India has witnessed a major policy and social shift in its approach to menstrual health since the 2011 launch of the Menstrual Hygiene Scheme (MHS) by the Ministry of Health and Family Welfare. This initiative marked a landmark attempt to destigmatise menstruation at a national level, by targeting adolescent girls aged 10–19 with subsidised sanitary pads and menstrual education. The period also saw a broader discourse emerge in the public sphere—through government campaigns, NGOs, and media—challenging the silence around menstruation. According to a systematic review of 138 studies covering 97,070 adolescent girls in India (van Eijk et al., 2016), only 48% were aware of menstruation prior to menarche, and more recent WHO/UNICEF data (2024) indicate that significant gaps persist in menstrual health education and hygiene infrastructure across Indian schools. This suggests that India’s policy gains since 2011 have not yet fully translated into social transformation across states or social groups.
Recent evidence reveals sharp inter-state and rural–urban disparities. A cross-sectional study published in BMC Public Health found that the use of hygienic menstrual products—sanitary napkins, menstrual cups, and tampons—remains highly uneven, with large differences between states. According to the National Family Health Survey (NFHS-5, 2019–21), about 77.3% of women aged 15–24 reported using hygienic methods of menstrual protection—figures that vary starkly across states, from 95% in Kerala to 32% in Bihar. While these statistics provide a useful snapshot, they remain limited by their focus on a single indicator—product use—rather than encompassing broader dimensions of menstrual health such as access, comfort, education, and cultural acceptability (IIPS & MoHFW, 2021).
In urban slums of Madhya Pradesh, 82% of adolescent girls used sanitary pads, but 37.5% still missed school during menstruation, showing that access to products does not equal social inclusion. The persistence of stigma, restrictions, and absence of private disposal facilities continues to reinforce exclusionary practices—girls are often barred from kitchens, temples, or communal spaces during menstruation (Indian Journal of Community Medicine, 2021).
Most menstrual health interventions in India have been anchored in schools, focusing on education and sanitation infrastructure within government institutions. While crucial, this approach unintentionally excludes girls who are out of school—such as child labourers, domestic workers, and those who drop out early due to poverty or early marriage. The Menstrual Hygiene Scheme (MHS, 2011) under the National Health Mission marked the first national policy effort to promote menstrual awareness and distribute sanitary pads through ASHA workers, but it remained largely school- and adolescent-girl-centric. Later, the Swachh Bharat Mission (Gramin) Guidelines (2015) expanded the conversation by linking menstrual hygiene with waste management and sanitation at the household and community levels (MoHFW, 2011; Ministry of Drinking Water and Sanitation, 2015). However, despite these advances, a meta-analysis of school-based menstrual hygiene management (MHM) programs found that fewer than half of schoolgirls were informed about menstruation before menarche and that few schools had adequate disposal facilities. Hence, the next phase of policy evolution must look beyond schools—toward communities, workplaces, and informal sectors—by institutionalising out-of-school menstrual education and support mechanisms. Therefore, the next phase of policy evolution must shift focus beyond schools—into the community, workplace, and informal sector—by establishing out-of-school menstrual education and support mechanisms.
Moreover, the current model of menstrual health inclusion within schools often relies on traditional pedagogy, where teachers are tasked with delivering menstrual education. This approach assumes educators are free from the social stigmas surrounding menstruation, an assumption contradicted by several studies that find limited comfort and efficacy in teacher-led sessions. For instance, a study by van Eijk et al. (2016) and subsequent evaluations (WaterAid, 2021) show that both girls and boys often retain myths or incomplete information even after formal instruction. Global and Indian research increasingly advocates for interactive, peer-based, and non-traditional pedagogic methods—including adolescent-led workshops, community dialogues, and visual storytelling—which have proven more effective in promoting comfort, participation, and long-term behavioural change (WaterAid, 2021).
The discourse around menstrual health and hygiene (MHH) in India has undergone significant evolution since the launch of the Menstrual Hygiene Scheme (MHS) in 2011, spearheaded by the Ministry of Health and Family Welfare. This initiative marked a crucial effort toward destigmatising menstruation, focusing on providing subsidised sanitary napkins to adolescent girls in rural areas while integrating menstrual education within school curricula. However, as Muralidharan, Patil, and Patnaik (2015) noted, the framework primarily targeted in-school girls, neglecting those who were out of school, working, or from marginalised groups. This institutional bias has limited the scheme’s reach and created uneven access across states, highlighting the need for out-of-school policies and community-led education.
