One in five young Indian women still lack hygienic menstrual protection: NFHS-6

Despite a decade of progress in menstrual hygiene, 20.8% of women aged 15–24 years continue to rely on unhygienic methods during menstruation, exposing deep regional, rural-urban and socio-economic inequalities, according to the latest National Family Health Survey (NFHS-6).

India has recorded another improvement in menstrual hygiene management among young women, but the pace of progress is slowing and millions remain left behind.

The National Family Health Survey-6 (NFHS-6), conducted in 2023–24, found that 79.2% of women aged 15–24 years use hygienic methods of protection during their menstrual period, up from 77.6% in NFHS-5 (2019–21). The survey defines hygienic methods as reusable sanitary pads, disposable sanitary pads, tampons and menstrual cups.

Yet the figures also show that 20.8% of young women, roughly one in five, continue to use unhygienic methods, primarily cloth.

Progress continues, but momentum has slowed

The latest findings extend a decade-long upward trend.

The proportion of young women using hygienic menstrual protection has risen from about 57.6% in NFHS-4 (2015-16) to 77.6% in NFHS-5 and 79.2% in NFHS-6. The overall gain of more than 21 percentage points over the past decade represents one of India’s largest gains in women’s health and hygiene indicators.

However, the increase between NFHS-5 and NFHS-6 is just 1.6 percentage points, substantially smaller than the jump seen between NFHS-4 and NFHS-5.

The data suggest that India may be entering a more difficult phase of progress, where reaching the remaining underserved populations requires targeted interventions rather than broad-based expansion of existing schemes.

The urban–rural divide persists

The national average masks stark disparities.

NFHS-6 shows that urban India is approaching near-universal adoption of hygienic menstrual products. Among women aged 15-24 years, 90.7% in urban areas reported using hygienic methods, compared with 75.0% in rural areas, a gap of nearly 16 percentage points.

This rural deficit remains the single biggest contributor to India’s menstrual hygiene gap.

The state-level data further underscore the divide. Andhra Pradesh reported that 94.3% of women aged 15-24 years used hygienic methods during menstruation, well above the national average. The state’s urban-rural gap was relatively narrow, with usage at 95.8% in urban areas and 93.6% in rural areas.

Moreover, wide regional disparities also persist. Coverage was highest in Lakshadweep (99.7%), Sikkim (99.1%), Mizoram (98.8%), Tamil Nadu (97.7%) and Goa (97.5%), while Bihar (63.0%), Madhya Pradesh (65.4%), Gujarat (66.9%) and Uttar Pradesh (69.2%) ranked lowest.

The nearly 37-percentage-point gap between the top and bottom performers highlights a persistent inequity in women’s health, with access still varying sharply by geography.

Menstrual hygiene reflects broader empowerment

The NFHS-6 findings suggest that menstrual hygiene is increasingly linked to wider social and economic development.

The survey recorded substantial improvements in indicators associated with women’s empowerment. Women’s ownership and use of mobile phones increased from 53.9% in NFHS-5 to 63.6% in NFHS-6, while the share of women who own and use a bank or savings account rose to 89.0%, from 78.6% in NFHS-5.

Menstrual hygiene adoption is strongly linked to education, household wealth, access to water, sanitation and hygiene (WASH) facilities and empowerment indicators. As seen in the consistent urban-rural divide (90.7% in urban areas vs 75.0% in rural areas), usage is significantly higher among better-educated, wealthier, and more digitally connected women. These patterns also overlap with rural residence and disadvantaged social groups, creating multiple layers of exclusion.

Young women with greater educational attainment and access to information are more likely to use sanitary pads, menstrual cups and other hygienic products. Conversely, girls from poorer households and rural communities remain more likely to rely on cloth.

Beyond access to products

However,  menstrual hygiene is not only about product availability.

Proper menstrual hygiene management requires access to clean water, private sanitation facilities, safe disposal mechanisms and accurate menstrual health education.

NFHS-6 measures whether hygienic products are used, but does not fully capture how frequently products are changed, whether disposal is safe, or whether girls have access to adequate sanitation facilities.

As a result, improvements in product use may not always translate into optimal menstrual health outcomes.

Why it matters

Menstrual hygiene is a critical public health issue.

The use of hygienic menstrual products can reduce the risk of reproductive tract infections, improve comfort and dignity, support school and college attendance, and help challenge menstrual stigma and taboos.

Poor menstrual hygiene management remains a barrier to education and social participation for many adolescent girls, particularly in rural India.

The persistence of a 20.8% shortfall therefore represents more than a health challenge. It reflects continuing inequalities in education, sanitation, awareness and access to essential products.

The next phase of policy

The latest survey suggests that India has moved beyond the stage where nationwide awareness campaigns alone can deliver major gains.

Future progress is likely to depend on targeted action in low-performing districts and states, improved last-mile delivery of menstrual hygiene products, stronger behaviour change communication, better disposal infrastructure and comprehensive menstrual health education in schools and colleges.

NFHS-6 confirms that India has made remarkable progress in menstrual hygiene over the past decade. Yet the survey also delivers a clear message: celebrating a national average of 79.2% should not obscure the reality that more than one in five young women still do not have access to hygienic menstrual protection.

The next challenge is not expanding access everywhere. It is reaching the women and girls who continue to be left behind.