Author: Smile Editorial Team

Summary

• Hygiene Day, observed on 28 May, draws global attention to menstrual health management — a subject that remains underfunded, under-discussed and deeply consequential for women’s health, education and economic participation in India and worldwide
• Despite urban expansion and growing digital connectivity, menstrual hygiene access in India remains deeply unequal — a 2022 NFHS-5 survey found that 77.3 % of women aged 15–24 use hygienic methods of menstrual protection, with significant rural-urban and income-based disparities
• An estimated 23 million girls drop out of school in India annually, with inadequate sanitation and menstrual hygiene facilities among the contributing factors making menstrual health an education issue as much as a health one
• Cultural taboos and social stigma remain among the most persistent barriers to menstrual hygiene management, preventing open conversation, limiting access to care and producing health consequences that accumulate across a lifetime
• India’s National Menstrual Hygiene Policy and related government schemes represent genuine progress but implementation gaps, particularly in rural districts and informal urban settlements, limit their real-world reach
• Grassroots programmes like Smile Foundation’s Swabhiman initiative demonstrate that sustained, community-rooted engagement combining awareness, peer education and hands-on health support produces the kind of behavioural change that policy alone cannot
• Menstrual hygiene in emergency and disaster contexts remains critically under-resourced as seen during Cyclone Fani in Odisha, where women lost access to basic hygiene materials alongside all other relief needs
• Addressing menstrual hygiene comprehensively requires integrating it into education, healthcare, sanitation, disaster response and workplace policy — not treating it as a standalone health communication issue

The Problem That Persists

Every 28 May, Hygiene Day returns to the global calendar, and with it, a set of questions that should, by now, have simpler answers. Why do hundreds of millions of women and girls worldwide still lack access to safe, dignified menstrual hygiene management? Why does a biological reality experienced by half the world’s population remain, in so many communities, a source of shame, silence and health risk? Why, despite years of awareness campaigns, policy commitments and development investment, does the gap between intent and reality remain so wide?

In India, these questions are not rhetorical. They describe the daily experience of a large and largely invisible population — women in urban slums who manage their periods with cloth and improvised materials, girls in government schools who stay home because the toilet block has no door, women in disaster-affected communities who lose access to basic hygiene products alongside everything else they own.

Hygiene Day matters because it creates a moment of public attention around a subject that is routinely marginalised — not because the stakes are low, but because the stigma is high. Menstrual health is directly connected to women’s physical health, education, economic participation and dignity. It is, in the most literal sense, a development issue. And in India in 2026, it remains one that demands sustained, serious and well-resourced attention.

The Current Landscape: What the Data Tells Us

India has made measurable progress on menstrual hygiene awareness over the past decade. The National Family Health Survey (NFHS-5) conducted in 2019–21 found that 77.3 % of women aged 15–24 use hygienic methods of menstrual protection, compared to significantly lower figures in earlier surveys. The removal of GST on sanitary napkins in 2018, state-level free sanitary pad schemes and the expansion of health education in schools have all contributed to improvement.

But the headline figure obscures deep and consequential disparities. In rural areas, access to and use of hygienic menstrual products is considerably lower than in urban centres. Among women in the lowest wealth quintile, the gap is even wider. A 2016 study published in the BMJ estimated that only 12-15% of women in India used commercial sanitary protection, with an estimated 85%–88% relying on home-made alternatives ranging from cloth to improvised pads stuffed with ash, husk or sand. While more recent data shows improvement, the underlying pattern in which income and geography determine access has not been resolved.

The school attendance dimension makes the scale of the problem concrete. An estimated 23 million girls drop out of school in India annually, with menstrual hygiene among the contributing factors. Research on South Asian schools has found that more than one in three girls miss school around the onset of menstruation — driven by the absence of private, clean toilet facilities, lack of access to sanitary products and the social discomfort of managing menstruation in a public environment that has not been designed to accommodate it. Once a girl begins missing school regularly, the academic gap widens quickly and the path to dropout shortens.

Globally, the World Bank Group estimates that 500 million women and girls lack adequate access to menstrual hygiene facilities. UNICEF data suggests that in low- and middle-income countries, less than half of schools have adequate single-sex sanitation. These figures place India’s challenges in a broader context but they do not diminish the urgency of addressing them domestically.

