Creating a Market for Low-Cost Menstrual

Hygiene Products in India

Case

Author: Sujit Raghunathrao Jagadale & Manisha Jagadale

Online Pub Date: January 02, 2018 | Original Pub. Date: 2018
Subject: Social Marketing, Health Care Management
Level: Intermediate | Type: Indirect case | Length: 2630 words
Copyright: © Sujit Raghunathrao Jagadale and Manisha Jagadale 2018
Organization: Better Tomorrow | Organization size: Medium
Region: India | State:
Industry: Human health activities
Originally Published in:
Publisher: SAGE Publications: SAGE Business Cases Originals
DOI: http://dx.doi.org/10.4135/9781526439635 | Online ISBN: 9781526439635
SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

This case was prepared for inclusion in SAGE Business Cases primarily as a basis for
classroom discussion or self-study, and is not meant to illustrate either effective or ineffective
management styles. Nothing herein shall be deemed to be an endorsement of any kind. This
case is for scholarly, educational, or personal use only within your university, and cannot be
forwarded outside the university or used for other commercial purposes. 2018 SAGE
Publications Ltd. All Rights Reserved.
This content may only be distributed for use within CQ PRESS.
http://dx.doi.org/10.4135/9781526439635

Page 2 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India

SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

Abstract

Unhygienic practices in menstrual management are a major public health concern in

India. This issue affects socio-economically vulnerable women in both rural and urban
areas. The major challenge for health professionals and policy- makers is addressing
myths associated with the biological process of menstruation. These myths make the
hygienic management of menstruation difficult, and ultimately lead to school drop-out,
loss of productive employment, and many reproductive tract infections and diseases.
Traditionally, women use clothes, mud, leaves, dung and animal skins to stop the
monthly flow of blood. Sanitary napkins currently available in the market are too
expensive for many women. Cost and cultural barriers to access have struck a chord
with some social entrepreneurs, such as Better Tomorrow (BT), a non-governmental
organization whose aim is to improve women’s health by introducing low-cost sanitary
napkins to the marketplace. Young management trainee, Sameera, is working with BT
and thinks their product and its price point are good, but she is clueless about the
strategy she should suggest for persuading women in the district of Sultanganj (in the
central province of India) to buy the low-cost sanitary napkin. Her dilemma concerns
attitudinal change towards menstruation, along with espousing the new menstrual
management practice using the low-cost sanitary napkin. The case outlines the
situation faced by Ms. Sameera by highlighting the objectives of her current
assignment, and her understanding of social marketing practices. Students need to
assume the role of Ms. Sameera and discuss the steps she can suggest for
generating a market for low-cost sanitary napkins. Students are asked to prescribe the
strategy as required by BT to roll out its plan. The theory of trying may help students
understand the theoretical underpinnings of such a strategy.

Case

Learning Outcomes

By the end of this case study, students should be able to:

Describe menstrual hygiene management practices and issues related to it in India.

Describe the existing menstrual hygiene market in India in terms of products available,
relative cost, and barriers to access for low-income women.
Explain the need for low-cost sanitary napkins in the marketplace for feminine hygiene
products in India.
Compare market creation strategies for different market segments, concentrating on social
marketing processes among women from the low-income group.
Apply the social–psychological theory of trying (TT) to the creation of the marketing
strategy.

Introduction

Sameera was starting her first professional assignment as a Management Trainee. She had
graduated from the country’s leading health management institute. She was always
fascinated by challenges and the promises that health management offers in a country such
as India. During her Masters in Health Management (MHM) course, she was struck by the

Page 3 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India

SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

dismal health indicators in India, primarily the gender disparities in health indicators. She was
always astounded by the belief system that had made some of the physiological phenomena
related to women mysterious, and now the data were staring her in the face, showing the
damage of these long-held cultural beliefs. During her MHM program she had decided to
work for the improvement of women’s health. Menstrual hygiene management was an area
where she wanted to make a substantial contribution. She began working for an organization
called Better Tomorrow (BT) working for an improvement of women’s health and incubating
the business models related to the same. She was ecstatic, nonetheless a chill passed
through her spine when she considered the magnitude of the issues confronting women’s
health in India. After successful completion of two months’ training, the Chief Executive Officer
(CEO) of BT called Sameera. She was a bit anxious before the meeting as she was unaware
of what was there in the offing. The CEO made her comfortable and then asked her, “are you
ready to take up a challenge?” she responded in the affirmative. The CEO continued, “can
you please create a strategy for the sustainable adoption of low-cost sanitary napkins by
women in the district Sultanganj in the central province of India?” Sameera started comparing
health indicators in India with those from BRICS nations. She realized the gravity of the
situation and the magnanimity of the task in the field of menstrual hygiene (Table 1).

