Introduction

Menstrual health and hygiene are key interventions under India’s Reproductive, Maternal, Newborn, Child Health and Adolescent Health (RMNCH+A) strategy. Over the years, the Government of India has advanced community-based programmes, enabling access to menstrual health products to a vast number of women and girls, especially through Accredited Social Health Activists (ASHAs). Complementing these efforts, the School Health and Wellness Programme (SHWP) and the Rashtriya Kishor Swasthya Karyakram (RKSK), launched in 2014, promote broader health education and adolescent well-being. While these flagship programmes focus on services and product provision, initiatives such as the Swachh Bharat: Swachh Vidyalaya, launched in 2014, ensure that schools have functional and well-maintained facilities for WaSH (water, sanitation and hygiene) requirements.^[1]

The product range is wide, including supplements, contraceptives, and sanitary supplies. However, the sanitary products supplied are limited to single-use pads. These products are made available to adolescents (including contraceptives for married adolescents above 18 years) through schools, colleges, Adolescent Friendly Health Clinics (AFHCs), and Anganwadi centres. For example, the Rajasthan state government provides Udaan single-use pads to women and girls. Since 2023, the Pradhan Mantri Bhartiya Janaushadhi Pariyojana has been distributing oxy-biodegradable Suvidha Sanitary Napkins across many states.

The challenge is that targeted programmes and campaigns have long relied on single-use menstrual pads, contributing to environmental waste. A woman menstruates for approximately 459 cycles between puberty and menopause.^[2] India alone generates an estimated 113,000 tonnes of discarded sanitary napkins annually.^[3] The improper disposal of soiled sanitary pads, often through burial or incineration, poses serious environmental and health hazards.^[4]

Project Laali (“Beloved Girl”) in Rajasthan, launched in July 2024, seeks to address both issues of menstrual health and environmental sustainability. By challenging the stigma around menstruation, it empowers women and girls in Dhaulpur with access to reusable menstrual pads. In partnership with Unipads and Srujna’s Saafkins pads, the project provides free Reusable Menstrual Pads (RMPs) and conducts counselling sessions on menstrual hygiene. Laali supports a diverse range of beneficiaries, from adolescents in schools and colleges to women in rural communities, promoting individual well-being and environmental consciousness.

RMPs for Sustainable Menstrual Hygiene

Menstrual hygiene practices in India are diverse and influenced by factors such as age, location, financial resources, mobility, and access to information. Cloth remains the preferred choice for many women, especially in rural settings and among older women, as it meets cultural norms and resource constraints.^[5]

While research has detected volatile organic compounds, parabens, and fragrance chemicals in menstrual hygiene products, further investigation is needed to assess women’s and girls’ exposure throughout the menstrual cycle.^[6],[7] This is a critical concern due to the potential endocrine-disrupting effects of these chemicals on reproductive health.^[8] Studies specifically examining these exposures in India remain limited.

Menstrual health programmes should address climate considerations, chemical exposures, and local behavioural patterns. Promoting RMPs aligns with these goals, especially that of environmental sustainability, by reducing plastic waste. However, transitioning to RMPs requires a nuanced approach that considers existing preferences and builds on the familiarity and comfort of cloth. Studies suggest that this strategy could be more effective.^[9] Research in low- and middle-income countries have also demonstrated that women are more receptive to RMPs when provided with education and quality products. Reduced menstrual blood leakage compared to traditional cloth use is a key advantage.^[10] Further, RMPs are a cost-effective, waste-saving alternative to single-use pads. In India, factors such as comfort, affordability, and leak-proof design have driven wider adoption. A quality improvement project in rural Tamil Nadu focusing on menstruation education and RMP promotion improved menstrual health and hygiene management knowledge, confidence, RMP adoption; a specific by-product has been the reduction of school absences.^[11]

While RMPs offer benefits, their limitations must also be acknowledged. Studies highlight the importance of proper hygiene practices, access to clean water and sanitation facilities, and appropriate disposal methods.^[12] Although both RMPs and single-use pads share some challenges, RMPs require substantially more water to clean and proper drying to prevent bacterial growth. While single-use pads contribute to landfill waste, discarding soiled RMPs can also be challenging in settings that lack waste management systems. These factors can influence health outcomes, and in resource-limited settings, the risk of infection may outweigh the benefits. Therefore, proper counselling and demonstrations on RMP use should be prioritised.^[13] With proper support and education, however, RMPs can be a safe and sustainable option.

