Rethinking the Language of Menstrual “Hygiene”

On International Menstrual Hygiene Day 2024, I attended an NGO-led event aimed at the promotion of menstrual awareness and the distribution of sanitary pads, in a cramped wedding hall-turned-community-centre in the Delhi slum where I was undertaking my doctoral fieldwork. Below the relentless, unforgiving summer sun, with a few women carrying toddlers on their backs or in their arms, a long awareness session and lecture was being held on menstruation, reproduction, and hygiene. Women were asked to see menstruation as something sacred and natural, yet at the same time, they were told it should be kept clean and managed properly. Having been involved with numerous such awareness-building sessions, these injunctions made me pause and think: what do we mean by “hygiene” in the context of menstruation? And, more importantly, what assumptions does this word carry and who does it serve? In this short piece, I want to reflect on how the language of “hygiene” flattens the complex lived realities of menstruation and, in doing so, often reinforces the very stigmas it seemingly seeks to eliminate. 

The UNICEF roundtable of 2005 saw the aegis of the term Menstrual Hygiene Management (MHM) emerge amid a discourse around improving sanitation and hygiene needs, particularly in low- and middle-income countries. The definition of MHM focuses heavily on providing women with menstrual products, privacy to change the product as often as necessary, and access to soap and water. Yet, from the outset, the emphasis on “hygiene” reflected a biomedical and infrastructural gaze that quietly encoded assumptions about cleanliness, pollution, and bodily purity. To label menstruation as a “hygiene” issue does more than organise policy—it moralises menstruating bodies. “Hygiene” evokes ideas of cleanliness vs. filth, health vs. contamination. In practice, this often leads to menstrual practices being judged against a narrow ideal: the disposable sanitary pad, used discreetly, changed frequently, and disposed of without fuss. 

Development interventions often approach menstruation with a two-pronged strategy: distribute products (usually sanitary pads) and conduct awareness-building sessions that “correct” misconceptions. In these sessions, women are told how to manage menstruation “properly”. Sanitary pads are presented as the hygienic gold standard; the use of cloth pads is pathologised as backward or dirty. Menstrual health is connected to reproductive potential, ultimately reinforcing motherhood as the defining feature of womanhood. During the event, for instance, a well-meaning NGO facilitator gave a long talk invoking goddess symbolism to fight stigma. As the women sat through hours of speeches in unbearable heat—often with children in tow—many were visibly restless. The real reason for their attendance became clear: the free sanitary pads handed out at the end. But the pads came with a price—photos, questions for the camera, and the performance of gratitude. These sessions assumed the women lacked knowledge or held dangerous beliefs. But as several women later told me, they already knew the information being shared, feeling that these events didn’t ask about their actual menstrual practices or the reasons behind them. This reveals a key flaw in the current menstrual health paradigm: it privileges technical solutions over embodied knowledge. Women’s fluid, adaptive, and deeply contextual practices around menstruation are overwritten by a top-down model of “hygienic” management, which rarely engages with the complex cultural, economic, and infrastructural realities they face. 

One common assumption in menstrual health interventions is that culture is the barrier: traditional beliefs, taboos, and “myths” need correction with “modern” biomedical knowledge. Many women I talked to during my year-long ethnographic research in a slum in Delhi described how their menstrual practices evolved after migrating from rural areas: they moved away from using cloth pads due to water scarcity, and adopted the use of sanitary pads for convenience. Others still preferred to use cloth under certain circumstances. Their choices were shaped not by ignorance or taboo, but by pragmatism. Rather than viewing culture as a static set of regressive norms, we should recognise it as a dynamic field of negotiation, shaped by migration, work, religion, caste, age, and kinship. The language of “hygiene”, in contrast, offers little space for such nuance. It reduces complex practices to compliance or deviance—clean or dirty. 

In NGO and development interventions, success is often measured quantitatively: how many sanitary pads have been distributed? How many sessions have been conducted? How many women have been “reached”? These metrics, while easy to report, obscure the deeper question: what changed? Interventions I worked on as an NGO worker before embarking on my doctoral research rarely followed up to ask whether women’s experiences of menstruation had actually improved. Nor did they account for how infrastructure (or lack thereof) shaped women’s practices. For instance, the National Family Health Survey in India defines “hygienic” menstrual management as using a disposable pad—yet many urban women, especially in informal settlements, lack regular access to clean water or toilets, making the use and disposal of such products both impractical and environmentally unsound. This metrified audit culture of development prioritises replication over reflection. It glosses over local context, ignoring how caste, class, religion, and generational dynamics mediate access to infrastructure and health. 

The moral emphasis on “hygiene” places the burden on the most impacted by the absence of infrastructure to take care of their own “cleanliness” in the “right” manner. But menstruation is not just about “managing” blood: it’s about navigating the intersections of body, space, culture, and power. It's crucial to acknowledge that people who menstruate are not passive recipients of goods or information; they tend to make deliberate, knowledgeable choices informed by their actual lives. Only paying attention to “hygiene” runs the risk of overlooking the broader context and histories that frame individual experiences. Reducing menstruation to “hygiene” erases people's agency and experiences, reinforcing the shame MHM interventions seek to eradicate. 

Author Bio

Prerna, a PhD candidate in South Asian Studies at the University of Edinburgh, researches how women in Delhi’s slums navigate menstrual practices across generations, linking culture, migration, and infrastructure through an intersectional lens