The Layered Challenge: More Than a Product Problem

One of the most persistent misframings of menstrual hygiene as a development issue is the reduction of it to a product access problem. If we could just get sanitary pads to every woman and girl, the thinking goes, the problem would be solved. The reality is considerably more complex.

Cultural stigma and behavioural barriers are among the most significant obstacles. In communities across India cutting across regional, religious and socioeconomic lines, menstruation is surrounded by restrictions and taboos that communicate to girls and women that their bodies are sources of impurity during their periods. These norms are not merely symbolic. They prevent open conversation, limit knowledge transmission, discourage health-seeking behaviour and produce a sense of shame that can persist throughout a woman’s reproductive life.

A girl who has absorbed the message that menstruation is something to be hidden and managed in silence will not ask for help when she experiences symptoms that require medical attention. She will not speak up in a classroom about needing to manage her period. She will not, in many cases, seek out or use the health services that exist for her because accessing them requires acknowledging, in public, something that she has been taught is private to the point of secrecy.

Infrastructure gaps compound these behavioural barriers. Clean, private, functional toilet facilities remain inadequate in many government schools, particularly in rural areas. Workplaces in the informal sector where the majority of India’s working women are employed typically have no provision for menstrual hygiene management. Public spaces rarely offer facilities adequate for women managing their periods with dignity.

Economic barriers persist alongside the removal of GST. Sanitary napkins, while cheaper than they once were, remain financially out of reach for many women in low-income communities. And the broader economic logic matters: a woman who spends money on sanitary products is making a trade-off with other essential expenditures — food, transport, children’s schooling — in a household context where every rupee counts.

What Is Missing: The Overlooked Dimensions

For all the progress made on menstrual hygiene awareness in India, several dimensions remain consistently under-addressed.

The urban slum dimension receives insufficient attention in policy and programme design. Awareness campaigns and government schemes tend to be calibrated for either rural or formal urban settings — missing the significant population of women who live in informal urban settlements and who face a combination of rural-origin stigma and urban-infrastructure inadequacy. The 2007 door-to-door survey conducted by Smile Foundation’s Swabhiman change agents in Delhi’s Shashi Garden — an urban slum — found that most women in the area were using cloth instead of sanitary products, turning to traditional remedies instead of medical care and suffering from preventable infections. Seventeen years later, the conditions that produced those findings have not been systematically addressed.

The disaster and emergency context is one of the most significant gaps in India’s menstrual hygiene response. When Cyclone Fani struck Odisha in May 2019, Smile Foundation’s disaster response teams found women using contaminated water and whatever cloth they could find, having lost access to all hygiene materials along with everything else. This is not an isolated scenario. Every major flood, cyclone or displacement event in India creates a population of women whose menstrual hygiene needs are acute and largely invisible to standard relief frameworks.

The recognition that hygiene kits including soap and sanitary products must be standard components of disaster relief is growing, but implementation remains inconsistent. The Sphere Humanitarian Standards include menstrual hygiene materials as essential items for women of reproductive age, but field-level compliance varies significantly.

The mental health dimension is almost entirely absent from India’s menstrual hygiene discourse. The psychological burden of managing a normal biological process with shame, secrecy and inadequate resources over years and decades produces anxiety, reduced self-esteem and a fractured relationship with one’s own body that has real and lasting consequences. This dimension requires attention from mental health professionals, educators and programme designers who currently treat menstrual hygiene as a purely physical health concern.

The environmental dimension is gaining awareness but not yet adequate policy response. India generates an estimated 113,000 tonnes of menstrual waste annually, most of it from synthetic disposable products that take hundreds of years to decompose. Scaling up sanitary product access without simultaneously developing sustainable disposal and waste management infrastructure creates an environmental problem that will compound over time.

What Works: Evidence from the Ground

The evidence on what produces genuine, lasting change in menstrual hygiene management points consistently in one direction: community-rooted, relationship-based engagement, sustained over time.

Information campaigns that arrive once and leave do not produce behaviour change. Product distribution without accompanying education does not produce sustained use. School infrastructure improvements without teacher training and curriculum support do not reduce absenteeism.

