The Pressing Need for Improved Menstrual Hygiene Management
Menstrual hygiene management (MHM) is a critical public health issue that affects the health, education, and dignity of women and girls worldwide. Inadequate access to affordable and hygienic menstrual products, as well as limited access to water, sanitation and hygiene (WASH) facilities, can lead to the development of reproductive tract infections (RTIs) with serious long-term consequences.
Studies from India have revealed a strong association between poor MHM practices, such as the use of reusable cloth pads and infrequent washing, and higher rates of common RTIs like bacterial vaginosis (BV) and vulvovaginal candidiasis (1, 2). These infections not only cause discomfort and embarrassment, but also increase the risk of acquiring sexually transmitted infections, pelvic inflammatory disease, and adverse pregnancy outcomes (3, 4).
Disturbingly, a recent hospital-based study in Odisha found that over 60% of women seeking gynecological care were diagnosed with at least one RTI (5). The prevalence of BV, the most common RTI, was a staggering 41% (5). These findings highlight the urgent need to address the underlying drivers of poor menstrual health and hygiene in order to improve women’s reproductive wellbeing.
Barriers to Safe Menstrual Practices
Menstrual hygiene practices are heavily influenced by sociocultural norms, economic status, and access to WASH facilities. In many low-resource settings, women and girls lack the means to afford or consistently access commercially produced sanitary pads. As a result, the use of reusable cloth materials, which are often washed and dried in unhygienic conditions, remains widespread (6).
Lack of privacy and proper WASH facilities: Even when affordable menstrual products are available, the absence of private spaces and inadequate WASH infrastructure at home, school, and work can prevent women and girls from being able to change, clean, and dispose of materials safely and with dignity. This can lead to the use of unsanitary practices, such as changing pads in open spaces or reusing soiled materials for extended periods.
Socio-cultural taboos and restrictions: Menstruation is often shrouded in shame and secrecy in many cultures, with women facing social ostracization, movement restrictions, and exclusion from religious/cultural practices during their periods. These taboos can discourage open discussion about menstrual health and hygiene, limiting access to information and appropriate products (7, 8).
Economic barriers: The high cost of commercially produced sanitary pads places them out of reach for many women and girls, especially those from low-income households. This financial burden can force reliance on less hygienic, reusable alternatives or lead to the use of pads for extended periods, increasing the risk of infection (9).
Prioritizing Menstrual Health in Policy and Practice
Addressing the multifaceted challenges of poor menstrual hygiene requires a holistic, multi-stakeholder approach that tackles the issue from various angles. Key areas of intervention include:
1. Improving access to affordable, high-quality menstrual products
Governments and civil society organizations should work to increase the availability and affordability of safe, eco-friendly menstrual products, such as reusable pads and menstrual cups. This can be achieved through subsidies, social marketing campaigns, and the involvement of local entrepreneurs in product development and distribution.
2. Ensuring access to WASH facilities that enable safe menstrual practices
Investments in water, sanitation, and hygiene infrastructure at the community, school, and workplace levels are crucial. Providing private spaces, running water, and proper disposal systems empowers women and girls to manage their menstruation with safety, dignity, and comfort.
3. Challenging menstrual stigma and taboos through education and advocacy
Comprehensive menstrual health education programs, targeting both women and men, can help normalize discussions around menstruation and challenge harmful socio-cultural norms. Community-based awareness campaigns and the involvement of religious and traditional leaders can further destigmatize the issue.
4. Conducting research to inform evidence-based interventions
Continued research on the linkages between MHM and reproductive health, as well as the evaluation of various MHM interventions, is crucial for developing effective, context-specific solutions. Collaborations between policymakers, practitioners, and academic institutions can drive this agenda forward.
A Call to Action for Improved Menstrual Health
Menstrual hygiene is not just a women’s issue – it is a critical public health and human rights concern that affects the well-being of an entire generation. By prioritizing menstrual health in policy, programming, and research, we can empower women and girls to manage their periods safely and with dignity, ultimately improving their reproductive, educational, and economic outcomes.
Governments, civil society organizations, and international development agencies must work together to break the silence around menstruation and ensure that all women and girls have access to the resources and support they need to thrive. Only then can we truly achieve sustainable development and gender equity.
References
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Torondel, B., Sinha, S., Mohanty, J. R., Swain, T., Sahoo, P., Panda, B., … & Panigrahi, P. (2018). Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India. BMC infectious diseases, 18(1), 1-13.
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Das, P., Baker, K. K., Dutta, A., Swain, T., Sahoo, S., Das, B. S., … & Cairncross, S. (2015). Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India. PloS one, 10(6), e0130777.
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Hillier, S. L., Nugent, R. P., Eschenbach, D. A., Krohn, M. A., Gibbs, R. S., Martin, D. H., … & Klebanoff, M. A. (1995). Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. New England Journal of Medicine, 333(26), 1737-1742.
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Ness, R. B., Kip, K. E., Hillier, S. L., Soper, D. E., Stamm, C. A., Sweet, R. L., … & Richter, H. E. (2005). A cluster analysis of bacterial vaginosis–associated microflora and pelvic inflammatory disease. American journal of epidemiology, 162(6), 585-590.
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Torondel, B., Sinha, S., Mohanty, J. R., Swain, T., Sahoo, P., Panda, B., … & Panigrahi, P. (2018). Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India. BMC infectious diseases, 18(1), 1-13.
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Sumpter, C., & Torondel, B. (2013). A systematic review of the health and social effects of menstrual hygiene management. PloS one, 8(4), e62004.
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Garg, R., Goyal, S., & Gupta, S. (2012). India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls—issues and challenges. Maternal and child health journal, 16(4), 767-774.
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Sommer, M., Hirsch, J. S., Nathanson, C., & Parker, R. G. (2015). Comfortably, safely, and without shame: defining menstrual hygiene management as a public health issue. American journal of public health, 105(7), 1302-1311.
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Montgomery, P., Ryus, C. R., Dolan, C. S., Dopson, S., & Scott, L. M. (2012). Sanitary pad interventions for girls’ education in Ghana: a pilot study. PloS one, 7(10), e48274.
