Every month, 25% of girls and people who menstruate in India miss school because of their period. Hopefully one day, that number will be zero. This year the Dasra forum hosted a virtual session looking at the progress made in India’s menstrual health sector since they published their first report on the issue 10 years ago, and where we need to go from here. 

Moderated by Arundati Muralidharan, co-founder of the Menstrual Health Alliance India, the panel included Kruti Desai (Whisper, P&G India), M Sivakami (Tata Institute of Social Sciences), Pranita Achyut (International Centre for Research on Women Asia), and Tanya Mahajan (The Pad Project, MHAi). 

The session started off with a quick snapshot of the current state of India’s menstrual health sector, and the progress that’s been made in the last decade. 

While there’s still an awareness gap around body literacy in India, 77.6% of menstruators use a hygienic menstrual product. Particularly in rural communities, there’s mixed use of disposable and cloth pads, with lower-income communities more likely to use cloth pads.

While significant progress has been made in access to water and sanitation, there needs to be more focus on the operation and maintenance of these facilities, as well as ensuring they are available in workplaces and community spaces. 

Unfortunately, progress is still lagging behind in the menstrual healthcare sector, which requires significant investment. 

Big wins and misses 

The panellists shared what they thought were the big wins and misses in the menstrual health sector over the past 10 years, celebrating progress made and highlighting areas for improvement. 

The panellists agreed that greater overall recognition of the significance of the issue and a broader commitment to it is the biggest win. Progress has been made in destigmatizing menstruation, with it being spoken about in mass media and brought into the public spotlight. Through this, the issue has garnered the attention of government, civil society and the academic community, enabling more collaboration. 

However, there has also been a lack of progress in translating ‘policy intentions to real action on the ground.’ Panellists highlighted missed opportunities around situating menstrual hygiene within a wider conversation about reproductive health and engaging with women throughout their lifecycles including those reaching menopause. They also discussed the need to involve mothers more and encourage them to actively educate their children about menstruation, particularly younger pre-pubescent girls. 

Tackling the social stigma 

Achyut spoke about how ‘social norms around menstruation shape girls’ experiences of their bodies.’ Shame can prevent them from asking for the support or hygiene products that they need. Many girls using cloth pads can’t dry them properly in the sun because of the taboo, and 25% of girls miss school during their period due to factors such as pain, lack of appropriate toilet facilities, and social stigma. 

A survey found that ‘30% of girls hadn’t heard about menstruation before they started menstruating.’ Mothers are the primary source of information on menstruation, but Achyut argued that ‘we should ensure mothers are not the only stakeholders responsible for that.’ 

There is a need to ‘normalise menstruation without undermining the physiological experience of it’. Achyut suggested that the best place to start this is in the school system, by destigmatizing the discussion of menstruation and creating a positive image of it through an understanding of the biological processes involved. For this to happen, more needs to be done to help teachers discuss and explain it comfortably beyond textbooks.

This could be done by bringing menstruation into capacity-building workshops with teachers so that they have a chance to discuss their concerns. It’s also important to engage boys in the conversation so they can be allies to their friends and family members who menstruate. 

Improving equitable access to hygiene products

Mahajan focused on how we can bridge the gap in equitable access to menstrual hygiene products through market interventions. 

Bleeding management products in India are currently growing at 10% per annum, with new innovations in single and multiple-use products. Competition in the sector has increased, and India has some of the most affordable menstrual health products in the world because they’re manufactured in the country. However, availability through retail and distribution is inequitable, particularly in more rural areas. 

Mahajan recommended looking at the supply chain holistically to see where the blocks are. For example, researching new materials that can be used to create menstrual products could reduce dependencies on global supply chains for raw materials. She also called for more technical and financial support for raw material aggregating. 

When it comes to distribution, she recommended connecting manufacturing companies to distribution channels and organisations to fill downstream market gaps, as well as looking at how taxes across the value chance influence prices today and in the future. 

She advocated for more quality assurance standards in the sector which are actively enforced, and ensuring that labs have the support they need to carry this out. Other necessary investments include; more incubation support to drive new innovations in the sector, financing small and mid-size enterprises, and new solutions to integrating menstrual health with the larger reproductive health industry.

Academia and menstrual health

Speaking from her experience as an academic researching health systems, Shivakami argued that ‘we must collectively identify and agree on core indicators’ in collaboration with government and implementing partners to track progress in the sector. These indicators should be disseminated and popularised among key stakeholders, which would help the collectivisation of the work on menstrual health. 

While there’s been a huge amount of academic work in the area, most of the existing literature focuses on adolescent girls and there are many missing groups underrepresented in the research. These include people with special needs and disabilities, people in prison, displaced people, sex workers, adults closer to menopause, and non-binary and trans people, among others. Shivakami advocated for greater inclusivity in the academic body of work. 

She also advocated for including men in policies surrounding menstruation, so that they are better able to be allies to those who menstruate. There’s also a need to build greater evidence on the connection between menstruation health and mental health, sexual and reproductive health, and overall physical health so that this can be included in policy and implementation. 

Driving awareness in the sector

Desai asked the sector some pertinent questions: ‘How do we leverage mass media to drive awareness? And how do we translate awareness to on-the-ground action?’ 

Her organisation currently serves about 65,000 schools across India and runs campaigns to educate students about menstruation. However, the modes of teaching have changed. They’ve gone from using paper leaflets to digital videos and reaching younger students than ever before. They also ensure that sessions are gender inclusive and that boys and girls are educated about it together. 

She emphasized the need for organisations to work with multi-sector actors to drive change so that all menstruators can have access to this information and people are given options and choices around how they manage their periods. It’s also important to continue learning from other actors about how to strategically meet these long-term objectives. 

Five years forwards 

Following a closing question from the moderator, each panellist gave their opinion on where they would like to see progress in the next 5 years. 

The consensus among the panellists was that collaboration is essential for progress in the sector. They are keen to see more ‘multi-sectoral and comprehensive programmes which require collaboration among all stakeholders’ as well as greater investment in evidence building, and presenting that evidence in usable and digestible formats. 

Destigmatising menstruation and educating people about it is also important, as it equips menstruators with the knowledge to choose the products and healthcare that are right for them. Desai wrapped up the event with the hope that in 5 years’ time, the number of girls dropping out of school due to their periods will be down to zero.