What works is the combination — trusted messengers, sustained presence, open conversation, practical knowledge and the kind of social permission that comes when peers talk openly about their own experiences.

Smile Foundation’s Swabhiman programme, operational since 2005, is one of the longer-running examples of this model in India. Working with women from low-income and underserved communities across urban and peri-urban settings, the programme trains community members including women from the communities themselves as change agents. These change agents conduct door-to-door outreach, facilitate group sessions and build the kind of trust that enables conversations about menstruation, family planning, nutrition and reproductive health in communities where these subjects were previously unaddressable.

The results visible in Swabhiman communities reflect what the broader research literature suggests: when girls and women have access to accurate information, delivered by trusted people, in a context that normalises rather than stigmatises menstruation, their behaviour changes. They use safer products. They seek medical care when they need it. They talk to younger girls. The peer multiplication effect where one informed woman becomes the entry point for many others is one of the most powerful mechanisms available in menstrual hygiene programming, and it is one that community-based models are specifically designed to activate.

Policy Architecture: Where Progress Has Been Made and Where It Has Not

India’s policy framework for menstrual hygiene has developed significantly over the past decade. The National Menstrual Hygiene Policy, developed with multi-ministerial input and civil society engagement, provides a framework for improving access to facilities, products and education across schools, workplaces and public spaces. Several state governments have implemented free sanitary napkin schemes for girls in government schools. The Swachh Bharat Mission has invested in school toilet construction and maintenance. The National Health Mission incorporates menstrual health in its community health worker training.

These are genuine advances. But the distance between policy design and programme delivery remains a persistent challenge in India’s social sector, and menstrual hygiene is no exception.

The most significant implementation gap is at the last mile: the rural government school where the toilet exists but has no lock, the ASHA worker who has received training but not the materials needed to distribute, the urban slum community that falls between the coverage areas of rural and urban schemes. Closing these gaps requires not just better design but better accountability — monitoring systems that track not just whether facilities have been built, but whether they are functional, clean and used.

The workplace dimension also requires more deliberate policy attention. The debate around menstrual leave policies has attracted significant media coverage, but the more fundamental question — whether working women across sectors have access to adequate sanitation and hygiene facilities during their working hours — has received less attention and less policy response.

The Way Forward: What Hygiene Day Should Prompt

Hygiene Day is most useful not as a day of awareness — awareness, by itself, has limited lasting impact — but as a moment to assess progress honestly and recommit to the harder work of structural change.

For governments, this means ensuring that policy commitments on menstrual hygiene are matched by implementation infrastructure, maintenance budgets and monitoring systems that hold delivery accountable. It means integrating menstrual hygiene into disaster response frameworks consistently, not selectively. And it means investing in community health worker capacity — the ASHA workers, Anganwadi workers and peer educators who are the primary interface between health policy and the women it is designed to serve.

For civil society and NGOs, it means maintaining the sustained, community-level engagement that national programmes cannot replicate and documenting the evidence from that engagement in ways that can inform policy design.

For the private sector, it means recognising that menstrual hygiene is a workplace issue, not just a CSR opportunity, and investing in facilities, policies, and workplace cultures that genuinely support women employees.

And for all of us, Hygiene Day is a reminder that the silence around menstruation is not neutral. It has costs to health, education, economic participation and the simple experience of moving through the world with dignity. Breaking that silence, in families and schools and workplaces and policy forums, is not a communication exercise. It is a precondition for the structural changes that menstrual health in India genuinely requires.

Beyond the Day

When Hygiene Day passes on 28 May, the conversation it generates tends to fade quickly. Social media posts are archived, events are concluded and the subject returns to its usual position at the margins of public discourse.

The challenge is to resist that fading to maintain the urgency and the attention that Hygiene Day momentarily produces and to channel it into the sustained, unglamorous, community-level work that actually changes outcomes for women and girls.

India has the frameworks, the institutions and the civil society capacity to make menstrual hygiene management a reality for every woman and girl in the country. What it requires is consistent political will, adequate resourcing and the kind of accountability that ensures delivery reaches the last mile — not just the policy document and not just the press release, but the woman in the urban slum, the girl in the rural school, the relief worker’s hygiene kit.

