Menstrual Health Policy: A Case of Deflection from Action

Editor: Priyanka Tibrewal
March 22, 2021


The discourse on menstruation did not always enjoy the same attention it does today. In fact, the period between 1990-2000 was referred to as a “wall of silence: poor menstrual hygiene not recognized as an issue; absence of literature” by Dasra, an Indian philanthropy foundation that researched the Menstrual Health Management (MHM) landscape in India1. In 2005, an Oxford Roundtable, jointly sponsored by UNICEF and the International Rescue Committee (IRC), brought explicit attention to menstrual issues impacting schoolgirls. The UNICEF strongly advocated for girl-friendly sanitation facilities – toilets that are fully private, located in secure areas away from boys’ toilets and equipped with facilities for menstrual hygiene.2

In 2007, WaterAid awakened the collective consciousness of menstrual health needs in India. In January, an adolescent girl from Madhya Pradesh spoke to WaterAid staff about challenges faced during menstruation. This triggered a conversation around menstrual hygiene, which was addressed through training programs, workshops and women’s self-help groups organised by WaterAid in collaboration with UNICEF. As NGOs and governments scrambled to take the first step, capitalist enterprises like Procter & Gamble chose to profit from their range of period products, given the increased importance menstrual hygiene gained. 

As companies started competing for market share by creating partnerships with local bodies, the narrative of menstruation became product-centric, deflecting from the source of the problem – the social taboo. The product approach was based on a misguided assumption that the lack of menstrual hygiene led to social taboo. In reality, it was the social taboo that inhibited progress in menstrual hygiene, relegating menstruation as an issue to be managed as opposed to a normal biological process. 

Market norms have convinced society that sanitary napkins are the solution to social taboo, so much so that the government followed suit by providing sanitary napkins at affordable rates through schemes like the Freeday Pad scheme and Suvidha pads under the Menstrual Hygiene Scheme. It is essential for period products to be available, affordable, and accessible. However, ignoring the need for lifecycle menstrual education, sanitation infrastructure, and special provisions to address the social taboo of menstruation is curtailing menstrual health and education from reaching full potential. 

This paper aims to critically analyse schemes launched by the government such as the Menstrual Hygiene Scheme (MHS) and Adolescent Friendly Health Clinics (AFHCs) under Rashtriya Kishor Swasthya Karyakram (RKSK) against the backdrop of the current health system and unaccommodated menstrual health needs.

Knowledge and Gaps

Many studies show the importance of increasing general awareness about menstrual hygiene. Rahatgaonkar. VG et al., highlight the need for introducing counselling sessions and menstrual health education activities for adolescent school girls with both parent and teacher participation3, Bachloo. T., Kumar. R et al. recommend incorporating menstrual health in the school curriculum4. Phillips-Howard. P.A., Hennegan. J et al., express disappointment in the Guttmacher-Lancet Commission’s reductive approach to menstruation and champion inclusion of menstrual health education as a component of sexual and reproductive health and rights globally5

Tackling menstrual health becomes important as a large number of adolescent girls experience severe pain and weakness due to menstruation. Bachloo et al., find that 77.6% and 66.2% (n=358) of the adolescent girls report pain in the abdomen and legs, respectively. Holambe et al. state that 60.71% and 59.52% (n= 252) of college-going girls in Latur city experience pain in the abdomen and weakness as symptoms.6 Rahatgaonkar. VG et al., record that 66.9% (n=471) of adolescent girls experience painful menses. Smitha et al., (2016) observe that 72% (n=700) of adolescent girls experience one or the other symptoms during menstruation. 7

The government launched the Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy (RMNCH+A) in 2013. These programmes focus exclusively on reducing maternal and child morbidity and mortality. An additional dimension of adolescent health was added to ensure lifecycle coverage. The predecessors of this strategy – Reproductive and Child Health (RCH) and RCH – II were launched in 1997 and 2005, respectively. The strategies focused solely on reproductive and child health. 

In 2014, Rashtriya Kishor Swasthya Karyakram (RKSK) was put in motion to expand the narrow focus of RMNCH+A, “limited to sexual and reproductive health.” It now includes nutrition, injuries and violence, non-communicable diseases, mental health, and substance misuse. The Adolescent Reproductive Sexual Health Clinic was initiated in 2006 under RCH-II, and the clinic exclusively provided counselling on sexual and reproductive health issues. These ARSH clinics were rebranded as Adolescent Friendly Health Clinic Services (AFHCS) under RKSK in 2014 to include the expanded objectives. 

