In October 2025, Karnataka became one of the few states in India (and countries across the world) implementing a menstrual leave policy. 1The Karnataka policy to offer working women across public and private sectors 12 paid menstrual leaves annually. The other states include Bihar, Kerala, Odisha and Sikkim. Outside India, ountries like Japan, South Korea, Zambia and Spain have similar policies.

The state government explained its decision as a move to address women’s health by attending to social determinants such as gender-responsive workplaces. The move brings much-needed attention to a natural, biological process that women routinely undergo, but are discriminated and stigmatised for, with implications on their health, mental health, and well-being.

The socio-cultural taboos around menstruation restrict girls’ and women’s access to nutrition, healthcare and menstrual hygiene products, mobility and play.

Menstrual leave is a debated issue, with national legislation remaining stuck in Parliament (BCP Associates, 2023). 2Bills were introduced in 2017 and 2018, and most recently, the Right of Women to Menstrual Leave and Free Access to Menstrual Health Products Bill, 2022.  Prominent women lawmakers have argued that menstruation is a natural phenomenon and must not be seen as a limitation. Others worry that such policies might create a bias against hiring women. Yet others predict productivity loss, especially in smaller enterprises, and difficulties in monitoring implementation. On the other side, provisions for a single day of leave for a phenomenon that extends over three to five days, and affects women differently, have been considered as tokenism.

Such a framing of the issue misses how welfare measures around menstruation could normalise women’s sexual and reproductive health (SRH), bring attention to neglected aspects of women’s health within public discourse, and strengthen women’s empowerment outcomes. It further fails to acknowledge principles of equity, and the historical discrimination and stigma that women of reproductive age regularly experience as a result of the natural and biological process of menstruation, every month.

Women’s Experiences of Menstruation

The average women experiences menstruation for nearly three decades of her life, starting in the adolescent years and continuing up to the age of 45-50 years. This age-span also overlaps with critical periods of education, employment, and care-work for women.

The socio-cultural taboos around menstruation restrict girls’ and women’s access to nutrition, healthcare and menstrual hygiene products, mobility and play (Gold-Watts et al., 2020; Kumar & Srivastava, 2011; Saini et al., 2024). School dropouts are correlated with the attainment of menarche (first menstruation) for girls, which is further correlated with early and child marriages, and teenage pregnancies (Beattie et al., 2019; M Khanna, 2019).

Menstrual health entails more than just ensuring access to menstrual products or resources to manage menstruation, such as toilets and water.

Public celebrations within several communities at attainment of menarche, announcing girls’ preparedness for marriage, may put adolescent girls at discomfort, affecting their mental health. Stigma and taboo often prevent women from seeking help or taking action towards healthy management of menstruation, including access to household spaces, foods, and healthcare (Suman, 2025). This means that many women suffer silently through uncomfortable period cycles with heavy menstrual bleeding, anaemia, pain, fatigue or mood disorders. These symptoms that are often normalised, may in fact signal more serious underlying conditions, such as Polycystic Ovary Syndrome, Abnormal Uterine Bleeding or Endometriosis. It is estimated that 15-87% women in India experience dysmenorrhea or painful menstruation, with wide variations in prevalence across states (Chaudhary et al., 2025). Dysmenorrhea may also be associated with psychological distress and irritability, and decreased self-esteem. Studies have shown a likelihood of exacerbation of psychiatric symptoms and suicidal ideation prior to and during the menstrual cycle (Handy et al., 2022).

The severity of these conditions associated with menstruation not only call for better public awareness and data, but also supportive educational and work environments with flexible arrangements.

Menstrual health: A Complete State of well-being

Public discourses on menstrual health and health equity is largely limited to menstrual hygiene and is primarily directed towards adolescent girls through the Menstrual Hygiene Scheme. Little attention has been paid to the importance of menstrual health — achieving an overall wellbeing in relation to the menstrual cycle for all girls and women across the gender and age spectrum. We do not have, for instance, even a comprehensive national dataset on the prevalence of dysmenorrhea (Chaudhary et al., 2025).

Menstrual health entails more than just ensuring access to menstrual products or resources to manage menstruation, such as toilets and water. It includes individuals’ awareness and access to resources that can support them to participate fully in all spheres of education, work and life during their menstrual cycle, including access to healthcare, early diagnosis, support systems, and policies that recognise period pain as a serious public health issue.

Stigma and taboo often prevent women from seeking help or taking action towards healthy management of menstruation, including access to household spaces, foods, and healthcare.

Menstrual health management is affected by social determinants, such as geographical remoteness, which affects transport and supply chains for menstrual products and services, built-environments, and access to water and sanitation facilities, employment conditions, education, sociocultural taboos and stigmas. Differences emerging from these social determinants further contribute to inequities in menstrual health management. Period poverty, defined as limited access to period products, menstrual education, or adequate water sanitation and hygiene facilities, affects millions of girls and women worldwide, preventing them from fully participating in education and work.

