From Silence to Solutions: Why Menstrual Health Deserves Attention
By Arunima Rajan
Poonam Muttreja, executive director of the Population Foundation of India, cuts through the usual rhetoric about menstrual hygiene. In a candid conversation with Arunima Rajan, she argues that pads and policies won’t cut it without tackling the cultural discomfort, lack of infrastructure, and the silence that surrounds menstruation in India.
The recently approved Menstrual Hygiene Policy for School Going Girls aims to address accessibility and awareness. From your perspective, what are the most significant barriers to achieving menstrual hygiene equity in India?
Cultural taboos and stigma around menstruation lead to silence, misinformation, and shame, which prevent open discussions and proper care. Limited access to affordable menstrual products, especially in rural and underserved areas, remains a significant challenge. According to the National Family Household Survey-5 (2019–21), while 90% of urban girls use hygienic methods, only 73% of rural girls do. Additionally, many schools lack adequate WASH (Water, Sanitation, and Hygiene) facilities, including gender-segregated toilets, water supply, and waste disposal systems, compromising girls’ dignity and school attendance. Research shows that a quarter of all schoolgirls in India take time off during menstruation due to inadequate gender-specific toilets and non-availability of sanitary pads in schools (Liverpool School of Tropical Medicine and UNICEF, 2014–15). Furthermore, insufficient menstrual health education leaves many girls unprepared for menarche; NFHS-5 data reveals that 65% of girls are unaware of menstruation before their first period, increasing the likelihood of unhygienic practices that lead to fungal, urinary, and reproductive infections. Environmental concerns also pose a challenge, as disposable products generate approximately 125 kg of menstrual waste per woman over her lifetime. Addressing these issues requires a holistic approach, including community engagement, improved infrastructure, education, and sustainable practices.
Menstrual Hygiene Policy for School Going Girls emphasizes inter-departmental coordination to tackle challenges like infrastructure and supply chains. What practical steps do you think can ensure seamless collaboration between various stakeholders?
Poonam Muttreja, Executive Director, Population Foundation of India
Effective inter-departmental coordination requires a robust convergence mechanism. This should bring together departments like education, health, women and child development, and sanitation to facilitate coordinated planning, resource-sharing, and joint implementation of activities. These could include improving WASH infrastructure, distributing menstrual products, and conducting awareness campaigns. A shared monitoring framework and integrated data systems can enhance transparency and accountability. Regular inter-departmental meetings can address challenges in real time, ensuring the policy’s success. Engaging local stakeholders, such as NGOs and community leaders, will further strengthen outreach efforts and ensure culturally sensitive implementation.
Menstrual health has long been stigmatized in many communities. What strategies do you believe are most effective in driving behavioral and social change to break the stigma around menstruation?
Breaking menstrual stigma requires education, awareness, and community involvement. Schools must integrate menstrual health education into their curricula, teaching both girls and boys to normalize the topic. Community discussions and media campaigns can challenge entrenched taboos and misinformation. Targeted social and behavior change communication (SBCC) campaigns, tailored to local cultural contexts, can help dispel myths and promote healthier practices. Involving men and boys in these conversations is critical to creating a supportive environment. Frontline workers should also be trained to provide accurate information, which empowers individuals and fosters lasting behavioral change.
One key objective of the policy is to integrate menstrual hygiene education into school curriculums. In your experience, what are the best ways to design and deliver such programs so they resonate with both students and educators?
Menstrual hygiene education programs should be age-appropriate, culturally sensitive, and delivered through interactive methods such as discussions, storytelling, and multimedia tools. Educators need to be trained to handle these topics confidently, with workshops addressing myths and providing practical teaching aids. Including boys in the curriculum helps normalize menstruation, while peer-to-peer learning can make the information more relatable. For instance, Population Foundation of India's digital resource, ARSH for You, is an online teacher-training program hosted on Educately.org. This program equips educators with relevant knowledge about adolescent health and well-being, including menstrual health, growth, identity, relationships, conception, and contraception, ensuring they can deliver this information effectively and empathetically.
The policy also highlights the need for eco-friendly menstrual waste management. How do you envision balancing environmental sustainability with the need to provide affordable hygiene products to underserved communities?
Balancing environmental sustainability with affordability in menstrual hygiene requires promoting reusable options like menstrual cups. A study by Action Research and Training for Health (ARTH) found menstrual cups to be a low-cost, effective option that improves menstrual protection, particularly for women working long hours outdoors. Additionally, providing affordable biodegradable sanitary pads offers an environmentally responsible alternative, ensuring all women and girls can access sustainable choices. Partnerships with local organizations can help subsidize costs and improve distribution, especially in underserved areas.
With many girls in India facing mobility and participation challenges due to inadequate menstrual hygiene resources, what immediate interventions could have the greatest impact in bridging these gaps?
Immediate interventions to address mobility and participation challenges include infrastructural interventions such as constructing safe, clean, and gender-sensitive toilets in schools and ensuring the availability of affordable menstrual products. Awareness campaigns in communities can reduce stigma and empower girls to fully participate in educational and extracurricular activities. These steps help bridge gaps, keeping girls in school and improving their overall engagement.
States have been urged to assess local needs and submit tailored action plans. What role do you see for organizations like the George Institute in supporting state governments with data-driven insights and implementation frameworks?
Research organisations and NGOs can play a crucial role in supporting state governments by providing data-driven insights to assess local needs and develop effective action plans. Their research expertise can identify gaps, track progress, and create practical frameworks for implementation. By offering evidence-based recommendations, these organizations ensure that menstrual hygiene programs are impactful, locally relevant, and sustainable.
The policy’s success hinges on timely and continuous access to hygiene products in schools. What lessons can India draw from other countries that have successfully implemented similar initiatives?
India can draw lessons from countries like Kenya and Bangladesh, where menstrual hygiene initiatives have yielded positive outcomes. In Kenya, the government distributed free sanitary pads in partnership with NGOs, significantly reducing absenteeism among schoolgirls. Similarly, Bangladesh combined the provision of menstrual products with education campaigns to combat stigma. Both countries prioritized reliable supply chains and community involvement. India can adapt these strategies, integrating product distribution with education and local engagement to ensure long-term success.
Looking ahead, what indicators would you consider critical for measuring the long-term success of this policy in improving menstrual health outcomes for schoolgirls?
The long-term success of the policy can be measured through several critical indicators. These include improved school attendance during menstruation, increased awareness of menstrual health among students and teachers, and consistent access to menstrual products in schools. Surveys that assess reductions in stigma and monitoring health outcomes, such as decreases in infections, will provide valuable insights into the policy’s impact. Together, these indicators will gauge how effectively the policy improves the health and education of schoolgirls over time.
Beyond individual metrics, the integration of menstrual health into broader frameworks of gender equality and education can lead to transformative outcomes for adolescent girls. The policy’s ultimate success lies in its implementation and fostering an environment where girls feel empowered, confident, and supported, enabling them to achieve their full potential in both academic and personal spheres.