Inclusive menstrual health is still missing in rural Bangladesh

In the monsoon-soaked village of Nobogram, Jhalokathi district, the narrow mud paths connecting households turn into slippery streams. For women like Rahima Begum (42), who cannot walk without support due to a childhood injury, these conditions exacerbate a struggle that comes every month: managing menstruation without support, dignity, or safety.

"Sanitary pads cost money we do not have," Rahima whispered, looking at a bundle of old cloths. "Sometimes I just wait for the day to pass. My family cannot help me, and no one in the village cares."

Rahima's story is far from isolated. Across rural Bangladesh, girls and women with disabilities face systematic neglect during menstruation. 

During our recent fieldwork across Jessore, Jhalokathi, Habiganj, Sirajganj, Kurigram, and Mymensingh districts, conducted as part of a study by the BRAC Institute of Governance and Development (BIGD), BRAC University, we met dozens of women and girls for whom menstruation had turned into a source of pain, shame, and health risk. 

For them, this monthly biological process is not private or simple—it is a struggle at the intersection of poverty, disability, gender, and social invisibility.

Physical vulnerabilities: Navigating inaccessible environments

For many women with physical, visual, or mobility impairments, menstrual hygiene management is a daily challenge of navigation and safety. Rahima struggles to reach the distant latrine along slippery paths. 

Amena Khatun (35), visually impaired, relies entirely on her teenage daughter to help her bathe and manage menstrual cloths. During the monsoon, the yard floods, making trips to latrines nearly impossible.

Even for women with mild physical impairments, narrow, unsafe toilets, lack of private washing areas, and absence of ramps or handles create a constant risk of falls, injuries, and infections. 

Our fieldwork showed that over 60% of women with mobility impairments in these villages lacked accessible sanitation, forcing them to improvise, often in unhygienic conditions.

WHO (2024) indicates women with disabilities are 2–3 times more likely to experience poor menstrual hygiene and face an elevated risk of infections due to physical and environmental barriers.

Lack of menstrual products: Reliance on cloth

Across our fieldwork, we found that almost all women and girls with disabilities relied on old cloths for menstruation. Pads were either too expensive or unavailable locally.

Shathi (19), a girl with an intellectual disability, uses folded cloths that are washed and reused repeatedly. "I cannot manage pads myself," she told us, her mother, Rokeya, adding, "I try to help her, but I cannot always be there. Sometimes I leave her alone."

Farida (28), a deaf woman, explained through gestures that she reuses cloths even when damp, because she has no access to pads and no one can explain hygienic practices in sign language.

The consequences are serious: infections, rashes, and discomfort are common, and the mental strain of shame and isolation compounds the problem. 

For many women, menstruation becomes a period of confinement, missed household activities, and avoidance of social interactions.

Over half of rural women in Bangladesh still rely on cloths for menstrual management, but for PWDs (Persons with Disabilities), the lack of support amplifies health risks and reduces dignity (UNICEF, 2023).

Denial of care and family neglect

A particularly alarming theme is neglect and denial of care by family members. Our fieldwork revealed that families often leave women and girls to manage menstruation alone, either due to lack of knowledge, social stigma, or perceived burden.

Rahima reported that her own family rarely assists her. "They say I am old, I should manage. I feel invisible," she said.

Neglect is especially common for girls with intellectual or sensory disabilities. Farida, deaf since birth, described her mother leaving her to manage alone, unable to communicate the process or guide her.

Women with disabilities are often doubly marginalised—by gender and disability. Denial of care increases physical risks (infection, injury) and mental health stress, including anxiety, shame, and depression.

Social norms around menstruation further isolate PWD women. In Shathi's case, she is confined to her room, away from household or community activities. Rahima avoids visiting neighbours or participating in religious or social events during her period, fearing judgment.

"People in the village laugh if they see me changing my clothes," Rahima said. "It is easier to just hide and wait for the days to pass."

This isolation is compounded by disability. Women who cannot communicate easily, see, or move independently are cut off from knowledge, support, and community networks. For many, menstruation becomes a monthly experience of invisibility, shame, and neglect.

Social stigma around menstruation in rural Bangladesh contributes to chronic stress, low self-esteem, and exclusion, especially for women with disabilities.

Health risks and mental impacts

The physical, social, and emotional vulnerabilities converge to create heightened health risks. Poor hygiene, reliance on reused cloths, inaccessible water and sanitation, and lack of caregiver support increase the risk of infections, rashes, and reproductive health complications.

Mental health is also impacted. Isolation, neglect, and repeated humiliation lead to stress, anxiety, and low self-worth. Rahima said, "I feel ashamed, invisible, and trapped. No one notices me or my struggles."

Research supports these observations. According to WHO (2024), PWD women face higher rates of infections and mental health challenges related to menstrual neglect compared to non-disabled women.

Current interventions largely focus on schoolgirls, ignoring out-of-school PWD women and girls. Toilets are inaccessible, distributions of pads are not disability-inclusive, and caregivers receive no formal guidance.

Health outreach programmes rarely consider communication barriers, environmental constraints, or seasonal challenges like monsoon floods. As a result, women like Rahima, Shathi, and Farida are invisible to policymakers and service providers.

Pathways for Change

Addressing these vulnerabilities requires targeted, disability-inclusive interventions. 

One critical pathway for change is ensuring free access to menstrual products for women with disabilities. Integrating these essentials into disability allowances, community clinics, and local social protection schemes, as evidence suggests, improves hygiene and reduces infection risks. 

Equally important is strengthening caregiver support and training. Mothers, sisters, and other family members must receive practical guidance on safe, dignified menstrual care. Training should address privacy, hygiene, and mental well-being.

Improving sanitation infrastructure is another essential step. Toilets, washing areas, and disposal mechanisms must accommodate mobility, vision, and cognitive impairments.

Change also depends on shifting social attitudes. Menstruation for women with disabilities must be normalised. Families, neighbours, and leaders should be included in campaigns.

Finally, health outreach must become genuinely disability-inclusive. Health workers must be trained in communication with deaf, visually impaired, and intellectually disabled women, providing guidance on hygiene, infection prevention, and mental health support.

As Rahima said quietly, "We just learn to live with it." But living with pain, neglect, and shame is not dignity. Menstruation is natural, and every woman, including women and girls with disabilities in rural Bangladesh, deserves safety, privacy, care, and dignity every month.

Inclusive menstrual health is not charity; it is a human rights and public health imperative. Until families, communities, and policymakers acknowledge and address the vulnerabilities of women with disabilities, millions will remain invisible, enduring their struggles silently, month after month.

Md Al-Mamun is a Research Associate at the BRAC Institute of Governance and Development (BIGD), BRAC University. 

Sketch: TBS

Marufa Alam is a Lecturer in the Department of Public and Community Health at Frontier University, Garowe, Somalia.

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.