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Promoting Intersectoral Action on Menstrual Health and Hygiene Management: Arriving at a Framework and Indicators to Inform Policy and Programs


Menstrual health and hygiene management (MHHM) is increasingly recognized as a critical issue facing adolescent girls, affecting their health and well-being, limiting opportunities to pursue education and employment opportunities, and has adverse implications for the environment. Given the range of factors that influence girls’/women’s ability to manage their menses, action to improve MHHM calls for an intersectoral approach. While tools to address MHHM exist, a comprehensive framework that facilitates mapping all program components is not easily available. Relatedly, a set of relevant, easy to use program indicators specific to MHHM are not widely accessible. A comprehensive framework can potentially facilitate the identification of opportunities for collaboration, and the development of a core set of indicators will enable those taking action on MHHM to monitor and assess their program’s progress and achievements, and can inform future programs and policy initiatives. Drawing upon the research and intervention literature on MHHM, as well as consultations with program implementers, stakeholders engaged in advocacy efforts, and policy makers, this chapter proposes a comprehensive framework to address MHHM in India, outlines key MHHM indicators, and discusses how these products can be used by various stakeholders in the country to improve MHHM in a comprehensive manner.


  • Menstrual health and hygiene management
  • Intersectoral approaches
  • Action and monitoring framework

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Fig. 9.1


  1. 1.

    WSSCC is a global multistakeholder partnership and membership organization that works to save lives and improve livelihoods, driven by the mission to achieve sustainable water supply, sanitation and hygiene for all people in the world.


  1. Garg S, Sharma N, Sahay R. Socio-cultural aspects of menstruation in an urban slum in Delhi, India. Reprod Health Matters. 2001;9(17):16–25.

    CAS  CrossRef  PubMed  Google Scholar 

  2. Narayan KA, Srinivasa DK, Pelto PJ, Veerammal S. Puberty rituals, reproductive knowledge and health of adolescent schoolgirls in South India. Asia Pac Popul J. 2001;16(2):225–38.

    Google Scholar 

  3. Khanna A, Goyal RS, Bhawsar R. Menstrual practices and reproductive problems: a study of adolescent girls in Rajasthan. J Health Manag. 2005;7(1):91–107.

    CrossRef  Google Scholar 

  4. Dasgupta A, Sarkar M. Menstrual hygiene: how hygienic is the adolescent girl? India J Community Med. 2008;33(2):77–80.

    CAS  CrossRef  Google Scholar 

  5. Nemade D, Anjenaya S, Gujar R. Impact of health education on knowledge and practices about menstruation among adolescent school girls of Kalamboli, Navi-Mumbai. Health Popul Perspect Issues. 2009;32(4):167–75.

    Google Scholar 

  6. Jogdand K, Yerpude P. A community-based study on menstrual hygiene among adolescent girls. Indian J Matern Child Health. 2011;13(3):1–6.

    Google Scholar 

  7. Kumar A, Srivastava K. Cultural and social practices regarding menstruation among adolescent girls. Soc Work Public Health. 2011;26(6):594–604.

    CrossRef  PubMed  Google Scholar 

  8. Dasra. Spot On! Improving menstrual health and hygiene in India. Accessed 28 Oct 2014.

  9. Birdthistle I, Dickson K, Freeman M, Javidi L. What impact does the provision of separate toilets for girls at schools have on their primary and secondary school enrolment, attendance and completion? A systematic review of the evidence (internet). London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2011. Accessed 14 Feb 2014.

  10. WHO Commission on social determinants of health. Closing the gap in a generation: health equity through action on the social determinants of health: commission on social determinants of health final report. World Health Organisation; 2008.

    Google Scholar 

  11. Muralidharan A, Patil H, Patnaik S. Unpacking the policy landscape for menstrual hygiene management: implications for school WASH programmes in India. Waterlines. 2015;34(1):79–91.

    CrossRef  Google Scholar 

  12. Patkar A. Preparatory Input on MHM for End Group (Internet); 2010. Accessed 2 Feb 2014.

  13. House S, Mahon T, Cavill S. Menstrual hygiene matters: a resource for improving menstrual hygiene around the world; 2012. Accessed 31 May 2015.

  14. Global Monitoring Working Group on Hygiene. Meeting report of joint monitoring program post‐2015 global monitoring working group on hygiene. Washington DC; 2014.

  15. Way U. Measuring program outcomes: a practical approach. United Way of America; 1996.

    Google Scholar 

  16. van Eijk AM, Sivakami M, Thakkar MB, et al. Menstrual hygiene management among adolescent girls in India: a systematic review and metaanalysis. BMJ Open. 2016;6:e010290. doi:10.1136/bmjopen-2015-010290.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  17. Omidvar S, Begum K. Factors influencing hygienic practices during menses among girls from South India: a cross sectional study. Int J Collab Res Intern Med Public Health. 2010;2(12):411–23.