According to UNICEF, India is home to 253 million adolescents who make up 20.9% of the total population. The Menstrual Health Scheme programme under RKSK disproportionately focuses on sanitary napkins, has inadequate training modules and reading information for Auxiliary Nurse Midwives (ANMs) and adolescents. The Adolescent Friendly Health Clinics, on the other hand, do not cater to the menstrual health disorders observed in the adolescent population. Adolescents under the MHS are unequipped to understand menstrual symptoms, hindering their menstrual health-seeking behaviour. Among the reasons for not seeking treatment, a perception that their symptoms were normal or a lack of perception about the severity of symptoms were notable. Thus, the MHS programme and AFHCS under RKSK take a narrow approach to menstrual health. Current health care programmes are, therefore, ignoring menstrual health needs of adolescent girls.

Holambe and others reported that of college-going girls in Latur city, 56% seek help from their mothers, 8% visit a doctor, and 6% seek help from a pharmacist. Rahatgaonkar. VG et al., recorded that 33%, 26.7%, and 25.7% of the girls with cycle irregularity, painful menses, and high menstrual bleeding respectively visited a doctor for their symptoms. Additionally, it also reported that approximately 19% of adolescent girls face debilitating effects from menstrual symptoms.

Studies have shown that the exclusion of menstrual health from government schemes targeting reproductive health has dire consequences. Tariq. N., Hashim. MJ et al., cite Sharma. P., Malhotra. C et al., 17% of adolescent girls in India reported missing school due to dysmenorrhea8. Smitha. MC, Narayana. MMR et al., observe 60.2% of adolescent girls seek help. While 43.4% sought advice from family members, 39.2% visited doctors, and 22.5% asked friends. On average, 22.1% to 43% exhibited help-seeking behaviour for menstrual symptoms.

Despite the presence of AFHCs across the country, a significant percentage (58%) of young women seek help for menstrual problems from private facilities. In comparison, 15.9% seek help from government facilities, 15.7% from informal bodies, 14.2% from friends and family members, and only 4% and 5% from ASHA and ANMs, respectively. Less number of young women seeking help from AFHCs is an indicator of a deficit in the system. It can be attributed to a highly fragmented system with uneven health care delivery, lack of privacy, and fear of embarrassment.9

AFHC services are provided by medical officers, ANMs, and counsellors at primary health centres, community health centres, district hospitals, and medical colleges. The ANMs and counsellors are trained to counsel and refer the adolescents to medical officers in cases of menstrual disorders such as primary and secondary amenorrhea, primary dysmenorrhea, and premenstrual syndrome. However, other common menstrual disorders such as abnormal uterine bleeding, menorrhagia, metrorrhagia, hypermenorrhea, secondary dysmenorrhea, and premenstrual dysphoric disorder are overlooked. Considering that underlying menstrual disorders can be a sign of significant medical conditions with negative long-term health consequences for both physical and mental health, the clinical practice for menstrual disorders at AFHCs is inadequate.  


The undue emphasis on period products, tunnelled focus of MHS programs on hygiene, exclusion of comprehensive lifecycle approach to menstrual health education, and lack of intervention in addressing the social taboo of menstruation have left the society burdened with the inability to access menstrual health care needs.   

The MHS programme is insufficient to promote menstrual health education, thus hindering the progress towards achieving Sustainable Development Goals 3, 4, 5, and 8 through the following pathways. 

Failure to ensure healthy living (SDG 3) can be attributed to a lack of knowledge that affects symptom perception and constrains menstrual symptoms’ or disorders’ health-seeking behaviour. Many adolescent girls have reported missing school due to painful menses and heavy bleeding, establishing the need for menstrual health care interventions without which SDG 4 i.e. inclusive and equitable quality education cannot be achieved. 

The absence of policies that specifically address social taboo and myths related to menstruation is causing feelings of disempowerment without the dignity of menstruation to the extent that a 13-year-old girl in Tamil Nadu died by suicide after being allegedly shamed for menstruation.9 With the current prevalence of social taboo on menstruation, achieving gender equality and empowerment (SDG 5) seems far-fetched.

Persistent menstrual symptoms that affect everyday activities impede labour participation of women in the economy. The disregard for menstrual health during adolescent development may lead to delayed diagnosis of potential chronic conditions, further leading to the burden of out-of-pocket expenditure and financial risk. This will lag the progress of full and productive employment and decent work for all (SDG 8).  

