Menstrual hygiene management (MHM) is increasingly recognized as a critical issue at the intersection of public health, gender equality, education and human dignity. But for millions of women and girls, managing menstruation safely and with dignity remains a daily challenge. This reality—often described as period poverty—extends far beyond the inability to afford menstrual products. It reflects deeper structural inequalities linked to sanitation, education, stigma and access to reliable information.
According to UN Women, period poverty is not merely an issue of cost. It is a manifestation of exclusion—one that limits participation in school, work and public life. Girls miss classrooms. Women withdraw from economic activity. Silence and shame take the place of support and care.
This understanding has recently received powerful constitutional recognition. In a landmark observation, the Supreme Court of India affirmed that menstrual health is integral to the right to life and dignity under Article 21 of the Constitution. By framing menstrual hygiene as a matter of dignity, equality and access—the Court signalled a fundamental shift: menstruation is no longer a private inconvenience but a public responsibility.
But even as this recognition marks a critical step forward, it also exposes a persistent gap in how menstrual health is addressed on the ground—one that lies between access and adaptability.
Access is necessary but not sufficient for Menstrual Health in India
Over the past decade, conversations around menstruation have expanded, particularly in low- and middle-income countries. Governments, civil society organizations and private actors have focused on improving access to menstrual hygiene products—especially disposable sanitary napkins. While this has helped normalize menstruation in public discourse, access alone does not guarantee use, comfort or sustained adoption.
Access to menstrual hygiene products includes:
- Availability of safe and affordable products
- Privacy and clean water for washing
- Functional toilets and disposal mechanisms
The World Health Organization has repeatedly highlighted that inadequate menstrual hygiene facilities in schools and communities are linked to absenteeism, discomfort and health risks. The Supreme Court echoed this concern, directing states to ensure not only the provision of sanitary products but also functional, gender-sensitive sanitation facilities in schools.
However, even where products and facilities exist, usage often remains inconsistent. This is where adaptability becomes central.
What Adaptability Really Means
Adaptability refers to how well menstrual hygiene solutions fit into women’s and girls’ social, cultural, economic and infrastructural realities. A product may be hygienic, affordable over time and widely available, but if it clashes with cultural norms, requires facilities that do not exist or is introduced without adequate education, it is unlikely to be adopted.
Adaptability includes:
- Cultural acceptance and bodily autonomy
- Awareness and practical knowledge
- Infrastructure compatibility
- Supportive social environments
Understanding menstrual health through both access and adaptability explains why progress remains uneven despite innovation and policy attention.
Persistent Barriers to Access
Economic constraints
For many low-income households, particularly in rural areas and informal urban settlements, the recurring cost of disposable menstrual products competes with essential expenses such as food, healthcare and education. While tax reductions and free distribution schemes have helped, affordability remains a barrier, reinforcing gendered economic inequality.
Inadequate sanitation infrastructure
Without private toilets, running water or safe disposal systems, menstrual hygiene becomes difficult regardless of product availability. These infrastructural gaps disproportionately affect government schools, urban slums and remote rural areas—directly influencing girls’ attendance and comfort.
Stigma and silence
Deep-rooted taboos continue to frame menstruation as impure or shameful. This discourages open conversation, delays care-seeking and perpetuates unsafe practices. The Supreme Court explicitly acknowledged this silence, emphasizing that menstrual health education must include boys, teachers, families and communities to dismantle stigma.
Geographic inequality
Supply chains rarely reach the last mile consistently. Remote villages face irregular availability, while dense informal settlements struggle with overcrowding and poor sanitation—further compounding access challenges.
When Products Don’t Fit Lives: The Adaptability Challenge for Menstrual Health in India
Improving access does not automatically lead to sustained or effective use. Adaptability determines whether products align with lived realities.
Awareness and product suitability
Disposable pads remain the most commonly used products due to familiarity and ease. Reusable options—such as cloth pads or menstrual cups—offer long-term cost and environmental benefits but require greater awareness, privacy and water access.
A recent analysis highlighted that while awareness of menstrual cups is high, adoption remains strikingly low. Despite nearly 80% awareness in some surveys, fewer than 5% of women reported actual use—underscoring the gap between information and confidence.
Cultural acceptance and bodily autonomy
Norms around virginity, bodily purity and internal products significantly influence acceptance. Menstrual cups, which require vaginal insertion, are often viewed with suspicion, especially for adolescents and unmarried women. Without addressing these beliefs, choice remains constrained, even when products are available.
Infrastructure–product Mismatch
Reusable products require clean water and private spaces for washing and sterilisation. In settings where these are absent, such products become impractical. Adaptability, therefore, is not a feature of the product alone—it is shaped by the environment in which women live.
Menstrual Cups: Innovation with Limits
Menstrual cups illustrate the tension between innovation and lived reality. From a public health and sustainability perspective, they are compelling—long-lasting, cost-effective and environmentally friendly. But for many women, the initial cost, lack of hands-on guidance, health misconceptions and cultural discomfort remain significant barriers.
Without community-led education, demonstrations and supportive dialogue, menstrual cups risk becoming symbols of choice without agency—available in theory, inaccessible in practice.
Bridging Access and Adaptability: Smile Foundation’s Approach
At Smile Foundation, menstrual health initiatives are designed with this dual lens in mind. The focus extends beyond distribution to include awareness, education and community engagement recognizing that dignity cannot be delivered through products alone.
Through school-based programmes and community outreach, Smile Foundation:
- Distributes sanitary napkins to address immediate access gaps
- Conducts menstrual health education sessions in local languages
- Trains community workers and engages parents to build supportive environments
- Encourages open conversation to challenge stigma and misinformation
This integrated approach aligns closely with the Supreme Court’s emphasis on dignity, education and inclusion. By combining material access with knowledge and cultural engagement, Smile Foundation works to ensure that menstrual health interventions are not only available but usable, acceptable and empowering.
Evolution of Menstrual Health in India: From Provision to Rights-based Equity
The Supreme Court’s recognition of menstrual health as a constitutional concern creates an opportunity to rethink how menstrual hygiene is addressed in India.
What is needed now is convergence:
- Policy that treats menstrual health as a rights issue, not a welfare add-on
- Infrastructure investment in WASH facilities across schools, workplaces and public spaces
- Education integrated into curricula to normalize menstruation early
- Community-led approaches that respect local contexts and choices
Encouraging product diversity, rather than promoting a single solution, allows women and girls to decide what works best for their bodies and circumstances. Innovations must be accompanied by education, infrastructure and trust.
Menstrual dignity cannot be achieved through access alone. It requires adaptability, agency and social acceptance. When menstruation is recognized not as a private inconvenience but as a public issue—linked to dignity, equality and participation—real change becomes possible.
At Smile Foundation, we believe that combining access with education and community engagement is key to advancing menstrual health equity. The goal is not just to manage menstruation, but to ensure that no girl or woman is held back because of it.