Despite the sustainability benefits of RMPs, single-use pads remain the preferred choice in India, largely influenced by policy and programme provisions.^[14] Recognising this, the Indian government, along with partners like Unicef, has contributed to raising awareness about menstrual hygiene management, improving healthcare provider capacity, addressing behaviour change, enhancing the nutritional status of adolescent girls and women, and reducing school absenteeism.^[15] However, there is considerable scope for improving environmental sustainability within the public health sector, particularly regarding menstrual waste management.^[16]

Women’s Health Challenges in Dhaulpur, Rajasthan

Rajasthan’s experience is illustrative of the complex factors that affect women’s health, underscoring the need for interventions beyond single-use menstrual products. The state ranks eighth out of 21 large states on NITI Aayog’s Health Index.^[17] Combined with lagging indicators in water management and human development, the challenges are massive, necessitating sustained investment in health and empowerment programmes.

Dhaulpur, designated as an ‘aspirational district’ by NITI Aayog, exemplifies the difficulties faced by underdeveloped regions within the state. With approximately 222,432 women of reproductive age, expanding access to health services remains crucial.^[18] Its location near the Chambal Ghaats on Rajasthan’s eastern border adds to its vulnerabilities, exacerbating barriers to essential health services, including menstrual health. The district reports a high anaemia prevalence of 69 percent among women ages 15-49 years.^[19]

Malnutrition, including stunting and low Body Mass Index (BMI), has been associated with an increased risk of anaemia in both children under five years of age and women of reproductive age.^[20] Furthermore, menstrual disorders, such as abnormal bleeding patterns, can aggravate existing anaemia and contribute to the overall burden.^[21] Only 76 percent of women ages 15-24 in Dhaulpur use hygienic menstrual protection, highlighting the urgent need for comprehensive health programmes in the district.^[22]

 

Project Laali: Empowering Women and Girls

Project Laali, symbolically linked to the colour red (‘laal’), addresses issues at the intersection of menstrual health and environmental sustainability. Its name promotes acceptance while challenging menstrual stigma. Implemented by the Jagan Innovation Foundation or Jagan Foundation (registered as a not-for-profit organisation in 2024), the project partners with Unipads and Srujna’s Saafkins pads to provide RMPs to women and girls in Dhaulpur. It reaches a diverse group, from adolescent girls in schools and colleges to women in rural communities. Initially, the project partnered with Unipads to provide RMPs but later transitioned to Srujna’s Saafkins pads due to Srujna’s Rajasthan focus and its ability to contribute a larger number of pads.

Saafkins reusable menstrual pads cost INR 450 per set of three for the company providing them. These sets are distributed free of charge to women. With a lifespan of at least 12 months, Saafkins provides a sustainable and economical alternative to single-use menstrual products. Over a year, the cost of single-use pads can easily exceed INR 450, making Saafkins an economical choice, especially for women in low-income communities where menstrual hygiene expenses can be a substantial burden. The free provision of Saafkins not only alleviates financial strain but also promotes environmental sustainability by reducing the waste generated from disposable products.

Key to Laali’s success is its evidence-based counselling sessions. These sessions, conducted in group settings, provide a platform for raising awareness, dispelling myths, and promoting the adoption of eco-friendly RMPs. The project also underscores the importance of girls’ education and improved school attendance.