The MHS programme must include a comprehensive lifecycle menstrual health education covering a wide range of topics from menarche to menopause. It will improve menstrual health-seeking behaviour by improving knowledge and perceptions of the symptoms. The implementation guidelines of RKSK place only menstrual hygiene under sexual and reproductive health, compounding the barriers to seek menstrual health care. Improving the current clinical practices of the AFHCs to include robust screening and diagnostic tools, access to ultrasound is the need of the hour. This will help in the early diagnosis and treatment of any underlying conditions that exhibit menstrual disorders and decrease the average time of diagnosing any underlying conditions such as endometriosis. 


  1. Bobel. C (2018). The Managed Body: Developing girls and menstrual health in the Global South. Palgrave Macmillan
  2. UNICEF/IRC (2005). Water, Sanitation and Hygiene Education for schools Roundtable Meeting. Oxford, UK.
  3. Rahatgaonkar. V.G., Watankar. A.H., Oka. GA, & Kambte. VS (2018). Menstrual disorders and treatment seeking behaviour of adolescents, International journal of community medicine and public health, 5(10), 1-6. Doi: 10.18203/2394-6040.ijcmph20183886
  4. Bachloo. T., Kumar. R., Goyal. A., Singh. P., Yadav. S., Bharadwaj. A., & Mittal. A (2016). A study on perception and practice of menstruation among school going adolescent girls in district Ambala, Haryana, India, International Journal of community medicine and public health, 3(4), 931-937. Doi: 10.18203/2394-6040.ijcmph20160931
  5. Phillips-Howard. P.A., Hennegan. J et al., (2018). Inclusion of menstrual health in sexual and reproductive health and rights, The Lancet, vol. 2.
  6. Holambe. V.M., Thakur. NA, & Wadagale. AV (2013). Pattern of menstruation and health seeking behaviour of college going girls in Latur city, Maharashtra, International journal of recent trends in science and technology, 8(3), 224-227.
  7. Smitha. MC, Narayana. M. M. R., Srinivasa. B.M., & Renuka. M (2016). Adolescent menstrual health: Profoundness of the problems and the rationale behind denial of treatment, National journal of community medicine, 7(6), 499-504.
  8. Tariq. N., Hashim. M. J., Jaffrey. T., Ijaz. S., Sami. S. A., Badar. S., & Ara. Z (2009). Impact and health care seeking behaviour of premenstrual symptoms and dysmenorrhea, British journal of medical practitioners, 2(4), 40-43.
  9. India Today Desk. (2017, August 30). 13-year-old girl scolded for ‘period stains’ commits suicide by jumping off the terrace. India Today.
  10. Santhya, K. G., R. Prakash, S et al., (2014). Accessing Adolescent Friendly Health Clinics in India: The Perspectives of Adolescents and Youth, Population Council, 12-19.
  11. Dixit. G.T., Jain. S et al., (2017). Adolescent Friendly Health Services: Where are we actually standing? International Journal of community medicine and public health, 4(3), 820-824. Doi: 10.18203/2394-6040.ijcmph20170765
  12. Jena. P., Andalib. S., Khuatia. S., & Mishra. A (2017). Spectrum of menstrual disorder and health consciousness of adolescent school going girls: a competitive study between two socio-economic group, Indian journal of Obstetrics and Gynaecology Research, 4(3), 235-239. Doi: 10.18231/2394-2754.2017.0053
  13. Kabir. A., Saha. N.C., Wirtz. AL, & Gazi. R (2014). Treatment seeking for selected reproductive health problems: behaviours of unmarried female adolescents in two low performing areas of Bangladesh, Reproductive Health, 1-7. Doi: 10.1186/1742-4755-11-54
  14. Menstrual Hygiene Management Needs in Schools, PLoS Med, 13(2), 1-9.
  15. National Health Mission, Government of India (2014). Adolescent Friendly Health Clinics.
  16. National Health Mission, Government of India (2011). Menstrual Health Scheme.
  17. UNICEF. The State of the World’s Children. Adolescence: An Age of Opportunity. New York: UNICEF; 2011. p. 138.

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.