Table 1. Comparison of India across health indicators with peer BRICS* nations.

Indi Brazi Russi Chin South

Health indicators
a l a a Africa

Gross domestic product spending on healthcare,

4 9.3 6.3 5.4 8.8
2012 (%)

Life expectancy at birth 66 74 71 75 59

Infant mortality per 1,000 live births 41 12 9 11 33

Child mortality under 5 per 1,000 live births 53 14 10 13 44

Maternal mortality ratio per 100,000 live births 190 69 24 32 140

*BRICS is a group of nations –Brazil, Russia, India, China, and South Africa.

Sources: KPMG (2016); Rodwin (2015).

Menstrual Hygiene in India

Menstruation is a natural bodily process of woman’s health cycle. It indicates women’s

reproductive health. However, in India, the extent to which menstruation is considered a
“normal” health issue that can be discussed openly differs amongst women from different

Page 4 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India

SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

socio-economic strata. For women from the underprivileged socio-economic background,

menstruation becomes the most dreaded time of the month. Menstruation is shrouded in
deep-rooted taboos associated with myths describing menstruating women as impure, filthy,
sick – women are even said to be cursed during their periods. It is viewed with shame and
treated with secrecy in India. Women are confined to certain spaces, marked for the purpose,
outside the main living space in the house premises during their menstrual cycle. Their
movements are restricted, and their need to stay clean and dry is neglected. As a result,
women from poor rural and urban households often experience poor reproductive health and
increased maternal mortality compared to wealthier women in India. Women are isolated from
family, friends, and their community – even other women – due to the social stigmas
associated with their menstruating bodies. They cannot enter kitchens, temples; cannot
perform rituals and participate in festivals; they must eat with different utensils and are barred
from touching pickles, for fear they will turn the food rotten.

In a study by the Indian Council of Medical Research, it was found that 70% of mothers
consider menstruation as ‘dirty’ and ‘polluting’. Many teachers and frontline health workers
echo the same sentiments. Lack of management of menstrual hygiene, both due to
misinformation and structural issues such as not having safe and dignified sanitation facilities,
becomes a cause of girls’ drop-out from school. One in five girls in India drops out of school
due to menstruation. Adolescent girls in India miss up to 50 days of schooling in a year due to
the lack of menstruation care. It also compromises women’s ability to engage in productive
employment.

Traditionally women use cloths to manage their menstrual hygiene in India. These cloths are
cut out from the used sarees and lungis which are the conventional dress of Indian men and
women. In small homes, the lack of private spaces makes it difficult to clean and dry these
cloths. Thus, women re-use soiled cloths rather than replacing them frequently, and become
prone to infection. Wearing the same soaked fabric all day at school or work causes outer
clothing to stain, adding to shame for young girls and the pressure to drop out from school.
Left unchecked, infections can cause heavy bleeding and subsequent chances of anemia
which is very common amongst Indian women. Some reports state that tribal and rural women
go to the extent of using dirty rags and mud to check the menstrual flow. In some extreme
cases leaves, dung, and animal skins are used to manage the menstrual flow. In a study
conducted by A. C. Nielson and Plan India, 88% of menstruating women were found to be
using old un-sanitized fabric, rags, or sand.

