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Menstrual Hygiene
Management in India
Sophia Eclarin
University of Maryland
14 November 2019
FMSC 110S
Dr. Maring

I pledge on my honor that I have not given or received any unauthorized

assistance on this assignment.
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I. Introduction

Menstruation is a natural biological process that every woman and adolescent girl

experiences once a month. However, in certain countries such as India, it can be very difficult for

them to effectively deal with their menstruation. In India, poor menstrual health management is a

large issue that is often overlooked due to the extreme gender inequality. Several rural areas lack

adequate infrastructure and clean water, which prevents girls from being able to clean themselves

properly. According to the Journal of Global Public Health, an inability to maintain good

menstrual hygiene can lead to several health problems such as “an increased risk of reproductive

and urinary tract infections” (Sivakami, 2019). Also, the cost of feminine products can be very

expensive or unavailable in certain areas. Professional researchers from Emory University have

stated that the low access and high costs of sanitary products forces women to resort to using

other materials, such as “cloth, cotton, and old clothing” (MacRae, 2019). Aside from increasing

susceptibility to other health infections and diseases, poor menstrual management can also lead

to girls missing out on their education. The Academy of Family Physicians of India reports that

23% of adolescent girls in India “drop out of school when they begin menstruating” (Garg,

2015). The relatively high school dropouts contribute to the low female literacy rate in the

country. Overall, poor menstrual health management has several consequences that impact many

women and adolescent girls in India.

II. Background

While poor menstrual health management affects females all over India, there is a higher

prevalence in rural and impoverished areas. A study conducted in Odisha, one of India’s most

poverty-stricken districts, reported that “65% of the population does not use a sanitation facility”
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and “90% of households do not have piped water” (MacRae, 2019). Living in a low-income area

results in less funds being allocated to adequate infrastructure, meaning that women will have

fewer access to facilities to properly clean themselves during menstruation. The study further

revealed that “94% [of surveyed women] indicated that they did not use a latrine while

menstruating” (MacRae, 2019). Because the community does not have the necessary facilities,

women lack the ability to dispose of their products and clean themselves. Furthermore, rural

areas tend to lack access to sanitary products because they cannot be distributed in hard to reach

areas. Due to this, women and adolescent girls tend to use other materials that are readily

available to them, like cloth.

Another factor as to why poor menstrual health management occurs in India is because of

the taboo and stigmatization of menstruation that is part of the country’s culture. Menstruation is

negatively looked upon in several aspects of Indian society, such as in the house and religion. In

an article from the Academy of Family Physicians of India stated that women and girls are often

“restricted from entering the kitchen” because of the belief that women are “unhygienic and

unclean” during menstruation (Garg, 2015). In terms of religion, women are forbidden from

“offering prayers and touching holy books” due to the notion that women are impure when they

menstruate. The large stigma surrounding menstruation plays a very big role in menstruation

management. Because menstruation is seen negatively in society, women and girls feel extremely

embarrassed discussing their periods and believe that they cannot seek help and attention.

Furthermore, the stigma prevents society from being educated on the menstrual cycle, which

results in a lack of facilities being created for women to be able to take care of their periods. In
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Delhi, there are only “132 public toilets for women”, which leaves women with few options

(Garg, 2015). Because people feel reluctant to discuss menstruation,

III. Significance

Inadequate menstrual health management is an overlooked issue that many fail to realize

impacts several women and adolescent girls in many ways. For example, the issue prevents India

from achieving Sustainable Development Goal #3, which is “Good Health and Well-Being”

(United Nations, 2019). If girls do not have access to the right sanitary products and facilities to

take care of their periods, they will face several problems to their physical health that will be

detrimental in the future. As previously stated, poor menstrual hygiene can result in issues such

as reproductive and urinary tract infections. When women are faced with these health problems,

their ability to have children will be negatively impacted. Furthermore, health issues will prevent

girls and women from participating in the workforce and education because they will not be

physically healthy. In India, women are seen as the “nurturers and providers of emotional

caretaking”, meaning that they play a large role in family households (Rao, 2015). Without

women being at their healthiest, many households become affected because there is no one to

offer emotional support or complete household chores.

While good health and well-being is essential, poor menstrual hygiene is extremely

detrimental to a girl’s education. In India, many girls miss school when they are menstruating

due to shame and embarrassment, as well as there not being the necessary sanitary and disposal

facilities. The study conducted in Chhattisgarh, India reported that “1 in 5 girls miss one day of

school while menstruating” or had problems concentrating in school because of “pain and fear

of staining or smell” (Sivakami, 2015). Because the adolescent girls are not effectively educated
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on how to manage their periods, they do not feel comfortable enough to attend school; if they do

attend school, they will likely be judged or shamed, which brings them out of their focus.

