sanitary pad is to absorb and retain menstrual fluid discharge, prevent leaks and of course help a woman stay comfortable.
For these reasons, sanitary pads are made of different layers—the cover stock, acquisition and distribution layer, absorbent core, back sheet, and siliconized paper.
“The absorbent layer is the key component of the napkin and the extent to which this layer is able to absorb and retain the fluid determines the efficiency of the napkin. This bulk layer of a napkin is a non woven web, made of hydrophilic cellulosic staple fibers like wood pulp, cotton linters, viscose etc. Most of the wood pulp used for the purpose is imported, and therefore expensive, increasing the overall cost of a sanitary napkin. Cotton is seen as a major fiber poised to replace wood pulp especially in the feminine hygiene products where less bulky is preferred and thinner is better. The high cost of cotton is the reason why it has not been able to replace pulp,” according to Chanana’s paper Design and Development of Low Cost Sanitary Napkins using Cotton Knitwear Waste, published in Health Positive, Journal of Best Practices in Clinical Medicine and Public Health, November 2009.
Since absorption is the key to efficiency, products use superabsorbent polymers (SAPs) either in the form of granules within cellulosic fibre matrix or in the form of composite fabric layer. By adding SAPs, the pad can hold water up to 30 times its weight.
This absorbent layer, which is the main component, is attached to a permeable top sheet (made of non-woven, mainly spunlace fabric), then attached to a non-permeable bottom sheet (made of polyethylene). The three layers are later glued and sealed to prevent leakage by using heat or ultrasonic vibrations.
Sharma’s team is looking at the potential use of electrospun cellulose acetate nanofibres to make the absorbent core of sanitary napkins, instead of SAPs that are currently used.
The team uses a technique called electrospinning to produce cellulose based nano-fibers. Nanofibres are generally more than a hundred times thinner than human hair. As the nanofibres have a much larger surface area and porosity, they can absorb much more fluid even without adding SAPs.
Sharma said since this is a nano-fabric, its surface finish and also the comfort factor is found to be better than that of regular napkins.
In India, price plays an important role. And, pricing is decided based on what additional features the sanitary pads offer. “The MRP (maximum retail price) depends on the incremental product benefits offered by a particular product, which could be longer length, wider back, superior absorption and wetness protection, or gentleness on skin,” said a P&G India spokesperson.
So the add-ons are mostly cosmetic, and not really hygiene related. Srinivas Krishnaswamy of Krya Consumer Products Llp, a company that deals in plant-based products for sustainable urban living, worked with Johnson and Johnson (J&J) India from 2001-09. “Working in the sanitary napkin market, I know that absorption and cost were the only two factors that were taken into consideration. I doubt it has changed,” said Krishnaswamy.
The Indian sanitary napkin market at the moment is dominated by P&G and J&J. According to a 2016 report by market researcher Euromonitor International, P&G’s Whisper brand led value sales with a share of 50.4%, followed by J&J’s Stayfree with 23% (with higher usage in rural areas) and Kimberly Clark Corp.’s Kotex with 2.2 %.
Even though all the leading brands in the Indian sanitary market are global ones and sell the same products worldwide, the quality of the chemicals used in India is believed to be inferior.
According to a senior executive at one of the sanitary napkin makers, who has worked in both developing and developed countries for close to two decades, use of inferior quality components to reduce cost is not new and companies cannot be blamed as they do not need to comply with any specified safety or hygiene standards in India.
“What companies usually follow is the US Food and Drug Administration standards. But the constituents in these pads behave differently in the Indian environment, which is humid and sweaty, as against environments that are cool and dry. But things have improved in the recent years,” the executive said, asking not to be named.
The most contested constituents of sanitary pads are dioxins and SAPs. According to a 2016 paper, High absorbency cellulose acetate electrospun nanofibers for feminine hygiene application, by IIT-Hyderabad’s Sharma and his colleagues Shital Yadav, Mani Pujitha Illa and Tulika Rastogi, “Dioxins are used to bleach the cotton/material used for making absorbent core, and it is responsible for side effects in the body such as pelvic inflammatory disease, ovarian cancer, immune system damage, impaired fertility and diabetes. SAPs are added to increase the absorption capacity, but in 1980s, use of SAPs was restricted in tampons (in the US) due to its possible link with toxic shock syndrome, a potentially fatal illness caused by a bacterial toxin.”
