Around half of the women in India use unhygienic methods of protection during menstruation, such as cloth or make-do pads stuffed with ash, husk or even sand, according to the recent National Family Health Survey-5.

The proportion of women using hygienic period products went up by much more than the reduction in those using unhygienic products. While the percentage of hygienic period product use, among women aged 15-24 years, went up by 20 percentage points — 58% in NFHS-4 (2015-16) to 78% in NFHS-5 (2019-21), the dip in unsafe methods was much less — 13 percentage points (63% in 2015-16 to 50% in 2019-21).

This shows that while women have begun or tried using hygienic products like locally prepared napkins, sanitary napkins, tampons and menstrual cups, they have not adopted them completely and continue to use unsafe methods.

In India, which has approximately 35.5 crore women who menstruate (almost a quarter of the country's population), 89.6% women in urban areas have some or complete access to hygienic menstrual products and this figure stands at 72.6% in rural areas. This is a gap of 17%, which has come down from the 29% in 2015-16.

The experience of menstruation is not the same for all women. Good menstrual hygiene management (MHM) can play a fundamental role in enabling women, girls, and other menstruators to reach their full potential. MHM in India falls under the National Health Mission, with its key objectives being increasing awareness about safe menstruation, increasing access to high quality sanitary napkins, and ensuring their safe disposal.

The surveys show that the prevalence of unsafe menstruation methods is high in the lowest wealth quintile (nearly 75%) and it dips as one moves up, with the highest quintile still reporting a figure of 30%.

The level of education amongst women also contributed to a corresponding rise in the usage of safe period products — from 44% for women with no schooling to 90% in women with 12 years of schooling or more.

Safe Products Least Accessible in Bihar

Tamil Nadu has the highest share of women (98.4%) with access to hygienic menstrual products, followed by Delhi (97.1%) and Goa (96.8%). Bihar is the worst performing state in making safe menstrual practices accessible to women. With a prevalence of only 59.2%, it is the only state to report a figure lower than 60%. Following behind is the central state of Madhya Pradesh (60.9%), and the north-eastern state of Meghalaya (65.3%).

A woman may use multiple products throughout her cycle across multiple cycles, so the % figures are a representation of women who have some or complete access to safe period products.

Uttar Pradesh has the highest percentage of women (69.4%) still using unsafe methods like cloth pieces or old rags at all or at some points of their menstrual cycle. Bihar and Madhya Pradesh are part of the top 5 such states 67.5% and 64.8%, respectively.

Overall, 16 states and union territories, out of the total 36 surveyed, reported a prevalence rate of above 90% for safe menstrual practices. Sanitary napkins are the most prevalent form of hygienic period product across states, with a total prevalence of 64.4%.

Safe Periods Lead to Low Dropout Rate

Girls in India tend to miss school, on an average, six days a month due to lack of quality sanitation facilities, according to Dasra Foundation's 2019 report Dignity for Her.

Another meta-analytic research across 138 studies reveals that school absenteeism is associated with menstruation, with one in four girls missing one or more days of school. The primary reasons are physical discomfort or pain, lack of water, hygiene and disposal facilities in school toilets, fear of staining their clothes and restrictions imposed by relatives or teachers.

The research also shows that there are cultural and religious taboos associated with periods at play here. The most frequent being restrictions in visiting places of worship, and touching religious items or praying (77%), followed by cooking and food-related restrictions (between 38-50%).

The culture of silence around menstruation results in 71% of young girls in India not knowing what periods are until menarche, reports United Nations International Children's Emergency Fund (UNICEF). Around 70% of mothers consider menstruation 'dirty', perpetuating a culture of shame and ignorance.

All of the above listed factors, combined with limited access to sanitary period products, subsequently leads to young girls dropping out of school around the time they hit puberty.

This state-wise breakdown of access to hygienic period products, along with upper-primary and secondary dropout rates for girls shows that the higher the state's prevalence of safe period products, the lower is the school dropout rate.

Unhygienic Periods Cause Health Issues

The recent NFHS data highlighted that one in every two or half of the pregnant women and three in every five breastfeeding women in India suffer from anaemia. Overall, 57% of women, aged between 15-49 years in India, are anaemic, highlighted NFHS-5. This is not only a 4% increase from the NFHS-4 figure, but also 1.7 times more than the global average of about 33%, according to the WHO. Fewer men suffer from anaemia – 25.1% of men in the 15-49 age group are anaemic.

Poor menstrual hygiene can also pose physical health risks and has been linked to reproductive and urinary tract infections, according to UNICEF. This can result in future infertility and birth complications. Neglecting to wash after changing sanitary pads can spread infections, such as hepatitis B and thrush.

There has been a 70% increase in incidences of reproductive tract infections due to poor menstrual hygiene in India. Spanish researchers found that improper nutrition and heavy menstrual bleeding can increase iron deficiency as well as anaemia. This is an indicator of poor health and nutrition, and can cause symptoms like fatigue, dizziness, and drowsiness. Pregnant women are especially vulnerable, with an increased risk of maternal and child mortality.