What India Still Misunderstands About Menstruation: Expert Explains

A young girl in Amgachi, Jharkhand, got her first period and cried. Not because she was in pain, but because she was terrified and did not understand what was happening to her body. She found out later from her mother, about periods, and learnt how to use a cloth. Many girls meet one of the most significant physiological events of their lives entirely alone, and without language for it.

Menstruation education at school, in some cases, can shift this understanding. In Rampurwa, Uttar Pradesh, a girl in Class 12 could comfortably explain ovulation without drawing immediate connections to fertility or motherhood. The tragedy is that what is taught at school often stays in school.

When older girls dropped out of school to take up the family's farm work, or because they were married young, it did not matter if their beliefs pre-marriage or at school were led by modernity; they often unlearned prior knowledge and adopted the values and traditions governing their home or their husband's home. This is not an exception.

Across deep ethnographic research conducted in rural communities in Jharkhand, Gujarat and Uttar Pradesh, a common question emerged: Can we build menstrual health infrastructure in a society where periods are still primarily understood as signaling readiness for marriage? Here, 'infrastructure' extends beyond toilets, sanitary napkins, or disposal systems. It includes the social and institutional systems that shape menstrual health: accurate information, trained health workers, supportive families, privacy, access to medical care, and the agency to seek help without shame or fear.

This is not just a question of access to sanitary napkins and safe, hygienic disposal solutions. It is also a question of whether women have the information, privacy, and agency to navigate menstruation with dignity.

The menstrual conversation, anchored in fertility, matrimony, and motherhood

An elderly woman in Bambhaniya, Gujarat, laid out how a girl's life follows a clear path; "basic education, then marriage, then household."

A girl's menstrual journey is understood almost entirely through the lens of fertility, reproduction and marriage readiness. An Anganwaadi worker in Rampur Tribauna captured this fear as a factor driving the silence around menstruation, which often emerged from protection, not disinterest. "Don't tell anyone, people will say the girl has grown up. Don't even tell Pitaji (i.e. Father); if he finds out, he'll get her married." This message is passed from woman to woman. Menarche is viewed as dangerous and a piece of information to conceal.

Elsewhere, in the tribal village of Lakarjoriya, Jharkhand, some women approached it with a positive outlook, albeit still with a direct link to fertility. "It is a good thing. If it does not happen, a girl cannot give birth to a child." Others highlighted how it could help guide family planning. Even there, in arguments for menstrual education and attempts to drive away shame, the end goal was anchored around reproduction and motherhood.

This reflects a system where menstruation is still not understood as an important part of women's health that deserves attention and care. As a result, many girls grow up without knowing what a healthy cycle looks like or when something may be wrong. Information about severe pain, irregular periods, or unusually heavy bleeding is often not discussed openly or passed on. Many women therefore learn to ignore symptoms that may actually require medical attention.

Also Read: Menstrual Blood Can Help Detect Endometriosis Without Surgery, Reveals Study

Endured pain, absent solutions

Menstrual pain, as a result, is understood as something to endure, and the absence of clinical research around it is abysmal, pointing to an evident gap: despite affecting half the population, menstrual research is significantly neglected.

Women often report abdominal, back, or chronic pain as routine, not seeing it as a sufficient reason to seek medical attention. Many also lack the vocabulary or confidence to clearly describe their symptoms, creating greater distance from timely diagnosis and treatment. With a recent review finding that anywhere between 60% and 80% of Indian women suffer from at least one menstrual disorder, with dysmenorrhea and premenstrual symptoms being the most widespread, this is particularly concerning.

When irregular cycles begin to be understood as possible indicators of underlying health conditions, and when on-ground health workers, whether ASHAs or Anganwaadi workers, are trained to unlearn beliefs that restrict and isolate women during her period, the system can begin to shift.

A socio-cultural shift from signaling fertility to health

NFHS-5 suggested that only 27.7% of young women aged 15-24 had access to all four essential menstrual health hygiene resources; period products, a private toilet, water within the premises, and soap. NFHS-6 (2023-24) shows modest progress: 79.2% now use hygienic menstrual protection, but 21% still don't. But the challenge is not just about products or toilets alone. It is about the need for privacy, prevailing belief systems, the knowledge to help decode it, and normalisation of the freedom to seek care.

This is why reframing must be socio-cultural. It can begin with treating the menstrual cycle as a vital monthly indicator of health. Menstruation must be understood not merely as a marker of fertility, but as an important indicator of overall health. Changes in cycle length, frequency, or symptoms such as severe pain and excessive bleeding can offer important insights into hormonal balance, nutrition, stress, and other underlying health conditions. The WHO has already made a case for this framing, and it is imperative that we follow suit.

The recent Supreme Court judgment recognising menstrual health as part of the fundamental right to life offers an important opportunity in this direction. By mandating access to free sanitary pads and better menstrual hygiene facilities in schools, the ruling has the potential to go beyond addressing period poverty alone. If implemented meaningfully, it can help normalise conversations around menstruation, strengthen menstrual health education, encourage girls to better understand their bodies and symptoms, and foster a culture where seeking care is not accompanied by shame or silence.

Over recent decades, we have invested in awareness campaigns, school-based education, and access to sanitary napkins. But ensuring a shift in viewing it as a health marker is essential. This would entail parents telling their girl children early on, about this physiological process, tracking cycles regularly and inquiring around delays or painful symptoms, seeking medical advice when needed. Most importantly, it would require creating a caring supportive environment grounded in the belief that periods are an important marker of good health for women and girls, rather than simply a signal of fertility or readiness for marriage.

(By Divyang Waghela, Deputy Head of Programmes and Head, Water, Sanitation and Hygiene (WaSH), Tata Trusts)

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