From taboo to discussion — advancing menstrual hygiene management

As we celebrate menstrual hygiene day, marked by numerous initiatives and awareness sessions, it’s essential to consider this: What happens after the spotlight fades? This question is pivotal, but there is also much to celebrate and be proud of.

The increased menstrual hygiene management (MHM) awareness in our culturally rich nation signifies a remarkable journey. What was once a taboo topic is now openly discussed, showcasing the collective progress of Indians towards understanding, exploring and launching new initiatives. Significant strides have been made in researching sustainable solutions for menstrual waste management, highlighting our awareness on its environmental impact and commitment to direct action. 

As we mark another significant day, it’s time to move beyond product-centred strategies and embrace a comprehensive approach by re-imagining MHM in a way that empowers individuals, fosters gender equity and cultivates a culture of openness and acceptance. Our actions now are not just about what we do, but how we do it, fostering inclusive dialogues, amplifying marginalised voices through efforts rooted in empathy and dignity.

Progress & policy: A decade of advancements

Over the past decade, several statistics indicate significant improvements in the awareness and concern for menstrual hygiene.

Advancements in menstrual protection methods & adoption of hygienic practices 

The proportion of individuals aged 15-24 constitutes 78 per cent in NFHS 5, a notable increase from 58 per cent in NFHS 4. While the latest survey, NFHS 5, has included a section on menstrual hygiene with some updates compared to NFHS 4, a comprehensive analysis is still needed. Given the survey’s credibility and its thorough coverage of health and family welfare criteria, it is imperative to allocate considerable space and detail to MHM. 

While it’s commendable that the current survey addresses menstrual hygiene and protection, there’s room for improvement in future iterations. This could involve updating the section to reflect the current scenario, emphasising the menstrual health of women, their susceptibility to reproductive-related issues and period abnormalities. 

Additionally, it would be beneficial to inquire whether participants are aware of eco-friendly menstrual products and how many are using biodegradable pads, cloth pads, menstrual cups or other alternatives.

Furthermore, there’s been a considerable expansion of educational initiatives, the emergence of technological innovations, community interventions and impactful policy reforms and advocacy efforts. Additionally, the global recognition and action surrounding MHM underscore a collective commitment towards promoting menstrual health and dignity worldwide.

The Union Ministry of Health & Family Welfare serves as the key entity for MHM policy formulation, responsible for drafting comprehensive guidelines and standards to ensure effective implementation of best practices. In 2011, the ministry initiated the menstrual Hygiene scheme, focusing on low-cost distribution of sanitary napkins. The integration of MHM into the Swachh Bharat Mission (SBM) Gramin initiatives by the Ministry of Jal Shakti in 2014 and the launch of MHM guidelines by the Ministry of Education in 2015 further underscore the  government’s commitment to menstrual health.

Intersectionality of MHM with SDGs

The COVID-19 pandemic has underscored the importance of accessibility and availability of menstrual products, highlighting the necessity of categorising them as essential goods. Beyond health and hygiene concerns, menstrual waste management now encompasses broader societal and environmental issues too. MHM is intricately linked to multiple Sustainable Development Goals (SDG) mandated by the United Nations, highlighting its critical importance. Key connections include:

Goal 3 (Good health & well-being): MHM is crucial for overall health, as proper menstrual hygiene reduces the risk of infections and other health issues.

Goal 4 (Quality education): Educating people about menstrual health promotes gender equality and reduces stigma, ensuring everyone has access to accurate information.

Goal 5 (Gender equality): Providing access to menstrual hygiene products and facilities empowers menstruating individuals and promotes gender equality by removing barriers to education and work.

Goal 6 (Clean water and sanitation): Access to clean water and sanitation facilities is essential for maintaining menstrual hygiene and preventing health problems.

Goal 8 (Decent work and economic growth): Promoting dignified work conditions for sanitation workers involved in managing menstrual waste (mixed up with other domestic hazardous waste).

Goal 9 (Industry, innovation & infrastructure): Innovations in sustainable menstrual products and waste management help reduce environmental impact and support sustainable infrastructure development.

Goal 10 (Reduced inequality): Addressing the needs of all menstruating individuals, including marginalised groups, helps reduce inequality and promotes social inclusion.