Due to the omnipresence of dioxins, the World Health Organization says not all the exposure will affect human health. However, due to the highly toxic potential (dioxin accumulates in the body fat and can add up to the residual levels over time), efforts need to be undertaken to reduce current background exposure.
A 1993 study (conducted over 10 years) found that 79% of a group of monkeys in the US developed endometriosis (a disorder in which the tissue that forms the lining of the uterus grows outside the uterus) after exposure to dioxin in their food. The severity of endometriosis was directly related to the amount of TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin—the most toxic dioxin) to which the monkeys had been exposed. Those that were fed dioxin in amounts as small as five parts per trillion also developed endometriosis. The dioxin-exposed monkeys also showed immune abnormalities similar to those observed in women with endometriosis.
“These products seem innocuous but they may be laced with dioxins, petrochemicals, Genetically Modified Organisms and fragrances. When these chemicals come in contact with sensitive skin, tissue may get irritated. Dioxins are carcinogenic in nature hence the risk of cancer increases even at very low levels of exposure,” write Anuradha Barman, S.D. Asagekar and Pooja Katkar in the paper An Overview on Sanitary Napkins published on Technicaltextile.net.
Some of the variants of the products sold by P&G come with fragrances. The company does not disclose what fragrance it uses, but states that it meets safety standards set by the International Fragrance Association.
Route of exposure
Menstrual pads sold commercially are designed in such a way that they have direct contact with the vaginal area. The vulvar and vaginal tissues are structurally different from the skin of the rest of the body, being more permeable and covered in mucous membranes.
The mucous membranes and the fact that the walls of the vagina are filled with numerous blood vessels and lymphatic vessels, allow for direct transfer of chemicals into the circulatory system, without being metabolized first. But studies say while rapid absorption can work well when a patient needs a drug delivered rapidly, it may also expose women to higher levels of chemicals from feminine hygiene products since the area of contact has a direct route to a female’s reproductive organs.
“Contrary to claims, most of what is in the market doesn’t even use cotton. It is mostly wood pulp. Almost all use the same materials, changes are in the form—how it looks and feels versus what materials are used. As for the chemicals used, every company will say that the quantity of chemicals, SAP or chlorine bleach they use will not kill you,” said Sarah McMillan, business development lead at Saathi Pads, a start-up that makes biodegradable sanitary pads.
The plastic revolution changed the nature of the sanitary napkin. SAP and polyethylene (for back cover) made the napkins waterproof. The polypropylene top sheet kept it dry. Today sanitary pads are almost entirely made of plastic material. And even the plastic used is of an inferior quality.
“While all our products are required to meet the strict safety expectations of regulatory bodies such as the US Food and Drug Administration, to make sure we meet the highest standards of safety expectations, we also share our feminine care product information with independent experts including medical consultants and university scientists, and publish our safety studies in scientific and medical journals,” the P&G India spokesperson said in an emailed response.
Spokespersons for J&J India and Kimberly-Clark (Asia Pacific) declined to comment.
Since only 12% of menstruating Indian women use sanitary napkins, questions haven’t been raised over how these pads are made, and consequently there isn’t much pressure on companies to come up with better quality products.
Padma Shri awardee Arunachalam Murugunantham, inventor of a low-cost sanitary pad making machine in Tamil Nadu, said those living in the metros tend to think that the real India is the India of the cities.
“Ninety per cent of those who don’t even have access to sanitary napkins are facing many more adverse effects than these 10-12% who are using the wrong ones,” said Murugunantham, whose start-up Jayaashree Industries has manufactured more than 1,300 machines that are installed across 27 states in India and seven other countries.
“We are fighting to make sanitary pads accessible to every woman. It is because of the ads like those which claim day-long protection that women are misled about the duration for which it is safe to use one pad. If they know they should change after every four hours, they will be saved from infections,” he added.
Even the 12% of Indian women who have access to these products—each one would be using on average 11,000-17,000 sanitary napkins in her lifetime—deserve to know what goes onto and into their bodies.
Sounak Mitra contributed to this story.