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Conditional Cash Transfer programmes have been lauded as one of the most successful social protection schemes of recent times. However, the lack of a gender perspective has resulted in its proposed conditionalities to cause time-poverty amongst its participating women. Time poverty is understood as the lack of discretionary time available and is often observed to disproportionately affect women due to the prevalent gender norms and unaccounted nature of care work. The conditionalities of the CCTs have been furthering the prevalence of this poverty by increasing the burden of responsibilities on women. The study explores the notion of time as a necessary resource and as a means of wellbeing. Following this, it scrutinises the CCT policies of Juntos in Peru and Kyrgyz- Swiss- Swedish Health Project in the Kyrgyz Republic. It uncovers the causal relation between CCT conditionalities and gendered time poverty and further delves into the properties of ‘control’ and ‘quality’ of time. Conclusively, it proposes the need to include an analysis of time poverty and the properties important to the same for gender-inclusive CCT programmes.


Conditional Cash Transfers (CCTs) are programmes that work on the condition that participating households make pre-specified investments in certain areas of human capital. Conditions range from vaccinations, periodic checkups, prenatal care for mothers and attendance in other health initiatives.1,2 They often have educational conditions as well that encompass school enrollment and attendance.3

These programmes have been lauded as one of the most significant and successful policies of recent times, especially in the context of Latin America that has around 18 Conditional Cash transfers policies currently operating in the region.4 The continuous aid towards these programmes is a result of its accounted success in reducing consumption poverty, increasing nutritional benefits and improving healthcare indicators.5 

Most CCT programmes transfer the money to the mother of the household or the children in some cases and hence, portray women as the beneficiaries of the programme.6 This has led to narratives and conclusions that view gender empowerment as a consequence of CCTs. Moreover, the literature also claims that 80% of the programme benefits are claimed by the poorest families thereby pulling these families out of income poverty. Hence, seeming pro-poor and valuable to the vulnerable sections of society.

However, it is vital to identify that the conditionalities of these programmes build on the caretaking responsibilities that women often assume as part of their roles as mothers, wives and daughters. As a result, these programmes reinforce the existing gender division of labour within the household.7 Most evaluations of CCTs that deem it a success fail to evaluate the burden of responsibilities imposed on the participating women through the presented conditions. Hence, the lack of a gendered perspective in CCT policies has often led to what is recognised as time poverty in the case of the women engaged in these programmes.

Research Aim

This study aims to understand the causation of time poverty through operating CCT policies. It further ventures into the nature of this poverty through an analysis of its operation in Peru and Kyrgyzstan. Through this, the study presents the important variables which must be considered to make CCTs more gender-sensitive and inclusive.


The study will primarily use the principles of exploratory research to investigate the established research aim. Here, the primary purpose of the research is not to prove a particular hypothesis, but to add to the current literature on CCTs and the nature of gendered time poverty it causes. 

To undertake this task, the researcher utilises the case study method and attempts to uncover the operationalisation of CCT programmes- Juntos in Peru and the Kyrgyz-Swiss-Swedish Health Project in the Kyrgyz Republic. This allows the researcher to account for policy behaviour and implication patterns. 

Conclusively, the study and comparison of CCT policy assumptions, implementation and impact on participating women present a set of conclusive variables that prove to be of paramount importance for the implementation of gender-sensitive CCT programmes.

Literature Review

Time Poverty: Understanding Time As a Resource and as Wellbeing

References of time poverty in literature are categorised as time as a resource and as leisure and human wellbeing. Both of these conceptions are interlinked and build on time as an important aspect of an individual’s life. It allows us to look at deprivation from outside of the present ideas that focus only on evaluating the market and remunerated activities.8

Time as Resource – This relates to the understanding of time as an important resource of consumption itself as this resource could be converted into remuneration and services by work.9 Sen’s capabilities approach also builds on this perspective of time as a resource, deprivation from which can impact the individual’s health, lead to loss of human capital and consequently lead to poverty.10

Time as Wellbeing – Since being engaged in any one activity directly correlates to the loss of engagement in other activities (which could include the tasks for basic functionality and health); how we choose to allocate time is then directly understood to impact wellbeing.11

Bardasi and Wodon as well as the Gender Equality Observatory have proposed that the time invested in remunerated or non-remunerated work reduces the time for leisure or rest.12,13

It is important to understand what is meant by the idea of wellbeing. According to McGregor wellbeing is “an interplay between the resources that a person is able to command; what they are able to achieve with those resources; and the meanings that frame these and that drive their aspirations and strategies”.14 This suggests that when an individual is viewed as poor in regards to time, they are unable to command their resource of ‘time’ for their benefits and/or for their aspirations and strategies to benefit their quality of time.  