    Google Scholar 

  18. Deo DS, Ghattargi CH. Perceptions and practices regarding menstruation: a comparative study in urban and rural adolescent girls. Indian J Community Med. 2005;30(1):33.

    Google Scholar 

  19. Kamath R, Ghosh D, Lena A, Chandrasekaran V. A study on knowledge and practices regarding menstrual hygiene among rural and urban adolescent girls in Udupi Taluk, Manipal, India. Glob J Med Public Health. 2013;2:1–9.

    Google Scholar 

  20. Shanbhag D, Shilpa R, D’Souza N, Josephine P, Singh J, Goud BR. Perceptions regarding menstruation and practices during menstrual cycles among high school going adolescent girls in resource limited settings around Bangalore city, Karnataka, India. Int J Collab Res Intern Med Public Health. 2012;4(7):1353–62.

    Google Scholar 

  21. Sinha K. 70% can’t afford sanitary napkins, reveals study. Times of India. 23 Jan 2011. Accessed 18 Feb 2014.

  22. Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PLoS ONE 2013; 8(4). Accessed 8 May 2015.

  23. Ali TS, Rizvi SN. Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan. J Adolesc. 2010;33(4):531–41.

    CrossRef  PubMed  Google Scholar 

  24. Sommer M. Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania. J Adolesc. 2010;33(4):521–9.

    CrossRef  PubMed  Google Scholar 

  25. Joshi BN, Chauhan SL, Donde UM, Tryambake VH, Gaikwad NS, Bhadoria V. Reproductive health problems and help seeking behavior among adolescents in urban India. Indian J Pediatr. 2006;73(6):509–13.

    CrossRef  PubMed  Google Scholar 

  26. Sharma P, Malhotra C, Taneja DK, Saha R. Problems related to menstruation amongst adolescent girls. Indian J Pediatr. 2008;75(2):125–9.

    CrossRef  PubMed  Google Scholar 

  27. Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh LR, et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27(4):311–5.

    CAS  CrossRef  PubMed  Google Scholar 

  28. Das B, Das P, Dutta A, Misra PR, Pradhi B, Sahoo K, et al. Social and psychological impact of limited access to sanitation: the link between MHM and reproductive tract infections, and between WASH practices and pregnancy; 2015. Accessed 2 Feb 2015.

  29. Ministry of Women and Child Development. Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG): SABLA implementation guidelines; 2010. Accessed 2 June 2014.

  30. Sommer M, Kjellén M, Pensulo C. Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries. J Water Sanit Hyg Dev. 2013;3(3):283.

    CrossRef  Google Scholar 

  31. Jasper C, Le T-T, Bartram J. Water and sanitation in schools: a systematic review of the health and educational outcomes. Int J Environ Res Public Health. 2012;9(8):2772–87.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  32. Water Aid India, Centre for World Solidarity. Study on status of school sanitation in Andhra Pradesh. 2012.

    Google Scholar 

  33. Jewitt S, Ryley H. It’s a girl thing: menstruation, school attendance, spatial mobility and wider gender inequalities in Kenya. Geoforum. 2014;56:137–47.

    CrossRef  Google Scholar 

  34. WHO/UNICEF JMP. India: estimates on the uses of water sources and sanitation facilities (1980–2012); 2014. Accessed 5 Oct 2014.

  35. WHO/UNICEF JMP. Post-2015 WASH Targets and Indicators; 2013. Accessed 5 Oct 2014.

  36. Ministry of Health and Family Welfare. National rural health mission—operational guidelines: promotion of menstrual hygiene among adolescent girls (10–19 year) in rural areas; 2010. Accessed 2 Feb 2014.

  37. Ministry of Health and Family Welfare. Rashtriya Kishor Swasthya Karyakram strategy handbook; 2014. Accessed 2 Feb 2014.

  38. Ministry of Drinking Water and Sanitation (2014). Swachh Bharat Mission (Gramin) Guidelines.

    Google Scholar 

  39. Ministry of Drinking Water and Sanitation (2015). Menstrual Hygiene Management—National Guidelines.

    Google Scholar 

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Muralidharan, A. (2017). Promoting Intersectoral Action on Menstrual Health and Hygiene Management: Arriving at a Framework and Indicators to Inform Policy and Programs. In: Nambiar, D., Muralidharan, A. (eds) The Social Determinants of Health in India. Springer, Singapore.

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