Taboo is over does not mean challenges have ceased to exist. Taboo relating to menstrual hygiene is largely over, indicates the NFHS-6 data. It means good progress has been made so far. Now, attention has to go beyond use of sanitary pads, or environmentally-conscious use of pads and other options. Some steps have been taken, and some thinking is still evolving.
Demographics of Progress: NFHS-6 and Menstrual Hygiene in India
The release of the NFHS-6 for 2023-24 conducted by the Ministry of Health and Family Welfare (MoHFW) with the International Institute for Population Sciences (IIPS) as the nodal agency, provides important insights into maternal and child health, reproductive health, and gender equality in India. One of the key indicators the survey highlights is the use of hygienic menstrual protection methods among young women aged 15-24 years.
According to the survey, 79.2% of women in this age-group in India use hygienic methods of menstrual protection. This marks a steady improvement from 77.6% in NFHS-5 (2019-21) and a significant increase from 57.6% in NFHS-4 (2015-16). The rise reflects the impact of public health awareness campaigns, improved access to menstrual hygiene products, and increasing levels of female education.
Under the NFHS framework, hygienic methods include disposable sanitary pads, reusable sanitary pads, tampons, and menstrual cups. In the past, large differences existed between rural and urban areas in access to, and use of, these products. However, NFHS-6 shows that this gap is gradually narrowing. While 90.7% of young women in urban areas reported using hygienic methods, the figure in rural areas increased to 75.0%, indicating notable progress towards more equitable menstrual health practices across the country.
The progress in menstrual hygiene is closely linked to improvements in women's digital and financial inclusion across India. According to NFHS-6, the share of women who have used the internet increased from 33.3% in 2019-21 to 64.3% in 2023-24. During the same period, personal mobile phone ownership among women rose from 53.9% to 63.6%, while the proportion of women who owned and actively used a bank or savings account increased from 78.6% to 89.0%.
These developments have played an important role in improving Menstrual Hygiene Management (MHM). Greater access to the internet and mobile phones helps girls and women access reliable health information, track menstrual cycles, and purchase menstrual products more easily. Financial inclusion also gives women greater control over spending on their personal health and hygiene needs.
Despite this progress, significant challenges remain. Only 27.7% of young women have access to all four essential components of menstrual hygiene: hygienic menstrual products, an unshared toilet, running water on the premises, and soap. Large disparities also persist based on education and income levels. The use of hygienic menstrual protection is 43.5% among women with no formal education, compared to 90.3% among those with 12 or more years of schooling. Similarly, usage stands at 53.6% among women in the lowest wealth group, compared to 94.8% in the highest wealth group, highlighting the continued impact of poverty and educational inequality on menstrual health.
Improving Menstrual Health Through Affordable Sanitary Pads and Community Healthcare
The increase in the use of hygienic menstrual products in India has been supported by government welfare initiatives aimed at making menstrual hygiene products affordable and accessible. Two key programmes driving this effort are the Menstrual Hygiene Scheme (MHS) under the Rashtriya Kishor Swasthya Karyakram (RKSK) and the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP).
To reduce the cost of menstrual hygiene products, the Department of Pharmaceuticals launched the Janaushadhi Suvidha programme, which provides oxo-biodegradable sanitary napkins at a subsidised price of Re. 1 per pad. These pads are manufactured by WHO-GMP-compliant companies and are tested in NABL-accredited laboratories to ensure quality and safety.
The programme has witnessed significant growth. The cumulative sale of Suvidha sanitary pads increased from 47.87 crore pads by November 2023 to 72 crore pads by January 2025, crossing 100 crore pads by January 2026. With more than 18,000 Jan Aushadhi Kendras operating across the country, access to affordable menstrual products has expanded considerably, particularly in rural areas. Rural adoption of these subsidised pads has increased from around 11-12% to nearly 45% in recent years.
Supporting this effort is the network of 1.5 lakh Ayushman Arogya Mandirs (formerly Health and Wellness Centres), which provide comprehensive primary healthcare services in rural and remote areas. These centres conduct regular community awareness sessions in schools, Anganwadi centres, and villages to promote menstrual hygiene and adolescent health. Educational initiatives, including UNICEF-supported programmes such as ‘Paheli Ki Saheli’, help raise awareness and break social taboos surrounding menstruation.
The integration of Jan Aushadhi Kendras with Ayushman Arogya Mandirs has further strengthened access to menstrual hygiene products. Frontline health workers, including ASHAs and ANMs, distribute ₹1 Suvidha pads while also providing guidance on menstrual health, reproductive tract infections (RTIs), and urinary tract infections (UTIs). Studies frequently linked poor menstrual hygiene to RTIs and high dropout rates among adolescent girls. This can help understand the importance of the guidance. The coordinated approach ensures that affordable menstrual hygiene products and health services reach even the most vulnerable women and adolescent girls in rural areas.
Maharashtra Leads in Menstrual Hygiene: The Asmita Yojana
Maharashtra has emerged as a leading state in promoting menstrual hygiene, accounting for nearly 20% of India's sanitary napkin market. This progress has been driven by rapid urbanisation, strong retail and healthcare networks, and government policies that recognise menstrual hygiene as an important public health issue.