 

Menstrual Health Counselling Session in Village Beelpur, Dhaulpur district, by Jagan Foundation (October 2024)

Project Laali has positively impacted over 1,800 women and adolescent girls across 16 villages in Dhaulpur through the distribution of Srujna’s Saafkins pads. During the first phase, Jagan Foundation’s partnership with Unipads reached 300 students across six government schools, taking the total number of beneficiaries to over 2,100 across the district.

Counselling on RMPs

The counselling sessions use culturally sensitive language and approaches. For instance, the phrase “period ka period” is used in schools to create a comfortable and relatable atmosphere. Open dialogue is encouraged, covering fundamental menstrual health and hygiene topics such as the duration of menstruation, typical blood loss, puberty, menopause, and pain-management strategies. Visual aids simplify the menstrual process and break myths about menstruation, such as that of menstrual blood being “impure”.

The counselling sessions also address local cultural taboos, such as restrictions on washing hair, visiting temples, touching/eating pickles, or entering the kitchen during menstruation, promoting a more informed and empowering understanding of menstrual health. A key component of the sessions involves comparing different menstrual hygiene products—traditional cloth, disposable plastic pads, and reusable cloth-based pads. The advantages and disadvantages of each are discussed, highlighting the environmental and economic benefits of RMPs.

Following the sessions, Saafkins pads are distributed to participants. Recognising the importance of clean water for menstrual hygiene management, Jagan Foundation also provides safe drinking water through purifiers and cooling systems in schools via corporate social responsibility (CSR) initiatives, contributing to a larger canvas of adolescent girls’ health and well-being. This integrated approach aims to create a supportive environment where girls can comfortably manage their periods. 

Figure 1: Project Laali Implementation 

 

 Source: Author’s own 

User Experiences with Saafkins Pads: Challenges and Adaptations

To assess the effectiveness and user satisfaction with the Saafkins pads, post-use surveys are conducted via phone calls or face-to-face interactions after at least two to three months of use. A total of 425 participants were enrolled in the post-use survey (women and school-going girls). The results are encouraging, with an 85 percent positive response rate, showing high traction among women aged 25 years and older (see Table 1).

Table 1: Post-Use Survey Results

Girls (n) Age (14-17 years)	Women (n) Age (25+ years)	Total users
65	360	425

Source: Author’s own

Many users reported washing the pads with regular laundry detergent or bathing soaps and drying them effectively. Leakage was minimal.

Madhu, a 25-year-old primary school teacher, shared her experience: “For the first time, someone not only made me aware of menstruation but also openly talked about health during this time. The counselling session was very informative. I used the free reusable pads, which I liked very much. They can be washed and reused, which is important. Now, I am using these pads. The first counselling session was very informative. I have learned and understood a lot about menstrual health from this.”

Some areas for improvement were also highlighted. For example, school-going girls and college students preferred the convenience of disposable pads over reusable ones, citing washing and drying as barriers. Out of the 425 respondents, 55 were students from schools and colleges. Of these, 15 did not use the RMPs at all, opting to continue using disposable pads or giving the RMPs to their mothers. Additionally, 10 girls found the standard-sized pads too large and expressed a need for smaller pads designed for lighter flow days (see Table 2).

Table 2: User Feedback (Girls)

Total Girls (n=65)
Used RMP with Positive Experience	Oversized RMP	Did Not Use RMP
40	10	15

Source: Author’s own

This preference for disposable pads aligns with research in low- and middle-income countries, which suggests that convenience in use and ease of disposal are key factors influencing choice in menstrual products.^[23] This feedback offers valuable insights for future distribution strategies, helping the project better address the diverse needs of women and girls in Dhaulpur.

