Addressing the critical issue of menstrual hygiene in India

UNICEF reports that in countries worldwide where menstrual hygiene is taboo, girls in puberty are typically absent for 20% of the school year. Most girls drop out at around 11 to 12-years-old and miss school not simply because they fear being teased by their classmates if they show stains from their period, but also because they are not educated about their periods and their need for safe and clean facilities is not prioritised. In India, 66 % of girls’ schools do not have functioning girls’ toilets resulting in a drop out rate of more than 40% of girls after finishing year 5. Around 23 % of girls drop out of school every year in India due to a lack of menstrual hygiene facilities including toilets or adequate disposal units for sanitary pads.

Girl outside toilet

In A Decade of the Total Sanitation Campaign (TSC): Rapid Assessment of Processes and Outcomes, undertaken by the Water and Sanitation Programme, in 2010, it states, ‘Disaggregating the impacts of sanitation by gender reveals that the privacy afforded by access to adequate sanitation facilities imparts a sense of dignity, especially to women and young girls. Access to safe sanitation in schools is also linked to continued education enrolment by young girls and teenage women, particularly at puberty (Bruijne et al 2007).’ Despite this statement, there has been a lack of attention paid to providing menstrual hygiene services in the TSC.  This failing not only impacts directly on girls and women but also on the achievement of Millenium Development Goals relating to social exclusion, access to water, sanitation and hygiene services, education and health.

This failing is partially reflective of the gendered balance of power. The TSC represents a departure from the way that conventional rural sanitation programmes have previously been implemented. According to programme guidelines, the TSC seeks to be community-led and demand-driven rather than target-led and supply-driven.  But who is leading the community and driving demand? Women are often excluded from decision-making processes and not represented in community decisions. By generating more awareness of menstrual hygiene, more children can be kept in schools creating a better future for the individual and community, and contributing to MDG 3 of promoting gender equality and the empowerment of women. Menstrual hygiene is a critical issue for agencies to address because lack of facilities to ensure it effect the disempowered and improving facilities is in itself a means of empowerment.

A 2011 programme by UNICEF shows how an improvement in facilities can directly lead to a drop in absenteeism. One school in Krishnagiri noted that over two thirds of girls studying in standard 8 and 9 skipped school during their periods with one third of these girls eventually dropping out.  Following UNICEF’s Menstrual Hygiene and Management programme and the installation of disposal units in schools, the dropout and absenteeism rate in the school has come down to almost zero and academic performance has reportedly improved. (

HEEALS (Health, Education, Environment And Livelihood Society), based in Gurgaon, is currently working on an awareness campaign for better sanitation and hygiene practices and the provision of girls’ toilets in five states: Delhi (National Capital Region), Uttar Pradesh, Rajasthan, Leh Ladakh, Himachal Pradesh and Haryana. HEEALS typically works in slum schools or schools in unauthorised areas where no other NGOs are working. It also works with orphanages and refugee camps. Find out more about its Water Sanitation Hygiene and Girl Education Project at  and support our work.




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