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Menstrual Health and Hygiene: A closer look – – Malvika Chandnani

By November 27, 2021April 27th, 2022No Comments7 min read

The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity. (Source: The relationship between menstruation and the SDGs is deep and at first, may feel counterintuitive. This read unearths the relations between menstruation and three SDGs – SDG 5, 6 and 9.

SDG 5: Gender Equality

The aim of SDG 5 is to end gender-based discrimination and violence, support participation of all genders in social, economic and political development, and ensure universal access to reproductive health rights. UNICEF’s Gender Action Plan 2018-21 presents suggested actions to dismantle the most stubborn barriers to gender equality by securing health and education for all. Two listed priorities in the plan are to promote gender-responsive adolescent health and Menstrual Health and Hygiene (MHH).

Gender disparity principally affects menstruators from marginalised groups, and those who don’t identify as cisgender women. Gender-restrictive social norms instil barriers in availing menstrual hygiene information, materials, facilities and services affecting their menstrual experience. Further, they’re exposed to additional vulnerabilities, and limit their academic and work opportunities. So, how can we influence change for our menstruators?

The first step would be to adopt a non-gender specific vocabulary. E.g. saying periods/menstruation instead of ‘lady business’, not referring to pads and tampons as ‘feminine hygiene products.’ The second step would be to invest in Menstrual Health Education. Promoting the flow of factual information is fundamental to systematically eliminate the stigma associated with menstruation. Such dialogues help build a supportive social environment wherein menstruators can manage their periods with dignity. These Education programs have immense potential in becoming gender-transformative initiatives. Engaging pre-teens (before they start menstruating) in such gender-inclusive programs would have two benefits. First, they would learn about effective menstrual health management, therefore, increasing acceptance and reducing apprehensions about menstruation. Second, through effective communication, we can help them develop acceptance of different genders before they’ve formed strong notions. These pre-teens would therefore become the seeds of a gender-inclusive society, which even though today seems a far-fetched dream, could be manifested through such initiatives. Through policy and advocacy, we can empower millions of menstruators with facilities, materials, education, and social support, moving closer to a healthier world.

In summary, social transformation is the stepping stone to gender-inclusive economic development of menstruators, and for communities at large.

SDG 6: Clean Water and Sanitation

SDG 6 aims to secure global accessibility of safe water for drinking and domestic purposes, and sanitation facilities for all. The first series of targets are directed at building sustainable systems allowing flow of freshwater, treatment of wastewater, and addressing water scarcity. The second set of targets bring together local and international corporations to build capacity in marginalised communities through Water and Sanitation Hygiene programs (WASH). Globally, six in ten lack access to sanitation facilities. In India, out of 718 districts, 22% had no appropriate toilets for girls and 56% preschools had no access to clean water on premises. This translated to high school dropout rates – nearly 23% menstruators dropped out of schools due to lack of WASH infrastructure. We would ask, what do these statistics mean for menstruators in these settings?

Menstruators are deprived of private spaces with clean water to clean themselves and change menstrual hygiene materials as needed. This leads them to use these materials for longer hours than recommended thereby creating an environment for reproductive and/or urinary tract infections (UTIs). Further, lack of safe disposal methods in these facilities pushes them to dispose of their materials in secluded places or in the dark, which has been linked to increased probability of violence and assault against menstruators. The end results of these practices are school dropouts, missed work opportunities and threat of violence.

How can we facilitate change through SDG 6? Acknowledging that investing in WASH-MHH programs is investing in social and physical well-being of menstruators and the communities as a whole. According to UNICEF, the four-pillars of Menstrual Health and Hygiene (MHH) programs are social support, menstrual education, accessible and safe WASH facilities, and clean menstrual hygiene materials. Constructing separate toilets for menstruators and children in schools is projected to increase overall sanitation and mitigate disease risk, raising the attendance by nearly 11%. New WASH programs and policies are revolutionizing MHH by upscaling the construction of ‘period-friendly toilets’. The beauty of these toilets is that they are designed to be gender-sensitive and accessible by those with disabilities. Social, behavioural and knowledge barriers preclude menstruators, especially in low-income settings from efficiently practicing hygiene. The MHH-WASH programs must focus on continuous learning to overcome these barriers.

In summary, recognising that menstruators are fundamental health resources will enable us to support them in keeping themselves healthy through best hygiene practices.

SDG 9: Industry, Infrastructure and Innovation

The goal of SDG 9 is to facilitate sustainable development of industries, support small scale enterprises, boost quality research and innovations, build sustainable and resilient infrastructure by ensuring a conducive policy environment.

Menstrual health and hygiene (MHH) is majorly impacted by the growth of feminine hygiene industry. The key products of this market are tampons, sanitary napkins, menstrual cups, and vaginal health products. Analysis of the Indian feminine hygiene industry reported by predicts a steady growth of ~14.92% compound annual growth rate (CAGR) for the period starting from 2018 to 2024.

Note: Although referred to as feminine hygiene industry, the consumers are not restricted to cis-gender women and encompass many other genders who menstruate. A new gender-neutral term for referring to this industry would be a step towards gender equality.

Despite this growth, only 58 % of women in the age group 15 – 24 use a hygienic method of menstrual protection while 42% use unhygienic means of menstrual protection. Socio-cultural and economic factors contribute to these statistics. These are presented in the form of lack of awareness, acceptance and affordability. Lack of awareness prevents menstrual products from becoming a priority household need. Lack of acceptance leads to reservations to talk about and purchase menstrual products. Lastly, lack of affordability unfolds in the pattern of household spending. Menstrual hygiene products constitute only a small fraction of what is spent on other items.

On a positive note, with the expansion of digital media and online resources, awareness about intimate hygiene is growing. This is surging the demand for sanitary hygiene products and creating avenues for start-ups and innovations e.g. biodegradable sanitary napkins. Reusable products such as aesthetically designed cloth pads and menstrual cups are friendly to the environment and the pocket. Upcoming green technologies for menstrual waste management e.g. disposal units, chemical treatment units, and fumeless incinerators, are paving ways for efficiently managing the ever growing menstrual waste. MHH policies empowering new entrepreneurs would lay the foundations for sustainable menstrual management.

MHH Infrastructure encompasses safe sanitation and disposal facilities and systems for Menstrual Health Education. Many menstruators in low-income settings have an unclear understanding of efficiently managing periods. According to, 71% menstruators in India remain unaware of menarche until their first period. Apprehension and shame about the subject prevents them from seeking vital menstrual health information.

We can have transforming impacts on the lives of menstruators by establishing an ecosystem of Menstrual Health Educators who use teaching models catered to different demographics. Further, engaging teachers, community leaders and elders in these initiatives would not just reform menstrual health, but also bring about social transformation.

In retrospect, collaboration of governments and non-governmental organisations with communities is imperative for creating better structured environments and resources for growth and development.

About The Author: About The Author: A student of Health Policy and Public Health evidence, Malvika is part of Red Is the New Green Sustainable Development Foundation, a Forbes 30 Under 30 recognised organisation centered around Menstrual Health and Hygiene. From a Research Associate to the Operations Head, Malvika has worked with and led cross-functional teams to successfully execute research and community training projects. Currently, she is pursuing a Master of Public Health from one of Canada’s leading academic and research institutions – the University of Alberta. She aspires to work in healthcare advocacy by gaining mastery in environmental health and public policy.

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