A Period of Change:
Knowledge, Attitudes, and Practices 
of Menstrual Hygiene in India

Menstrual hygiene management (MHM) is crucial for the well-being of women and girls, and is intrinsically linked to broader systemic issues such as health, education, gender equality, and well-being. Menstruation signifies the transition of a girl into womanhood, marking the attainment of reproductive maturity (Tyler and Woodall, 1982). Despite its biological basis, discussions about menstruation are often shrouded in silence, unacknowledged, and stigmatized. Sociocultural restrictions, shame, and discomfort shape the menstrual experiences of many women. In India, menstruation transcends being a mere biological process, intertwining with complex socio-cultural traditions upheld by religion and entrenched social hierarchies (Hughes 2015). This prevailing mindset profoundly affects women's daily lives, restricting their access to public facilities, education, and healthcare (Kendre & Ghattergi, 2013). Adolescent girls, in particular, are vulnerable and require a supportive environment and positive guidance. Therefore, systematic management of menstrual hygiene is a critical component of the Sustainable Development Goals (SDGs) and an integral part of WASH (Water, Sanitation, and Hygiene) initiatives.

The term menstrual hygiene management originated in the WASH (Water, Sanitation, and Hygiene) sector and refers to practices enabling women and girls to safely manage their menstruation. As per WHO and UNICEF the term MHM is defined as - ‘women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear’ (WHO & UNICEF 2012). The above definition includes various resources necessary for women and girls to manage their hygiene.

Recognising the prioritised need of MHM, the government has undertaken several initiatives to promote menstrual hygiene. The Ministry of Health and Family Welfare's Scheme for Promotion of Menstrual Hygiene provides subsidized sanitary napkins to adolescent girls. The Ministry of Jal Shakti's Swachh Bharat Abhiyan includes guidelines for menstrual hygiene management, and the Pradhan Mantri Bharatiya Janausadhi Pariyojna (PMBJP) offers affordable sanitary napkins through Janaushidhi Kendras. However, significant gaps remain.

Sewa International recently conducted an in-depth study titled “Knowledge, Attitude, Practice on Menstrual Hygiene Management in India” which is a descriptive cross-sectional study to understand the challenges and gaps in MHM, with the survey being conducted with 796 adolescent girls, 151 adolescent boys and 70 teachers from 20 schools. The Knowledge, Attitude, Practice (KAP) study sought to analyse - Knowledge - what people know about menstrual hygiene; Attitude - how people feel about menstrual hygiene; Practice - how people behave feel about menstrual hygiene. Overall, the study aimed to contribute to sustainable development by promoting good menstrual hygiene practices (Sewa International, 2023).

Knowledge

Knowledge

The data on menstrual knowledge among adolescents analysed in the study revealed significant gaps and misconceptions. While 51% of adolescent girls reported having some knowledge about menstruation, a concerning 40% of adolescent boys indicated they were entirely unaware of the subject. Alarmingly, 11.8% of girls perceived menstruation as a sin or a curse, highlighting deep-rooted stigmas. Furthermore, 55% of adolescent girls and a staggering 93% of boys lacked any understanding of menopause. Many boys (60%) did not know the typical age at which girls begin menstruating, and 68% were unaware of the duration of menstrual periods. Among the girls, 46% were only familiar with single-use sanitary pads or napkins as menstrual absorbents. Misconceptions were also prevalent, with 14.7% of both boys and girls viewing menstruation as a female disease, and 2.4% attributing it to divine punishment. Notably, girls primarily received information about menstruation from their mothers or friends, whereas the majority of boys reported receiving no information at all, with only 19% citing their mothers as their source of knowledge

Attitude

Attitude

The study elaborated the attitudes towards menstruation among adolescents which reflected significant cultural and social biases. A troubling 20% of adolescent girls agreed that women should be prohibited from entering the house during menstruation, and 17% of girls and 13% of boys believed that menstruating women should be isolated in a separate room. The stigma surrounding menstruation also extends to food practices, with 29% of girls and 12% of boys strongly disagreeing with the idea that one can consume food prepared by a menstruating woman. Additionally, 34% of girls disagreed that menstruation is a sign of good health, and 32% felt that menstruating women should not be assisted. Moreover, 26% of girls strongly opposed the notion that women should have special dietary considerations during menstruation. These attitudes underscore the pervasive cultural and social barriers that perpetuate menstrual stigma and discrimination

