It was her first time using a menstrual cup, but Ashwini (name changed), a Chennai native, was more curious than apprehensive. “It involves insertion [into the vagina], so I was a little unsure. There was some initial discomfort, but after a few tries, I got used to it,” says the 38-year-old.
Ms. Ashwini was one of the beneficiaries of the Thinkal project, as part of which about 2,000 menstrual cups, or M-cups, were distributed for free in select areas of North and South Chennai over the past two years. The project, launched by HLL Lifecare Limited — a government-owned company under the Union Ministry of Health and Family Welfare — was then expanded to other parts of Tamil Nadu, including Dindigul, Erode, and Thanjavur.
Menstrual hygiene challenges
Menstrual hygiene remains a significant challenge in India, particularly in low-income settings, due to deeply rooted social and cultural beliefs and limited awareness. Common products like sanitary napkins and tampons are expensive, placing them out of the reach of many women, who are then forced to rely on unhygienic alternatives, which can cause numerous health issues and lead to poor reproductive health. Sanitary napkins and tampons also contribute substantially to environmental waste.
Menstrual cups, on the other hand, are widely considered healthy, safe, and affordable alternatives. An M-cup is essentially a device that is inserted into the vagina during menstruation to collect blood. The cups distributed under the Thinkal project are made of non-absorbent, reusable, medical-grade silicone, and are bell-shaped, sealing against the wall of the vagina, just below the cervix. They can ideally be used for 6-12 hours depending on blood flow, must be boiled in water after each period, can be reused for a minimum of five years, and are suitable even when water and sanitation facilities are scarce.
Sapna Raina, Senior Consultant and Clinical Lead in the Obstetrics and Gynaecology Department, Narayana Health City, Bengaluru, says menstrual cups have been shown to improve menstrual hygiene, when compared to cloth, sanitary pads, or even tampons. “Unlike cloth or sanitary pads, there are no issues of chafing with menstrual cups. They are also less likely to cause infections,” she says.
From relief camps to households
During the 2018 Kerala floods, women in relief camps in Alappuzha — one of the worst-hit districts — faced severe difficulties accessing and disposing of sanitary pads. The Thinkal project was launched in the Alappuzha municipality that same year to address some of these concerns. The programme involved identifying beneficiaries, educating them about the use of M-cups before their distribution, and analysing the product’s acceptability through feedback. This was done with the help of anganwadis, civic bodies, healthcare workers, local NGOs, self-help groups, medical practitioners, and the State government.
Thinkal was soon extended to other parts of Kerala, and in two villages in particular — Kumbalangi in Ernakulam and Kallikkad in Thiruvananthapuram — the acceptance of M-cups was so high that they were declared ‘sanitary napkin-free’ grama panchayats.
Besides Kerala and Tamil Nadu, over 10 lakh cups have been distributed under the project across six States and two Union Territories — Karnataka, Andhra Pradesh, Telangana, Maharashtra, Jharkhand, Haryana, Lakshadweep, and the Andaman and Nicobar Islands — as of March 2025.
“This is an end-to-end activity; it starts with awareness and ends with post-supply support. We also have a dedicated helpline if the beneficiaries have any questions or concerns,” explains Harikrishnan Namboothiripad, Associate Vice President at HLL, adding that the project focuses mainly on women from lower economic sections of society, in urban, rural, and tribal areas.
“In certain areas we have taken our project to, M-cups are seen as an alternative to sanitary napkins, but in certain other places — for example, in the tribal villages of Jharkhand — women don’t even have access to menstrual hygiene products. They use clay instead of sanitary pads. So, for them, this is the primary menstrual hygiene product,” he adds.
The menstrual cup distributed under the Thinkal project
| Photo Credit:
Instagram@hlllifecarelimited
Understanding behavioural patterns
The adoption of a menstrual hygiene device like a menstrual cup, however, is neither easy nor quick, primarily because it requires insertion into the vagina, which is tied to various physical, social, and cultural perceptions. This is a concept that demands a high level of awareness, says Mr. Harikrishnan. There will be challenges when establishing a new concept, so frequent follow-ups are necessary to ensure sustained use, he adds.
An independent study conducted in 2021-22 on the project implemented under the Cochin Corporation limits, which involved 704 users of M-cup, showed an acceptance rate of 84.6%, meaning nearly 600 respondents continued to use the product during their period. Beneficiaries of the age group 25-35 years were more confident in using the cup, whereas those between 41 and 45 years were the least confident.
Another independent study from 2020-21, published in Public Health in Practice, which examined the progress of the project in Alappuzha, also observed that there was a higher acceptance of menstrual cups among women in the age group of 25-45 years. Moreover, the usage was higher among beneficiaries who attended the awareness sessions than those who did not, the study found.
As far as non-users were concerned, both studies noted that a lack of confidence in the menstrual cup, the fear that it might get stuck in the vagina, the discomfort of using it in a public toilet, the fear of catching infections, the pain during insertion, the lack of support from family, and the fear of leakage were some of their major apprehensions.
“The biggest challenge we have come across is fear. No matter how many awareness sessions we conduct or how many medical professionals we bring in, this fear needs to be addressed from within,” says Krishna S.H., manager, Public Health Initiatives, HLL.
Dr. Krishna says they try to tackle this fear by using uterus models to show how the menstrual cup is inserted and how it is placed inside the vagina. “When a person is inserting it for the first time, it may not happen properly. This initial discomfort will trigger an apprehension, and they might stop using it,” she adds. The key is to keep going, and having peer support helps, she says.
Dr. Krishna says awareness among doctors and medical professionals is also necessary to make a project like this work. “Often, when women face some discomfort after using the product, they might end up consulting their local doctor. And these doctors may shame them for using a menstrual cup due to certain preconceived notions, which in turn might dissuade the users. Therefore, we make it a point to conduct classes for doctors too.”
Perceptions surrounding virginity
While the post-supply studies from Kerala focused mainly on married women, Dr. Krishna says among adolescents, a major factor that contributes to the fear of usage of M-cups is the idea of hymen tear.
When the device is inserted, it opens up from the inside. In some cases, it can lead to the hymen tearing or stretching, but this concept is shrouded in misinformation, she says. In India, the hymen is falsely considered an indicator of a woman’s virginity, with the social practice of ensuring a newly-married woman has bled after sex often seen as proof of her chastity.
Dr. Sapna says: “The hymen is a thin tissue that can stretch and tear due to other activities as well, like while playing a sport or cycling. Does that mean that we should stop those activities? The hymen is not an indicator of virginity.” Adding that there is a need to create awareness about this, she says the concept of virginity itself is flawed as it puts a heavy burden on young girls and women, and if they don’t satisfy certain conditions of virginity, they may be subjected to gender-based violence.
Dr. Krishna says the premise of the Thinkal project was to raise awareness among mothers first, and let them take the product to their daughters. “We conduct a need assessment survey before launching the project in any place. In Chennai, for instance, it focused mainly on married women. But now, we are slowly moving on to college students and the adolescent population because they have shown a lot of interest in the product,” she adds.
Moreover, perceptions are changing, Dr. Krishna says, adding that their studies observe that about 50% of mothers who have become comfortable with menstrual cups recommend it to their daughters.
Ms. Ashwini, for instance, has a seven-year-old daughter. “When she gets her period, I will make sure this is her first product. I have been saving a lot of money by using menstrual cups, it doesn’t leak, and it is very comfortable,” she says.
Published – March 21, 2025 03:37 pm IST
