Policy to Practice: Insights from Implementation of a School-Based Sanitary Napkin Distribution Program in Odisha, India

Abstract

Abstract Background For optimal menstrual hygiene among women and adolescent girls, access to affordable menstrual products, sanitation facilities, education, privacy, and destigmatization are essential. Recognizing this need, the Indian government has implemented various interventions to improve menstrual hygiene practices and personal hygiene among schoolgirls. In Odisha, an easternmost state in India, one such key initiative is the ‘Khushi’ program, a collaboration between the Health and Education departments. This program provides free sanitary napkins to all girls in standards 6–12 across the state. Our study explores the perspectives and challenges associated with implementing the ‘Khushi’ program in Odisha. Methodology : This paper emanates from a larger study examining the situation of menstrual health and hygiene in Odisha, conducted from September 2021 to December 2022. The focus of this paper is on qualitative findings related to implementation of the ‘Khushi’ program. In-depth interviews were conducted with key stakeholders, including officials from health and education departments, and school personnel involved in program implementation. Focus group discussions were held with schoolgirls of 6–12 standard to explore their experiences and perceived challenges regarding menstrual hygiene practices within the school environment. Further, review of program documents and relevant government policies was also undertaken. Results Analysis of data concerning experiences, enablers, and systemic roadblocks associated with implementing the ‘Khushi’ program yielded five key themes: (1) Approach to micro-planning, (2) Interdepartmental convergence, (3) Indenting and supply chain, (4) Capacity building, and (5) Monitoring and supervision. The study underscores the importance of designing and implementing a comprehensive behavior change strategy, that should capitalize on the existing collaboration between the health and education departments, while addressing identified weaknesses. These weaknesses include 'knee-jerk' planning and implementation without proper preparedness, limited coordination between departments, and overburdened frontline workers. Conclusion ‘Khushi’ is a state-specific initiative which has the potential to bring a paradigm shift in the menstrual health behaviour of school girls. Government may need to adapt a comprehensive strategy, including strengthening menstrual hygiene management (MHM)-friendly school infrastructure, imparting education and sensitization to implementing partners and beneficiaries alike, and integrating environment-friendly menstrual hygiene products in the program.