Authors: Anamika R, Anaswara Obrin, Sreelakshmi PM.

1.Introduction

Menstrual health is a fundamental aspect of women’s well-being, yet millions around the world continue to face barriers to accessing safe, affordable, and hygienic menstrual products. These barriers are often rooted in financial strain and social stigma surrounding menstruation. In many low- and middle-income countries, particularly in rural or underserved areas, menstruators are forced to resort to unsafe alternatives due to the high cost and unavailability of menstrual health products. The result is a pervasive cycle of “period poverty,” with consequences that extend beyond physical discomfort, impacting education, mental health, economic productivity, and social inclusion.

This paper explores the role of financial constraints and social norms in shaping menstrual health expenditure and access. Drawing on both secondary data and a primary survey of urban women in India, the research highlights the disparities in menstrual product accessibility, spending patterns, and awareness across different income groups and age brackets. It also examines the challenges of adopting sustainable menstrual products and assesses the effectiveness of existing government schemes and private initiatives. By identifying key gaps in awareness, affordability, and accessibility, this study aims to provide actionable recommendations for policy and community-level intervention.

2. Literature Review 

Period poverty is an issue that is rooted in economic disparity and gender inequality. It reflects a broader systemic issue where essential health needs of menstruators, especially women and girls, are often overlooked. According to a World Bank Report, in 2022, over 500 million women globally lacked access to menstrual products and adequate facilities for menstrual hygiene management. 

An overview report for Low and Middle-income countries estimates 78% of menstruators use purpose-made menstrual health products, which include single-use pads and tampons, with reusable options remaining underutilized. The annual cost of such products amounts to $28.8 billion, with 99% of costs attributed to single-use items. Highlighting a significant opportunity to promote reusable menstrual products, which are more cost-effective and environmentally sustainable in the long term.  (S.K et al,.2024). However, the uptake of reusable products remains low due to a lack of awareness, unavailability and social stigma. 

In India, the situation is alarming as 12% of women cannot afford period products. NFHS data show that in 2021, approximately 50 percent of women aged 15-24 years still used cloth for menstrual protection. In rural areas, many women resort to unsafe alternatives such as rags, sand, hay, and ash as alternative methods due to the lack of availability of products. This increases the risk of urinary tract infections (UTIs) and other health complications (Wilson, 2022). While the average cost of menstrual products per month is Rs. 300, this constitutes a significant burden for lower-income groups, particularly when the average daily wage remains around Rs. 180. Given that the exorbitant cost of period products is a gruesome burden on the lower-income groups. Around 23 million girls drop out of school annually due to the lack of safe and sanitary menstrual hygiene management, including access to products and a lack of awareness about menstruation. (Wilson,R.2022)

In response, international and national organizations have introduced initiatives aimed at improving access and affordability. The World Bank suggests removing market entry barriers for the private sector companies to improve competition and access. Organizations like Zana Africa demonstrated a successful model by distributing sanitary pads and health education, which is supported by the Kenyan Teacher Service Commission. 

Similarly, in India, social enterprises like Aakar Innovations have empowered women to manufacture and distribute affordable, high-quality sanitary napkins, while also raising awareness about menstrual hygiene management. Their “Anandi” pads serve as a locally produced, low-cost and eco-friendly alternative. 

On the policy front, India has taken several steps towards improving menstrual health: 

• Rashtriya Kishor Swasthya Karyakram (RKSK), launched in 2014 by the Ministry of Health and Family Welfare, focuses on raising awareness on menstrual hygiene among adolescent girls.
• ASHA workers distributed subsidised packs of sanitary napkins at Rs. 6 each. 
• Under the Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP), over 8,700 Janaushadhi Kendras offer oxo-biodegradable pads at just Rs. 1 per pad (Roy, 2024).

While the measures adopted by the government shall be appreciated doubt still lingers on the effective implementation of these schemes. The supply of pads at health centers is reported to be irregular, which erodes the effectiveness of the scheme. The lack of awareness regarding the government initiatives promoting the use of menstrual products prevents women in need from availing them (S.K et al.,2024).