In the Indian context, undoubtedly, girls and women from the most socio-economically marginalised groups such as Scheduled Caste and Scheduled Tribes, rural and hard-to-reach tribal communities, trans girls and women, women working in the informal and unorganised sectors, are most likely to bear the highest burden of poor menstrual health, stemming from these inequities (Roy, 2024; UN Women, 2025).

A first step, but miles to go…

Not every menstruator may require relief from paid work or school during their menstrual cycle, but Karnataka’s menstrual leave policy, in principle, protects women’s right to make decisions regarding their bodies and management of health. From a health equity lens, it is a step in the right direction.

However, there is much more to be addressed in implementation of the policy, including extending the same opportunities to women in unorganised sectors and adolescent girls in schools and colleges. Karnataka has 60 lakh women in the workforce, of which 4.5 lakh women work in garment factories under highly restrictive conditions, with long hours of work and limited breaks (Dev, 2025). One-third, or about 80,000 active job card holders under the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGA), are also women. For women engaged in these forms of casual work, and other sectors such domestic work, daily-wage labour, sanitation, street vending, construction sites, plantations and small-scale service sectors, outside formal institutions, office spaces and environments, management of menstruation are rarely simple or straightforward. 

Menstrual management in these contexts entails decision-making around leaving the house for work or education, keeping in mind considerations such as availability of toilets with water, restrooms, adequate breaks, and frequent travel or fieldwork (e.g., gig workers, frontline health workers like ASHAs). What the policy offers these workers is an opportunity to prioritise health and manage menstruation with dignity.

Supplementing Leave with Education and Infrastructure

Menstrual leave is just the first among several steps needed to assure better health, well-being and dignity for women. Stronger efforts will be needed to break the stigma around menstrual health, through curriculum, public health campaigns and social and behavioural change strategies.

Educational institutions and workplaces have to become more conducive to menstruators, through sensitisation programmes for employees. They also need to provide access to menstrual products, and functional toilets that are women-, trans-women-, and disabled-friendly. (An estimated - 3,500 schools, in Karnataka lack functional toilets and about 4,000 lack WASH facilities, indicative of the menstrual health management challenges [R Khanna, 2025]).

Menstrual leave is just the first among several steps needed to assure better health, well-being and dignity for women.

Routine menstrual health awareness programmes and screening for menstrual disorders, and its effects on mental health, must be put into place, through public health systems, educational and community-based institutions and facilities, including Sanjeevini Sanghas or other self-help groups. Instituting these provisions can increase timely detection and support to women to manage menstruation and mental health. Along with this, increased awareness, knowledge and skills to manage conditions such as endometriosis and menopause, for women, as well as men -as care givers - needs to be inculcated.

Another area that has received less attention is the impact of climate on menstrual health (Moore, 2022). Climate change is known to impact women’s hormonal balance affecting their menstrual cycles. Further, in the context of climate-induced migration and displacement, women’s access to information, knowledge, menstrual health services and products may be affected. Thus, it is important to develop a proactive public health strategy focused on mitigating the impacts of climate on menstrual health.

Conclusion

Building a supportive ecosystem for improved menstrual health management for women is an important step towards achieving health equity, and the Sustainable Development Goals (SDGs). Not just the state, but employers, particularly in the unorganised sector, and civil society, must also take on the moral responsibility of adequately supporting women’s menstrual health needs.

There are significant gaps currently, in assuring women safe and dignified periods at the workplace. Successful implementation of the policy, particularly ensuring buy-in by industry and educational institutions, and women’s demonstrated confidence in availing the leave without stigma or fear, can provide the much-needed impetus to move a legislation on menstrual leave and menstrual health at the central level. Within a month of announcing the policy, private institutions have already drawn this matter to court, challenging the government’s implementation of the policy (Express News Service, 2025). The state’s efforts at resolving such contentions and working with industry bodies in sensitising them to the issue and allaying fears around productivity, providing clear guidelines for implementation, building monitoring and accountability mechanisms to ensure the implementation of the policy can provide lessons for implementation for other states to follow. Legal interpretations and the precedence set by the Karnataka High Court in interpreting the state’s mandates towards health equity and powers to enforce the menstrual leave policy will have broader significance. It can provide directions for better accountability and regulation of health provisions and services for other states and the country, in the context of extensive neoliberal reform of the economy and privatisation of welfare.

Karnataka is yet to outline the mechanisms for availing leave without the fear of loss of remuneration, ensuring compliance, for grievance redressal mechanisms in case employers do not adhere to the regulations. Public support and provisioning, and civil society acceptance and respect for menstruators and their needs will be key to successful implementation of the policy, particularly for women workers in unorganised sectors, such as daily wage labour, domestic workers, street vendors, agricultural and plantation workers, who are still to be covered under the policy ambit and for whom infrastructure provisioning remains inadequate.

R. Maithreyi is the thematic lead of the Women’s Health vertical at Karnataka Health Promotion Trust (KHPT). The opinions expressed in this article are her own, and do not represent the views of any organisation.

This article is being published under the Appan Menon Memorial Award 2025 which has been awarded to The India Forum.