Sanitation barriers, lack of awareness and unaffordability affecting menstrual health management among urban low-income group, informal sector women workers: A study from Mumbai suburbs

Abstract: (i) Background and objectives: Millions of women across the world experience menstruation, yet for those in the low-income, informal urban workforces, it can be accompanied by an unpleasant experience due to poor sanitation, financial constraints and lack of awareness. In the Indian urban context, despite a decade of implementing policy initiatives, including the Rashtriya Kishor Swasthya Karyakram and the Menstrual Hygiene Scheme by the Government of India, urban women of reproductive age in the low-income group informal workforce have seen limited benefits. We sought to understand the gaps preventing healthy menstrual health management (MHM) among these women in Mumbai's suburbs and aimed to learn, directly from them, what interventions might help in their MHM. (ii) Methods: 100 randomly selected women of reproductive age, belonging to the low-income group urban work force, in Mumbai Suburbs were surveyed. A structured 18-item questionnaire was used to conduct a one-on-one interview, surveying about demographics, menstrual hygiene product use, hygiene practices, sanitation access, diet, and challenges faced. (iii) Results: More than half the participants of the study (53%) earned under INR10,000 a month and 87% were aged above 18 years. A striking 79% of the participants had experienced at least one clinically significant menstrual morbidity; sanitation barriers affected 67% while 15% were forced to change pads in unsafe, open spaces; and adequate nutrition during periods was reported by only 24%. 57% of the participants reported that a combination of awareness, better toilets and subsidised pads will help them manage their menstrual hygiene better. (iv) Interpretation and conclusions: For low-income women in the informal urban workforce, menstrual health challenges arise from gaps in knowledge, inadequate sanitation infrastructure and unaffordability of menstrual hygiene products. This highlights the need for coordinated action- spreading awareness, building accessible sanitation facilities, and strengthening primary healthcare to screen and treat menstrual morbidities- along with distribution of subsidised menstrual hygiene products for these underserved population.