Saying the Dirty Word Out Loud: Menstrual Health Management in India


Author- Sheel Chandra

There are 335 million menstruating women in India. 23 million women drop out of school every year owing to a serious deficiency in menstrual hygiene management (MHM). Menstruation is the second biggest factor for girls to miss school after household work. 70% of mothers with menstruating daughters consider menstruation to be “dirty”.[1] Menstruation has a huge stigma attached to it and before addressing menstrual health and hygiene, everyone, both men and women, have to be comfortable saying the “dirty word”.

Arunachalam Muruganantham, a social entrepreneur who invented a low-cost sanitary pad-making machine, experienced this stigma when he tried to make affordable sanitary napkins for his wife after discovering she was using old cloth rags. For Muruganantham, the quest to make these sanitary napkins came from a sense of curiosity as he reverse-engineered pads sold for 40 times the cost of their raw materials. But during his trial-and-error journey, Muruganantham became aware of the insidious taboo surrounding menstruation. He had turned his home into a workshop while developing his machine. During that time people in his village believed that he was possessed by demons and wanted to chain him to a tree and exorcise him. While on a field trial of his invention, Muruganantham travelled to Bihar. When he told the local men what he wanted to do, he was almost beaten up. Today, more than 2,100 production centers with machines as simple as Muruganantham’s have opened, selling pads at cheap costs.[2]

India, however, still has a long way to go. BharathyTahiliani, a consultant who drafted menstruation lesson plans for UNICEF has said that 80% of teachers believe menstrual blood is impure.[3] For the adolescent girls that do decide to go to school once they get their first period, there is a good chance their teachers would discourage them.

Most adolescent girls are not aware of what menstruation is until they reach menarche. Once they start menstruating, they are not aware of healthy and hygienic menstrual practices. A 2014 UNICEF report states that 66% of women in Uttar Pradesh remain unaware of menstrual hygiene practices. Most adolescent girls are not told by their parents or any other adults what menstruation is or how to deal with it in a hygienic way. Some don’t know enough about menstruation to tell their children, and some don’t encourage or feel comfortable with a dialogue about reproductive and sexual health. A Ministry of Education survey from 2015 points out that in 63% schools in villages, teachers have never discussed menstruation. These things combined with the perception that the blood coming out of girls is impure build up a sense of shame, guilt, and fear in young women about menstruation who then decide not to discuss the matter altogether, ultimately closing off any possible dialogue about healthy and sanitary menstrual habits.

There is a 70% increase in incidence of reproductive tract infections. There are almost 60,000 cases of cervical cancer deaths reported every year from India. 66.67% of these cases are due to poor menstrual hygiene.[4] Poor menstrual habits should become a matter of national concern. Not only do they infringe on every citizen’s right to health but they also violate every child’s right to an education. Menstrual health management also contributes to the United Nations’ Sustainable Development Goals, namely, quality education, gender equality, and clean water and sanitation.[5] This is also an incredibly important and resourceful opportunity for the government and the country. Resolving issues in MHM generates a triple-return on investment with improved outcomes in health, environment, and education. Girls staying in school delays early marriage and pregnancy and can add $100 billion to India’s GDP in their lifetimes.[6]

  There is a two-pronged diagnosis to this crisis of menstrual health. One, awareness. This covers ignorance about menstruation in general, stigmas attached to menstruation and a lack of information about healthy menstrual practices. Two, access to clean and proper bathrooms and efficient and safe sanitary products.One survey for the National Guidelines on Menstrual Hygiene Management reports that in the 14,724 government schools surveyed only 53 percent had a separate and usable girl’s toilet.  Only 12% of women have access to sanitary napkins in India. The rest use home-grown, often unsanitary, alternatives like old fabric, ash, newspapers, dry leaves, etc.

 What do we do? Arunachalam Muruganantham’s story has two lessons. One of them is that in order to advance in any way in menstrual hygiene management, societal barriers and taboos must be broken. Muruganantham met with judgment and shame everywhere- including his own village. One could surmise that if men and women weren’t ashamed of menstruation, a conversation on affordable sanitary products couldhave started sooner. How do we accomplish that?

 A study[7] sponsored by the Bill and Melinda Gates foundation reports that even within the limited range of awareness about MHM, most of it heavily focuses on the actual use of sanitary products, which while important, only has a short-term impact without education on the psycho-sexual aspects of adolescence[8], sexual and reproductive health and myths related to menstruation. Reuters reported a story of a young girl in Maharashtra, where the government has made menstrual hygiene education mandatory in all schools. Dhere, who learnt from school that nothing would happen if she touched food while on her period, was intrigued. She tested her teacher’s claim and was surprised- nothing did happen. So she went on to touch a god’s idol, empowered and excited to debunk another taboo. Nothing bad happened there either. A single teacher could debunk years-old myths. The most important channel to improve kids’ understanding of menstruation is schools. Both boys and girls must be taught what menstruation is- its biological significance and how nothing about it is impure. Content on MHM should be integrated in the schools’ curriculum. Education should be the cornerstone of any framework associated with MHM because it is not short-term. These children can grow up and educate their own families about menstruation instead of telling their daughters that what is happening to them is “dirty”. Within the umbrella of awareness also comes educating parents, family members, and other adults. This includes both men and women. MHM-capacity building and training programs in villages should not only focus on the children but also everyone in the family. This ensures that there is a positive and healthy dialogue about menstrual health and adults can be persuaded to improve sanitary conditions for their families, for instance, building an indoor and clean bathroom. This also educates parents on good nutrition and menstruation-related illnesses such as anemia. This also makes sure that people in that community are more receptive to any other initiatives related to menstrual health and sanitary products so that the next Muruganantham, is not in the danger of getting beaten up. 