Time Poverty and Gender

The focus on time as an aspect of poverty and its unequal allocation comes from the need to account for the invisible work undertaken by women which is often undervalued.15 There exists a dearth of time-based evaluations, however, the limited studies conducted show that in a general overview of about 45 developing nations, women predominantly (75% of the households) bear the responsibility of collecting water and other domestic tasks.16 Upon analysing who does what and when it was observed that in African households women and girls were considered responsible for the domestic chores which included looking after children as well as the general health of the household.

The issue however is not limited to developing or rural regions and extends itself in all contexts that are governed by the traditional gender roles. Conceptualisations of time poverty can be traced back to a study by Clair Vickery, who conducted household time surveys in the US to show that it was not just the variable of income but also the variable of time that plays an important role for a certain level of consumption to occur.17 Time-use surveys conducted within the UK have also shown similar trends in accounting for consistent time poverty amongst women.18 Hence, the issue of time poverty is embedded in the gender roles that assign time-consuming but non-market tasks of food management, domestic cleaning and health as the domain of the women. These widespread inequalities within the units of household have led to concepts of ‘Reproductive Tax’ and ‘Household Overhead’ which are terms used to recognise the additional labour that women engaging in paid work have to perform by also engaging in the domestic unpaid work as part of performing their gender roles.19,20

Time Poverty and Conditional Cash Transfers 

Time is understood as an ultimate resource permeating every individual life and experience. Hence, its unequal allocation on the basis of gender is an important gap that needs to be addressed by functioning social policies in different regions. However, gender inequalities in regards to time are often reinforced by CCT interventions as they operate on increasing demands on women’s unpaid labour inputs.21,22,23

However, it is important to understand not only the gendered nature of time poverty but also the related conditions of ‘who controls the time of women?’ and the ‘quality of time’ they spend on the activities of these CCTs. Through the analysis of the programmes and its impact in the cases of Peru as well as the Kyrgyz Republic, these conditions and the issue of time poverty will be explored through the lens of gender in the following parts of the essay.


Gendered Conditionalities and Time-Poverty: Juntos in Peru

The ‘Junto’ Programme of Peru draws its inspiration from cash transfer programmes of Mexico, Chile, Brazil and Honduras and was launched in the region in 2005. It targeted children under the age of 14 and aimed to break the cycle of intergenerational poverty by setting conditions of accessing public education and health services for the children, much like other conditional programmes.24,25 The transfer was to be given to the mothers of the household on the assumption that they are more likely to be accountable for their children’s well-being. Drawing from Mexico’s cash transfer programmes, it was also viewed as providing women with more decision making power.26 In return, women had signed an agreement with the State for four years, agreeing to the suspension of three-months payment as a penalty for the non-compliance of the conditions.

Right-away, assumptions in the policy implementations are made not only in regards to the gender roles of women but also in regards to what constitutes their empowerment. As discussed, CCTs are often given an empowerment view due to their action of transferring money to the woman member of the household. This action does show a change in expenditure behaviour of the household, as evaluations show that women often spend more on consumptions that benefit the household collectively.27 However, this does not translate into ‘empowering’ the woman herself. Due to the lack of a gender lens and hyper-focus on economic transfers, the policy assumes the fulfilment of the socially-dictated gender roles (of providing better healthcare and education for her children) as empowering; giving women empowerment a utilitarian lens.

Tara Cookson conducted an ethnographic study in the Andean mountains of rural Peru to record the impact of Juntos on the women of the community. During the course of the 11-month study, she accompanied the women for the Juntos activities along with their daily responsibilities of care work and ploughing of land. The qualitative data collected allowed her to criticise the programme for its inabilities to record the gendered implications of programmes. She found that cash was helpful and there were more children now going to school, however accounting for women’s care work for the same allowed her to confront the realities of the programme. She reported that they often had to travel long distances for meetings, health clinics were often closed and schools were massively understaffed. It sheds light on the rushed operationalisation of these programmes even in the midst of inadequate administration and infrastructure. The implications of all these shortcomings were borne by the women who had to spend extra time travelling or waiting. These struggles remained unaccounted for as time poverty is not an assessed variable in these programmes.

This has also bought into question other research that suggests that pulling parents from income poverty at the cost of deepening women’s existing time poverty is unlikely to improve children’s well-being in the long term.18 Moreover the progress that is assessed only on the basis of schools enrolments and quantitative data failed to note how women were forced to perform the conditionalities, making the project unsustainable in the long term.

