As we celebrate Menstrual Hygiene Day, in many parts of the world, menstruation is still cloaked in silence, stigma, and inadequate support. Millions of girls and women face barriers to managing their periods safely and with dignity - barriers that are often rooted in systemic deficiencies in water, sanitation, and hygiene (WASH) services. The broader implications extend beyond personal hygiene: the inability to manage menstruation adequately affects educational outcomes, workforce participation, physical and mental health, and overall gender equality.
Menstrual hygiene is not only a matter of dignity. It is a global development issue. In their 2021 report, Mission-critical: Invest in water, sanitation and hygiene for a healthy and green economic recovery, WaterAid and Vivid Economics emphasise that universal access to menstrual hygiene is both a moral responsibility and a smart economic strategy.
A Gendered Inequity
Women and girls bear the brunt of poor WASH infrastructure. Tasks like water collection - taking an hour or two daily per household - disproportionately affect them, limiting opportunities for education, work, and leisure. Safe and private sanitation is essential for menstrual management, yet many schools and public spaces fall short.
The consequences are stark: a third of schoolgirls in Malawi miss at least one day of school per cycle. These interruptions affect academic performance and future workforce participation. Inadequate menstrual hygiene facilities also increase the risks of gender-based violence, health complications, and social exclusion. Poor hygiene access is linked to 1.6 million preventable deaths each year, and contributes to 60% of diarrhoeal fatalities.
The Dignity Deficit
Lack of menstrual hygiene compromises not just health, but dignity and mental well-being. Without private toilets, girls and women face harassment and emotional distress, particularly in already marginalised communities. The psychological toll of menstruating in unsafe or unsupportive environments is immense and long-lasting.
Economic Gains From WASH Investments
Investing in menstrual hygiene yields high returns. The report shows benefit-cost ratios of up to 21:1 for basic hygiene services. Key projections include:
- Time savings: Up to 77 million additional working days annually for women.
- Disease prevention: 96 million diarrhoeal and 160 million respiratory infections averted with universal hygiene.
- Relational Uplift: Preventing 11 billion cases of helminth infections could generate $420 billion in economic gains between 2021 and 2040.
Enhancing menstrual hygiene not only promotes gender equity but also strengthens economies through improved education, health, and productivity.
The Indian Context
In India, menstruation is often accompanied by stigma and inadequate support, leading to significant challenges for women and girls. A comprehensive report on menstrual hygiene management in India was released by NGO Sulabh International in December 2023 found that girls are "fearful" of using school toilets during menstruation owing to a lack of water, soap, sanitation and missing doors.
According to the report, the fear among school girls provokes absenteeism during their menstrual cycle. It also says that "distance from home to school is not as big a deterrent for girls to miss school, as is lack of menstrual hygiene management facilities". A meta-analysis involving 97,070 girls aged 10-19 across the country revealed that approximately 25% of girls miss school during their periods due to fear of staining, lack of changing rooms, and unavailability of water and cleaning facilities.
Strengthening Policy on Menstrual Health and Hygiene
India has made commendable progress in improving access to sanitation and hygiene, notably through the Swachh Bharat Mission (SBM), which catalysed nationwide action to eliminate open defecation and improve sanitation coverage. However, menstrual health and hygiene (MHH) remains a critical yet often under-addressed component of WASH policy.
To build on existing momentum and align with national goals for gender equality, health, and education, the following policy considerations can help guide a more integrated and inclusive approach:
1. Mainstream Menstrual Health into Flagship Programs: While there is a National Menstrual Hygiene Scheme (MHS), and menstrual hygiene has been included in some other health and education initiatives (such as under the Ministry of Health and Family Welfare's Rashtriya Kishor Swasthya Karyakram and the Ministry of Education's WASH in Schools program), effective roll-out of the recently drafted National Policy on MHH would ensure coordinated implementation across sectors.
Policy Suggestion: A coordinated and integrated effort on MHH from various ministries will result in better ground-level implementation. Notable among them are the ministries of health and family welfare, women and child development, human resources, Jal Shakti, among others. Positioning menstrual health as a core pillar within SBM 2.0 and Jal Jeevan Mission 2.0 implementation plans is crucial, with targeted indicators and budget lines.
2. Ensure Sustainable Financing: Menstrual health services - including awareness campaigns, sanitary napkin distribution, disposal infrastructure, and training for frontline workers - require consistent and predictable financing. States currently rely on varied models and allocations, leading to gaps in coverage and quality.
Policy Suggestion: Encourage states to utilise existing untied funds (such as those from the 15th Finance Commission) and bring additional funds involving private players under corporate social responsibility (CSR) to build MHH-inclusive WASH infrastructure, especially in schools and Anganwadis.
3. Improve School Infrastructure and Curriculum Integration: While most of the state-sponsored pad distribution schemes are free, it is important that this goes hand in hand with infrastructure and education. Many schools still lack functional, private, and well-maintained toilets with water access, which is essential for managing menstruation with dignity.
Policy Suggestion: Mandate MHM-friendly toilet spaces for menstruators in all government schools, and link these facilities for monitoring under the Unified District Information System for Education Plus and Samagra Shiksha, and include menstrual health in life skills education.
4. Foster Innovation in Menstrual Products and Disposal: There is growing awareness of the environmental impact of single-use sanitary pads, with India generating over 12 billion used pads annually. Promoting safe, affordable, and sustainable alternatives - such as biodegradable pads or menstrual cups - requires policy support and behaviour change campaigns.
Policy Suggestion: Create incentives under Start-Up India, or the Atal Innovation Mission, or SBM 2.0 for menstrual health enterprises, and issue disposal and incineration standards for public institutions and schools.
5. Learn from Schemes Run by Different States: Many states have taken initiatives and launched free or subsidised sanitary napkin provisions. Some notable schemes are Khushi (Odisha), Asmita Plus (Maharashtra), Suchi (Karnataka), Udita (Madhya Pradesh), Udaan (Rajasthan), and SanFed (Tamil Nadu). Though excellent initiatives, these schemes face the problem of a fragmented landscape marked by inconsistent implementation, limited reach, and chronic underfunding.
Policy Suggestion: Policy should ensure adherence to quality and access, sustained budgetary support, strong product chain, and robust monitoring mechanisms. Additionally, it must adopt an inclusive approach that encompasses marginalised groups and actively involves adolescents, teachers, health workers, and civil society. Learning from good practices from various states and regions will go a long way to make all these schemes successful.
6. Collect and Disaggregate Data for Evidence-Based Policy: Currently, limited national-level data exists on access to MHH services, especially among marginalised groups (such as girls with disabilities, tribal populations, or displaced communities). Disaggregated data is essential to target interventions effectively.
Policy Suggestion: Integrate adequate MHH indicators into national surveys like the National Family Health Survey, National Sample Survey, and Annual Health Surveys, and support local governments to include MHH in baseline data collection.
In essence, menstrual hygiene transcends access to sanitary products and facilities - it is a matter of fundamental human rights, equity, and empowerment. As India advances toward its vision of 'Viksit Bharat', menstrual health must evolve from a narrow public health concern into a pivotal driver of gender equality, educational equity, and economic participation.
This is not merely a moment for awareness but a call for systemic change. Bridging the gap between rhetoric and reality demands policy innovation, community-driven solutions, and a cultural shift that dismantles stigma. For a truly developed nation, periods must no longer derail education, limit opportunities, or compromise dignity. The path to progress lies in transforming dialogue into decisive action - and the time to act is now.
(The writer, a senior social sector leader, can be reached at mbiswanath@gmail.com. The opinion expressed here is his own.)
Disclaimer: These are the personal opinions of the author