A key initiative is the Asmita Yojana, launched in 2018 by the Department of Rural Development through the Maharashtra State Rural Livelihoods Mission (MSRLM). The scheme uses a decentralised model in which women-led Self-Help Groups (SHGs) purchase sanitary napkins from approved suppliers and distribute them within their communities through a dedicated mobile application.
The scheme aims to achieve three major goals. First, it provides packs of eight sanitary napkins at a subsidised rate of ₹5 to girls aged 11-19 years studying in rural government, Zilla Parishad, and Ashramshalas. Second, it improves access to affordable sanitary napkins for rural women, with packs priced between ₹24 and ₹29. Third, it promotes women's economic empowerment by enabling SHG members to earn income through the distribution and sale of sanitary napkins.
Between 2018 and 2022, more than 19 lakh schoolgirls and 29 lakh rural women benefited from the scheme. To further expand its reach, the Maharashtra government announced plans to allocate ₹100 crore to reduce the price of the schoolgirl pack from ₹5 to ₹1. The state is also working to extend the programme to low-income urban areas through pad-vending machines and disposal facilities in public toilets.
Compared with other states, Maharashtra's approach stands out for its SHG-led distribution model. While states such as Odisha, Rajasthan, Kerala, Karnataka, and Bihar have introduced their own menstrual hygiene initiatives, Maharashtra combines affordable access with women's livelihood generation.
Despite its success, the Asmita Yojana has faced some challenges. Early evaluations reported concerns about the quality of certain sanitary napkin batches, including issues related to absorbency and size. In addition, dependence on a smartphone-based distribution system sometimes caused supply disruptions in remote and tribal areas with limited internet connectivity. These challenges highlight the need for strong quality control measures and alternative distribution channels to ensure consistent access for all beneficiaries.
Balancing Menstrual Hygiene and Environmental Sustainability
The growing use of sanitary pads in India has significantly improved menstrual hygiene, but it has also created a major environmental challenge. A person using disposable sanitary pads can generate nearly 150 kg of non-biodegradable waste during their lifetime. Currently, India produces around 432 million used sanitary pads, or about 9,000 tonnes of waste, every month. If sanitary pad usage becomes universal, annual sanitary waste could exceed 10 lakh tonnes.
Most of the disposable sanitary pads are made of plastic-based materials and super-absorbent polymers, which can take 500-800 years to decompose. Improper disposal can block drainage systems, pollute soil and water bodies, and expose sanitation workers to health risks. In rural areas, where waste management facilities are limited and social stigma remains strong, used pads are often discarded in open spaces or water bodies, while in schools they are sometimes flushed into toilets, causing plumbing and sewerage problems.
To address disposal issues, many schools and institutions installed small sanitary pad incinerators. However, studies have shown that these low-temperature incinerators can release harmful pollutants including dioxins and furans, which are linked to respiratory problems, reproductive disorders, immune system damage, and other health risks. Research by the Indian Institute of Science found that many commonly used single-chamber incinerators fail to meet basic emission standards.
In response, the National Green Tribunal directed that sanitary pad incinerators should operate at temperatures above 800°C and use twin-chamber technology to ensure safer disposal. The CSIR-National Environmental Engineering Research Institute, along with the Department of Science and Technology, developed the Green Dispo incinerator, which uses high-temperature combustion to reduce harmful emissions and meet environmental standards.
Despite these advancements, many institutions continue to use older, low-cost incinerators due to financial constraints. This highlights the need for better waste-management systems and a gradual shift towards biodegradable and reusable menstrual products, which offer a more sustainable solution while maintaining menstrual hygiene and dignity.
Emerging Technologies and Eco-Friendly Alternatives
To reduce the environmental impact and long-term cost of disposable sanitary pads, reusable menstrual products such as menstrual cups are gaining attention. Made from medical-grade silicone, menstrual cups collect menstrual blood rather than absorbing it, making them a sustainable alternative. They can hold significantly more menstrual flow than pads or tampons and provide protection for up to 12 hours, even during heavy periods.
Menstrual cups also collect menstrual clots effectively, reducing leakage and discomfort often associated with disposable products. In addition to menstrual cups, reusable cloth-based products, such as fabric inserts, offer eco-friendly options for individuals who prefer non-invasive alternatives.
Using a menstrual cup requires some initial learning, including choosing the correct size, understanding insertion and removal techniques, and following proper cleaning and sterilisation practices. Once mastered, menstrual cups can be used safely for several years, reducing both waste and monthly expenses.
Despite their health, environmental, and financial benefits, the adoption of menstrual cups in India remains limited. Many women report concerns about insertion, removal, and ease of use. Limited availability in local stores and persistent social taboos surrounding vaginal insertion further restrict acceptance, particularly among unmarried adolescents and women in rural areas. Increasing awareness, improving accessibility, and addressing cultural misconceptions are essential to expanding the use of these sustainable menstrual hygiene solutions.
NFHS-6 data can be treated as a context, which may be used to ensure menstrual hygiene without compromising on environmental sustainability.
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