Anupama Shukla, a postgraduate in sociology, believes that menstruation is dirty and that failing to avoid the Gods during this time will invite calamity. In a country of 355 million menstruating girls and women, such ideas are rampant.

Since Shukla is the principal of a girls’ college in Uttar Pradesh's Sant Kabir Nagar district, her ignorance as potentially far-reaching effects. When she says that college is best avoided during "those" days, human contact should be minimised and daily activities suspended, Shukla is spreading dangerous prejudices.

A plethora of studies lay out the numbers: 23% of Indian girls drop out of school when they hit menarche, 31% of women miss 2.2 days of work per month when they menstruate, girls miss 20% of school days every year.

One study that focussed on 2,579 girls and women in 53 slums and 159 villages in Madhya Pradesh, Chhattisgarh and Uttar Pradesh found out that while 89% of respondents used cloth, with over half of them using the same cloth for more than one period, 2% used cotton wool and the same numbers used ash to absorb menstrual flow while only 7% used sanitary pads.

More alarmingly, of the 63% who had access to toilets, 20% did not use them during menstruation for fear of staining it, and more than two out of five girls had no idea about menstruation when they started with their periods. Of those who had some idea, only 16% received any information in school.

Against this backdrop, the UP government has rolled out an ambitious scheme, the Kishori Suraksha Yojana under which one pack of 10 sanitary napkins every month shall be handed out to all girl students in classes 6-12 in government and government-aided schools. Of the many glaring gaps in that plan is its complete disregard of girls who have dropped out of school and those who attend non-aided schools like the one Shukla heads.

Neelam Singh, Lucknow based gynaecologist and the founder of Vatsalya, an organisation that has been on the forefront of the fight against female foeticide, criticised the scheme for its lack of coherence. “A supportive environment needs to be created for girls to use sanitary napkins," she said. "How does the giving of sanitary napkins make a difference when there are no functional toilets in schools or where functional toilets have no water?”

Singh was also sceptical about loading Accredited Social and Health Activists, or ASHA, who function as the lynchpin of the centre’s National Rural Health Mission, with more work.

Those are extremely valid considerations in a state where 64.7% of all households do not have functional toilets. While official data says that only 2.99% government schools and 10.32% private schools do not have toilets, the reality of these is dismal.

closer look at the status of hygiene and sanitation in 182 schools across six districts of UP in 2013 found that there was an average of one toilet per 145 students but the average for girls was one for 301.

Environmental costs

While merely doling out sanitary napkins without awareness and supportive infrastructure is unlikely to make any long-term difference, the mere idea of what currently mass-produced pads will do to the environment is also worrisome.

Meenakshi Gupta, founder member of Goonj, an organisation that has put clothing on the agenda of development and has produced low cost sanitary pads, said that cloth is something most women are familiar with. "We are just trying to get them to take up safe and hygienic practices around using cloth," she said. "Right now the mass-produced sanitary pads are not biodegradable; thus these products entering rural India would cause havoc in the environment. Most cloth-based or other biodegradable products are either very small scale or at an experimental level still. Thus we want to make sure that women in villages have a safe, familiar and a long-term viable product which will not strain their meagre resources.”

To put Gupta’s concern in perspective, consider that research in 2007 put the sanitary pad market in India at $155.49 million in 2007. This was calculated at a mere 4.5% usage and worked out to 2,659 million units made of non-biodegradable, non-recyclable products, the safe disposal of which does not figure in the agendas of the corporations that are making profits of this vast and still growing market.

Some answers have already been found – the most prominent among those by Arunachalam Muruganatham, the Tamil Nadu-based world-renowned pioneer of low cost sanitary napkin making units, who is advising the UP government in its quest for 100% menstrual hygiene.

While the government’s own target date for that achievement is 2017, Arunachalam said, “This is a long-term agenda. Handing out free napkins can be an election gimmick at best. Affordability, awareness and availability are the key issues. Big corporates that peddle sanitary napkins as comfort products used by tight jeans wearing women have no interest in reaching underserved villages."

His solution –  a biodegradable, low-cost pad that is manufactured and sold by women, who in turn are the biggest advocates for menstrual hygiene – could well be a precursor to a larger change. “As awareness of the harms of mass-produced napkins grows, silent brand shifts will begin to happen," he said." After farming and handloom, low-cost sanitary napkins will become the third-biggest livelihood option.” After all, India has more menstruating girls and women than any other.

Tackling menstrual waste through incinerators has been on the agenda of the  government since December 2013 when the Nirmal Bharat Abhiyaan guidelines were modified to specify that “setting up incinerators in schools, in women’s community sanitary complexes, in primary health centres, or in any other suitable place in village, etc can be taken up”.

This was taken further ahead by the Swachh Bharat Swachh Vidyalaya mission which aims for “at least one incinerator in the girl’s toilet block and niche to keep sanitary napkins,” but despite all the rhetoric, progress has been slow.

In April, for instance, the UP government announced a partnership with Sulabh International for setting up incinerators in 300 government colleges and schools. Despite ready availability of technology, as per Sulabh’s WASH in School programme in-charge Rupak Roy Choudhary, the programme remains at the drawing-board stage.

Rays of hope

Yet promising stories of change are emerging from the state. Anil Singh Sengar, a Gram Panchayat officer from Mahoba was supported by the state’s bureaucracy and guided by Arunachalam to set up a low-cost sanitary napkin production unit which today produces 65,000 packets a month and employs 28 women – all under the umbrella of the Panchayat Udyog, a decentralised enterprise model promoted as part of local self governance.

The six-piece packet sold for Rs 15 under the brand name "Subah" (Morning) has an ISO-2014 certification and enjoys wide acceptability in all four blocks of the district. However as Sengar points out, when the unit was set up in 2013, it was difficult to sell even 10 packs. “If you go to purchase vegetables, you will buy only those you know or have eaten," he said. "Similarly while our pads were made available in local shops, women paid no attention to them as they had no awareness about them."

An intensive awareness drive, spread over one and a half years and covering all 14,570 schools in the district, has today resulted in a situation where the demand of Subah outstrips supply and where men from villages come to collect supplies without any sense of embarassment.

It is drives such as these which are crucial if any headway is to be made in ensuring menstrual health in the country’s most populous state. Till then, misconceptions such as those harboured by Shukla shall continue to flow freely.

This article was first published on, with the support of Oorvani Foundation – community-funded media for the new India.