[1]Much has been assumed regarding the sanitary pad usage in rural India. The general perception is that, sanitary napkins are not available or affordable by rural women and girls. It will therefore come as a surprise to many that, even in the rural areas, the prevalence of disposable products for managing menstruation is much higher than the 12% number often quoted. The study was conducted by A.C. Neilsen and endorsed by Plan India in October 2010, which stated that only 12% Indian women use Sanitary Napkins and the rest are using unsanitary methods of managing menstruation. However, this study titled “Sanitary Protection: Every Woman’s Health Right” is not available on any public domain.

This was a 2010 study. Years later, most CSR programs, NGO interventions and even Government schemes are still based on this “12%”. What’s more, it is assumed that the rest 88%, that do not use sanitary napkins, must be using unsanitary means. According to National Family Health Survey, NFHS 2015-16, the numbers both in rural and urban India are far higher than this. The NFHS 2015-16 survey pegs the number for women using hygienic means of managing menstruation in India at 78% in urban areas, 48% in rural areas and 58% overall. Today, nearly 6 out of 10 women in India have access to disposable sanitary napkins. According to this survey, locally prepared napkins, sanitary napkins and tampons are considered as hygienic methods of protection. One can assume from the language used that single use disposables are considered hygienic. There are wide variations in usage of ‘hygienic products’ across different states, with Tamil Nadu, Kerala and Delhi as high as 90% and rural Bihar as low as 30 %.


Government has been running free sanitary pad programmes in rural areas where a girl student receives a pack of pads on a regular basis. Scheme for promotion of menstrual hygiene has rolled out in 17 states in 1092 blocks through Central supply of ‘Freedays’ sanitary napkins. Till August 2014, over 1.4 crore adolescent girls have been reached and 4.82 crore packs of ‘Freedays’. However, recently published article in a leading daily, The Hindu shows that such government programmes are often marred by lack of funds, as ensuring a continuous supply of disposable single use pads is not a onetime expense. Not only are such programmes financially unsustainable for governments, but are also inadequate as girls receive only about 5 or 6 pads per month. There also exists a large gap between the guidelines and the actual practices in these schemes in terms of execution and quality of pads distributed. A detailed report on one such scheme in Kerala touches upon these issues. The quality of pads handed out in most programs is sub-standard, says Kavya Menon, a Bio-Technology graduate from IIT Madras who has first-hand experience of reaching out to nearly 700 girls in 15 villages while working in Vedaranyam, a rural municipality in Nagapattinam district. To manage a normal period, 12-20 pads are required on average. Anything less than that means changing less often and leading to reduced hygiene. 5 pads are not sufficient anyway!

Government. NGO and CSR programs that distribute sanitary napkins are based on the assumption that adolescent girls drop out of school because of lack of sanitary products. Interestingly, there is no substantive research or data to back this assumption – that providing sanitary napkins free or subsidized to school going girls increased their attendance or performance. In the absence of supporting data, what is so simplistically reduced to access or lack of products, is actually a more complex situation. Shradha Shreejaya, a menstrual hygiene advocate and educator at Sustainable Menstruation Kerala collective, who has worked in Assam, Odisha, Tamil Nadu and Kerala at various times, opines that the girls miss school during periods due to two main reasons – Period cramps and lack of private changing space and clean toilets. Ground situation is not very different in Rajasthan.


Our underwear is made of cloth and that is not unhygienic, so why should cloth for menstruation be considered unhygienic? Perhaps, we as a culture, directly associate cloth with lack of hygiene because of the way we view menstruation! That said, due to such a culture and unreasonable taboos, most women end up being denied access to clean cloth (and sunlight!) and dry their menstrual cloth in damp nooks and corner areas or under other clothes, as a result it makes them highly susceptible to infections. The journal on a study in Orissa conducted in 2015 [4] establishes a direct correlation between urogenital infection and bacterial vaginosis with users of reusable pads compared to users of disposable pads. However, it also clarifies that hygiene management practices, access to clean water and private changing areas for women were not explored in this study. Possibly more such studies need to be conducted to explore this aspect to ensure that women follow hygienic practices in storing and washing their reusables.

Space in corner of a house for bathing and washing menstrual cloth in a home in rural Rajasthan. Lakshmi Murthy, Vikalpdesign, Uger Cloth pads, Udaipur, Rajasthan.

