Women menstruate for approximately six to seven years in their lifetime. Current levels of menstrual hygiene vary significantly across Indian states--from 34.5% to 96.6% across parliamentary constituencies.

Inadequate access to menstrual hygiene management has far-reaching consequences, affecting individuals physically, emotionally and economically. There is also societal stigmatisation and cultural taboos associated with menstruation. Low access to safe menstrual hygiene products might also increase school absenteeism, and result in girls dropping out of school. Girls who drop out of school are more likely to be married young, bear children before the age of 18, experience poorer health and nutrition outcomes and have lower earnings in adulthood.

Areas with low levels of menstrual hygiene are concentrated in central India. Bihar (59.9%), Madhya Pradesh (61.5%), Uttar Pradesh (74%) and Rajasthan (85.8%) lie in the bottom deciles while states like Tamil Nadu (99.1%), Goa (98.1%), Punjab (95.3%), Kerala (95.2%) and Haryana (95.2%) have the highest use of safe methods of menstrual hygiene.

Managing menstruation hygienically and with dignity requires adequate knowledge, appropriate facilities, and a supportive cultural environment.

In recognition of the importance of menstrual hygiene, on April 10, 2023, the Supreme Court (SC) asked the Union government, along with state governments, to submit their menstrual hygiene management strategies and plans “which are being executed either with the help of funds provided by the Central Government or through their own funds to the Mission Steering Group of the National Health Mission within a period of four weeks”. The SC bench also asked states and UTs to indicate steps taken for the availability of low cost sanitary pads and vending machines in schools and for their appropriate disposal.

For this dataviz, we use data from the NFHS Tracker for Parliamentary Constituencies developed by India Policy Insights initiative, a collaboration between the Geographic Insights Lab at the Harvard Centre for Population and Development Studies and the Centre for Geographic Analysis at Harvard, and the International Institute for Population Sciences (IIPS).

Menstrual hygiene levels have improved significantly over the years

The National Family Health Survey, on which this dataviz is based, was launched in 1991, but it only started measuring menstrual hygiene levels in 2015-16. The 2019-21 NFHS survey defined the use of “hygienic methods of protection” as the use of locally prepared napkins, sanitary napkins, tampons and menstrual cups, during their menstrual period by women, aged 15-24 years. The definition in the 2015-16 survey did not include menstrual cups.

In 2015-16, the national prevalence of use of menstrual hygiene products was 57.6%, which rose to 77.3% in 2019-21, as per data from NFHS-5.

Nearly all (97.7%) of parliamentary constituencies registered an average increase of 20.1 percentage points in use of menstrual hygiene products. Aska parliamentary constituency in Odisha had the highest improvement of 54.7 percentage points, followed by Barmer (52.5-percentage-point increase) in Rajasthan and Maldaha Uttar (49.3-percentage-point increase) in West Bengal.

Overall, use of menstrual hygiene products increased the most in Odisha, Bihar and Rajasthan, with an increase of 34.5, 30.1 and 29.0 percentage points respectively. However, in the same time period, use of menstrual hygiene products reduced in 12 parliamentary constituencies--five of which are in Gujarat (Mahesana, Surat, Patan, Surendranagar and Ahmedabad East) and three in Kerala (Palakkad, Thrissur and Chalakudy).

Access to sanitation facilities linked with improved menstrual hygiene

A 2021 UNICEF study noted that a higher percentage of women and adolescent girls practising adequate menstrual hygiene methods live in households with improved sanitation facilities and with safe excreta disposal on site. The NFHS data highlight a similar trend.

Most parliamentary constituencies with low levels of menstrual hygiene also have a low proportion of households using improved sanitation facilities. States like Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh and Tripura have low levels of sanitation as well as menstrual hygiene.

Inadequate menstrual hygiene aggravates the risk of anaemia

As per NFHS-5, 57% of females, 15-49 years, were estimated to be anaemic in the country. The government has been promoting initiatives to ensure Iron and Folic Acid supplementation, provide fortified food for women at risk and run awareness drives. However, improvements in promoting menstrual hygiene can also play a significant role in India’s fight against anaemia. Improper menstrual hygiene management can lead to urinary or reproductive tract infections and pelvic inflammatory disease that can further lead to blood loss ultimately resulting in a higher risk of anaemia.

Parliamentary constituencies with poor menstrual hygiene overlap those with high levels of anaemia across multiple regions in India.

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