Walk into almost any government school in India and you will likely find a toilet block for girls. On paper, the progress is real: the government’s own school-records system, the Unified District Information System for Education, (UDISE+) 2024–25 data, which tracks every recognized school in the country, reports that 97.3% of schools have girls’ toilets, 99.3% have drinking water, and 95.9% report handwashing facilities. These figures are showcased as markers of how far school sanitation has come, most of that gain arriving over the past decade, after the 2014 Swachh Bharat: Swachh Vidyalaya drive to build toilets in every government school.

But ask an adolescent girl what happens when she gets her period at school, and a different story emerges. Behind the signage lie broken or missing disposal bins and dry taps; incinerators installed during high-profile drives often sit unused for want of maintenance. Left with no dignified option, a girl changes her pad, wraps it in newspaper, carries it out in her bag, and hopes no one notices.

This is the norm, not the exception, and it points to a misdiagnosis at the heart of our menstrual health agenda. We have treated menstruation as a product-distribution problem, when it is, above all, an infrastructure failure.

The product-plumbing paradox

On the supply side, India has achieved something genuinely remarkable.  India’s National Family Health Survey-5 shows that 77.3% of women aged 15–24 now use period products, up from 57.6% five years earlier. Pads reach girls through schools, anganwadis, ASHA workers, and state schemes.

But product access is not menstrual equity. In rural and marginalised communities, close to half of women still rely on cloth. And handing over a product without a safe place to use it solves only half the problem. Against the near-universal handwashing figure schools report, the WHO–UNICEF Joint Monitoring Programme and UNICEF India find that only about half of Indian schools actually have handwashing with both soap and water, and that around a quarter of girls miss school during their period. The gap between infrastructure that exists on paper and infrastructure that works is where menstrual health quietly fails.

The community toilet blind spot

Schools at least draw occasional attention. Public toilets, often the only sanitation available to domestic workers, street vendors, women in informal settlements and the urban homeless, remain largely invisible in policy. An ActionAid India survey of 229 public toilets in the national capital found that 35% had no separate section for women at all; of the women’s toilets, 53% had no running water, 45% had no way to lock the door from inside, and only 39% had soap. For a woman managing her period on the street or in a settlement, this is not an inconvenience; it is a direct assault on her dignity and health.

Coping by shrinking

When infrastructure fails, women adapt, but the adaptations are themselves harmful. Many drink less through the day to avoid the toilet. Others stay home, or withdraw from school, work and social life for the length of their period, not because of pain or stigma alone but because the built environment cannot accommodate them. These are rational responses to an irrational situation, and in aggregate they are a serious drag on women’s health, schooling and earnings. Menstrual absenteeism is not only a problem of shame and silence. It is also a problem of broken taps and missing bins.

What we don’t measure, we don’t fix

Part of why this persists is that we measure the wrong things. UDISE+ and similar systems ask largely binary questions: does a girls’ toilet exist, is there water on the premises, … not whether there is water inside the cubicle, a working lock, or a functioning way to dispose of a pad. There is no national indicator for what practitioners call an Menstrual Hygiene Management (MHM)-compliant toilet: private, clean, with water and soap to hand and safe disposal. A peer-reviewed assessment of India’s WASH databases shows that functionality data are often collected but never made public, leaving real gaps invisible to planners and budgets. What is not measured is not funded.

None of this is technically hard. Every cubicle women use needs water, soap and a covered bin inside, not outside, not shared. Maintenance must be a recurring budget line, not a post-construction afterthought. Urban frameworks like the Smart Cities Mission should treat menstrual-hygiene standards as a baseline, not an add-on.

India’s menstrual movement did something important: it brought menstruation into public conversation and put pads in the hands of girls who had none. But continuing to distribute products while the plumbing stays broken is like handing someone a toothbrush without water or a basin. The product was never the whole problem; the plumbing is the half we have ignored. Menstrual health cannot be achieved with pads alone; it demands pipes, privacy and policy, in that order, and urgently.