 When Arunachalam Muruganantham saw his wife and sisters using unsanitary cloth rags to absorb blood, he asked them, almost naively, why they didn’t just use pads. His wife Shanthi answered, “If your sisters and I start buying them, we will have to cut down the family’s food budget.”[9]The second, and perhaps most obvious message from Muruganantham’s story is access to sanitary materials and facilities. Owing to the high costs of commercial sanitary napkins, most adolescent girls and women in villages use home-made, albeit often unsanitary, alternatives. A lot of these alternatives are also extremely uncomfortable and restrict girls and women from going to school or working. Some stores in villages don’t even stock sanitary pads. None of the shops in the 65 villages of Pali Block, Chhattisgarh, sold any sanitary napkins.[10] While using cloth as a substitute is not a bad alternative, most women in villages do not practice sanitary ways to use the cloth. Most of these women actually use the dirtiest cloth available to them because menstruation is a “dirty” phenomenon.[11] Access to proper toilet facilities is another problem. In the absence of a toilet, most women and girls bathe in nearby rivers, ponds, or wells. During their period, however, they avoid bathing altogether or go out in the dark to bathe.

   How do we address the problem of accessibility? While commercial sanitary napkins are expensive, there are a lot of ways to improve access to sanitary products. Following Muruganantham’s example, women can simply be taught how to use low-cost sanitary napkins production machines. Self-help groups (SHGs) can partner up with organizations that sell these production units and each village community can have its own manufacturing center. This not only ensures employment and teaches women essential entrepreneurial skills, but also provides them with their own low-cost sanitary napkins. These groups can also set up incinerators for the safe disposal of these napkins. Recently, UNICEF advocacy helped make these incinerators a part of a new government supported toilet design.[12] Some technical organizations can collaborate with local government, schools, and workplaces to install vending machines for sanitary napkins made by small local businesses. This not only improves access but also financially helps local businesses. Home science curriculum can include stitching usable and sanitary cloth pads for women who cannot afford normal sanitary pads. Through this they can utilize their own skills to self-make cheap, environment-friendly cloth pads made out of skin-friendly material designed for maximum absorptions. They can start their own businesses and help curtail the use of unsanitary and dirty cloth pads. Engineering students from all across the country, including rural and remote areas, can collaborate and come up with smart, affordable and quick designs to make sustainable and cheap sanitary products through government-sponsored contests and grants. Getting college students involved in comping up with new, creative ideas to improve menstrual hygiene will also encourage dialogue about broader issues on gender empowerment, water sanitation, sustainable development and public health. Furthermore, the government must act on a long overdue crisis of sanitation in India and ensure that every house has an indoor toilet. Every government school should have separate, clean toilets for girls and boys. Special attention should be given to make the toilets MHM-accessible. Meaning, toilets should have light, space, water supply, disposal units for used pads, soap, etc. The Swacch Bharat Abhiyan considers menstrual health to be one of its major and important goals, and accessible and sanitary toilets are a must to accomplish that.

Menstrual Health Management is important. It improves public health and sanitation.It brings girls back to school who can grow up to contribute to the country’s economy. Menstrual Health Management is not just about providing access to clean, safe, and affordable sanitary products, but also about allowing a free and open dialogue about sexual and reproductive health and rights. It, perhaps most importantly, allows girls to free themselves from shame and be their own, empowered agency. Menstrual Health Management has the potential to lift this country up and can be passed on to future, brighter generations. Let us finally say the dirty word out loud, period.


[1]Spot On! : Improving Menstrual Health and Hygiene in India. USAID, Kiawah Trust, Dasra.

[2]The New York Times, How an Indian Innovator Reverse-Engineered The Making Of Sanitary Pads, YudhijitBhattacharjee, November 10 2016.

[3]Thomson Reuters Foundation, “Not a dirty word: Indian girls shatter menstruation myths”, Roli Srivastava, February 1 2018.

[4]UNICEF. WASH in Schools Empowers Girls’ Education – Proceedings of the Menstrual Hygiene Management in Schools VirtualConference 2012: http://www.uniceforg/wash/schools/files/VVASHin_Schools_Empowers_Girls_Education_Proceedings_

[5]The World Bank Blog, “Globally, periods are causing girls to be absent from school” by Oni Luski-Stover, June 27 2016.

[6]USAID, Kiawah Trust, Dasra. “Spot On!: Improving Menstrual Health and Hygiene in India.

[7] FSG. 2016. “Menstrual Health in India: Country Landscape Analysis”, May.

[8]The Hindu, Hype over Pad Man but India’s Menstrual Woes Continue, R.Gopinath, March 12 2018.

[9]The New York Times, How an Indian Innovator Reverse-Engineered The Making Of Sanitary Pads, YudhijitBhattacharjee, November 10 2016.

[10]USAID, Kiawah Trust, Dasra. “Spot On!: Improving Menstrual Health and Hygiene in India.

[11]Goonj: “Not Just a Piece of Cloth”, Gupta, A., 2011.

[12]UNICEF. WASH in Schools Empowers Girls’ Education – Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2012: http://www.uniceforg/wash/schools/files/VVASHin_Schools_Empowers_Girls_Education_Proceedings_

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