Goal 12 (Responsible consumption & production): This encourages the use of eco-friendly menstrual products by gradually reducing plastic and chemical compositions.

Goals 14 & 15 (Life below water & life on land): To protect the aquatic and terrestrial environments through proper waste management practices.

Goal 17 (Partnerships for the goals): Collaboration between governments, non-governmental organisations, businesses and communities is essential for implementing effective MHM initiatives.

The holistic approach to MHM intersects with multiple SDGs, underlining its significance in promoting health, gender equality, environmental sustainability and socioeconomic development. Strengthening partnerships and adopting innovative solutions are essential to address the complex challenges associated with MHM comprehensively.

Analysing past initiatives, refining future strategies

Now that the stage is set with support from communities, practitioners, researchers and policymakers, it’s time for a thorough review of our initial phase in the MHM transformation journey. While initiatives like distributing low-cost sanitary napkins since 2011 and promoting menstrual cups in recent years have been implemented, the lack of authentic studies on their target population, success rates and impacts is concerning. 

Field observations and interactions reveal widespread unfamiliarity with menstrual cups among communities, hindered by lingering fears and stigmas. Moreover, distribution efforts often prioritise meeting numerical targets over ensuring informed choices and accessibility. Initiatives like menstrual cup distribution projects at panchayat- and urban local body-level suffer from vague beneficiary lists and standardised product sizes that may not suit customised individual needs.

At the school level, distributing menstrual cups without considering students’ preferences can limit their freedom of choice. Therefore, initiatives should prioritise disseminating knowledge and promoting informed decision-making, focusing on sustainable alternatives and best practices. This requires a collaborative effort among stakeholders, particularly ministries responsible for health, hygiene, waste management and infrastructure related to MHM. Efforts should aim to provide safe and hygienic environments for menstruation, subsidise eco-friendly products and move beyond conventional solutions like vending machines and incinerators. While these facilities exist, they often perpetuate waste generation due to the use of synthetic sanitary pads and inefficient incinerators.

Focusing on WASH and menstrual hygiene highlights the necessity of accessible infrastructure like public and community toilets, equipped with clean water, handwashing facilities and proper menstrual waste disposal. Effective operation and maintenance are crucial for achieving the ‘open defecation free’ status. Refining the process by replacing synthetic sanitary products with eco-friendly alternatives in vending machines can significantly enhance effectiveness.

Initiatives should prioritise practical, cost-effective and hygienic eco-friendly options like bio-pads or cloth pads. Scrutinising ‘green labelled’ products is essential, ensuring genuine claims of biodegradability and eco-friendliness. Standardisation of eco-friendly products in the market is imperative for consumers to make truly sustainable choices.

Monitoring and reviewing past efforts is essential to address gaps and set a credible, impactful, inclusive and sustainable direction for MHM initiatives. This ensures that MHM efforts focus on meaningful impact and empowerment of all menstruating individuals!

In conclusion, adopting comprehensive approaches, practices and policy interventions for MHM considering ground-level realities is vital. 

Second, while advocating for eco-friendly products, ensuring their accessibility and affordability is crucial. Synthetic sanitary pads, despite their chemical content and environmental impact, are widely available and affordable. Hence, there’s a pressing need to familiarise the masses with eco-friendly alternatives through information, education, and communication (IEC) initiatives and behavioural change programmes through proper funding and channels, making them available at affordable prices, possibly under government schemes. 

Third, establishing a proper database for MHM, including major players, products and waste generation data on a state and urban local body level, is essential. Governments must prioritise managing and discussing menstrual and sanitary waste by conducting thorough studies on synthetic sanitary products available in the market. Implementing extended producer responsibility regulations, with strict enforcement of the “polluter pays” principle, is essential for addressing the adverse impacts of these toxic products that act as slow poison, on both human and environmental health. 

Finally, urging all government bodies, organisations and private entities to actively include MHM as a crucial topic in workshops, conferences and panel discussions, providing exposure to case studies, best practices and field visits whenever feasible.

Devika Jayssell is a WASH professional (SWM & MHM) and IIT Gandhinagar alumnus. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.