Written by Ellen McCammon

Managing menstruation in India can be difficult. It may be marked by challenges with obtaining, cleaning, storing, and disposing of menstrual supplies, and insufficiently private, safe, and clean bathrooms [1]. In addition to the logistical and resource-based difficulties with managing the physical experience of menstruation, there are also emotional, and psychological challenges associated with menstruating in India, where periods are highly stigmatized [1, 2].

A study published in SRHM in 2001 about menstruating women in the slums of Delhi, India, found that many women knew nothing of menstruation before its onset and received only minimal information about it afterwards, reflecting a widespread “cultural silence” about menstruation [3]. Women were often told that menstrual blood was dirty or unclean and were restricted from participating in some of their regular activities while on their periods.

Though nearly two decades have passed since these findings were reported, a number of similar challenges were reported by participants in a recent study conducted by researchers from the University of Chicago’s Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3). Life course interviews were conducted with girls and young women between the ages of 15 and 24 living in the slums of Lucknow, Uttar Pradesh to explore their menstruation experiences [4]. Most participants learned about menstruation for the first time after its onset, and they often had limited information or held misconceptions about menstruation as a biological process. Socially, women and girls received messages that they were impure during menstruation and were instructed to limit activities like worship and going out into the community. Few opportunities existed to discuss period-related issues openly as participants were advised not to speak of it to younger girls, boys and men, or community members. While most participants reported attending school during menstruation, managing bleeding at school was difficult due to poorly maintained bathrooms without adequate privacy, teasing by boy students, and shaming by teachers.

It is striking to consider how so many of the challenges experienced by participants are created or exacerbated by how menstruation is or is not talked about. When no one speaks to girls about menstruation before menarche, their first menstruation experiences are often distressing and disorienting. By tightly limiting the circumstances in which menstruation is discussed to certain women family members, little opportunity arises for information to be shared or misconceptions to be corrected. How can mothers, older sisters, and cousins provide information that they themselves never received?

When menstruation was spoken of, it was often in a negative context. Participants received messages that it was shameful for other people to know they were menstruating, and that menstruation is dirty. They were subject to malicious teasing when others became aware they were menstruating. It is no wonder, then, that the primary emotions described in association with menstruation were fear, embarrassment, frustration, and shame.

Conversely, participants were reassured by conversations communicating that menstruation was a normal phenomenon and not something bad. These findings highlight the importance of open conversations about all aspects of the menstruation experience, including the negative psychosocial aspects of menstrual stigma and taboo, for shifting the culture around menstruation.

Proponents of a menstrual hygiene management approach sometimes suggest that providing comprehensive biological and health information and adequate resources for menstrual management is enough to facilitate healthy, safe, and comfortable menstruation. While these strategies are important, they are not sufficient. A human rights perspective on menstruation makes it clear that reducing menstrual stigma is a precondition to effectively and sustainably addressing the material and informational needs of menstruation [5]. After all, if periods are a dirty secret, who will ensure that the accessibility of these resources remains a policy priority?

Facilitating open conversations about menstruation will not only reduce stigma against menstruating individuals, but help promote inclusivity in the menstrual justice movement. Menstrual hygiene management is often framed as a “women’s issue,” and yet, not all women menstruate, and not all menstruators are women. While the stigmatization of menstruation is part of a broader system of the marginalization of women [6], it is important to resist essentializing menstruation as a universal experience of womanhood. Everyone should have a chance to share how menstruation has impacted their life, regardless of whether or not they menstruate.

It is encouraging to see the novel approaches taken by Indian activists and organizations in recent years to open up conversations about menstruation. In urban areas, young Indians are using TikTok to share poetry and thoughts on menstruation. In rural Jharkhand, artist and activist Srilekha Chakraborty organized young people, art students, and community organizations in painting beautiful menstruation-themed murals with the aim of sparking discussion. Photographer Poulomi Basu created the transmedia campaign Blood Speaks in the hopes of ending the Nepalese Hindu practice of chauduri, or isolation in menstrual huts during periods. And of course, the much-awarded short documentary “Period: End of Sentence” follows several women as they start a sanitary pad-making business in a village outside Delhi.

The importance of developing and sharing stories to create empathy and decrease stigma cannot be overstated [7-9]. Narratives and stories help facilitate understanding of the lived experiences of young people and foster honest dialogue about sensitive issues. Storytelling has always been central to our own work on Kissa Kahani, the parent study from which our data on menstruation was drawn. For more than two years, a team of interdisciplinary experts from Ci3 surfaced the perspectives of a group of young people in India by eliciting their stories, concerns, and desires about issues related to gender and sexual and reproductive health using novel, narrative-based research methods. These collected stories have been turned into short videos, graphic novels, and games that are part of an intervention for young adolescents in India, to be implemented later this year. In the meantime, let’s all keep talking about our experiences with menstruation—let’s fill the silence.

1. Chandra-Mouli, V. and S.V. Patel, Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries. Reproductive Health, 2017. 14(1).
2. Mahon, T. and M. Fernandes, Menstrual hygiene in South Asia: A neglected issue for WASH (water, sanitation and hygiene) programmes. Gender and Development, 2010. 18(1): p. 99-113.
3. Garg, S., N. Sharma, and R. Sahay, Socio-cultural aspects of menstruation in an urban slum in Delhi, India. Reproductive Health Matters, 2001. 9(17): p. 16-25.
4. McCammon, E., et al., Exploring young women’s menstruation-related challenges in Uttar Pradesh, India, using the socio-ecological framework. Sexual and Reproductive Health Matters, 2020. 28(1): p. 1749342.
5. Winkler, I.T. and V. Roaf, Taking the bloody linen out of the closet: menstrual hygiene as a priority for achieving gender equality. Cardozo JL & Gender, 2014. 21: p. 1.
6. arora, N., Menstruation in India: Ideology, politics, and capitalism. Asian Journal of Women’s Studies, 2017. 23(4): p. 528-537.
7. Muralidharan, S. and E. Kim, Can empathy offset low bystander efficacy? Effectiveness of domestic violence prevention narratives in India. Health communication, 2019: p. 1-10.
8. Batson, C.D. and N.Y. Ahmad, Using Empathy to Improve Intergroup Attitudes and Relations. Social Issues and Policy Review, 2009. 3(1): p. 141-177.

9       Barroso, J., et al., A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South. AIDS patient care and STDs, 2014. 28(9): p. 489-498.

Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.