Potential Partnerships for Menstrual Hygiene and Sustainable Products in Rajasthan

The Rajasthan government could enhance the availability and use of RMPs, particularly in areas where pilot programmes like Saafkins have demonstrated promising results. Established distribution channels like ASHAs, schools, colleges, and Anganwadi centres could be leveraged to promote distribution. Collaborations with organisations like Jagan Foundation, Unipads, Srujna, and international development organisations like Engender Health can further expand access. The School Health and Wellness Programme (SWHP), launched in Rajasthan in 2021, offers a suitable platform for RMP distribution. It targets the nine ‘aspirational districts’ where the SHWP is already being implemented, including Kasturba Gandhi Balika Vidyalayas and government upper primary and senior secondary schools covered under the SWHP.

A “train-the-trainer” model, empowering local women as peer educators, can effectively leverage existing social networks for sustainable information dissemination and promotion of RMP adoption. Integrating information and counselling on RMPs into Village Health Sanitation and Nutrition Days is another avenue for increasing awareness and access.

Government stakeholders can also utilise CSR initiatives and incentivise RMP manufacturers through tax breaks. Prioritising RMP provision in resource-adequate settings, where access to water, sanitation, and proper disposal mechanisms is available, is essential. A comprehensive approach encompassing product availability, education, and infrastructural support will empower women and girls to manage menstruation with dignity and promote environmentally sustainable practices.

Advocating for Sustainable Alternatives in India

Evidence from India indicates that women in low-income households often use reusable cloth and commercially available disposable sanitary pads, with varying levels of satisfaction and challenges.^[24],[25] Integrating RMPs into the existing supply chain could benefit women who lack the resources for single-use products.

Research on the environmental impact of menstrual products is crucial for informed policy decisions. Studies comparing the life-cycle impacts of reusable versus single-use pads can quantify the environmental benefits of RMPs, including reduced waste and decreased resource consumption. This research can guide public awareness campaigns and product development, promoting more sustainable materials and designs. Understanding the long-term environmental benefits of RMPs is essential for promoting their adoption and creating a more sustainable approach to menstrual hygiene management.

Monitoring and evaluating RMPs through post-use surveys are crucial for adapting the project and maximising its positive impact. These surveys provide a direct channel for user feedback, allowing RMP projects to remain responsive to the evolving needs of the community. This iterative process of feedback collection, analysis, and adaptation is essential for ensuring the long-term sustainability and success of the RMPs. The Srujna Saafkins pads project and its post-use surveys show that RMPs are being proactively accepted by women, providing a practical example of how RMPs can be integrated into women’s communities and adapted within the health system framework.

Endnotes

^[1] Rabindra Nath Sinha and Bobby Paul, “Menstrual Hygiene Management in India: The Concerns,” Indian Journal of Public Health 62, no. 2 (2018): 71-74.

^[2] Myles F Elledge et al., “Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries—A Review of the Literature,” International Journal of Environmental Research and Public Health 15, no. 11 (2018): 2562.

^[3] Achuthan Krishnashree et al., “A Novel Banana Fiber Pad for Menstrual Hygiene in India: A Feasibility and Acceptability Study,” BMC Women's Health 21 (2021): 1-14.

^[4] Elledge et al., “Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries”

^[5] Nikita Gandotra, Reena Pal, and Sonam Maheshwari, “Assessment of Knowledge and Practices of Menstrual Hygiene Among Urban Adolescent Girls in North India,” Int J Reprod Contracept Obstet Gynecol 7 (2018): 2825-8.

^[6] Joanna Marroquin et al., “Chemicals in Menstrual Products: A Systematic Review,” BJOG: An International Journal of Obstetrics & Gynaecology 131, no. 5 (2024): 655-664.

^[7] Mayuri K Gaikwad et al., “Impact of Hazardous Chemical Compounds on Reproductive System Reported in Sanitary Products,” Research Journal of Pharmacology and Pharmacodynamics 15, no. 3 (2023): 112-118.

^[8] Mauri José Piazza and Almir Antônio Urbanetz, “Environmental Toxins and the Impact of Other Endocrine Disrupting Chemicals in Women's Reproductive Health,” Journal Brasileiro de Reprodução Assistida 23, no. 2 (2019): 154.

