Social exclusion and a lack of education on menstrual hygiene are forcing many girls in India to drop out of school early or be ostracized for the duration of their menstrual cycle every month.

This practice continues to be observed in huge pockets of India's rural hinterland where a lack of awareness and knowledge regarding menstrual hygiene is prevalent among school-aged girls.

Millions denied proper education

A recent study by the UN's child protection agency, UNICEF, stated that 71% of adolescent girls in India remain unaware of menstruation until they get their first period. When they do so, many drop out of school.

Another report by the NGO Dasra, which was published in 2019, pointed out that 23 million girls drop out of school annually due to a lack of proper menstrual hygiene management facilities, which include the availability of sanitary pads and information about menstruation.

Public health experts and NGOs working in this area also point to a lack of basic services, such as access to toilets and clean water; as well as social stigmas, harassment, and taboos.

"Practically no information is available to young girls before their first period," Vandana Prasad, a community pediatrician and public health professional, told DW.

"We have heard young girls and women recall how they were so worried that they had contracted some life-threatening illness the first time they ever had a period. The information they do receive is generally from peers and is often incomplete and incorrect," she said.

Having worked on reproductive health issues with women and girls in tribal and rural areas for over two decades now, Prasad said menstruation is a major public health issue causing immense struggles and difficulties on many levels.

"Social taboos still abound and girls face various forms of discrimination during their periods such as denial of certain foods, denial of physical access to spaces like kitchens and temples and on rare occasions even have to stay in some outhouse for a couple of days," Prasad added.

Menstrual products out of reach

On top of the mental and psychological stress is the enormous challenge of getting hold of sanitary pads, disposing of them and keeping themselves dry and clean, which particularly affects school-age teenagers.

"All in all, it's a monthly additional burden of misery for poor girls and women that increases their marginalization and puts them at an additional disadvantage over and above their already poor health, nutritional, educational and social status," Prasad said.

For many, menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining unaware of the scientific facts and hygienic health practices, which can sometimes cause health problems.

This culture of silence builds up shame and embarrassment around menstruation in families and communities.

Jaya Velankar, director of Jagori, an NGO working on women's issues, believes it is very common for adolescent girls to not attend school during their periods for both cultural and material reasons.

She explained to DW the social concerns that arise in families once their daughters begin menstruating.

"For many girls, especially in rural areas, the onset of menstruation becomes the end of their school education as parents have dual fears in mind," Velankar said.

"They are scared that the girls become more vulnerable to sexual violence. They also fear that girls may become sexually active and get into relationships, the real fear being girls falling in love with boys from 'lower castes,'" she added. 

Silence about menstruation

Some experts who have studied the issue closely believe that age-appropriate, standardized sex education is the necessary solution.

They say sex education not only imparts scientific information about bodily processes like menstruation but also covers a wide range of issues from intimate relationships, gender identity, sexual orientation and most importantly, the importance of consent and responsibilities including contraception.

"However, there is a huge resistance to it from governments of all political tendencies. We need more public discourse on the issue," Velankar said.

The latest National Family Health Survey (NFHS) report published in May revealed that about half of all women aged 15-24 in India still use cloth for menstrual protection, which experts warn can lead to multiple infections if reused. They attribute this to a lack of awareness and a taboo existing around menstruation.

Dialogue must continue

Film producer Guneet Monga won an Oscar in 2019 for her documentary, "Period. End of sentence," which is about the deep-rooted stigma attached to menstruation. She urges stakeholders to continue talking about the subject.

"Change is a socio-political-economic process. I am happy at least more people are talking of girls dropping out of schools and I know there is a long way to go," Monga told DW.

Period bullying, when peers, characteristically boys, or teachers mock and ridicule girls for issues related to menstruation, has also been a factor resulting in school dropouts.

"In some of the rural schools I work in Uttar Pradesh and Delhi, I try to involve boys in achieving a period-supportive community. Boys need to be made aware of this natural bodily process and that is important," Sulekha Singh, campaign coordinator of Action India told DW.

Anshu Gupta, who quit his corporate job to start Goonj, a non-profit organization that began to make low-cost sanitary pads out of waste cloth for rural women believes the issue has to be looked at again with a different lens.

"This is a complex issue with different challenges. But I think access, affordability, and awareness about menstrual hygiene is important," Gupta told DW.

Edited by: Alex Berry