Unpacking cultural taboos, poor menstrual hygiene, and nutritional neglect in India
Lucknow: Despite decades of public health programs, anemia continues to affect over half of India’s adolescent girls. According to the National Family Health Survey (NFHS-5), 57% of girls aged 15–19 years are anemic, with prevalence increasing in many states since the previous survey. This persistent issue is not just about iron deficiency but deeply linked to cultural taboos, poor menstrual hygiene, and chronic nutritional neglect—all of which undermine our girls’ health and potential.
The Scale of the Crisis
Anemia, particularly iron-deficiency anemia, leads to fatigue, poor concentration, compromised immunity, and impaired growth. During adolescence, the body undergoes rapid changes, and iron needs increase, especially with the onset of menstruation. However, biological demand is only part of the story. Societal discrimination and poverty, particularly in rural and low-income households, often mean girls eat last, least, and worst.
In many families, adolescent girls lack access to iron-rich foods like green leafy vegetables, pulses, eggs, or meat. Even when food is available, myths or household norms can limit consumption. Coupled with poor awareness and inadequate supplementation, this results in widespread anemia—a public health issue with both nutritional and gender-based dimensions.
Menstruation Myths and Food Taboos – Menstruation in India is surrounded by misinformation and stigma. In several regions, menstruating girls are prohibited from eating “hot” or “sour” foods such as papaya, tamarind, or eggs, believed to worsen menstrual flow. Ironically, these are often iron-rich or aid iron absorption.
Further, some girls are isolated during menstruation, made to eat separately or miss meals. Many believe that excessive bleeding is normal and avoid discussing symptoms like fatigue or dizziness. Girls internalize these beliefs and stay silent, delaying treatment or avoiding supplementation out of fear or misinformation.
Over 70% of adolescent girls lack proper knowledge of anemia, and many are unaware that heavy bleeding or skipping meals during menstruation can lead to or worsen anemia. This silence contributes to a cycle of undernutrition and untreated illness.
The Menstrual Hygiene Gap – Equally concerning is the lack of access to hygienic menstrual products. Many adolescent girls—especially in rural areas—still use cloth pads, often washed in unhygienic conditions or reused without proper drying. Poor menstrual hygiene can lead to infections, increased iron loss, and general ill-health, all of which are associated with a higher risk of anemia.
Inadequate sanitation facilities, lack of privacy, and insufficient menstrual education in schools often lead to girls missing classes or dropping out altogether. This also results in missed health check-ups, iron supplementation programs, or nutrition sessions—compounding their risk of chronic anemia.
Nutritional Neglect and Unbalanced Diets– Beyond menstruation, nutritional neglect is widespread. In both urban and rural settings, there’s a growing preference among adolescents for processed and packaged foods low in micronutrients. Traditional iron-rich foods are often replaced by fast food, snacks, and sugar-laden drinks, which do little to meet the body’s needs.
In poorer households, affordability plays a big role. Even where programs like mid-day meals or rations exist, coverage and quality remain inconsistent. Girls from low-income families may not receive enough protein or iron in their daily diets, and education on balanced diets remains limited.
Micronutrient deficiencies are rarely isolated. A girl deficient in iron is often also low in vitamin A, folic acid, or zinc—nutrients that are all essential to proper haemoglobin formation and iron absorption.
Policy Gaps and Missed Opportunities – India has introduced several promising initiatives to combat anemia. The Weekly Iron and Folic Acid Supplementation (WIFS) program and the more recent Anaemia Mukt Bharat (AMB) campaign aim to reduce anemia by 3% annually through supplementation, deworming, fortification, and behavior change communication.
However, implementation challenges persist
- Iron tablets are often not consumed due to fear of side effects.
- School-based distribution is disrupted by irregular attendance or dropout rates.
- Community workers are overburdened or undertrained in adolescent counselling.
- Behavior change communication remains infrequent and superficial.
COVID-19 further disrupted service delivery, including school health programs and community nutrition campaigns, setting back years of progress.
Cultural sensitivity is another missing link. Programs often avoid directly addressing menstrual taboos or gender norms, fearing resistance. Yet unless myths and food taboos are openly challenged, even the best interventions will remain underutilized.
A Way Forward – Integrated, Inclusive Approaches
Solving anemia among girls requires multi-sectoral, gender-sensitive strategies:
- Nutrition Education – Strengthen adolescent health education in schools and communities. Teach girls and families about locally available iron-rich foods, cooking practices that enhance absorption (like combining iron with vitamin C), and the importance of regular meals—especially during menstruation.
- Breaking Menstrual Taboos – Encourage open dialogue around menstruation. Community-led awareness drives involving mothers, teachers, and even boys can help normalize periods and reduce stigma.
- Improved Menstrual Hygiene Access – Ensure that girls have access to safe, affordable menstrual products. Invest in clean toilets, water, and waste disposal facilities in schools and Aaganwadi.
- Screening and Counseling – Regular non-invasive anemia screeningin schools and villages can identify at-risk girls early. Adolescent-friendly health services should offer counselling, dietary guidance, and iron supplementation in a respectful, non-judgmental way.
- Engaging Families and Communities – Mobilize SHGs, Panchayats, and youth groups to run community kitchens, nutrition gardens, and peer learning sessions. Girls’ health must become everyone’s concern—not just the health department’s.
Anemia in adolescent girls is not just a health issue—it’s a social and cultural crisis. Taboos, gender bias, and poor access to information and services have kept millions of Indian girls chronically anemic. It’s time to shift focus from token iron tablets to transformative change—empowering girls with knowledge, dignity, and nutrition.
Let’s stop missing opportunities and start valuing our girls’ health.
Ranu Singh
Community Nutritionist | Founder – Nutrition Punch
National Executive Committee Member – IAPEN India
Chief Program Officer – Community Nutrition Core Group, IAPEN India
Disclaimer: This article is intended for educational and awareness purposes. It reflects current knowledge and public health perspectives and is not a substitute for professional medical advice.
