Unprescribed painkillers turn risky for women workers in garment factories

Sudha seldom thought about the pills she took to ease her period pains during 10-hour shifts as a seamstress. She could not afford to let anything interrupt her work and cut her wages so she sought medicine from a factory supervisor. But by the end of her first year of work, and after months of taking painkillers without medical advice, Sudha’s menstrual cycle had gone haywire by age 17.

She was not the only one. An expose based on interviews with about 100 women in the multi-billion dollar garment industry in the State found all of them were given unlabelled drugs at work for period pains, and more than half said their health suffered. The drugs were rarely provided by medical professionals, in violation of labour laws, and the State government said it would monitor the health of garment workers in light of the findings.

Many of the women said it took them years to realise the damage the medication had done as they were never warned about side effects, with health problems ranging from depression and anxiety, to urinary tract infections, fibroids and miscarriages.

Two doctors who analysed these pills said they were non-steroidal anti-inflammatory drugs that could help relieve menstrual cramps but were known to have harmful side-effects if taken frequently.

Medical tests found that Sudha – who did not give her surname for fear of reprisals - had fibroids, which are non-cancerous growths that develop in or around the uterus. A doctor said she needed to stop working and rest. But missing work and wages was not an option as she was helping her mother - a ragpicker - pay back a loan of Rs 1.5 lakh to local moneylenders.

“Half my salary (Rs 6,000) would go in paying off the loan and a big amount on my trips to the doctor,” Sudha said. “It became a cycle I was not able to break. And even though my health became worse, I needed to keep working to pay the bills.”

Sudha, now 20, said frequent gynaecologist visits have wiped out her savings while it is a daily struggle to stitch around 400 parts of clothing from collars and buttons to pockets.

“I have learnt to ignore my aches and pains when I go to work. I also stay away from pills now,” she said, holding a faded folder full of doctors’ notes and medical prescriptions. “My body feels weak after the last couple of years working in the factory,” Sudha added. “It is difficult but I manage.”

About 40,000 garment factories and spinning mills across Tamil Nadu employ more than 3,00,000 female workers, according to government data, but the true number could be far higher with thousands of informal workers uncounted.

Mainly young village women from poor, illiterate and marginalised communities toil in these factories, working long days to produce garments destined for leading global retailers.

In each factory a supervisor known as the “time keeper” monitors workers’ hours and bathroom breaks and often manages a small medical dispensary for workers suffering aches and pains.

The women who spoke - most of whom were aged 15 to 25 - said they were always told to swallow the pills in front of the overseer, never knowing the name of the drugs or being warned about possible side-effects. They identified the pills only by colour, size and shape. Kanaga Marimuthu took medication every month for almost a year until she noticed a white discharge followed by aches, pains and a fever - then her periods stopped. The 21-year-old was now in better health having visited a doctor, taken time to recover, and steered clear of the pills.

“The choice was between losing wages and popping more pills to get through the day’s production targets,” said Marimuthu, who now takes time off work if needed during her periods. “I chose my health and pray every day that I will recover completely soon.”

Jeeva Balamurugan, general secretary of the all-women Tamil Nadu Textile and Common Labour Union, said factory bosses knew the pills they provided could disrupt women’s periods yet still handed them out freely to keep the staff at work. “(Some) workers take up to three days off during their periods and that impacts production,” said Jeeva, who took pills during her periods at her old spinning mill job.

One “time keeper”, who spoke on condition of anonymity to protect her job, said her role mainly involved providing painkillers to the 4,000 female workers under her watch. “The pills that are consumed the most are the ones for stomach ache, but I don’t know their names or side effects,” said the woman.

“During their periods, the medicines help them finish work,” she added. “I myself would never swallow the pills - and dissuade my close friends working from taking them also.”

At a clinic in Dindigul, doctor P Nalina Kumari said she treated many women from spinning mills and garment factories. “The pills they seem to be given are basically causing a hormonal imbalance in their bodies,” she said. These lead to nausea and vomiting, and also erratic menstrual cycles, depression and in many cases difficulty in conceiving.

Selvi does not like to talk about her periods. She remembers being teased by her male supervisor when she complained of cramps after starting work at a spinning mill. From then on she kept quiet and asked for painkillers but six months later felt her insides “burning” and fell ill, forcing her to take 10 days off work and lose wages. Selvi decided to stop taking the drugs after her health worsened, but said she was scared the damage had been done. “I was always told this happens to everyone, it’s normal and I shouldn’t fuss,” Selvi said, sitting outside her home in Dindigul. “So after a point, I stopped fussing.”

Social stigma and taboos around menstruation in India are exploited by factory supervisors and managers, said James Victor, head of labour rights charity Serene Secular Social Service Society.

“These girls have proper menstrual cycles when they are at home and things go wrong only after they join work,” said Victor, whose organisation advocates for spinning mill workers.

Instead of being given spare sanitary pads or allowed longer bathroom breaks, women were handed pills that stop their periods and were harassed for working slowly, according to Victor. “It is an issue no one talks about or acknowledges but everyone knows about. The prevalence .... is alarming.”

Sudha still works at the factory and has stopped hoping for change. “I was very scared to speak up about the long hours, the period pain, the dirty bathrooms and so many other problems when I joined the factory,” she said, recalling her first few days. “Four years later, the salary is still the same, the work hours are the same and armed with her medicine box, the time keeper is always watching our every move. Nothing has changed.”

In response to the findings, officials from the State and central governments said they were not aware of pills being provided to workers. A State government official said the State would launch a project this year to monitor the health of the garment workers and collect data on how many suffered from work-related health problems.

While Factories Act requires medical dispensaries to be run by qualified nurses or doctors, some small factories flout the law, said Manivelan Rajamanickkam, the top official for occupational and environmental health.

“Unqualified supervisors doling out medicines should not be practiced,” he said, adding that medical dispensaries are legally required to be handled by a qualified nurse. “But compliance, especially in smaller factories, is a problem. We will soon be doing surveillance across factories to get a real picture that will reflect the problems workers face.”

The Ethical Trade Initiative (ETI), a group of trade unions, charities and companies including top brands such as H&M, Mothercare, and Gap Inc., said it had heard of pills being given to workers and was investigating. Peter McAllister, head of the ETI that represents about 66 companies in the garment sector - most of whom source from India - said his organisation had only recently heard of the practice. “It is clearly unacceptable,” McAllister said. Two top manufacturers’ associations said their member factories did not give our medication for menstrual pains, and that drugs were not normally provided without a prescription.

“We have given clear instructions to our members to be sensitive during such times (menstruation),” said Selvaraju Kandaswamy, general secretary of the Southern India Mills’ Association (SIMA), which represents 500-odd factories.

Raja Shanmugam, head of the Tirupur Exporter’s Association, said medicine was not normally provided to workers without a doctor’s prescription, and that factories only stocked basic medication for fevers or headaches and a balm for muscle pains. “I am not aware of any medication being given to workers for their periods and we definitely would not support such a practice,” said Shanmugam.