A reason to smile: the five ‘A’s approach to promote menstrual hygiene management in adolescent girls

Menstrual hygiene is an issue that every girl has to deal with from adolescence until menopause. Bringing the issue of menstrual hygiene management (MHM) out of the closet has been a constant struggle and challenge, even in a progressive state like Maharashtra, India, where nearly 19 million adolescent girls and women of menstrual age live (55 per cent of total rural female population of the state, GoI, 2011). Field studies by UNICEF suggest only 13 per cent of menstruating adolescent girls between 11 and 19 years of age were aware of menstruation before menarche and 60–70 per cent of adolescent girls do not attend school during their time of menstruation. Also, 84 per cent report the absence of a place to change absorbents at school. Girls simply stay away from school to avoid staining and embarrassment. Given the nature of the findings, which involves both demand (awareness) and supply (access) interventions, this paper proposes a framework of enabling factors at five levels: awareness, aspiration, affordability, availability, and access. The paper looks at an approach to design and implement MHM programmes with scale, and concludes with recommendations based on systemic challenges in the overall political and administrative priority for MHM programmes in India with reference to Maharashtra.