It is also important to recall the link between time and wellbeing, which is affected by this gendered policy. For example, even though the Juntos programmes aim at adolescents below the age of 14 to access education, only 39% of girls in rural areas complete secondary school in comparison to 51.3% of boys due to factors such as domestic responsibilities, the insecurity of travel, teenage pregnancy and early marriage.28 None of these factors are addressed through the interventions of CCTs. Moreover, it increases the work in the domestic sphere and with the growing pressure of household chores, young girls are more susceptible to engaging in these roles. Hence, ultimately becoming counterintuitive to its own goals.

Considering gender implications within this development policy would bring in time analysis and accounting of care work which then would urge policymakers to ask questions like- How can the policy promote sharing of domestic responsibilities amongst men and women? How much time does travel take? How can it be minimised? What can be done to make the conditionality more accessible for both genders? All of which are important questions to make CCTs more sustainable and equitable.3 

‘Control Over Time’ and ‘Quality of Time’: The Kyrgyz-Swiss-Swedish Health Project

The correlation between time poverty, gender and wellbeing when looking at CCTs is more intricate than the reinforcement of gender roles causing time poverty. Research conducted in this field has also suggested that in some cases women enjoyed increased self-esteem and status as a result of CCTs which can also be viewed as wellbeing. Evaluations of certain ‘Bolsa Familia’, ‘Familias en Accion’ and ‘Chile Solidario’ programmes expressed that women felt empowered due to an increase in their bargaining power in household decisions and did not mind the consequent time poverty.

This can be analysed in the case of The Kyrgyz-Swiss-Swedish Health Project (KSSHP) which has been operating since the 2000s and is a CCT programme prioritising the promotion of health systems in rural regions of the Kyrgyz Republic. The case of KSSHP is interesting, as even though the CCTs cause gendered time poverty (just like in the case of Peru, Bolivia and other Latin American countries); the data collected shows that this time poverty was not considered as a disadvantage.

Women traditionally (much like all other regions observed) have a less public role and are primarily dominant in the domestic domain.29,30 In fact many men during surveys justified their non-participation in KSSHP activities by suggesting that they do not have as much time as the women in the community. 

However, due to the operating Village Health Committees (VHC) established through Participatory Rural Appraisal (PRA) exercises, the CCT policy saw grassroots mobilisation where women were given the opportunity to be part of the health committees (85% of VHC members are women) and determine the central health objectives of the community.31 Hence, though there were complaints of having lesser time for other activities, the programme helped in contributing to their wellbeing by promoting women to publicly participate. This encouraged women to determine their own goals.

The concepts of ‘control over time’ and ‘quality of time’ become important here. Control over time can be understood as providing women with the power over the utilisation of their own time, the use of which is otherwise dictated by the demands of their families and male counterparts. The Kyrgyz model, by providing women with the power to control the conditionalities of the programme, gave them the power over what they will be devoting their time to. This was lacking in the Peruvian model which had an imposed systems of conditions and penalisation that often forced the women participants to use the services (such as that of the daycare) that they either did not require or have trust in. Quality of time is an aspect of time evaluation that is often considered more important than analysing the quantity of time. It is determined by having autonomy over time allocation that aligns with certain aspired goals of the individual.32 Autonomy and aligning of desired goals with the time spent increases the utility of the time spent on the activity, hence increasing what is considered the perceived quality of time. In the case of KSSHP activities, the women not only had autonomy over time allocation but also received desired outcomes of public participation. The motivation for these activities despite the quantitative time poverty was the derived increase in societal decision making.

Evaluations have not attempted to disentangle which components are more important for the women that are part of the programme. This has created a huge hole in the effectiveness of CCTs that otherwise as shown through analysis of its implementation in different regions, have much room to improve and grow. 

The Trade-offs: The Cost of Empowerment Within Social Policies

The concept of trade-offs has been consistent throughout the presented literature of time poverty and its gendered impact on women. In the initial Peruvian case, there was a trade-off between time and women’s wellbeing for tackling income poverty. Whereas in the KSSHP case, foregoing women’s leisure time for increased agency and participation was seen as an acceptable trade-off. 

Bardasi and Wodon question whether the wilful and consensual action of exchanging time for empowerment or remuneration can still be considered as poverty? They argue that it is. They justify this by arguing that the existence of time poverty does not necessarily conclude worse conditions in other aspects of wellbeing. However, it is still the lack and loss of a resource that is an important dimension.