The consequences of these systemic failures are not only physical but also social and psychological. Poor menstrual hygiene can lead to infections and reproductive health issues (Babagoli et al., 2022). At the same time, providing good access to menstrual hygiene products reduces the risk of infections and teen pregnancies and increases fertility. A sanitary pad intervention in Ghana found that after six months of free sanitary pad provision and puberty education, girls missed significantly less school (Montgomery et al.,2012).

The word is synonymous with injustice and inequity (Jaafar et al.,2023). Affordability is a strong barrier to access to menstrual products, particularly for poor women. The implicit sexism and underlying gender inequality in the high pricing of essential female hygiene products is not unnoticed (Miller et al.,2024)

3. Methodology

The cross-sectional analysis was conducted using primary data through questionnaire based web survey on urban women. Data has been collected from websites of The world Bank, The UN and the WHO. Articles from Google Scholar, National Institute of Health, International Journal of Reproduction, Contraception, Obstetrics and gynecology, Ujaas, Rashtriya Kishor Swaasthya Kaaryakram website for the comprehensive literature review.

4. Analysis

A survey was conducted with 70 urban women aged between 20 to 50 years, segmented into three age groups: 20–30, 30–40, and 40–50. The respondents were categorized by household income:

• Low income: ₹15,000–₹35,000

• Middle income: ₹35,001–₹75,000

• High income: Above ₹75,000

Respondents also represented a diverse occupational range: employees (45.7%), self-employed, homemakers, students, and others. Educational backgrounds varied, with the majority holding postgraduate degrees (57.1%).

This was to check the incidence of meeting menstrual requirements of non-earning female members in the household depending on if they are less (1 or 2) or more (3 and above) in number.

Most of the women have Post Graduate level of education (57.1%), followed by an Undergraduate level (40%). Only one sample has Primary Education and Doctorate, while no one belongs to the High school level education.

The total amount spent at the time of purchase for the individual (Low: Below 100–300, Medium: Above 300-800, High: Above 800) and the frequency of spending were used to interpret whether spending is less, reasonable, satisfactory, good or high.

Infrequent spending (Quarterly or lesser frequency):

·       Low amount: Less

·       Medium amount: Reasonable

·       High amount: Satisfactory

Frequent spending (Weekly or monthly):

·       Low amount: Satisfactory

·       Medium amount: Good

·       High amount: High

Questions explored the mode and source of funding for the expenditure and difficulties faced for expenditure on menstrual products, pain management & hygiene products and services like doctor consultation and medical treatment.

A case question highlighting the cost benefit of menstrual cups was included to analyse the chance of its choice as they are cheaper and easier to handle than other sustainable menstrual products.

The survey aimed to identify the spending patterns of women on menstrual requirements and the level of prevalence of influential factors such as financial strain, societal stigma, lack of accessibility, lack of awareness, and lack of importance given to menstrual hygiene, among others.

5. Findings

5.1 Spending Patterns

35.7% of respondents have a good level of spending on sanitary products, indicating affordability and minor difficulties. 30% had satisfactory spending while 17.1% had low levels of expenditure. 

5.2 Quality of Products 

The main concern for women when purchasing menstrual products was quality, with 74.3% of respondents choosing this as a main factor of concern. 74.3% chose quality as the major factor affecting their spending compared to price, personal requirements, availability, and brand. A majority, 85.7%, never had to compromise menstrual products for other essential items, and 76.8% never had to use traditional methods.

5.3 Financial Strain and Accessibility Challenges

The two major difficulties are financial strain (12.9%) followed by inaccessibility (11.4%). The small proportion of respondents who face issues of societal perceptions (2) and ignorance of the importance of menstrual health expenditure (4), specifies that they are not prevalent among the urban population.

5.4 Number of Dependents

Households of all income categories with a smaller number of dependent women could meet their menstrual needs. 1 household that could not meet the requirements was attributed to financial issues and ignorance of menstrual hygiene. 5 out of 8 households that could meet the expenses of 3 or more dependent women belonged to higher income groups, while 2 of the remaining belonged to the low-income category and 1 to the high-income category with accessibility limitations.

