375 million. That’s the number of menstruating people that are there in India.
Periods are normal and healthy, yet many people lack access to sufficient information, period products, and support to manage their periods well.
They may suffer from poor health, and many are unable to participate in daily activities, including going to school and work, during their periods.
Recognizing the importance of menstrual health and hygiene (MHH), the Supreme Court of India, on 10 April 2023, responded to a public interest litigation and directed the Central Government to develop a “uniform national policy” with an emphasis on free sanitary pads and separate toilets for girls in schools.
Period products and female toilets in schools are undoubtedly important.
We also see this as a pivotal opportunity to address MHH comprehensively in India, learning from the rich work done so far, to support menstrual health for all.
India has a commendable record of action on MHH by the Government, from the Menstrual Hygiene Scheme (2010-11), catalytic initiatives like the National Guideline for Menstrual Hygiene Management in Schools (2015) that sparked several state level schemes, and innovative financing approaches such as the recent Suvidha Sarthi Scheme (2023).
NGOs and social enterprises have demonstrated novel solutions to spread awareness, tackle menstrual shame and stigma, and develop innovative period products, toilet designs, and disposal technologies, in school and non-school settings, and with diverse groups.
In light of the Supreme Court’s directive and the leadership for the new policy, we highlight key takeaways from India’s commitment to MHH to inform a comprehensive MHH policy framework:
MHH is important for adolescent girls in schools and out of schools:
Empowering adolescents with information about their bodies and life skills to communicate, make decisions and assert their rights, lays the foundation for health and wellbeing throughout their life.
Schools are undeniably an important platform, but some girls may drop out or never go to school, and need to be reached as well, as they often come from particularly vulnerable backgrounds.
MHH requires comprehensive and accurate information, and a supportive environment:
Both girls and boys must have essential and accurate information about puberty, periods and the menstrual cycle, to understand normal bodily processes, have greater control over their bodies, and bust myths and misconceptions about periods being unclean, and people who menstruate as impure.
Parents, teachers, and other community influencers also need education to create a supportive environment free from shame and stigma.
MHH needs a basket of period products:
Sanitary pads are the most popular “hygienic” period product; however, they don’t work for everyone as people’s needs, preferences, and realities differ widely.
The National Family Health Survey - 5 (NFHS-5) found that while almost 78 percent of young women used a hygienic period product (mostly sanitary pads), around 50 percent continued to use cloth, particularly in rural areas.
Providing reusable period products in addition to sanitary pads may work better than a single product type alone, particularly if supply is intermittent, of poor quality, or the product itself is not preferred.
India has a plethora of period products, and this rich market must be leveraged to promote MHH.
In Jharkhand, the Missi Garima program found success with reusable cloth pads, and in Alappuzha (Kerala) and Siddipet (Telangana), menstrual cups are a popular choice.
A period product basket enables a person to choose what all products they can use during their periods to be comfortable and healthy, and also helps with long-term access to period products, complementing free product distribution efforts.
MHH requires water, sanitation and disposal facilities in toilets for all:
With the Swachh Bharat Mission (SBM), more homes and schools in rural India have toilets than ever before, and the focus now needs to be on keeping those toilets clean and in working order so that girls and women are comfortable and feel safe using them when they need to. We also need toilets in worksites and public spaces.
With an increased use of sanitary pads, safe disposal and downstream management of this waste needs consideration.
Low-cost incinerators, while popular, work only with reliable electricity supply, and moreover, these machines are often of poor quality and break down easily.
Other technologies and context specific solutions for menstrual waste exist and are under development, and future efforts need to identify and test scalable solutions that are safe for human health and the environment.
MHH needs linkages with health and nutrition services:
While girls do miss school during their periods, a leading reason is menstrual discomfort and pain.
Conditions such as anaemia and polycystic ovarian syndrome (PCOS) affect periods. Close to 60 percent of girls and adult women (15-49 years) in India are anaemic, according to the NFHS-5, and between 6-10 percent are to have PCOS.
Linkages with health and nutrition services are essential to improve menstrual health.
MHH is important for people across the lifespan and those in vulnerable contexts:
While girls embark on their menstrual journey in their early teens, adult women have periods for 20-30 years - and need information and support, too. People who are non-binary, transgender or intersex may also have periods, as do girls and women with disabilities, and those affected by disasters and conflicts.
These groups need tailored information, period products and supportive services for healthy periods. The Government of Assam for example, has included period products as a part of the emergency relief package for disaster affected zones, and some NGOs provide MHH support to refugees, people with disabilities and transgender communities.
The Ministry of Health and Family Welfare is already working along these lines for the new policy, building on the Supreme Court directive.
375 million girls and women, 28 States and 8 Union territories - can we have a “uniform national policy”?
Considering India’s population and diversity, a comprehensive national policy framework can guide action by laying out what all needs to be done, encouraging cross learning and collaboration for scale, amplifying successful practices, promote innovation and research, all the while responding to specific contexts and lived realities to support menstrual health for all.
(Arundati Muralidharan is a public health professional, and co-founder of MHAi. She works in India and globally to advance menstrual health and hygiene. Karan Babbar is an Assistant Professor at Jindal Global Business School, OP Jindal Global University. Mayuri Bhattacharjee is a menstrual health advocate and Founder of the Dignity in Disasters campaign. )