Blood Sisters: How One Organisation Is Addressing Period Poverty and Plastic Waste in Rural India

‘I was playing with my friends when I saw the blood and panicked,’ Parul told FairPlanet, recalling the day she first got her period at 16. Her elder sister then handed her a piece of cloth and explained what had happened. ‘During her period,’ Didi told her, ‘she must use a cloth to soak the blood.’

For the next few years, Parul says she dreaded her menstruation. ‘First you find a clean cloth, then keep adjusting it and finally figure out how to dispose of it,’ she said. Later, an Accredited Social Health Activist (ASHA) worker in her village encouraged her to switch to sanitary pads. It helped, but the cost quickly added up. Parul’s story reflects a wider reality in India, where millions of women still rely on improvised materials during their periods, often because sanitary products remain expensive or inaccessible. 

While access to hygienic menstrual products has improved, rising from around 15% in 2010 to about 78% in 2019–21, according to the National Family Health Survey 5, affordability and access remain uneven, especially in rural areas. At the same time, the widespread use of disposable pads has created a growing waste problem. A single sanitary napkin can take between 500 and 800 years to degrade in soil, according to research published in the National Library of Medicine.

This tension has led some organisations to explore alternatives. In northern India’s Saharanpur district, the Lal Sakhi Foundation, is encouraging the use of menstrual cups made from medical-grade silicone as a low-cost and reusable alternative to disposable sanitary products. A single cup can last up to 10 years and hold three times as much blood as a sanitary pad, according to a study in The Lancet Public Health.

Last year, Parul, 28, learned about the menstrual cup through an awareness session in her village. ‘The cup is great. I feel like I’m not even having a period,’ she told FairPlanet. While conversations around menstruation are still difficult in many communities and menstrual cups often face hesitation, Parul wants to start telling other women about them. Soon she will become what the Lal Sakhi Foundation calls a ‘change agent’.

Blood Sisters

Behind the Lal Sakhi initiative is 32-year-old social worker Preeti Jangra. Preeti herself struggled with heavy periods. While studying at the Tata Institute of Social Sciences, she switched to a menstrual cup and experienced its benefits. Later, working with Adivasi women, she encountered the realities of poor menstrual hygiene.

‘I knew many women used cloth, but here I saw women using ash, sand and leaves, often complaining of itching and infections,’ she told FairPlanet. 

During the pandemic, she returned to her hometown and founded Lal Sakhi — which translates to ‘Red female friend’ who is like a ‘sister’ in Hindi. Preeti knew that raising awareness around menstrual cups would require a different approach; going from village to village on her own would not work. ‘Change can happen if we come together. This is why we work on this “change agent model”, so we can reach more women through their communities,’ she explained.

In practice, this means working through women already trusted within their communities. These include government accredited frontline workers such as the ASHA and Anganwadi workers, as well as Samooh and Swasthya Sakhis, who are women supporting savings groups and community health initiatives. Lal Sakhi invites them to training sessions and encourages them to share information about menstrual cups with other women.

Change, slowly

For 32-year-old Anshika Saini, a Swasthya Sakhi from Wajidpur village in Saharanpur district, the cups have been a game changer. Earlier, she told FairPlanet, heavy flow meant constant worry about staining. After trying the cup herself, she began encouraging other women in the village to use it. ‘If one woman tries it and feels good, she tells her friends and family,’ Anshika said. ‘The biggest change is that we rarely see pads lying around now.’

The waste from disposable sanitary products is a growing concern in India. According to the nonprofit Toxic Link’s widely cited study, sanitary pads generate more than 113,000 tonnes of non-biodegradable waste each year, placing pressure on landfills and sanitation systems. Efforts to address disposal have included installing small incinerators in sanitation facilities under government programmes linked to the National Health Mission and the Swachh Bharat Mission-Gramin.

However, researchers note that the environmental impact of these technologies remains debated. Hema Sudhakar, a scholar from the Department of Civil Engineering at Sri Ramakrishna Engineering College, Coimbatore, notes in her research that many waste-treatment technologies, including incinerators, have yet to be tested at scale, particularly in rural settings.

