The Price of Blood

Inadequate Menstrual Health Management (MHM) Practices

Author: Rajat Shubhro Mukherjee & Shrutika Shridhar

Consultant, Bhajan Global Impact Foundation

Tag(s) : Health & Wellbeing

According to a recent report by Chen and Kiefer (2018), at least 500 million women and girls globally lack adequate facilities for MHM. UNICEF estimates that barely half of the adolescent girls have access to adequate water sources in schools, globally (ibid). In India, the challenge is equally glaring, if not more. A meta-analysis of 138 studies on MHM in India found that around a quarter of girls are reported missing school during their periods (ibid). Furthermore, barely 18 percent of Indian women have access to sanitary napkins (Sood, 2018). This lack of adequate and appropriate MHM leads to a wide range of health, social and economic challenges.

This essay attempts to present a brief snapshot on current issues in MHM and their impact on the health and well-being of women and overall familial environment, and suggests trajectories for the future.

Issues owing to poor MHM

The ramifications of not practising adequate MHM measures on a woman’s health are irreversible. Studies carried out in West Bengal and Odisha have found out that poor MHM practices can lead to reproductive and/or urinary tract infections (RTI/UTI) and bacterial vaginosis. A case-control study was conducted in Odisha on 486 women of whom 228 were symptomatic i.e. showing the symptoms of RTI/UTI and 258 asymptomatic (Das, et al., 2015, p. e0130777). Furthermore, women who used cloth or reusable absorbent material during periods of menstrual flow had a high likelihood of contracting bacterial vaginosis, or at least one kind of urinary or reproductive tract infection. In extreme cases, a woman may have to remove her uterus. These diseases happen to be highly contagious and may get passed on to men as well through sexually transmitted infections.

Haryana on its part does not fare much better than Odisha or West Bengal. The statistics related to MHM paint a dismal picture. According to Kanwar (2018), only 30 percent of women in rural Haryana use sanitary napkins. Additionally, according to a study conducted by School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), disposal of sanitary napkins is considered a taboo (Times of India, 2018). In a survey conducted in Mandi, Haryana, out of 344 women, 20.3 percent suffered from menstrual problems, mainly pain, and almost 50 percent did not use sanitary napkins (Ahamed, et al., 2015, p. LC06). Of the sample 47.7 percent used cloth, 45.9 percent used sanitary napkins, and 1.5 percent used dirty cloth (ibid.). A study from Ambala district gave similar results. Of the 400 adolescents interviewed 55.7 percent reported of not knowing about menstruation at all and 65.3 percent being afraid after the first period (Bachloo, et al., 2016, p. 931).

India is largely a patriarchal society; despite this, women have persevered and progressed in myriad fields, which augurs well towards targets envisaged under Sustainable Development Goal (SDG) 5 on Gender Equality. However, the harm caused in the past and that, which will be caused to future generations as a result of an outdated mind set needs to be mitigated. The non-prioritisation of women’s health, a hush-hush attitude regarding menstrual hygiene and implementation problems associated with well-intentioned government schemes have profound socioeconomic effects. For instance, according to Sharma (2018), in India a restructured version of the Menstrual Hygiene Scheme (MHS) to provide subsidised sanitary napkins was launched by the Ministry of Health in 2011; however, the scheme’s implementation has been mired with issues related to logistics, disposal, and budget.

Additionally, given the information deficit on MHM, adolescent girls – on becoming mothers – pass on this health ignorance to one generation after the other. The lack of awareness impedes an individual’s cognitive, emotional, and physical development. Negligent MHM also leads to a loss of employment for working age women, a loss of academic time for adolescent girls, as well as life-threatening infections. The diseases cause loss of employment for older women or loss of school or college time for adolescents and young women. It also causes infection which might threaten pregnancies. Furthermore, these diseases enhance the stigmatisation faced by women even during normal menstruation (Sumpter & Torondel, 2013, p. e62014). This is a vicious cycle as most of the problems arising from poor MHM are due to socioeconomic factors such as poverty, lack of education, lack of awareness, and a disregard for women’s rights. However, in the absence of concrete steps being taken to change the status quo by both men and women, and the institutional framework at large, breaking free from this cycle appears to be a distant dream.