[2]As to the correlation between reproductive tract disorders and use of cloth, Sinu Joseph, who undertook an intervention called Menstrual Health of Karnataka, covering 1058 adolescent girls and women across 4 districts in Karnataka in association with NRHM last year, debunks that theory. She quotes in her study, supported by compelling data mythrispeaks that prevalence of menstrual disorders is higher in developed countries than in developing countries. Also, according to the study, absenteeism in schools during menstrual days is not a result of lack of menstrual products and toilets. Quoting from the study – “A comparison of data owing to school absenteeism during menstruation in developing nations shows that the percentage of girls who remain absent during menstruation is around 12.1% in China, 15.6% to 24.2% in Nigeria, 24% in India and 31% in Brazil. If the current hypothesis – that school absenteeism is due to lack of toilets or Sanitary Napkins – is true, then surely developed countries must have little or no absenteeism. However, data indicates that it is no different in developed countries. Studies indicate that 17% teenagers in Canada, 21% in Washington D.C, 24% in Singapore, 26% in Australia and 38% in Texas miss school owing to menstruation.” Perhaps those skipping school during period days prefer the comfort of home or may have severe cramping or excessive bleeding. But the study suggests that lack of products or toilets cannot be the cause, at least in developed countries. Quoting from another PLOS study – “Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism.” The practice of rituals and taboos associated with menstruation could also be the reasons why girls missed school during period days as claimed in the report put together by Auroville Village Action Group (AVAG). Lack of water in villages? With anecdotal evidence gathered from many cloth pad users, most say that one needs 5-8 cloth pads per period to allow for drying and flow. Amount of water required to wash a cloth pad, hold your breath, is not significantly different from that required to wash underwear or clothing of similar size. Roughly, 3-4 mugs of water are needed to soak, soap-wash and rinse a cloth pad. Laura O’Connell from Ecofemme, a cloth pad marketing group based out of Auroville, opines: “We believe that most regions in rural India do have the resources to continue their traditional practice of using washable cloth for menstruation.” Most NGOs and educators working in rural India agree that menstrual cups are excellent solution for married women in rural areas with water shortage. But the idea of promoting menstrual cup in India has mixed takers mainly due to the cultural aspect and vague notions of virginity. Use of an internal device such as menstrual cup also requires more hand-holding for the user in terms of usage, maintenance and troubleshooting, without which the transition may not be successful. Interestingly, in the past, women did insert cloth like tampons to absorb menstrual flow, but we have not looked for documented research on this topic yet. In rural scenarios, the choice to promote menstrual cup varies depending on the educator and most take into account the cultural sensitivities around this topic. There have been instances of rural women embracing the menstrual cup. A behavioural experiment on 960 rural women from 60 villages in rural Bihar quotes reasonable success (30%) with introducing menstrual cup.


[3]A cross-sectional study was carried out on 536 female students recruited from the educational institutions in the urban areas of a major city in South India. The selected women were explained about the protocol and the purpose of the study and were requested to complete the questionnaires to elicit information relating to demographic features, menarche age, and menstrual characteristics.

The demographic information included family details relating to family size, type, parent’s education, occupation, house type, and possession of costly goods such as vehicles, computer, TV, DVD, refrigerator, and phones, and this information was used to derive their socioeconomic status (SES). The chronological age and age at menarche were also elicited.

The research protocol was approved by the Ethical Committee, University of Mysore.


The data were analysed using SPSS for Windows version 16 (SPSS Inc., Chicago, IL). Descriptive statistics were used to determine mean and percentages wherever applicable. The categorical data were analysed using Chi-square or Fisher’s exact test.

Subjective information is presented in Table 1; the participants’ age ranged from 10 to 19 years, with a mean of 15.6 ± 1.6 years.

Table 1

[4]Majority of the participants (80.2%) belonged to the families practicing Hinduism, and 86.5% of girls were from nuclear family. The girls belonged to low (43%), middle (48.2%), and high (8.8%) SES. Family size of the participants varied between <4 and >8 members; large families were less prevalent.

The menstrual pattern of the selected female students is presented in Table 2. It can be seen that mean age of menarche was 13 ± 1.1 years, exhibiting wide variations, i.e., 10–17 years among the participants. Cycle duration of 21–35 days was reported by 73.1% (n = 358); more than half of them reported 5–6 days’ duration of menstrual blood flow. Hence, 12% of the participants had >7 days of flow. Although this condition is found in a such a small part of the population, it is of concern as it is associated to higher blood loss, increasing the risk of anemia. Scarce-to-moderate blood loss during menstruation was reported by 69.9% (n = 369) of the population. abundant blood loss was experienced by 30.1% of the population. The overall prevalence of dysmenorrhea was 66.8%, and among them, 21.9% experienced severe pain. Regular cycles were reported by 77.9% of the participants; therefore, it is evident that irregularity of menstruation is frequent among adolescents.


