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The road to menstrual equity requires solutions that balance cultural contexts with sustainable innovations
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This essay is part of the series: World Health Day 2025: Healthy Beginnings, Hopeful Futures
Menstrual health management is more than just period management, it underscores a crucial and fundamental aspect of the overall health, well-being, and empowerment of adolescent girls and women. At any given moment, over 300 million women worldwide are menstruating. Yet over 500 million women still lack access to essential menstrual products, hygienic facilities and basic information needed to manage their periods healthily. This challenge is even more marked in India, where 71 percent of adolescent girls are unaware of menstruation until they experience their first period.
Researchers studying the National Family Health Survey-5 found that 76.15 percent of women exclusively use hygienic period products during menstruation. There is a notable urban-rural disparity, with 89.37 percent of women in urban areas compared to 72.32 percent in rural areas. In Rajasthan, 76 percent of young women use sanitary napkins, while 44 percent rely on cloth and 11 percent on locally produced napkins. There has also been progress, with the percentage of women using hygienic menstrual protection rising from 55 percent in the previous National Health Survey to 84 percent. The urban-rural gaps remain with only 82 percent of women in rural areas reporting using hygienic methods of menstrual protection versus the 92 percent of women in urban areas. These figures emphasise the urgent need for targeted interventions to ensure equitable access to menstrual health resources and education.
Dholpur, a district in Rajasthan, exemplifies the intersection of menstrual health with broader health and development indicators. Despite its proximity to urban centres—300 kilometres from Delhi and 60 kilometres from Agra—it is recognised by NITI Aayog [Government of India’s apex public policy think tank] as one of the most backward districts in the country. Dholpur also faces gender disparity challenges, with a sex ratio of 846 females per 1,000 males, well below the national average of 940.
The urban-rural gaps remain with only 82 percent of women in rural areas reporting using hygienic methods of menstrual protection versus the 92 percent of women in urban areas.
Over 3 million women of reproductive age live in Dholpur and face critical health challenges. Anaemia affects over 69 percent of women and 64 percent of pregnant women and is exacerbated by malnutrition and menstrual disorders. Comprehensive health interventions are required as improving menstrual health isn’t just about hygiene—but health, education and economic empowerment.
Menstrual health remains a deeply stigmatised topic, restricting women’s access to education, employment and healthcare. The Government of India has marked menstrual health and hygiene as a priority intervention in the Reproductive Maternal Child Health and Adolescent (RMNCH+A) strategy. They have started flagship programmes that provide broader health promotion and adolescent education, focusing on services and product provision, while campaigns such as “Swachh Bharat: Swachh Vidyalaya” (Clean India: Clean Schools) ensure that schools provide functioning and well-maintained WASH facilities.
The Rajasthan State Government has also launched the Udaan scheme in 2021, which provides free sanitary napkins to adolescent girls and women through schools, colleges, and Anganwadi centres. While the provision of free menstrual kits is noteworthy, overcoming existing information barriers through on-ground community engagement, education, and behavioural change is essential for these programmes to be truly effective.
While the provision of free menstrual kits is noteworthy, overcoming existing information barriers through on-ground community engagement, education, and behavioural change is essential for these programmes to be truly effective.
One key insight from working directly with women in rural Dholpur is that behavioural preferences shape product adoption. Many women prefer cloth over single-use pads, citing comfort and familiarity. Additionally, these programmes largely provide single-use menstrual pads, contributing significantly to environmental waste—estimated at 113,000 tons annually. Given that a woman typically menstruates for approximately 459 cycles during her lifetime, disposal remains a significant challenge with used products frequently ending up in open fields, water bodies, or being buried and burned in unsafe conditions.
Addressing menstrual health effectively requires a comprehensive approach that balances awareness with accessibility and behavioural considerations. Research indicates that without a dedicated focus on menstrual health and hygiene, achieving the Sustainable Development Goal of universal access to sexual and reproductive healthcare services by 2030 remains challenging.
A culturally sensitive approach is key to community engagement, as even terminology can affect participation. For example, when launching the menstrual hygiene project in Dholpur's villages and schools, we coined the term “Project Laali.” The word “Laal” in Hindi means red (symbolizing blood), and “Laali” is a term of endearment for girls or daughters. This name resonated culturally while avoiding clinical language that might have created barriers to engagement. Similarly, phrases like “Period Ka Period” (“Period for Period”) in schools and empowering statements such as “Period Humari Shakti Hai” (“Periods are our strength”) help normalise conversations, unlike technical terms such as “Kishoriavastha” (“Adolescence”) or “Maasik Dharam” (“Menstruation”), which can feel distant. This fosters acceptance, breaking barriers and encouraging open dialogue.
Introducing cloth-based, reusable menstrual pads aligns with existing habits while enhancing hygiene and durability and fostering gradual acceptance.
Bridging the information gaps through group-based, evidence-driven counselling sessions in schools and communities can help raise awareness, dispel misconceptions, and empower women to make informed health choices. Women accustomed to cloth for generations may find it challenging to transition to single-used pads; this is prominent in women over 29 years of age. Introducing cloth-based, reusable menstrual pads aligns with existing habits while enhancing hygiene and durability and fostering gradual acceptance. These pads also tackle the disposal issue, which is a significant challenge in rural areas where most plastic pads often end up in fields or water bodies creating environmental and public health concerns.
Reusable menstrual pads that can be washed and used eliminate disposal burdens. While sustainability may not primarily drive product choices in resource-constrained communities, reusable menstrual pads substantially reduce waste and lower the carbon footprint associated with menstrual hygiene, benefitting both individuals and the ecosystem.
The involvement of men is also crucial in advancing menstrual health initiatives. While women often lead the counselling programmes, men can mobilise communities, ensure safe spaces for discussions, and support logistics. In rural areas, men help organise gatherings and ensure women return home safely from these sessions before dark. On a policy level, sensitising male decision-makers—whether in governance, health administration, or local leadership—is crucial to mainstream menstrual health into broader health and development policies.
According to McKinsey, women spend 25 percent more time in “poor health” relative to men and for every US$1 invested in women's health could yield US$3 in economic growth. Bridging this gap would mean boosting the global economy by US$1 billion annually by 2040.
When interventions respect existing practices, provide evidence-based education and offer environmentally responsible alternatives, meaningful change is possible.
Focusing on sustainable practises in menstrual hygiene brings a threefold benefit for health, the environment and the economy. Firstly, improved menstrual hygiene reduces infections and promotes well-being. Secondly, reusable pads cut waste and reduce carbon footprints. Lastly, investing in menstrual health fosters greater economic participation and productivity.
The road to menstrual equity requires solutions that balance cultural contexts with sustainable innovations. When interventions respect existing practices, provide evidence-based education and offer environmentally responsible alternatives, meaningful change is possible. By replacing shame with dignity and barriers with opportunities, we are witnessing a transformation that extends beyond individual health to community well-being and economic resilience.
Malvika Mudgal is a social entrepreneur, ex-corporate worker, driving grassroots development in the Chambal Ghaats of Rajasthan, in the Dholpur district.
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Malvika Mudgal is a social entrepreneur, ex-corporate worker, driving grassroots development in the Chambal Ghaats of Rajasthan, in Dholpur district. Malvika’s background has been in ...
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