Inhibiting a girl’s education prevents India from achieving Sustainable Development Goal #4 to

“ensure inclusive and equitable quality education and promote lifelong learning opportunities for

all” (United Nations). The issue of poor menstrual management must be solved in order to get rid

of the barrier between girls and their education. Educated girls contribute greatly to not only

society, but their families. According to the Malala Fund, for every additional year a girl is in

school, the infant mortality and child marriage rate immediately reduces (Malala Fund).

Furthermore, girls with an education are more likely to enter the workforce and contribute to the

household income. UNICEF reports that every additional year of primary schooling that a girl

receives will boost their future wages by 10-20% (UNICEF). Overall, poor menstrual

management will prevent adolescent girls from being able to obtain their education, which will

impact not only herself, but her family as well as future generations to come.

All levels of the ecological model are affected by poor menstrual health management. On

a microsystem scale, the individual menstruating female can develop shame and embarrassment

whenever they get their periods, because of society’s beliefs that they are impure and unhygienic.

Adolescent girls are also in the developmental stage where they want to fit in with their

respective age groups, so they will likely experience more embarrassment compared to older

women. In the mesosystem, poor menstrual hygiene can be a result of family stigma and lack of

knowledge. Families tend to value the men in the household over the women, so they feel as

though women’s needs are not as important, meaning that they will not work to help and provide

them with menstrual resources. Through the exosystem, because there are no effective sanitary
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facilities for women during menstruation, they may not be able to actively participate in their

workforce because they will be too distracted with their periods and worrying about how to

manage them. Finally, the macrosystem plays the potentially biggest role in poor menstrual

health management because of the strong taboo in Indian culture regarding menstruation. In the

country’s culture, menstruation is seen as a negative circumstance, which places a sense of

indignity on any woman during their menstrual cycle. To conclude, poor menstrual hygiene

impacts all systems of the ecological model.

The World Bank Data Portal reports that females make up 48% of the population in India

(World Bank, 2019). A majority of these females are likely going through menstruation and will

experience the menstrual cycle for a large portion of their lives. Because females are half of

India’s population, it is important that the government makes a conscious effort to solve the issue

of poor menstrual hygiene and provide women and girls with the right resources and facilities

that they need to be physically healthy while still obtaining their education. Without females

being at their best, families will be negatively impacted not only in the present, but in the future.

If girls do not attend school because of their menstrual cycle, their lack of education will result in

low schooling rates for their future children, creating a cycle of poverty and inability to

participate in the workforce. The issue of poor menstrual hygiene must be fixed so that families

can benefit from healthy and strong women that can effectively contribute to their households.

IV. Current Efforts

Despite being overlooked historically, there have been strides to make menstrual health a

priority across nations. The Indian government’s most prevalent intervention to solve the issue is

the Menstrual Hygiene Scheme. Organized by India’s Ministry of Health and Welfare in 2011,
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the intervention works to develop education and training programs to increase the public’s

knowledge about menstruation (Ministry). The Menstrual Hygiene Scheme also works to

increase access to femenine hygiene products by providing six “Freeday” sanitary napkins to

girls in rural areas (Ministry).

A 2015 study was conducted in the rural village Haryana, 5 years after the scheme was

implemented. Researchers ultimately chose Haryana as an area to study because rural areas tend

to have the lowest access to hygiene products due to their high cost or unavailability, leading

women and girls to use other materials that may not be as sanitary. For example, women tend to

wash and reuse the same piece of cloth during their period, which can be extremely unsanitary

and lead to reproductive tract infections. The study interviewed several women and adolescent

girls throughout the village to determine if the Menstrual Hygiene Scheme was actually

effective. Results of the study concluded that while “79% of [interviewed women] felt motivated

to use the Freeday sanitary napkins”, however, only 30% of the interviewed females actually

used the provided napkins (Bhattacharya, 2016). Furthermore, the study also discovered that the

Accredited Social Health Activists (ASHAs), the people that distribute the Freeday products,

were displeased with the intervention because the supply of sanitary products was irregular and

short, not providing enough for the females in the village (Bhattacharya, 2016). Overall, the

study proved that work needs to be done to make interventions such as the Menstrual Health

Scheme more effective.

While providing menstruating females with sanitary products can be helpful in better

menstrual health management, it is not the only solution. Researchers from the study have

credited the irregular supply and lack of product variety to the ineffectiveness of the intervention
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(Bhattacharya, 2016). Because the Freeday products were not being distributed as frequently,

women and adolescent girls would still use other readily available material such as cloth to take

care of their periods. The Freeday products were also one standard small size, which makes it

difficult for women to use on days where menstrual bleeding is heavier. With the intervention’s

shortcomings, there is room for improvement. To better this intervention, the Ministry of Health

and Welfare must keep a consistent supply of products being available so that menstruating

females will not need to use cloth or other potentially unsanitary materials. Additionally, the

government must work with the hygiene product company to create a wider variety of sizes that

will cater to all blood flows during menstruation.