Practice

Practice

In terms of menstrual practices, the study informed that many adolescent girls fail to practice menstrual hygiene and face significant restrictions. 41% of girls reported not having any information on pain management during menstruation. Furthermore, 24.7% of girls did not stay in their usual room during their periods, often residing on the floor, outside the house, or in a separate room, reflecting traditional taboos. A significant 42% of girl respondents indicated they faced various restrictions within their homes during menstruation. The social silence around menstruation is also evident among boys, with 21% unsure about discussing the topic with parents or friends. These practices reveal the profound impact of cultural stigmas on the daily lives and well-being of menstruating adolescents, necessitating comprehensive educational and policy interventions to foster a supportive and informed environment. Addressing the challenges of MHM requires a multifaceted approach focusing on WASH facilities, education, and menstrual hygiene products. The following recommendations are crucial for effective MHM:

• Comprehensive education and awareness programs: Educational programs for both girls and boys are crucial to address knowledge gaps and dismantle social stigma. Schools should regularly conduct menstrual hygiene management workshops to provide accurate information to both girls and boys. Building the capacity of teachers and school management is essential to ensure proper knowledge dissemination
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• WASH facilities: Ensuring access to clean water, sanitation facilities, and private spaces for changing menstrual materials is essential for practicing good hygiene.
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• Market-Based Solutions: Supporting the innovation and distribution of low-cost, high-quality sanitary pads can significantly improve access to menstrual hygiene products. This also supports affordability and accessibility to menstrual hygiene products.
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• Community engagement: Community-based WASH programs can play a vital role in promoting behaviour change and encouraging positive attitudes towards MHM. Such programs also ensure the accessibility to necessary resources such as water, sanitation facilities, and hygienic products. Engaging the entire community such as parents, teachers, community leaders, and healthcare providers create a supportive environment. By encouraging open dialogue and creating safe spaces for discussions, community WASH programs enable adolescents to seek guidance and support from trusted individuals.
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• Pain Management Education: In the study by Sewa International, 41% of girls informed that they did not have required knowledge to manage pain and teachers confirmed that lack of pain management contributed to absenteeism amongst girls. Incorporating pain management into MHM education can help girls manage menstrual discomfort effectively and ensure that inappropriate medication do not adversely impact the girls health.
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• Role of men and boys: There is enough research and evidence to suggest that a change in the perception of boys and men towards menstruation can help reduce embarrassment associated with menstruation (Mohan et al 2015). Engaging men and boys in MHM discussions can help break down taboos and foster a supportive environment for women and girls.

MHM is not just a hygiene issue; it's a matter of women's and girls' dignity, health, and well-being. MHM further forms a critical component of sustainable development with profound implications for health, education, and gender equality. By addressing knowledge gaps, challenging negative attitudes, and ensuring access to resources through comprehensive policies and community engagement, we can create a supportive environment where women and girls can manage menstruation with dignity and confidence.

References

References

Sewa International, 2023. Knowledge, Attitude, Practice on Menstrual Hygiene Management in India. Delhi: Sewa International. Retrieved from (Link)
WHO/UNICEF (2012) Consultation on draft long list of goal, target and indicator options for future global monitoring of water, sanitation and hygiene. Retrieved from
https://washdata.org/sites/default/files/documents/reports/2017-06/JMP-2012-post2015-consultation.pdf
Tyler S. L. and Woodall G. M. (Eds.), Female health and gynecology across the lifespan. Bowie, Md.: Robert J.Brady, 1982. Kendre, V. V. ., & Ghattergi, C. H. . (2013). A Study on Menstruation and Personal Hygiene Among Adolescent Girls of Government Medical College, Solapur. National Journal of Community Medicine, 4(02), 272–276. Retrieved from Subheading
Mahon, Thérèse, Tripathy A., and Singh N. "Putting the Men into Menstruation: The Role of Men and Boys in Community Menstrual Hygiene Management." Waterlines 34, no. 1 (January 2015): 7-14.

About Authors

Vani Manoraj is a lawyer with Master of Laws from King's College London. She is currently Manager, Legal and Research at Sewa International. She worked at the United Nations International Residual Mechanism for Criminal Tribunals (IRMCT) in The Hague and the United Nations Office of the High Commissioner for Human Rights (OHCHR) in Geneva.

Vani Manoraj