The trade-off between time as a resource is viewed as sacrificing some needs so as to be able to achieve other needs. The benefits of empowerment are never achieved by women in the case of CCT’s without the presence of a ‘sacrifice’ or ‘trade-off’. The trade-off may be time for receiving income (in the case of Juntos in Peru) or time for receiving empowerment (in the case of KHSSP). However, for policies to truly and efficiently encompass gender in development, efforts should be made to minimise these trade-offs. Wherein the CCT’s should empower them not as a consequence of sacrificing a resource but as a streamlined aim of the policy itself.

This can be achieved through addressing the gender dynamics questioning the existing gender norms through the work of interventions. The CCT’s should revise their language and induce discussions within households over the responsibilities of children’s health and education and designs should encourage the inclusion of men in programme activities. Apart from this, the methods of evaluations need to be more gender-sensitive to include time poverty and must include room to record the programme’s impact on autonomy and empowerment of women.


The analysis is based on the researchers’ inferences of acquired secondary data. The lack of a primary study may lead to some unaddressed gaps and misperceptions of the same. Moreover, there exists a massive dearth of time surveys and evaluations which would have allowed for more precise quantitative arguments. However, the researcher has aimed to bridge this gap by using in-depth ethnographies of women’s experience of the programmes, bringing to fore the need for more time surveys and analysis for efficient evaluations of CCTs.


The policies of Conditional Cash Transfers are extensively used in several parts of the world to provide social protection to the vulnerable and poor sections of society. However, these CCTs fail to look at the impact of these conditionalities on the women and girl children participating in these programmes. 

The conditionalities of the CCTs often deepen the dimension of time poverty amongst the participating women by enabling stereotypes that associate the role of caregiving, domestic chores and responsibilities of children’s health and education with women. By not acknowledging this inherent inequality and unaccounted care work, policymakers engage women in ‘voluntary work’ for their children in exchange for remuneration that goes towards the household. Women who participate in these programmes hence partake in unpaid care work, depriving them of scarce leisure time which has been linked to general human wellbeing.32

As witnessed in the Peruvian case, the evaluations of the Juntos programme, which aims to increase education access, do not take into account deprivation of time. Moreover, the increasing pressures of domestic chores have been observed as one of the reasons many girls choose to drop out of schools making the programme implementation counterintuitive. It highlights the importance of gender considerations and time evaluations which would allow policymakers to make the CCT programme truly equitable and sustainable. 

However, only taking considerations of time poverty by accounting for care work will not be sufficient, as was observed in the case of KSSHP. To truly deal with the issues of time poverty, the programmes need to consider dimensions of ‘control’ and ‘quality’ that allows women to control increases the allocation and utility of their time. The case shows that CCT approaches need to be based on women’s daily experiences and their own perceptions of time and well-being. This will allow policies to encompass their priorities on how they desire to invest their own time.

Without incorporating the lens of gender, CCTs fail to acknowledge that social policies impact different groups differently leading to inequitable development. Gender analysis allows policymakers to look at a holistic picture of wellbeing that extends beyond income. The literature on how to minimise the trade-offs women often make for their own development suggests various small technological impetuses dealing with transport and mobility that makes a difference in the time women can have for themselves, along with interventions that ensure equal participation from both genders and push for structural change in the established gender roles.33


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  1. Gammage, S. (2010). Conditional Cash Transfers and Time Poverty: An Example from Guatemala. International Labour Organization. 
  1. Soares, F.V., & Silva, E. (2010). Conditional Cash Transfer Programmes and Gender Vulnerabilities: Case Studies of Brazil, Chile and Colombia (Working Paper No. 69). International Policy Centre for Inclusive Growth. Overseas Development Institute. 
  1. Fultz, E., & Francis, J. (2013). Cash transfer programmes, poverty reduction and empowerment of women: A comparative analysis. International Labour Organization. 
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The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.

Editor: Paavi Kulshreshth
March 22, 2021

When women own property there is a noticeable improvement in their socio-economic well-being, their family’s health and nutritional outcomes, and also in their own physical security. On the contrary, women with no ownership over property find themselves incapable of engaging in economic activities or having a say in household matters and are comparatively more vulnerable to domestic violence. Despite overwhelming evidence supporting asset ownership by women, a significantly minor population of women own land or property in the world today. 

