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Menstrual Health in India |Country Landscape Analysis
Executive Summary
Women and girls constitute half of India’s population. 1 Yet, gender disparities remain a critical issue in India impacting women and girls’ education, health, and workforce participation. Data shows that girls are largely on par with boys up to adolescence, but with the onset of puberty, outcomes for girls begin to diverge and girls face increasing restrictions to their mobility and agency. 2,3
There are over 355 million menstruating women and girls in India, 4 but millions of women across the country still face significant barriers to a comfortable and dignified experience with menstrual hygiene management (MHM). A study found that 71% of girls in India 5 report having no knowledge of menstruation before their first period. 6 At menarche, schoolgirls in Jaipur, Rajasthan report their dominant feelings to be shock (25%), fear (30%), anxiety (69%), guilt (22%), and frustration (22%). 7 Further, 70% of women in India say their family cannot afford to buy sanitary pads. 8 And in 2012, 40% of all government schools lacked a functioning common toilet, and another 40% lacked a separate toilet for girls. 9
Although there is evidence in India illustrating the problem, the evidence linking the impact of poor menstrual health, an encompassing term for menarche and MHM, on critical outcomes is limited. Current studies have small sample sizes and rely on qualitative, self-reported, or anecdotal data making it difficult to generalize findings across different types of adolescent populations and diverse regions with different cultural and socio-economic contexts. Yet, in some cases menstrual health programs are designed assuming these linkages. There is need for further research to understand the impact of menstrual health interventions on life outcomes. There has been increased momentum from donors, governments, and the private sectorto address menstrual health issues. The focus to date has largely been on products and more recently on improving awareness especially among girls.
There are immediate opportunities to leverage the national momentum in India to improve menstrual health, particularly for adolescent girls. Priorities include strengthening facilitator capacity to deliver awareness training, improving the reach and quality of low-cost pads, and improving targeting of influencers. Girls’ ability to manage their menstruation is influenced by broader gender inequities across India and can be hindered by the presence of discriminatory social norms. There may be opportunity to leverage MHM as a less sensitive entry point to address sexual and reproductive health topics, such as reproductive rights and teenage pregnancy prevention, and improve a girl’s empowerment at large, but research and programming are still nascent.
This report seeks to understand: (1) the current state of girls’ experience with menarche and MHM in India, (2) donor, government, NGO, and company responses to girls’ needs, and (3) opportunities for research, advocacy, and programming to better address these needs. This complements a Global Landscape Analysis and is one of three Country Landscape Analyses focused on India, Kenya, and Ethiopia. This report is the result of a review of over 60 peer-reviewed articles and grey literature, over 30 interviews with experts and practitioners in India, and a review of relevant programming focused on menstrual health. While experts interviewed for this research highlighted that gender inequality and hence, the state of MHM was likely to be worse in the northern states like Uttar Pradesh (UP) and Bihar as compared to southern states like Tamil Nadu, they did not indicate any evidence that MHM interventions were more prevalent, better organized, or more effective or in one Indian state over the another. The country research for India was also informed by 72 interviews with adolescent girls from rural and urban areas near Kanpur, UP, and Coimbatore, Tamil Nadu between November and December 2015 in the following categories: (1) early post-menarche 0 to 1 year post-menarche, (2) post-menarche 1 to 3 years post-menarche, and (3) late post-menarche 3+ years post-menarche up to 18 years old. Interviews were also conducted with 32 influencers including mothers, sisters, teachers, and community health care workers. This user-research is not meant to be representative of all adolescent girls in UP and Tamil Nadu. It is meant to bring the voice of adolescent girls where possible and illustrate distinct profiles of girls, whose needs may vary based on their context, requiring different intervention strategies. The regions were selected based on the following criteria (1) diversity in economic prosperity, (2) existing funding or focus for the Foundation, and (3) diversity in cultural, religious, and language background.