A woman spends on average 2100 days of her life menstruating, so the ability to care for
herself and stay healthy during this time greatly affects her educational development and
social mobility. Health conditions for women in rural areas are different from that of urban
areas since women from rural areas may not have known the use of sanitary napkins and may
not be aware of it. As per some reports in 2012, out of 355 million menstruating women in
India, only 12% use store-bought disposable sanitary napkins. However, the National Family
Health Survey report for 2015–2016 suggests that 78% of women in urban India uses hygienic
means to manage menstruation as against only 48% in rural India. As per this report overall
58% of Indian menstruating women use hygienic means for menstruation management.
However, in rural India only 2% of the target population use disposable products. Menstrual
cups and tampons are not preferred in India due to cultural reasons, where societies do not
accept internal application of sanitary protections, especially before marriage. Medical
practitioners are of the view that sanitary napkins can help prevent reproductive tract infection.
Sanitary napkins can also reduce the risk of cervical cancer, and lower the occurrence of
ailments such as urinary tract infections. Sanitary napkins are expensive, and cost is not the

Page 5 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India

SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

only barrier that inhibits women from buying quality napkins. Other barriers are discussed in
the section below describing Sameera’s market research. Seventy percent of women in India
cannot afford sanitary napkins which on average cost INR 40 per cycle. More than half of rural
households depend on manual labor for their livelihood, and 75% of the rural population (670
million) earn less than INR 5,000 per month. With an average family size of five, per month
income is around INR 33 per day per person.

Sanitary Napkin Business in India

The sanitary napkin industry makes up only 16% of the fast-moving consumer goods market.
Industry experts believe that due to its lower market penetration it may see a growth rate of
around 20% percent for the next five years. The sanitary napkin market is expected to be
around USD 450 million. The markets in towns and cities are controlled by the established
firms such as Procter & Gamble (P&G). Due to the high cost of sanitary napkins, sold by
multinational giants such as P&G, there is ample scope to develop a market for low-cost
sanitary napkins.

Low-Cost Sanitary Napkins

Low-cost sanitary napkins are of high-quality, on par with products offered by P&G and other
multinational companies, and have the potential to revolutionize India’s menstrual hygiene
market. They can be produced inexpensively thanks to an innovation of a machine by
Arunachalam Muruganantham, India’s ‘menstruation’ man, that simplified sanitary napkin
making at the local level. Arunachalam Muruganantham has pioneered the making of sanitary
napkins using raw materials such as banana fiber, bamboo, and water hyacinth pulp.

Organization and Project

Better Tomorrow was based out of the capital of the central province. It was established, as a
not for profit organization, by two feminist activists in 2007. Interestingly, an organization had
evolved over the years from being an advocacy organization to a program-based organization.
It was, mainly, working in women’s health and the education sectors. It had three strategic
business units (SBUs). The first unit would innovate business ideas to address women’s
health concerns such as anemia, reproductive health, undernourishment and breast cancer.
These ideas would be incubated by another SBU – here, they would analyze the feasibility of
the business idea and work out the financing. A third SBU would roll out the business idea to
implement these innovative solutions on a large scale. SBUs were headed by a Vice President
who reported to a CEO. Each SBU has many thematic groups. Themes included:
reproductive health; anemia; education–school drop-outs; and more. Thematic groups in
different SBUs would work closely based on the themes they work on. An SBU involved in an
implementation of the innovative business idea is the largest unit with multiple field teams.
Two support teams, finance and human capital, directly reported to the CEO.

Sameera was working in an “incubator” SBU. She was spearheading a team to suggest an
overall strategy to create a market for low-cost sanitary napkins. This project was very
important to address multiple social issues related to women’s health and education; thus, the
CEO was closely monitoring the project. He wanted Sameera to report to him so he could
monitor the development of the strategy-making. This made Sameera more excited about the
project.

Page 6 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India

SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

Initial Research

Sameera had taken the first step to strategize: market research. She was astounded by some
of the results regarding barriers to buying sanitary napkins. There is a shame associated with
buying sanitary napkins in India. A study by a sanitary napkin manufacturer found that in
cities 75% of women buying sanitary napkins buy them wrapped in a brown bag or
newspaper. They almost never ask a male member from a family to buy sanitary napkins.
Sameera found that there is a greater need to come out of this culture of shame and silence,
and start discussing it openly. However, because neither families, schools, or religious
communities provide basic education about menstruation, both men and women lack
knowledge about menstruation, which makes things more complicated. Sameera learned that
70% of women in rural India have no adequate knowledge about menstrual hygiene and care,
and that 10% of girls in India believe that menstruation is a disease.

