Sudha seldom thought about the pills she took to ease her period pains during 10-hour shifts as a seamstress in southern India.
She could not afford to let anything interrupt her work and cut her wages so she sought medicine from a factory supervisor.
“They are depressing days and the pills helped,” said the factory worker in Tamil Nadu, India’s southern textile hub.
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 aged 17 - and she was not the only one.
A Thomson Reuters Foundation expose based on interviews with about 100 women in Tamil Nadu’s multi-billion dollar garment industry 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 labor 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.
Pills given to the Thomson Reuters Foundation by workers had no markings to show the brand, their composition or expiry date.
But two doctors who analysed the pills said they were non-steroidal anti-inflammatory drugs - similar to ibuprofen and Advil - that could help relieve menstrual cramps but were known to have possible harmful side-effects if taken frequently.
Activists, academics and doctors have voiced concerns that female workers’ lives were being tightly controlled, from toilet breaks to periods, to keep production lines running as India’s garment sector faces ever greater demands from Western brands.
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 1,50,000 ($2,168) 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.”
In response to the Thomson Reuters Foundation’s findings, an official from Tamil Nadu said the state would this year launch a project to monitor the health of its garment workers and collect data on how many suffered from work-related health problems.
While India’s 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 in Tamil Nadu state.