CHENNAI: Tamil Nadu's success in ensuring universal access to sanitary napkins among adolescent girls masks deeper and unresolved challenges in menstrual hygiene, including unsafe disposal practices, inconsistent hygiene behaviour, persistent pain-related school absenteeism and entrenched social restrictions, according to a new peer-reviewed study.
The study, authored by Kanagabala Balasubramanian, Roseline F William, Thirunavukkarasu D, Geetha Mani, Vidya DC and Gladius Jennifer H, and published in the Tamil Nadu Journal of Public Health and Medical Research, assessed menstrual patterns and practices among 393 adolescent girls in the 11-19 age group from rural and urban field practice areas attached to a tertiary care teaching hospital in Tamil Nadu.
While all participants reported using sanitary napkins, the researchers cautioned that access alone has not resulted in comprehensive menstrual hygiene management. Only 62.5% of rural girls and 65.7% of urban girls met the study's criteria for good menstrual hygiene, which included frequent pad changes, daily bathing and genital cleaning with soap and water.
"This indicates that a significant proportion of adolescent girls continue to follow inadequate hygiene practices despite widespread pad availability," the authors noted, warning of heightened risks of reproductive tract infections and long-term health consequences.
One of the most concerning findings relates to sanitary pad disposal.
Burning was the predominant method, reported by nearly four in five rural girls and more than half of urban girls. The study flagged this as an unsafe and environmentally harmful practice, pointing to the absence of accessible, safe disposal mechanisms across communities.
Menstrual discomfort remains another major concern. Over 72% of rural girls and 85% of urban girls reported premenstrual or menstrual problems, with abdominal pain being the most common complaint. As a result, 15% of rural girls and nearly 23% of urban girls said they missed school during menstruation.
Equally striking is the persistence of social and religious restrictions, particularly in rural areas. More than 86% of rural girls and nearly 74% of urban girls reported being barred from religious activities or normal household routines during menstruation, reflecting the continued hold of cultural taboos.
The study added that menstrual hygiene programmes must now move beyond distribution to focus on education, pain management, school support systems and sustainable disposal. "Menstrual hygiene is not merely a supply issue; it is a public health and dignity issue," the authors noted.
Despite these challenges, the authors acknowledged key gains. Universal sanitary pad usage marks a significant shift from earlier unsafe practices, reflecting the impact of State-led initiatives under the Rashtriya Kishor Swasthya Karyakram. The absence of a significant rural-urban divide in overall hygiene practices also points to a gradual narrowing of historical disparities.