According to the Dasra (2014) report ‘Spot On!’, nearly 23 million girls drop out of school annually upon reaching menstruation, largely due to inadequate sanitation, lack of menstrual products, and the stigma surrounding periods. While states like Tamil Nadu and Kerala have demonstrated success through school-based menstrual programs and improved WASH facilities, Bihar, Jharkhand, and Uttar Pradesh still lag. A state-level analysis by NITI Aayog (2023) reported that the usage of menstrual hygiene products exceeds 90% in several southern states, while it remains below 60% in many northern and northeastern regions, highlighting persistent regional disparities in access and use of menstrual products. These disparities underscore how menstrual health outcomes mirror broader inequities in healthcare access, education, and gender norms.
In rural India, community-based workers such as Accredited Social Health Activists (ASHA) and Anganwadi workers have emerged as the linchpins of menstrual health awareness. As highlighted by Spriha Society, ASHA workers are not only distributing sanitary products but also challenging menstrual taboos through open discussions in villages. In Madhya Pradesh, for example, ASHA workers partnered with self-help groups under the National Rural Livelihood Mission to establish local sanitary pad manufacturing units, improving affordability and accessibility.
Similarly, Andhra Pradesh’s “Swechha” initiative empowers Anganwadi centres to conduct menstrual hygiene workshops for out-of-school girls and women in informal labour sectors. These initiatives illustrate how menstrual health interventions become more sustainable when decentralised and community-driven.
Research supports the importance of localised approaches to menstrual management. Rajagopal et. al (2017) found that menstrual stigma and infrastructural inadequacies combine to restrict girls’ participation in school life, even when sanitary products are supplied. Choudhary et al. (2019) conducted a comparative study of menstrual perceptions and practices and found that “not allowing girls to enter the kitchen” and “avoiding going to temple/attending religious functions” were among the most common restrictions reported by adolescent girls. This paper provides clear, India-specific evidence that taboos such as kitchen/temple restrictions are widespread in some regions. Contextualising interventions in local belief systems, rather than imposing uniform national policies, ensures long-term behavioural change.
Beyond schools, menstrual health education must reach out-of-school adolescents, women in informal labour, and marginalised communities. Studies reveal that menstrual taboos and restrictions differ markedly across India—for instance, girls in Rajasthan are often prohibited from entering kitchens or temples during menstruation (Choudhary et al., 2019), while in rural Odisha, women experience periods of enforced seclusion and exclusion from daily activities (MacRae et al., 2019), underscoring the need for culturally sensitive, district-specific mapping of menstrual practices. Integrating menstrual awareness into panchayat meetings, self-help group trainings, and vocational skill programs can bridge this gap. In Lok Sabha discussions (2022), several Members of Parliament urged that menstrual health be recognised as an essential component of the National Health Mission’s reproductive health strategy, giving states autonomy to innovate local models and strengthen community partnerships.
Recent state-level interventions exemplify this decentralised vision. Kerala’s “She Pad” program provides free sanitary pads in schools; Odisha’s “Khushi” scheme targets adolescent girls from low-income families; Rajasthan’s “Udaan” initiative distributes subsidised pads through ASHA networks; and Bihar’s “Jeevika” program enables rural women to produce and market eco-friendly pads. Other noteworthy examples include Maharashtra’s “Asmita Yojana”, Chhattisgarh’s “Suchita Abhiyan”, Himachal Pradesh’s “Disha” campaign, Telangana’s “Saukhyam” project, and Gujarat’s “Mission Red Dot”. Together, these initiatives reflect a nationwide shift toward recognising menstrual health as a cornerstone of gender equity, public health, and community-led development rather than a peripheral welfare concern.
Socially, India stands at a turning point. Despite advances in policy, menstruation continues to be shrouded in stigma and misinformation, particularly in semi-urban and rural communities. The World Bank (2021) notes that improved menstrual hygiene correlates strongly with higher school attendance, better self-esteem, and reduced health risks. Yet, without addressing sociocultural taboos and decentralising intervention frameworks, India’s menstrual health goals will remain incomplete. Decentralising schools—both in governance and outreach—empowers educators, ASHAs, and Anganwadi workers to integrate menstrual health into everyday community learning. The path forward lies in treating menstruation not merely as a hygiene issue but as a fundamental question of dignity, equity, and human rights.
Tanvi is a criminologist with a BA in Psychology (Hons) from Delhi University and an MA in Criminology, specialising in Forensic Psychology from National Forensic Sciences University, MHA. She has worked on research and policy-focused projects during her internships with the National Commission for Women and the Ministry of Information and Broadcasting, exploring issues at the intersection of gender, crime, and justice. Beyond her academic and professional work, Tanvi is a trained musician, holding a Prabhakar degree in Music, and a passionate cinephile with a love for storytelling in all its forms. She finds inspiration in films, music, and art, using each as a way to explore and better understand people and the world around her.