In terms of ecological model, the Menstrual Hygiene Scheme failed to address menstrual

management through the mesosystem. While providing hygiene products to individual

menstruating females allows them to feel clean and comfortable on their periods, communities

still may not understand the process of the menstrual cycle, which can prevent them from

providing the necessary facilities and resources to help women and girls. To improve the

intervention, the Indian government should implement educational programs that inform families

and schoolchildren about menstruation in health classes.

Furthermore, the Menstrual Hygiene Scheme did not address menstruation on a societal

level. The taboo and stigma surrounding menstruation in society is a large contributing factor to

poor menstrual management, because females feel uncomfortable discussing their periods for

fear of shame or humiliation. The Menstrual Hygiene Scheme could attempt to challenge

society’s beliefs by normalizing the process of menstruation and opening up the conversation. If
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society discusses the menstrual cycle more prominently, women and adolescent girls will be able

to seek help and resources to take care of their periods.

While there were several shortcomings with the Menstrual Hygiene Scheme, it was a

guiding intervention that could lead researchers and the government to better improvements. For

example, researchers can further study whether or not using cloth as a napkin is due to

accessibility or cultural viewpoints. From there, the government can find ways to inform the

public on the health risks of using cloth as a hygiene product and provide incentives on using

sanitary napkins. Researchers of the 2016 study have mentioned that people must be motivated

enough to use the sanitary napkins in order for any change to actually be made (Bhattacharya,

2016). Therefore, future research must be made to explore the cultural beliefs that lead women to

using other products for their menstrual cycle.

V. Discussion

Despite intervention attempts, there is still much more to improve to fix the problem.

Inadequate menstrual hygiene management is a result of many different factors within India. In

several rural areas, there is little to no sanitary facilities available for women to take care of their

periods, resulting in hygiene issues such as unclean materials being reused. Access to sanitary

products can be extremely limited in rural areas due to cost or availability. Additionally, the

cultural taboo and stigma surrounding menstruation prevents women and adolescent girls from

seeking help or resources, and instead making them feel humiliation and discomfort. Poor

menstrual hygiene management prevents girls from reaching their fullest potential through

education, because they feel uncomfortable discussing the process and there are no facilities to

help them deal with their periods at school, resulting in low attendance and high dropout rates.
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The lack of education in girls inhibits the achievement of the equal right to education desired in

Sustainable Development Goal #4. Lacking proper menstrual hygiene also can put girls and

women at a greater risk for several health complications, including reproductive and urinary tract

infections. Personally, I believe that this issue has been overlooked for so long because of the

fact that it only affects females; the large gender inequality in India promotes the ideal that

women are inferior to men, therefore making their problems less important. If measures are taken

to solve this issue, it will just be one of the first steps in reducing gender inequality in India. The

Menstrual Hygiene Scheme was an adequate approach because it wanted to increase the

availability of hygiene products to females, but the supply was too irregular and few people were

motivated enough to use the products. In order for true change to be made, the government must

normalize menstruation in society to challenge previous beliefs that menstruation is dirty and

impure. With the right education programs, communities can understand that menstruation is

natural and will be more willing to help girls. International organizations and governments must

continue to bring attention to the issue of poor menstrual hygiene on the global stage so that

everyone can work together to ensure that women and girls worldwide can feel comfortable and

healthy during their menstrual cycle.

VI. Conclusion

Based on several research findings and studies, it is evident that poor menstrual hygiene in India

is a very critical issue that needs urgent attention. Poor menstrual management has severely

negative consequences such as health risks and lack of education. Moving forward, action must

be taken to reduce the stigma and taboo surrounding menstruation, which is likely the biggest

factor resulting in poor menstrual health management.

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References

Bhattacharya, S., & Singh, A. (n.d.). How effective is the Menstrual Hygiene Scheme? An

evaluation study from North India. Retrieved from

https://www.ijcmph.com/index.php/ijcmph/article/view/235/235

Garg, S., & Anand, T. (2015). Menstruation related myths in India: Strategies for combating it.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408698/

Girls' education. (n.d.). Retrieved from https://www.malala.org/girls-education

India . (n.d.). Retrieved from https://data.worldbank.org/country/india

MacRae, E. R., Clasen, T., Dasmohapatra, M., & Caruso, B. A. (n.d.). 'It's like a burden on the

head': Redefining adequate menstrual hygiene management throughout women's varied

life stages in Odisha, India. Retrieved from

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220114

Ministry of Health & Family Welfare-Government of India. (n.d.). National Health Mission.

Retrieved from https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1021&lid=391

SDGs .:. Sustainable Development Knowledge Platform. (n.d.). Retrieved from

https://sustainabledevelopment.un.org/sdgs

Sivakami, M., Maria van Eijk, A., Thakur, H., Kakade, N., Patil, C., Shinde, S., . . .

Phillips-Howard, P. A. (2019, June). Effect of menstruation on girls and their schooling,

and facilitators of menstrual hygiene management in schools: Surveys in government

schools in three states in India, 2015. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286883/

UNICEF says education for women and girls a lifeline to development. (2011, May 04).
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Retrieved from https://www.unicef.org/media/media_58417.html