Menstrual Hygiene : Need to Break

Silence and Build Awareness

Dr Sushma Dureja
Deputy Commissioner (Adolescent Health)
Ministry of Health & Family Welfare
Government Of India
 Menstruation

 Menstruation is a natural, normal

biological process experienced by all Over 355 million
adolescent girls and women. menstruating women
 On any given day, more than 800 million
and girls in India*
women between the ages of 15 and 49
are menstruating around the world.

*Source: Menstrual Health in India, Country Landscape Analysis, Sponsored by the Bill and Melinda Gates Foundation, May 2016
Menstruation & SDGs

Ensure healthy lives and promote well-being

for all at all ages

Ensure inclusive and equitable quality education

and promote life-long learning opportunities for all

Achieve gender equality and empower all women and girls

While there is no specific goal or indicator for
MHM in Sustainable Development Goals
Ensure availability and sustainability of water and
(SDGs), it is linked directly or indirectly to sanitation by all

various SDGs Promote sustained, inclusive and sustainable economic

growth, full and productive employment and decent work
for all.

Ensure sustainable consumption and production

patterns.
 Current Situation Of Menstrual Hygiene Management In India

Women with 12
Women from the
Among women Overall, 58% of or more years of
48% of rural highest wealth
in the age group women in this schooling are
women use a quintile are more
(15-24 years), age group use a more than four
hygienic method than four times
42% use sanitary hygienic times as likely to
of menstrual as likely to use a
napkins, 62% method be using a
protection, hygienic method
use cloth, hygienic method
of menstrual compared with as women from
and16% use as women with
protection. 78% of urban the lowest wealth
locally prepared no schooling
women quintile (89%
napkins. (81% versus
versus 21%).
20%).

Source: National Family Health Survey 4, 2015-16

 Menstrual Hygiene: The Challenges

Lack of Awareness
• 71% of girls report having no knowledge of menstruation before their first period**
• Only about 23% of the girls knew that the uterus is the source of bleeding*
• 70% of mothers consider menstruation “dirty,” further perpetuating taboos**
• Rigid social norms and cultural taboos prevent open dialogue and discourse
Availability and affordability of appropriate products
• 58 percent of women aged 15-24 years report current use of safe, hygienic products (NFHS 4, 2015-16)
• Only 2-3% of women living in rural India use disposable sanitary napkins
• Women from the highest wealth quintile are more than four times as likely to use a hygienic method in
comparison to women from the lowest wealth quintile (89% versus 21%)
Lack of access to facilities
• 63 million adolescent girls
*Source: Vinita Satija, Alialiving in homes
Kauser, Rashmi without
Kukreja and May toilets**
Post, Literature Review to Assess Menstrual Hygiene Management Practices among Adolescent Girls in India, August 2017,
Bethesda, MD: Health Finance & Governance project, Abt Associates Inc
• Two out of five schools
**Source: Spot On!in India
Improving do not
Menstrual Health have separate
and Hygiene in India, USAID,toilets for
Kiawah Trust, girls**
Dasra
 Addressing Menstrual Hygiene

Menstrual Hygiene Management (MHM) has been taken up by various government departments, UN
organizations , development partners and NGOs

Ministry of Health and Family Welfare Working around:

Ministry of Women and Child Development
Ministry of Human Resource Development
Ministry of Drinking Water and Sanitation
UN Agencies
NGO partners
An important component under Swachh
Bharat Mission
• breaking the silence around menstruation ( 360* communication
material)
• normalizing the periods so as to create a conducive environment for
girls to be comfortable
• building capacities of community level health workers to address
menstrual health issues
• work with the adolescents, their parents, teachers, community based
leaders and the relevant line departments.
• making low cost and environmentally friendly options for managing
menstrual flow available in the community and promoting safe
disposal of menstrual waste
• Getting the newer products tested for their suitability for introduction
in public health program
MHM SCHEME

The Ministry of Health and Family Welfare has been implementing MHS scheme for promotion of menstrual hygiene among adolescent
girls in the age group of 10-19 years primarily in rural areas as part of RCH II since 2011. The scheme has the following objectives:
• To increase awareness on menstrual hygiene among adolescent girls
• To increase access to and use of good quality sanitary napkins among adolescent girls residing primarily in rural areas
• To ensure safe disposal of sanitary napkins in an environmentally friendly manner.
 The scheme was initially implemented in 107 selected districts in 17 States wherein a pack of six sanitary napkins called “Freedays”
was provided to rural adolescent girls for Rs. 6.
 From 2014 onwards, funds are being provided to States/UTs under National Health Mission for decentralized procurement of
sanitary napkins packs through a process of competitive bidding
 The ASHA worker is responsible for their distribution using a suitable platform . She receives an incentive @ Re 1 per pack sold and
a free pack of napkins every month for her own personal use.
 She convenes monthly awareness generation meetings at the Aanganwadi Centres or other such platforms for adolescent girls to
focus on issue of menstrual hygiene and also serve as a platform to discuss other relevant SRH issues.
 A range of IEC material has been developed around MHS, using a 360 degree approach to create awareness among adolescent girls
about safe & hygienic menstrual health practices
Funds Allocated Under MHS

