Blood Money: The Race to Crack India's Lucrative Menstruation Market

But as night falls, and she's left alone with her thoughts, Paravi's enthusiasm turns to anxiety. Because Paravi hides a dark and terrible secret—one so shameful it keeps her up at night and stops her from leaving the house.

Paravi, you see, menstruates.

You think I'm exaggerating? I'm not. Menstruation is so taboo in India that for many women and girls, including university-educated ones like Paravi, being on the rag is a recurring, real-life nightmare.

"For this girl, the impending dread was over how to manage her periods once she'd moved into her new home with her husband and his family," explains Ashish Malani, co-founder of India's first menstrual cup, Shecup. "It was a major concern for her."

Visit Shecup's Facebook page and you'll find plenty of stories like Paravi's: women whose lives have been transformed after discovering the menstrual cup.

And it's not just the Shecup. India is currently experiencing something of a menstrual health enlightenment. Numerous NGOs, government campaigns and social enterprises have sprung up in the last five years. All with the same mission: to address and remedy the country's complicated and complex attitudes towards menstruation.

In 2012, a report by the World Health Organisation's Globocan project found that one woman died of cervical cancer every seven minutes in India. It was in fact, the death of Malani's aunt, from cervical cancer, that motivated him and his brother to start Shecup.

"Cervical cancer is mostly spread by the HPV virus, which is sexually transmitted," says Malani. As his aunt wasn't promiscuous, he thinks it may have been poor menstrual hygiene that led to the infection.

This is certainly possible. The issues surrounding menstrual hygiene are convoluted in India. Shaped by centuries-old taboos and myths, they force many women to dry their home-made sanitary towels—made from spare pieces of cloth—in dark, unhygienic corners of the house, even in the roof, to avoid them being viewed by men.

These same women are often considered impure while on their period. They are barred from the kitchen, temples, mosques and, bizarrely, from pickle—which they're told will rot if they touch it. Taboos that would be farcical if the consequences weren't so dire.

So why not switch to disposable sanitary pads? I contacted Procter and Gamble, and Johnson and Johnson for this article. As the producers of India's two leading disposable sanitary pads, Whisper and Stayfree, I was interested in hearing what their business strategy was for India.

After all, there are around 355 million women of menstruation age in India, of which the vast majority don't use disposable sanitary pads (yet).

Instead they use "synthetic cloth, ash, sand, dry leaves, cow dung, newspapers and even polythene… anything and everything that will absorb [the blood]," says Anshu Gupta, the founder of Goonj, a social enterprise which distributes cloth pads to India's poorest women.

So here's a multi-billion pound market waiting to be tapped; presumably P&G and J&J had something to say about it? After two brief email exchanges and a couple of phone calls I got nowhere. I also contacted Kimberly Clark, producers of the Kotex pads. They suggested I speak to the "category leaders"—Whisper and Stayfree.

Enter SWaCH, a waste pickers' cooperative based in Pune, south India. In March 2013 these waste-pickers sent bin bags full of soiled sanitary napkins to the corporate offices of Procter and Gamble, Johnson and Johnson, and Kimberly Clark Lever.

This drastic move was a desperate one. Over the last few years they had begun noticing a new and unwelcome type of waste repeatedly turning up among the garbage: soiled disposable sanitary towels. So they wrote, again and again, to the manufacturers to ask for help. Dissatisfied with the response, they sent the pads instead.

The issues surrounding the disposal of non-biodegradable sanitary pads is one more strand in the complex web of Indian menstrual health management

Pads are often flushed down the toilet—which leads to blocked sewers and drains—or thrown into bins where they end up on one of India's hazardous 'landfill' sites. (I say 'landfill' but this would suggest these sites are managed, when in reality most are little more than enormous dumping grounds.)

So if disposables aren't the way forward, what is?

"Every woman needs a piece of cloth," says Gupta. "In many areas it's taken the shape of a sanitary pad, but ultimately it started as a piece of cloth—all across the globe."

Which is why Gupta's Delhi-based social enterprise, Goonj, has launched the MyPad and the Not Just a Piece of Cloth campaign. To date, Goonj has distributed three million biodegradable MyPads made from cleaned, discarded cotton materials to women across India.

The pads can be used a handful of times and are 100% biodegradable.

Gupta first began exploring India's issues with menstrual health in 2004, long before upcycling was a thing in the West, and menstrual health management were buzzwords in India.

"The fact remains that a whole lot of people are now talking about [menstrual health] and it's become a fashionable subject. But it's still more talking and less working," he says.

Jessamijn Miedema is co-founder of the reusable towel brand, EcoFemme, that's based in Auroville, southern India. Her outlook is more optimistic than Gupta's. "I feel the whole atmosphere around it has really changed," she says.

"When we first started five years ago, people would look at us like, 'What, where are you from! Are you trying to take us back to the Middle Ages?'… But at the moment there is so much interest growing for cloth pads."

This is because, historically, government programmes and certain NGOs have subsidized and distributed disposable pads over cloth ones. All of which has made it even harder for more expensive cloth brands like EcoFemme to penetrate the market.

And then there's the Menstrual Man.

One day in 1998, Arunachalam Muruganantham caught his wife hiding some "dirty rags" from him. He was shocked to learn that she used rags instead of sanitary napkins and decided to build a simple machine to produce low-cost, affordable pads.

He was branded a pervert for doing so, and his wife and friends abandoned him. Fast-forward eighteen years and he's the subject of countless articles, his own documentary titled Menstrual Man, and has given a TED talk that's been viewed over one million times. In 2014, he was one of TIME Magazine's 100 Most Influential People in the World.

Around 2,400 of his machines (as well as various spin-offs from other entrepreneurs) have now been installed in villages across India and the developing world.

The machines themselves cost £750 (a cost often subsidized by a government department, NGO or CSR initiative), but are then managed by a handful of village women who go on to produce and sell the pads in the community for one or two cents each.

But even India's beloved 'sanitary pad revolutionary' has his critics. People I spoke to for this article questioned the quality of the pads, the machines, and the overall concept of promoting a disposable product.

Muruganantham, meanwhile, remains as enthusiastic about his machines as ever: "It's a very simple mechanical device, anybody can learn to trouble shoot problems. It's very simple, like a sowing machine," he told me.

And as for the pads: "They're of same quality standard as the leading brands, the raw materials [processed wood pulp] are the same."

"I'm not a promoter of disposable pads, but it's great that he's brought so much attention to this issue," said Miedema, when I asked for her opinion. "And he speaks about the dignity for women too, and that's very important."

Miedema is right, of course. It's dignity that lies at the heart of all this. It was dignity that Paravi went looking for when she discovered the Shecup, and it is dignity that every young woman looks for when she begins managing her monthly periods.

Let's just hope the most dignified solution prevails.