[5]Menstruation is a normal physiological process to the females but sometimes it is considered as unclean phenomenon in the society. To compare the perceptions of different aspects of menstrual hygiene between adolescent girls of rural and urban area.

Materials and methods: 

A community-based cross-sectional study was conducted from April 2013 to September 2013 in urban and rural area of South 24, Parganas, West Bengal among 541 adolescent school girls in the age group of 13-18 years. Data were collected by the predesigned and pretested questionnaires.


Only 37.52% girls were aware of menstruation prior to attainment of menarche. The difference in the awareness regarding menstruation in urban and rural area was highly significant. Only 36% girls in the urban and 54.88% girls in the rural area used homemade sanitary pads and reused the same in the subsequent period. Satisfactory Cleaning of external genitalia was practiced by only 47.63% of the urban and 37.96% of the rural girls. This study found differences in hygienic practices followed by adolescent girls in urban and rural area.


Hygienic practices during menstruation were unsatisfactory in the rural area as compared to the urban area. Girls should be educated about the proper hygienic practices as well as bring them out of traditional beliefs, misconceptions, and restrictions regarding menstruation.


[6]Menstruation is a Challenge for Gender Equality, for many of us, menstruation is a normal process that occurs every month. While we might suffer from minor annoyances such as pain and discomfort, it doesn’t usually have impact our personal and professional development. For many girls in the world, this is not the case. Menstruation prevents them from going to school or to work, and sometimes from performing daily activities like cooking, praying, exercising or even being in their own homes. Widespread restrictions and negative perceptions around menstruation contribute to strong gender disparities in health, education and work participation. In India, which is ranked 125 out of 151 countries in the HDI Gender Inequality Index, menstruation is still a barrier to achieving gender equality. This is true for urban slums but even more so for women in rural areas. The statistics are in fact quite alarming if we take into account that the average years of schooling among girls is only 4.1 years versus 6.1 among their male counterparts.


In rural India, menstruation is embedded in myths and taboos. Due to cultural and religious beliefs, menstruation is perceived as dirty, impure and even unholy. Because of this, menstruation is surrounded by a culture of silence and shame. Menstruating women are often expected to follow a set of restrictions during their periods, such as not going to the temple or offering prayers, not entering the kitchen and not touching certain foods.

Menstruation is not openly talked about in families or at school. It is actually estimated that over half of girls don’t know about menstruation when they first get their periods. Their mothers are too ashamed to talk about it and frequently lack knowledge of the biological explanation of menstruation and of the adequate ways of managing periods. Schools tend not to fill this gap either. The issue is rarely discussed in classrooms and teachers themselves often find the topic embarrassing, perpetuating an environment of shame and secrecy around menstruation.

Furthermore, most rural women lack awareness or are too poor to buy sanitary napkins or tampons. In fact, it is estimated that only 12% of women in India use sanitary pads. The most common alternative is cloth, and while cloth is not unhygienic per se, without proper care its use increases the risk of infection and other diseases. Misinformation and stigma often lead women to use unsanitary methods to manage their menstruation like dirty rags, leaves, sand or ash. Moreover, taboos prevent them from washing their cloth publicly and more importantly from drying it in the sun, so they frequently use damp cloth which is unhygienic and hazardous to health. It has been reported that reproductive tract Infections are 70% more common in women who don’t use sanitary napkins. Other diseases like urinary tract infections, fungal infections and cervical cancer have a higher incidence among these women as well.


Besides having important consequences on health, the inappropriate management of menstruation has a negative impact on the education of girls. It is estimated that around 20% of girls drop out of school after reaching puberty, and many more are absent for the entire duration of their period. While this might sound insignificant, missing around five days of school per month can affect their academic performance and can lead them to drop out because they are lagging behind at school. The main reasons for missing school during menstruation are a lack of adequate private toilets at school, and a lack of access to proper sanitary materials that are discreet and absorbent enough. The fact that menstruation is seen as shameful further encourages period-related absenteeism. Female teachers are also affected by these issues and will often skip work during their periods. Absenteeism and school dropout have an extremely significant impact in a woman’s quality of life, making her more likely to get married early and have children while still in her teens, and affecting her economic independence and agency. Therefore, a gender gap in education and income will continue to exist unless serious efforts to fight these issues are undertaken.