Sameera’s research findings highlighted that affordability, ease of availability, and accessibility
need to be addressed, in that order. Through her research she concluded that access to safe
menstrual health is a big challenge. It is skewed towards women from higher income groups.
Also, the shame associated with menstruation inhibits women from buying products from
shopkeepers who are generally males. Not many shopkeepers in villages are willing to stock
sanitary napkins as there is little demand for them. Notwithstanding, women in rural areas are
reluctant to be seen as purchasing sanitary napkins.

Strategy Dilemma

Sameera was swift enough to discern several problems – lack of awareness of sanitary
napkins, the myths associated with menstruation, and the female-unfriendly distribution
channel. Now she had a quandary – how to address these problems?

Since Sameera had all the requisite information in hand she started thinking of a possible
strategy to generate a market for low-cost sanitary napkins in the district of Sultanganj. Her
predicament was how to persuade women to switch from their conventional menstrual
hygiene practices to the use of disposable napkins they could afford. She had a discussion
with Professor Suraj, one of her former professors in the marketing department. Their
discussion revolved around the TT by Bagozzi and Warshaw (1990). “You study how a theory
of trying can be used to make a marketing strategy”, said Professor Suraj. He continued, “the
context of menstrual hygiene is an ideal context for using this theory, trying out low cost
sanitary napkin is the key here. Once they try the product I am sure women will change the
unhygienic practices”. Sameera revisited the TT and tried to figure out what could be the
marketing strategy.

Theory of Trying

The TT focuses on goals rather than reasoned behavior choices. The theory focuses on trying
to achieve these goals rather than actual attainment of goals. In TT, if one is studying, say,
tobacco cessation, “rather than attempting to determine the predictors of (successful) quitting,
one should first determine the predictors of trying to quit” (Donovan & Henley, 2010, p. 134).
Using the basic principles from Bagozzi and Warshaw (1990), three factors determine an
individual’s overall attitude towards trying a certain behavior, in this case, purchasing a low-
cost sanitary napkin:

Page 7 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India

SAGE SAGE Business Cases
© Sujit Raghunathrao Jagadale and Manisha Jagadale 2018

attitude towards succeeding and the expected likelihood of success.

attitude towards failing and the expected likelihood of failing.
attitude towards the actual process of trying.

Discussion Questions

1. What are the conventional menstrual hygiene management practices in India? Discuss
the health and socio-economic issues related to them.
2. Which audiences should Sameera target to create the market for low-cost sanitary
napkins?
3. What could be the possible distribution channel, and who are the main players?
4. What promotion/communication strategy can Sameera use to influence her target
audience to buy the low-cost sanitary napkins?
5. What is the TT and, how can Sameera use it in her social marketing strategy?
6. What social marketing process and strategy can Sameera use to achieve her objective
of creating a market for low-cost sanitary napkins?

Further Reading
Bagozzi, R. P., & Warshaw, P. R. (1990). Trying to consume. Journal of Consumer Research,
17(2), 127–140.
Chowdhry, S. (2013, August 10). Freedom from Shame – An Uncomfortable Period. Live Mint.
Retrieved from http://www.livemint.com/Leisure/tyQAUWDEmEQtMOVt9saqLP/Freedom-from-
shame--An-uncomfortable-period.html
Garg, S., & Anand, T. (2015). Menstruation related myths in India: Startegies for combating it.
Journal of Family Medicine and Primary Care, 4(2), 184–186.

References
Bagozzi, R. P., & Warshaw, P. R. (1990). Trying to consume. Journal of Consumer Research,
17(2), 127–140.
Donovan, R., & Henley, N. (2010). Principles and practice of social marketing: An international
perspective. Cambridge, UK: Cambridge University Press.
KPMG. (2016). Healthcare in India: Current state and key imperatives – review of national
h e a l t h p o l i c y ( 2 0 1 5 ). Luxembourg: KPMG. R e t r i e v e d J u l y 2 4 , 2 0 1 7 f r o m
https://www.gita.org.in/Attachments/Reports/AHPI-Healthcare-India.pdf
Rodwin, V. G. (2015). Health and health care in BRIC nations. Retrieved July 24, 2017 from
https://wagner.nyu.edu/files/faculty/publications/SSRN-id2598570_2.pdf
http://dx.doi.org/10.4135/9781526439635

Page 8 of 8 Creating a Market for Low-Cost Menstrual Hygiene Products in India