^[9] Supriya Garikipati and Camille Boudot, “To Pad or Not to Pad: Towards Better Sanitary Care for Women in Indian Slums,” Journal of International Development 29, no. 1 (2017): 32-51.

^[10] AM Van Eijk et al., “Exploring Menstrual Products: A Systematic Review and Meta-Analysis of Reusable Menstrual Pads for Public Health Internationally,” PloS One 16, no. 9 (2021): e0257610.

^[11] Sassone S. Ciardi et al.,” Reusable Sanitary Napkins in Rural India: A Remote Quality Improvement Project for Adolescent Girls Promoting Menstrual Hygiene Health During the COVID-19 Pandemic,” Global Health Promotion 29, no. 3 (2022): 77-85.

^[12] Manas Ranjan Behera et al., “Household Sanitation and Menstrual Hygiene Management Among Women: Evidence from Household Survey Under Swachh Bharat (Clean India) Mission in Rural Odisha, India,” Journal of Family Medicine and Primary Care 11, no. 3 (2022): 1100-1108.

^[13] Supriya Garikipati and Penelope Phillips-Howard, “What’s the Bleeding Problem? Policy and Attitudes Towards Sustainable Menstrual Hygiene Materials in India,” AEA RCT Registry 7 (2019): 1-21.

^[14] Elledge et al., “Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries”

^[15] Sinha and Paul, “Menstrual Hygiene Management in India: The Concerns”

^[16] Rajanbir Kaur, Kanwaljit Kaur, and Rajinder Kaur, “Menstrual Hygiene, Management and Waste Disposal Practices and Challenges Faced by Girls/Women of Developing Countries,” Journal of Environmental and Public Health, no. 1 (2018): 1730964.

^[17] Government of India, Healthy States Progressive India: Report on the Ranks of States and Union Territories, NITI Aayog Government of India, 2019, https://www.niti.gov.in/sites/default/files/2023-02/SHI_Round_one%20_Report_09102021.pdf

^[18] Nishmeet Singh et al., “District Nutrition Profile: Dhaulpur, Rajasthan,” International Food Policy Research Institute, 2022, https://www.niti.gov.in/sites/default/files/2022-07/Dhaulpur-Rajasthan.pdf

^[19] M Shafiqur Rahman et al., “Association Between Malnutrition and Anemia in Under-Five Children and Women of Reproductive Age: Evidence from Bangladesh Demographic and Health Survey 2011,” PloS One 14, no. 7 (2019): e0219170.

^[20] Anubhuti Yadav and Deepa L Masand, “Study of Menstrual Disorder in Adolescent Girls at Tertiary Care Centre in Rural Area,” International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 5 (2018): 1980.

^[21] Rahman et al., “Association Between Malnutrition and Anemia in Under-Five Children and Women of Reproductive Age”

^[22] International Institute for Population Sciences (IIPS) and ICF, India Districts Factsheet National Family Health Survey (NFHS-5), 2019-21: India, Volume II, Mumbai, IIPS.

^[23] Elledge et al., “Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries”

^[24] Yasotha Ponnuswamy and Kiruthika P, “An Online Survey Study on Menstrual Hygiene Products and its Utilization,” International Journal of Advanced Research 9, no. 5 (2021): 162-168.

^[25] Tridibesh Tripathy et al., “Perspective on Issues About MHM at Community Level in the State of Bihar, India,” Journal of Bio Innovation 9, no. 6 (2020): 1184.

• Healthcare
• India
• menstrual health programs
• menstrual health scheme
• menstrual health scheme india
• menstrual hygiene practices in india
• menstrual hygiene scheme
• project lalli
• reusable menstrual pads
• reusable menstrual pads scheme
• rmnch+a policy
• rmnch+a policy india
• sustainable menstrual hygiene

The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.