Menstrual Hygiene Policy in India: Can It Bridge the Gap in Access and Deliver Equity?
By Arunima Rajan
In an interview with Arunima Rajan, Sandhya Kanaka Yatirajula , program lead, mental health, The George Institute for Global Health India talks about period poverty, menstrual stigma and the new menstrual hygiene policy.
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?
Millions of women and girls not just in India but worldwide experience what has been termed as period poverty. Period poverty is the limited access to period products, menstrual education, or adequate water sanitation and hygiene facilities. Although people's experiences of period poverty are varied and unique, the social determinants of health and structural determinants of gender inequality act as key drivers of period poverty across the globe. Most girls in India faced numerous barriers and restrictions, the use of sanitary protection has cost implications for low-income adolescents. Commercial pads are more commonly used in urban settings or schools, with girls in rural mainly being dependent on cloth. Cleaning and drying cloth is a problem if girls lack water, privacy and a drying place. Studies have shown that throughout their lifespan, individuals with higher incomes typically use around 15,500 sanitary pads, whereas those from lower-income brackets tend to use approximately 6,600sanitary pads.
In India many schools do not have separate toilets for girls with running water or incinerators to dispose soiled menstrual products and therefore a significant number of girls end up missing school during menstruation due to the lack of gender-segregated washrooms and period products in schools. Further it is important to adopt gender-responsive approaches to understanding the needs of all the individuals who menstruate, including girls and women, people with disabilities, transgender people, and gender non-binary individuals.
The policy 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?
Relying on a single ministry to handle menstrual health may not be enough. Instead, it would be better to have a central agency which is responsible for menstrual health initiatives but with works closely with local bodies, as the context in different districts and states may vary substantially. Hence, state and district-level administrators from the relevant departments (such as education, health, water and sanitation) as stakeholders before implementing interventions or policies at these levels.
Menstrual health has long been stigmatised in many communities. What strategies do you believe are most effective in driving behavioral and social change to break the stigma around menstruation?
For the policy to really reduce stigma, it is essential not only to acknowledge the existence of menstrual stigma and set out to break the silence surrounding menstruation and advance menstrual education, but it is essential to dismantle menstrual stigma. This policy should not be limited to only promoting bodily management during menstruation, rather it should promote agency and autonomy. Only when this is done will the policy succeed in breaking the silence around menstruation, as well as challenge the stigma surrounding menstruation. We first need to recognize its (invisible) power and its impacts in all spheres of life to actively challenge, dismantle, and redefine it. The policy should aim at transforming the social environment by creating structural level changes, such as promoting messaging to challenge societal norms by including men and boys, along with those who menstruate, towards reducing menstrual stigma, which is often a product of patriarchal norms
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?
In India, an estimated 12 billion pads are used annually, resulting in an estimated9,400 tonnes of menstrual waste per month (or 112,800 tonnes annually). As such, it is crucial that the policy recognises and encourages reusable period products such as cloth pads and menstrual cups. An essential step in this direction would be to subsidise environmentally friendly alternatives, or even provide them free to the target population. In addition, government should invest in providing information about the various period products available so that persons who menstruate can make informed and environmentally friendly choices based on their needs. Policymakers must also prioritise educating individuals who menstruate on how to create and reuse cloth pads.
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?
It is essential to provide knowledge and information about the physical and reproductive changes that adolescent girls will experience in school, this will help girls to understand that it is a natural biological phenomenon and how to deal with it. Such discussions will help to reduce the feelings of isolation, stress, embarrassment, and confusion that often exists because of the silence over this issue and the myths and misconceptions around it. It is therefore critical to start these conversations and focus on making our schools period -safe, in terms of knowledge, sanitation and proper menstrual hygiene management practices.
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?
The George Institute has the expertise to carry out high quality pilot studies that will provide a better understanding of the local context and needs and through discussions with the community identify and co-create solutions in consultation with the community. The George can also carry out studies to test the feasibility, acceptability and effectiveness of these solutions.
Given the intersection of menstrual health with broader issues like gender equality and education, how do you believe this policy can contribute to empowering adolescent girls beyond health outcomes?
The policy by creating and putting in place facilities to promote menstrual hygiene management, can ensure that girls are not forced to miss school. Studies have shown that a significant number of girls end up missing school during menstruation due to the lack of gender-segregated washrooms and period products in schools. The lack of social support from the teaching and non-teaching staff is also a contributing factor to school absenteeism.
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?
It was found that interventions are most likely to generate benefits if they are well designed for the context and that a carefully developed intervention engaging various stakeholders and including essential equipment, supplies and educational materials was successful in bringing about changes in the study area in Bangladesh.
Looking ahead, what indicators would you consider critical for measuring the long-term success of this policy in improving menstrual health outcomes for schoolgirls?
Reduction in absenteeism of girls from school, reduction in stigma associated with menstruation, reduction of myths related to menstruation, increased use of environmentally friendly products, creation of infrastructure in schools and workplaces that reduces period poverty.