5.5 Purchase Modes and Sustainability 

Retail stores were the dominant purchase source (84.3%), while online shopping was more popular among younger respondents (20–30 age group). While all respondents were aware of sustainable menstrual products, 57.1% had never used them. Menstrual cups were considered by 30%, but concerns around pain (37.1%) and lack of knowledge (25.7%) hindered adoption.

6. Discussion 

The findings illustrate a relatively higher awareness and adoption of menstrual products among urban populations. However, financial and access-related issues continue amongst low low-income group and households. The use of traditional methods in rural areas highlights the gaps in government schemes. 

While initiatives such as Rashtriya Kishor Swasthya Karyakran (RKSK) Suvidha Scheme and Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP) aim to enhance accessibility, the impact is limited by inconsistent supply and poor awareness. 

7. Recommendations

1. Awareness campaigns

Several workshops and awareness building programs, and seminars are to be conducted in schools, universities and other institutions to bring awareness about menstrual care and health among the ignorant group of society.

2. Install Vending Machines 

Installing vending machines with low-cost sanitary pads and tampons in public places can effectively normalize and improve access to menstruation products. 

Menstrual products should be made more accessible to women by implementing initiatives like ‘Suvidha’, providing oxo-biodegradable sanitary napkins by Pradhan Mantri Bharatiya Jan Aushadhi Pariyojana.

3. GST reforms 

GST must be reduced for manufacturers alongside the exemption for sanitary products for consumers. The GST exemption denies Input tax credit, besides 12% – 18% of GST on production which will ultimately be added to the prices of products.

4. Encourage MSMEs

Encouraging the production of reusable sanitary napkins by setting up more MSMEs with government support will encourage the use of sustainable methods other than menstrual cups as a result of increased availability at inexpensive rates, besides creating more employment opportunities.

8. Conclusion

Menstrual health remains a neglected dimension of public health policy, due to financial affordability and cultural stigma. While the findings of this study reveal that women in higher income brackets experience fewer difficulties in accessing menstrual products, inaccessibility persists among low-income households. Despite the growing awareness of sustainable menstrual alternatives like menstrual cups and reusable pads, usage remains low due to fear, misinformation, and a lack of targeted outreach.

Ultimately, menstrual equity can only be achieved through a multi-pronged approach: removing financial barriers, increasing awareness through education and outreach, incentivizing the production and distribution of sustainable products, and dismantling the social taboos that continue to surround menstruation.

To ensure menstrual health is no longer a privilege but a right, it is essential that stakeholders—from policymakers to educators to grassroots organizations—work collaboratively to normalize menstruation, prioritize hygiene, and create equitable access for all menstruators, regardless of their socio-economic background.

9.References

1. World Bank. (2022). Menstrual health and hygiene 2022. https://www.worldbank.org/

2. World Bank. (2021). A holistic approach to better menstrual health and hygiene: Entrepreneurs in action. https://www.worldbank.org/

3. World Bank. (2021). Menstrual health: Overview report for low- and middle-income countries. https://www.worldbank.org/

4. Jaafar, H., Ismail, S. Y., & Azzeri, A. (2023). Period poverty: A neglected public health issue. Korean Journal of Family Medicine, 44(4), 183-188. https://doi.org/10.4082/kjfm.22.0206

5. Miller, T. A., et al. (2024). Understanding period poverty and stigma: Highlighting the need for improved public health initiatives and provider awareness. Journal of the American Pharmacists Association, 64(1), 218-221. https://.doi.org/10.1016/j.japh.2023.10.015.

6. Godvin, S. K., Ullas, C. U. L., Anjana, V. M., & Mini, G. K. (2024). Menstrual product choice and the extent of period poverty among young adult females: Findings from a cross-sectional study in Kerala, India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology Indexing, 13(7), 1797-1808. https://doi.org/10.18203/2320-1770.ijrcog20241777

7. Babagoli, M. A., et al. (2022). Cost-effectiveness and cost–benefit analyses of providing menstrual cups and sanitary pads to schoolgirls in rural Kenya. Women’s Health Reports, 3(1), 773-784. https://doi.org/10.1089/whr.2021.0131.