Since 2010, India’s health ministry has focused on distributing disposable sanitary pads to girls and women as part of its efforts to improve menstrual health and hygiene. Menstrual health is crucial in ensuring that girls attend school and go on to pursue higher education.
Nearly 15 years since, India’s draft Menstrual Hygiene Policy continues to emphasise distributing subsidised sanitary pads while factoring in the need for environmentally-friendly disposal.
But this approach ignores the potential of reusable cloth pads and menstrual cups – options that are both environmentally friendly and cheaper.
Data shows that cloth is the dominant period product used in India. But that has been changing. According to the fourth National Family Healthy Survey, 2015-’16, more than half the respondents – 57% – used “hygienic products”, which the survey says are locally prepared napkins, sanitary napkins, menstrual cups, or tampons.
Among these respondents, 62% used cloth.
But among young women aged between 15 and 24, 77.6% used a hygienic method, shows the fifth round of the National Family Health Survey, 2019-’21. In this group, sanitary pad use was at 64%. This indicates a rapid transition towards disposable products. This is probably due to increased availability, government schemes and marketing.
Amidst this shift, data on reusables is limited: menstrual cup usage is a mere 0.3% and national data on reusable cloth pads remains largely absent despite traditional prevalence.
This data gap hinders the development of sustainable menstrual health strategies that could be suited to diverse needs.
Though well-intentioned, sanitary pad distribution, often led by government schemes and non-profits, faces challenges such as poor quality, having to make regular purchases and the growing burden of non-biodegradable waste.
An overwhelming focus on providing pads risks being a superficial fix that diverts attention and resources away from the deeper roots of poor menstrual health: inadequate sanitation facilities – such as clean water, private toilets, soap, disposal mechanisms – poor awareness and the stigma around menstruation.
Promoting reusable products underscores the necessity of investing in such infrastructure and healthcare support. Open conversations and the education to support reusable product adoption – such as discussing bodily functions, cleaning processes and sustainable practices – could challenge taboos and destigmatise menstruation.
Reusable period products
Social norms around purity and the compulsion on girls and women to hide the fact that they are menstruating heavily influence product choices. Disposables align with the need for invisibility.
In contrast, reusable cloth pads require washing and sun-drying for disinfection. This makes menstruation visibly public. At the same time, if reusables are managed unhygienically – without soap, clean water, or proper drying – the risk of reproductive tract infections increases.
Menstrual cups face distinct challenges contributing to their extremely low use (0.3%). First, their internal nature, requiring insertion into the vaginal canal, can be intimidating, physically challenging and is culturally unfamiliar.
Second, users need sustained, personalised guidance for proper fit and to address anxieties. Access to healthcare providers equipped to provide detailed counseling on using alternative products such as menstrual cups is severely limited in India.
Here, networks of trained and experienced local cup users could offer accessible and culturally resonant support that demystifies usage and builds community confidence. Integrating “cup clinics” or specialised counseling sessions within existing women’s health services could also provide safe spaces for advice.
Finally, the risk of undiagnosed reproductive tract infections means that there must be a cautious and health systems-oriented approach to menstrual cup promotion. Due to limited diagnostic access, reproductive tract infections are a “silent burden” in India, where many individuals have underlying infections unknowingly.
A study found that approximately 40% of randomly selected women in an urban Indian setting had reproductive tract infections.
Merely distributing menstrual cups to a population with such a high prevalence of undiagnosed reproductive tract infections, without concurrent health interventions, could lead to problems.
Promoting menstrual cups responsibly demands improved awareness of reproductive tract infection symptoms, widespread and affordable access to screening and treatment at the primary healthcare level, and clear guidance on when cup use might not be suitable or require medical consultation.
Communication campaigns must also address cultural fears, such as those surrounding virginity and hymen integrity, major unspoken barriers to cup adoption.
Product vs environment
The potential health risks associated with any reusable product, whether cloth pads or menstrual cups, are rarely inherent flaws of the products themselves but indicate problems with where the user is located.
For instance, data from the fifth round of the National Family Health Survey, shows that product usage is high, at 78%, but this figure plummets when access to water and sanitation facilities is considered alongside product use.
One study indicated that only 27.7% of individuals who menstruate have access to both products and sanitation that enables menstrual hygiene. This gap is a prime driver of poor menstrual health outcomes, even with high product penetration.
That is why promoting any reusable option responsibly and improving menstrual health overall must be inextricably linked with investment in infrastructure that enables hygienic and safe menstruation, education and strengthened healthcare systems.
Why do reusable products matter?
Integrating reusable products into India’s menstrual health management strategy aligns with national development and sustainability goals.
Disposable pads generate staggering amounts of non-biodegradable waste, whereas reusables such as cups and cloth pads drastically cut down this ecological burden.
Secondly, reusables offer an economic advantage, particularly for low-income households, by eliminating monthly expenses.
Thirdly, reusable products help with continuous and dependable menstrual management that is independent of fragile supply chains, ensuring minimal disruptions to daily life, especially in times of crisis.
Moving ahead
India’s policy focus should shift from products to systems that prioritise an enabling environment involving water and sanitation, menstrual health education that includes awareness on reproductive tract infections and campaigns to dismantle stigma.
It should recognise that promoting the use of menstrual cups requires strengthening healthcare, including training health workers on cup counseling, establishing referral pathways and peer educator models.
Lasting change requires establishing sustained, community-based programme that directly address social norms that stigmatise menstruation.
Focusing solely on disposable pad distribution is an incomplete and unsustainable solution to India’s menstrual health challenges.
Karan Babbar is an incoming Assistant Professor at Plaksha University.
May 28 is Menstrual Hygiene Day.