A Possible Way Forward

So, how do we move forward and ensure that women have access to basic MHM education and healthcare and the related infrastructure?

To begin with, gender sensitisation should take place from an early age. This should be prioritised in schools across the country. Measures can be taken towards institution- and awareness-building in order to offset the problems of menstruation being a tabooed issue in rural India, specifically Haryana. Collaborative efforts with self-help group (SHGs) driven schemes such as National Rural Livelihoods Mission (NRLM) could be undertaken with Corporate Social Responsibility (CSR) programmes, in order to promote public private community partnerships (PPCP). These measures will not just address sanitation and health related issues, but also empower women socially and economically. Similarly, women may be sensitised by observing ‘Menstrual Hygiene Day’ on May 28th every year at the state, district, local and gram panchayat level, in line with the #YesIBleed campaign by the Ministry of Women and Child, Government of India, carried out this year.

Similarly, in August this year, the Government of Haryana has launched a subsidised scheme under the aegis of which, Below Poverty Line (BPL) women and girls in government schools shall be provided sanitary napkins at ₹ 1. Under the scheme, girls till 18 years can avail these at schools, whereas those above can procure them from the Public Distribution System (PDS) at ration shops in the state (IANS, 2018). For effective implementation of such schemes, large scale awareness programmes on how menstrual hygiene is linked to overall productivity of women should be prioritised, by educating both adolescent boys and girls. This will help to mitigate the ‘gendered’ aspects that aggravate the problem. Additionally, these programmes can be incentivised by paying ASHA workers and other grassroots level functionaries in order to ensure the longevity of such well-intentioned schemes and policies.

Patriarchy, deep-rooted misinformation, and ignorance regarding women’s health issues will not disappear instantly, and seem to be improving, albeit incrementally. When a woman feels the power of voice, everybody stops to listen. For India to attain and sustain the ‘double digit growth’ over which people often, the better half of society needs to be empowered to contribute their share in India’s growth and developmental story.


Ahamed, F., Lohiya, A., Kankaria, A., Silan, V., Kharya, P., & Rizwan, S. A. (2015). Menstrual Disorders and its Determinants among Married Women of Rural Haryana. Journal of Clinical and Diagnostic Research, LC06-LC09.

Bachloo, T., Kumar, R., Goyal, A., Singh, P., Yadav, S., Bhardwaj, A., & Mittal, A. (2016). A study on perception and practice of menstruation among school going adolescent girls in district Ambala Haryana, India. International Journal of Community Medicine and Public Health, 3(4), 931-937.

Chen, G., & Kiefer, T. (May 24, 2018).  #NoMoreLimits: Good menstrual hygiene empowers women and girls to rise. The Medium. Retrieved from

Das, P., Baker, K. K., Dutta, A., Swain, T., Sahoo, S., Das, B. S., . . . Torondel, B. (2015). Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India. PLoS ONE, 10(6), e0130777-e0130793.

Dasgupta, A., & Sarkar, M. (2008). Menstrual Hygiene: How Hygienic is the Adolescent Girl? Indian Journal of Community Medicine, 33(2), 77-80.

IANS. (2018). Girl students to get sanitary napkins at Re 1 in Haryana. The Times of India. Retrieved

Kanwar, S. (2018). Only 30% women use sanitary napkins in rural Haryana: Study. The Times of India. Retrieved from

Sharma, Chandra N. (2018). Use of sanitary pads sparse despite govt schemes: studies. Live Mint. Retrieved from

Sood, P. (2018, July 11). “Only 18% women in India have access to sanitary hygiene in India”. Retrieved from Times of India:

Sumpter, C., & Torondel, B. (2013). A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management. PLoS ONE, 8(4), e62004-e62019.