Against this backdrop, initiatives such as Lal Sakhi’s DHARTI (Degradable Hygiene Management and Recycling Training Initiative) programme encourage the use of reusable menstrual cups instead of disposable products. The idea is gaining attention elsewhere in India as well. Earlier this year, the state of Karnataka announced plans to distribute menstrual cups to schoolgirls as part of efforts to promote more environmentally sustainable and cost-effective menstrual health practices.

A menstrual cup can last up to 10 years and generates only about 0.4% of the plastic waste and around 5% of the cost of disposable pads, according to research published in The Lancet Global Health. Programmes promoting cups are beginning to test these benefits in practice. So far, Lal Sakhi claims it has trained 24,500 change agents, leading to 9,560 cup users who together have prevented nearly 4,600 kilograms of plastic waste.

When the men walk out

But these numbers do not translate evenly across villages. In her village of Mehmoodpur, Sangeeta, a community health worker and a change agent with Lal Sakhi, has had to work harder to convince women about the menstrual cup, a hesitation she understands well. She faces the same questions and concerns she had at first: What if the cup moves upward and gets stuck? What if it causes infections?

‘Sometimes,’ Sangeeta tells FairPlanet, ‘these questions do not even come from women, but from their husbands,’ as many women have limited decision-making power within households. Discussions about menstruation can still be sensitive in many households, which sometimes slows the spread of new practices.

This is why Lal Sakhi has adapted its programme to target both men and women in its awareness and training sessions. ‘Sometimes men just walk out of the conversation because they feel uncomfortable discussing it with women,’ Preeti says. One way the organisation has addressed this is through longer counselling sessions in families’ homes. The most persuasive factor change agents point to is cost.

The Cost of Periods

For many women, the cost of menstrual products remains a recurring expense. On average, an Indian woman spends around INR 300 (USD 3.24) each month on period products. With female labour force participation at 41.5%, according to the Economic Advisory Council - much of it in unpaid or low-paid work, where the minimum daily wage can be around INR 180 (USD 1.95) - these monthly costs can be difficult to absorb.

‘There is also a much bigger structural problem at play,’ Preeti told FairPlanet. ‘Period capitalism means institutions continue to profit from keeping sanitary pads as taxable goods. That directly feeds and traps women in period poverty.’ The idea refers to the way menstruation has increasingly become part of a commercial market. Menstrual products are often not treated as essential health items, leaving many women to pay for products they cannot do without. ‘With a menstrual cup, which is reusable for 8–10 years, you make a woman self-reliant,’ Preeti added.

Through its programme, Lal Sakhi sells the cup to women at no profit, at INR 200 (around USD 2) per piece. Women can pay in monthly installments of as little as INR 10, and the organisation uses white labelling rather than promoting a single brand. Before distributing cups, Lal Sakhi asks women to complete an informed consent and screening form to ensure they are fit to use them and understand how to use and care for them properly

The Long View

One critique of menstrual cups is that they require clean water and regular boiling. In the villages around Saharanpur, women who spoke to FairPlanet said this has not been a major issue, though it could be more challenging in water-scarce regions. 

Scaling the model also depends on support from public health systems. Preeti said Lal Sakhi now has a memorandum of understanding with the district administration, though it took several years of knocking on doors. The agreement has helped lend credibility to the initiative, but funding remains a challenge, and the organisation still relies largely on donor support. While Lal Sakhi has carried out projects in other states, Preeti wants to keep the focus on Uttar Pradesh, India’s most populous state, where she says there is still significant work to be done.

Alongside this, she is thinking through a new idea: a national menstrual cup bank. Instead of typical donations, people would be able to deposit funds that are then used to provide menstrual cups to women, with the option of withdrawing that money later if they choose. The idea is to create a shared pool of resources. At the same time, the broader conversation around menstrual health in India is also evolving. Earlier this year, the Supreme Court recognised menstrual health as a fundamental right, bringing new attention to the issue.

‘Changing habits takes time,’ Preeti said. ‘The shift to menstrual cups is no exception. It is a slow journey, but it is already bearing fruit.’