Frequently Asked Questions (FAQs)

What is Hygiene Day and when is it observed?

Hygiene Day, formally known as Menstrual Hygiene Day, is observed globally on 28 May each year. Initiated in 2014 by the German NGO WASH United, the day brings together governments, NGOs, healthcare professionals and communities to raise awareness about the importance of menstrual hygiene management and to advocate for improved access to products, facilities and education for women and girls worldwide. The date is deliberate: May is the fifth month of the year and 28 represents the average length of the menstrual cycle.

Why is menstrual hygiene still a significant challenge in India?

Despite policy progress and growing awareness, significant gaps in menstrual hygiene access and practice persist in India due to a combination of economic barriers, inadequate infrastructure, cultural stigma and inconsistent policy implementation. The NFHS-5 survey found that only 64% of women aged 15–24 in India use hygienic methods of menstrual protection with significant disparities between rural and urban areas and between income groups. Cultural taboos that prevent open discussion further limit knowledge, health-seeking behaviour and the social normalisation of menstruation.

How does menstrual hygiene affect girls’ education in India?

The connection between menstrual hygiene and girls’ school attendance is direct and well-documented. When schools lack clean, private toilet facilities and girls have no access to sanitary products, menstruation becomes a reason to stay home. Research suggests that more than one in three girls in South Asia miss school during menstruation, and an estimated 23 million girls in India drop out of school annually with inadequate menstrual hygiene facilities among the contributing factors. Repeated absences widen academic gaps, reduce confidence and increase the likelihood of dropout.

What is India’s National Menstrual Hygiene Policy?

India’s National Menstrual Hygiene Policy provides a framework for promoting menstrual hygiene management across education, health and sanitation systems. It includes provisions for sanitary hygiene facilities in schools and public spaces, free sanitary product distribution through state-level schemes and menstrual health education as part of the health curriculum. While the policy represents genuine progress, implementation gaps — particularly in rural areas, informal urban settlements and schools where facilities exist but are not maintained — limit its real-world reach.

How does menstrual hygiene intersect with disaster relief and emergency response?

Menstrual hygiene needs do not pause during disasters but relief response has historically been slow to address them. During Cyclone Fani in Odisha in 2019, women lost access to all hygiene materials alongside everything else and were using contaminated water to manage their periods. Smile Foundation’s disaster response team, and others, have recognised hygiene kits including soap and sanitary products as essential components of emergency relief. The Sphere Humanitarian Standards include menstrual hygiene items as requirements for women of reproductive age in emergency settings, but field-level implementation remains inconsistent.

What role do community organisations play in improving menstrual hygiene outcomes?

Community organisations play an irreplaceable role in translating policy intent into behavioural change at the community level. Through sustained, relationship-based engagement — peer education, group sessions, door-to-door outreach — they create the social permission and practical knowledge needed for women and girls to manage menstruation safely and without shame. Smile Foundation’s Swabhiman programme has been working in this space since 2005, training community women as change agents who conduct health outreach on menstrual hygiene, family planning, nutrition and reproductive health in underserved urban and peri-urban communities.

What are the environmental concerns associated with menstrual waste in India?

India generates an estimated 113,000 tonnes of menstrual waste annually, primarily from synthetic disposable sanitary products that take hundreds of years to decompose. Improper disposal in open drains, water bodies and open land creates environmental and public health risks. As government schemes and NGO programmes scale up access to disposable products, the absence of adequate waste management infrastructure means that environmental consequences are growing. Reusable alternatives — menstrual cups, cloth pads and biodegradable products — offer more sustainable options but require broader awareness, cultural acceptance and access to washing facilities.

What can individuals and organisations do to support menstrual hygiene on Hygiene Day and beyond?

Individuals can contribute by normalising conversations about menstruation in families, schools and workplaces — reducing the stigma that remains one of the most significant barriers to menstrual health. Donating menstrual products to organisations working with underserved communities, supporting advocacy for stronger policy implementation, and amplifying the work of grassroots programmes provides practical support. Organisations can invest in workplace sanitation facilities, implement menstrual health-aware HR policies and partner with experienced NGOs to extend menstrual hygiene programming into communities that public systems do not consistently reach.