There are many factors which restrict women’s access to property rights. The World Economic Forum’s Annual Meeting at Davos in January 2018 noted that India was one of the 15 countries in the world, where the prevalence of patriarchal traditions prevented women from enjoying equal ownership rights to property. In addition, the lack of legal awareness about her inheritance rights and the skewed implementation of property laws have fueled gendered social discrimination in India. Though the government of India has been undertaking several initiatives to improve women’s access to property and assets through different policies and legal measures, there’s significant room for identifying and addressing the many barriers that impede women’s access to and retention of assets. Moreover, the mediation of women’s land rights in India through various personal laws and customary practices rather than through legal discourse, have also allowed patriarchal norms to dictate inheritance and succession rights of women historically. The 2005 amendment to the Hindu Succession Act, 1956 and the 2020 Supreme Court verdict affirming a daughter’s equal rights to coparcenary property has been a step towards undoing some of the gendered discriminations in our inheritance laws. But a lot still remains to be done. 

One of the first steps towards addressing any problem is understanding the extent, scale and nuanced impact of these problems. This is where we encounter one of the first obstacles when it comes to talking about property ownership among women – the lack of reliable, conclusive data. 

The Data Gap

Globally, it is estimated that women own less than 10 (FAO) to 20 percent (WEF) of the world’s land. In India, there are two national-level surveys which attempt to provide gender-disaggregated data on land ownership – the National Family Health Survey and the Indian Human Development Survey. However, both these databases, which vary significantly in their findings, are not without their weaknesses. While the NFHS-5 data estimates that among women aged 15 to 49, 38.7 percent own a house or land (either jointly or by themselves), the IHDS survey (2010-11) estimates that 6.5 percent of all women over the age of 18 are landowners (however, this data does not record joint ownership of property). 

Furthermore, when it comes exclusively to agricultural land ownership, the figures reveal a disheartening scenario. In India, where it is estimated that over 70 percent of rural women work as agricultural labourers, only 14 percent of agricultural land holders are women and they roughly own only 12 percent of the total operational land holdings. However, owing to the variance in methodology and findings of this study, not to mention its shortcomings, it is rather difficult to conclusively state what percentage of women own land and property, and what demographics these land-owning women belong to. In the absence of reliable data, it becomes increasingly difficult to design a gender-responsive policy that encourages property ownership among women.

The Need for Gender-Responsive Policies in Property Rights

While there may be a dearth of clear, reliable datasets on property ownership among women, it is still evident that women are greatly disadvantaged in their access to property rights. Even as per the more liberal estimates (i.e. the NFHS-5 dataset), which has been criticized for being unrealistically high, only 1 in 3 women own property, either jointly or by themselves. There is, therefore, a clear need for gender-responsive policies to encourage property ownership among women.

Firstly, existing laws should be studied from a gender lens to explicitly identify, and accordingly amend, laws which have been discriminatory towards women. For eg. a paper published by the National Institute for Public Finance and Policy for the Property Rights Research Consortium notes, while the Hindu Succession Act, 1956, has undergone some amendments to reduce discrimination against women (most notably the 2005 amendment and the recent judgement upholding daughters’ rights to coparcenary property), there continue to exist provisions under the Act which discriminate against women, specifically in the devolution of property under Section 15. Under these provisions, there have been instances in the past when the husband’s family was unfairly prioritized in the scheme of devolution as compared to the woman’s own family, even when the property belonged to the woman.  

Secondly, policies and schemes must incentivise property registration in women’s names. The legislation in some states under the Indian Stamp Act offers a lesson that can be emulated by other states as well. Under the Act, many state governments, by offering reduced stamp duty when the property is registered in the women’s names, have encouraged individuals to either consider joint ownership or sole ownership of the property in the women’s names.  

Thirdly, robust data-collection methods need to be deployed. This will not only ensure a clear understanding of the extent of ownership among women, but also help assess the varying degrees of disparity even among women, such as the disadvantage experienced by single women, women belonging to scheduled tribes and scheduled castes, widows, etc. 

Fourthly, we must acknowledge one of the biggest factors responsible for poor ownership among women – the patriarchal mindset prevalent in our society. Studies have recorded the hesitance in granting inheritance rights to daughters. The patriarchal biases can be found across institutions, from within families and communities to religious institutions and among government institutions as well. There is, therefore, a strong case to be made for awareness and outreach programmes which can sensitize policy-makers and government officials on the importance of women’s rights, while also ensuring increased awareness among women about their rights. 

At the end of the day, only that which gets measured gets done. And hence, it is important to start working towards a reliable dataset which records the clear extent of property ownership among women and has a clear understanding of the various factors that determine her access to property rights. Only through an evidence-based approach can we ensure the implementation of gender-responsive policies, which can help advance the rights of women in our country.

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.