Re-envision the evidence for Menstrual Health?
What we know, what we need to know, and how we gain insights to deepen and sustain action on menstrual health for all in India.
India has seen remarkable action on menstrual health and hygiene from a range of stakeholders, including the Government at all levels, NGOs, the private sector, CSR initiatives, and donors. A vast majority of interventions are on awareness generation, distribution (often free) of menstrual products, and making toilets accessible and usable by girls and women — all of which are essential for good menstrual health. Adolescent girls have been the mainstay of many of these interventions, with a few initiatives reaching adult women, people in sex work, persons with disabilities, communities in humanitarian contexts, incarcerated women, and people with gender-diverse identities, amongst other such vulnerable and overlooked groups. With such a wide-ranging set of actions by diverse actors across the country, what impact have we had, and do we know what works in the long term? To what extent are these interventions “evidence-based”, and what more do we need to know and do to support every person who menstruates to have good health (physical, social, and emotional) with respect to their menstrual cycle through their menstruating years and beyond?
We have more than 200 published research papers and organisational reports that give us valuable data and findings relevant for menstrual health and hygiene in India — more than any other country in the world. The Government of India has monitoring systems like the U-DISE and dashboards like the SMB-gramin with updated coverage or reach data, and national surveys such as the National Family Health Surveys that give us representative data on select aspects of menstrual health. We also have 100 plus organisations working on this issue, all having insights on the status of menstrual health and hygiene in the communities they work with, and what may improve their menstrual menstrual health. So is there a need for more evidence?
During the National Conclave, Re-envisioning Menstrual Health: Shaping India’s Narrative, held on 23–24 November in New Delhi, MHAi and Uninhibited brought together sector actors to deliberate on the status and need for evidence and insights on menstrual health, and how we can facilitate evidence-based action, fill lacunae, and foster understanding of emerging or lesser known (yet critical) issues. Here are some of our takeaways from the discussion:
- Need for a set of core indicators relevant for India to track progress
A plethora of research exists on menstrual hygiene management-related knowledge and practices, but a common set of basic indicators to assess improvements across community and school-focused studies, and Government initiatives is lacking. Drawing upon the rigorously developed priority indicators for menstrual health and hygiene for adolescent girls, we must deliberate on how India can use or adapt (as needed) these core indicators to generate comparable data that will enable us to track progress on awareness or knowledge; product access, hygienic usage, maintenance, and disposal; access to and use of functional, private and safe water, sanitation, hygiene, and waste management services, and even supportive social and political environments.
2. Generate evidence on long-term outcomes
Menstrual health is widely acknowledged to be an inter-sectional issue, requiring action across sectors (e.g., education, sanitation), and having direct and indirect multi-sectoral impact as well in the short and long term (e.g., sexual and reproductive health outcomes, school participation, women’s workforce participation). While short-term outcomes are known and measured to some extent, an understanding of relevant long-term outcomes relevant for India is required on priority. Further, how these long-term outcomes can be reliably evaluated needs attention, particularly those associated with educational attainment and sexual and reproductive health, mental health, and gender equality.
3. Identify where we need more evidence
We need to add to the substantial body of evidence on adolescent girls by garnering insights on groups or communities (e.g., refugees), life stages (adult women in their reproductive years), and issues (e.g., poly-cystic ovarian syndrome) that have been overlooked, lack understanding and documentation for diverse contexts in India.
4. Assess what works, with whom, and at what scale
A strikingly poor set of evaluations exists in India and globally. Such evidence is critical for us to inform policy, and investments in interventions with existing populations and newer areas of work. While experimental and quasi-experimental evaluations and complex qualitative studies are out of bounds for many organisations, non-experimental designs (e.g., pre-post test studies, case studies) can be deployed by implementing organisations. To enable this, a common set of menstrual health and hygiene indicators for India is required, along with capacity building to carry out practical, field-based intervention assessments. For those who can conduct robust research, collaborations with practitioners and policymakers to ground these studies is needed.
5. Widen the scope of evidence to include programmatic insights and community voices
Implementing organisations, social enterprises, and menstrual health educators and activists have a wealth of insights and understanding about the communities they work with. We acknowledge that this does not classify as scientific or academic research, yet can be pivotal in building understanding about sensitive issues and communities. Means to capture and disseminate such insights needs exploration and support. For instance, digital tools offered by some companies (e.g., Ooloi Labs, GritWorks) support field stories documentation, analysis, and reporting.
6. Invest to support evidence and insight generation, dissemination, and use
Investments are urgently required to support research and garnering of field insights by academics, research institutes, and implementing organisations and individuals. Donors may consider expanding their investment to support evidence generation, and case study documentation as a part of their intervention investments. Grants for scientific or academic research should be based on contextual relevance and need, and how the research findings will inform and support comprehensive and sustained policy and programmatic actions. Investments across the board must allocate sufficient funds to support the dissemination and utilisation of evidence. MHAi’s MHH Connect is a knowledge platform that is pooling together evidence and data on menstrual health in India. MIRA is an AI tool that provides a quick and accurate synthesis of existing evidence. These and other platforms can play a pivotal role in enhancing access to and use of evidence to inform action by all relevant stakeholders.
7. Ensure evidence and insight generation is ethical, respectful, and inclusive
Whatever be the shape or form of evidence on menstrual health and hygiene, the process of engaging with individuals and communities to collect data or hear perspectives must be done ethically, respectfully, non-coercively, and in a manner that research participants understand the process, voluntarily consent to participate, and are engaged meaningfully during and even after the data collection.
We want to support research, and importantly, the use of evidence and insights in menstrual health policies and programs in India. To this end, we call upon the community of practice to come together to:
- Co-develop set of essential and good to have indicators that can be used widely in school and community based studies to have comparable data and insights, and track progress
- Identify a research agenda for India, and explore funding to fill critical research gaps
- Support the recognition of program insights, and provide platforms to enable their amplification
- Collate, synthesise and share data, findings and field insights to all relevant sector actors
MHAi welcomes individuals, researchers, and organizatons to join the MHH research group. Further, the MHH Connect platform features research from India, and we invite you to share your research papers and collaborate with us to build this platform. Please reach out to Arundati (arundati@menstrualhealthaction.org) to learn more and to be a part of the research working group.
Written By
Arundati Muralidharan
Co-founder, MHAi
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