Beyond access to sanitary pads: a comprehensive analysis of menstrual health scheme impact among rural girls in Northeast India

Menstrual hygiene management (MHM) among girls in rural India poses a substantial challenge for public health, education, and quality of life, exacerbated by limited access to and affordability of menstrual products. In response to these issues, the Government of India initiated the Menstrual Hygiene Scheme (MHS) to enhance access and awareness. This study evaluates the impact of the MHS in Assam and Tripura, designated as "treatment states" with consistent pad supply from 2017 to 2021 compared to neighboring "control states" with negligible pad distribution. Utilizing data from two National Family Health Surveys, NFHS-4 and NFHS-5, and employing the propensity score matching difference-in-differences approach, we isolated the causal effect of the MHS distribution program. The key findings reveal a significant rise in sanitary pad and hygienic method usage in the treatment states, particularly among girls aged 15-19 years who received pads during the survey period. Their sanitary pad usage increased by 10.6 percentage points [95% confidence interval (CI) (0.046, 0.167)], and adoption of hygienic methods overall saw a 13.8 percentage point [95% CI (0.087, 0.188)] jump. Notably, younger girls aged 15-19 years also experienced a 6.1-percentage point [95% CI (0.004, 0.118)] increase in their understanding of ovulation, showcasing the MHS's potential to go beyond providing products and promoting menstrual health awareness. A rise in reported sexually transmitted infections in both age groups, with a statistically significant 1.8-percentage point [95% CI (0.004, 0.032)] increase for younger girls, warrants further exploration. Disparities in impact were observed, with girls with high media exposure and greater autonomy demonstrating greater improvements in hygienic practices, highlighting the importance of information dissemination and empowering girls. Most socioeconomic groups, except the highest wealth and education levels, witnessed rises in hygienic method usage, indicating the scheme's potential to reduce inequalities while hinting at the need for tailored interventions for marginalized communities.