NHM Funded Assam, Bihar, Delhi, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Kerala,
Lakshadweep, Maharashtra, Manipur, Madhya Pradesh, Odisha, Punjab, Rajasthan,
(20 States)
Mizoram, Telangana, Tripura, Uttarakhand, West Bengal

State Funded Dadra & Nagar Haveli, Daman & Diu, Jharkhand, Karnataka, Puducherry, Tamil
(8 States) Nadu, Uttar Pradesh, Bihar

Year 2015-16 2016-17 2017-18 2018-19 2019-20

Amount
allocated for
MHS 3078.8 3703.9 4444.0 3450.6 6416.6
(Rs. Lakhs )
 Menstrual Hygiene Materials

Basket Of Choices

A variety of options are available and the choice is

CLOTH PAD/
DISPOSABLE
SANITARY PAD REUSABLE PADS more often than not influenced by the cost, access to
private space to change, easy disposability and easy
and regular availability of the product.

TAMPON MENSTRUAL
CUP
 Factors affecting choice of product

Community norms
on products and
acceptability

Knowledge of Regular and Price of products

products and their consistent use and accessibility
use of product to money

Access to
product and
comfort
purchasing
product
Source: Vinita Satija, Alia Kauser, Rashmi Kukreja and May Post, Literature Review to Assess Menstrual Hygiene Management Practices among Adolescent Girls in India, August 2017, Bethesda, MD: Health Finance &
Governance project, Abt Associates Inc
 Bio Degradable Pads

Biodegradable, disposable ‘Suvidha’ pads, by the Ministry

for Chemicals and Fertilizers, Government of India
 These pads are oxy-biodegradable and made available
in packs of 4, priced at Rs. 2.50 per pad.
 Available across 586 Indian districts, at Pradhan
Mantri Bhartiya Janaushadhi centres.
 Contains a special additive that renders the napkin
biodegradable when exposed to sun and air  The aim is to enable more women to have access to
 The oxo- biodegradable napkin starts decomposing six affordable and healthy menstruation products.
months after its disposal in a landfill under certain  These affordable sanitary pads promise to promote hygiene,
pressure conditions. ensure the ease of disposal, and keep the environment clean.
 By comparison, an ordinary pad starts degrading after
500 years.
Sanitary Vending Machine And Electric Incinerators

Electric Incinerators

Sanitary vending machine

 Menstrual Waste Management: The Load

Estimated 121 million girls and women are currently using an average of eight disposable sanitary pads (non-
compostable) a month, the waste load generated in India is estimated to be*:
• 1.021billion pads disposed monthly
• 12.3 billion pads disposed annually
• 113,000 tonnes of menstrual waste annually

*https://path.azureedge.net/media/documents/ID_mhm_mens_waste_man.pdf
These figures have been calculated based on the National Family Health Survey 4 data, market penetration data, and census data.
 Issues in Disposal

• Disposal of commercial napkins is a matter of concern because of their high content of non-
biodegradable components
• Biodegradable napkins have a very limited availability as of now
• Disposal of menstrual wastage does not have clear guidelines and law in India as yet
• Incinerators are emerging as a preferred disposal and treatment option. However, it is still not
clear whether they can efficiently burn pads with high moisture content and Super Absorbent
Polymers (SAP)
• Still lack comprehensive information on effects of disposal and treatment for the complete range
of menstrual hygiene products (reusable, compostable and non-compostable disposable
products) on users and on the environment.
WAY FORWARD

Strengthen the capacity of influencers—teachers, frontline workers (ANM, ASHA, AWW),

mothers to give correct and accurate information and support to girls

Promote health-seeking behaviour: Over 90% of menstrual problems are preventable

Support market-based solutions to innovate and distribute low-cost, yet high-quality sanitary
napkins at scale

Explore cloth and other locally available material to ensure that marginalized girls have long-
term access to sanitary material, resulting in better health and environment outcomes

Address the growing problem of disposing menstrual waste in an environmentally safe and
affordable manner

Uniform standards and guidelines to be drafted and implemented for currently available menstrual waste
management technologies, especially incinerators, composting pits, and waste to resource technologies
 EXPECTATIONS FROM THE INDUSTRY

 Industry can significantly contribute to rationalize the prices to make the products more affordable to the
masses.
 Industry must invest in R&D and large scale manufacturing of the biodegradable/ compostable napkins as well
other products like menstrual cup.
 Need to develop a cost-effective sanitary napkin manufacturing technology through with which SHG women can
produce and market sanitary napkins locally and make available cheaper sanitary napkins at least for the
unreached and marginalized rural communities.

 Availability of these sanitary napkins in the market still continues to be an issue in remote rural areas and deep
tribal pockets. Efforts must be made to strengthen the distribution networks to reach the unreached population.

  Utilization of CSR Funds to make “Menstrual Hygiene” a meaningful Endeavour by investing in

 creating community awareness
 supporting local manufacturing units by SHGs
 strengthening the existing product distribution channels to ensure reach to the last mile and
 provision of toilets in the schools.
 © 2016 Arvind Jodha/UNFPA, Courtesy of Photoshare

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