Public policies and programs to ensure that all learning and working environments are gender-inclusive are urgently needed.  Building private and clean toilets in rural schools, ensuring the availability and accessibility of sanitary napkins and imposing mandatory menstrual health classes for both boys and girls are important measures that can potentially keep many girls from being absent or dropping out of school.

Furthermore, all women should be granted access to quality sanitary pads, tampons or other hygienic methods of protection. According to the WSSC, sanitary pads have the potential to improve girl’s attendance to school, since they prevent issues like staining and odor. They also significantly decrease the chances of infection and gynaecological disease. Self-help groups, NGOs and other actors are starting to produce low-cost pads for rural women, but many women in remote areas are yet to be reached. When combined with WASH (Water, Sanitation and Hygiene) and MHM (Menstrual Health Management) awareness campaigns, these initiatives can have a long-lasting impact on the health of women.


Even though sanitary napkins are recognized by most urban women as essential, they are still considered an unnecessary luxury for many. In fact, the government of India recently decided to impose a 12% luxury tax on sanitary napkins. In a country in which most women cannot afford such a basic product, the controversial measure was received with a lot of opposition. A campaign named #Taxfreewings was launched alongside a petition to remove the tax on sanitary napkins. You can read and sign this petition here.

Fortunately, menstruation is being talked about more openly in the public domain, and menstrual hygiene is slowly emerging as a human rights issue, but a lot of progress still has to be achieved. Ultimately, the goal is that every girl in every corner of the world has access to proper sanitation during their periods, and is aware that menstruation is a normal bodily function and that nobody has the right to shame her for that.

Govt says GST on sanitary pads actually lower than pre-GST era, The government said, “Sanitary napkins are classifiable under heading 9619. In pre-GST, they attracted concessional excise duty of 6% and 5% VAT and, the pre-GST estimated total tax incidence on sanitary napkins was 13.68%.  Therefore, 12% GST rate had been provided for sanitary napkin.”

After coming under fire from various quarters for taxing women’s essential products — sanitary pads — at 12% GST, the government on Monday clarified its position.

GST is Goods and Services Tax that came into force from July 1, 2017 trying to tie India into one nation, one tax thread.

The government said, “Sanitary napkins are classifiable under heading 9619. In pre-GST, they attracted concessional excise duty of 6% and 5% VAT and, the pre-GST estimated total tax incidence on sanitary napkins was 13.68%.  Therefore, 12% GST rate had been provided for sanitary napkin.”

It further said, “As raw materials for manufacture of sanitary napkins attract GST of 18% of 12%, even with 12% GST on sanitary napkins, there in an inversion in the GST structure. Though, within the existing GST law such accumulated ITC will be refunded, it will have associated financial costs [interest burden] and administrative cost, putting them at a dis-advantage vis-à-vis imports, which will also attract 12% IGST on their imports, with no additional financial costs on account of fund blockage and associated administrative cost of refunds.”

If the GST rate on sanitary napkins were to be reduced from 12% to 5%, it will further accentuate the tax inversion and result in even higher accumulated ITC, with correspondingly higher finical costs on account of fund blockage and associated administrative cost of refunds, putting domestic manufacturers at even greater dis-advantage vis-à-vis imports, the government explained.


[1] https://thelogicalindian.com/health/menstruation-in-rural-india/?infinitescroll=1



[3] US National Library of Medicine
National Institutes of Health

[4] US National Library of Medicine
National Institutes of Health

[5] pubmed.ncbi.nlm.nih.gov

[6] villagevolunteers.org 

Aishwarya Says:

I have always been against Glorifying Over Work and therefore, in the year 2021, I have decided to launch this campaign “Balancing Life”and talk about this wrong practice, that we have been following since last few years. I will be talking to and interviewing around 1 lakh people in the coming 2021 and publish their interview regarding their opinion on glamourising Over Work.

If you are interested in participating in the same, do let me know.

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The copyright of this Article belongs exclusively to Ms. Aishwarya Sandeep. Reproduction of the same, without permission will amount to Copyright Infringement. Appropriate Legal Action under the Indian Laws will be taken.

If you would also like to contribute to my website, then do share your articles or poems at adv.aishwaryasandeep@gmail.com

We also have a Facebook Group Restarter Moms for Mothers or Women who would like to rejoin their careers post a career break or women who are enterpreneurs.

We are also running a series Inspirational Women from January 2021 to March 31,2021, featuring around 1000 stories about Indian Women, who changed the world. #choosetochallenge

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