Ria Soni remembers her first period very well.

She was in fifth grade and had a band concert that night. Her section, the alto saxophones, were going to play a solo during “You’ve Got a Friend in Me” from “Toy Story.” She got her period during the school day, and because of health class, she knew she could go to the school nurse and get a pad.

“It was an exciting concert — I couldn’t really miss it. But I was unsure how it would be, would I feel uncomfortable?” said the now-21-year-old Rutgers University graduate. “The hardest thing was going home and having to tell my parents about it. Because it was a little awkward.”

Her mom told Soni’s father to buy more pads for her on the way home. Not knowing specifics, he bought the biggest pack he could — about a 200-count package — of super-thick pads.

Juhi Patel, 22, a pre-med student at the Massachusetts College of Pharmacy and Health Sciences, got her first period on the school bus home in sixth grade. When she got home and went to the bathroom, she saw the blood all over her underwear and screamed. Her mom was home to help her.

Soni and Patel, who are both Indian American, knew that many girls in India don’t have the same access to resources they did when they got their first period. The two friends started Project Stree in 2019, a nonprofit to address period poverty in India, where societal shame surrounding menstruation can be strong and persistent. Periods have historically been stigmatized, despite how common they are. Menstruating women are often excluded from entering temples or shrines, or are kept home from religious or social events when menstruating. Project Stree started off by holding workshops on menstrual health and hygiene at schools throughout the state of Gujarat.

It’s a problem that has only been exacerbated by the pandemic, which is now in the depths of a deadly struggle. The country reported another record rise in coronavirus cases on Friday. To date, India has recorded more than 21.4 million confirmed infections and at least 234,083 deaths, though reports widely suggest the number of lives lost is much higher than the official toll.

“India has over 355 million menstruating women and girls, but millions of women across the country face uncomfortable and undignified experience” with menstrual hygiene management, according to a 2020 study in the International Journal of Environmental Research and Public Health. “… Fear, shame, ongoing social taboos, ignorant unsupportive teachers, lack of water, sanitation, disposal facilities, and privacy, are some of the barriers in building an enabling environment for safe and hygienic menstrual practices.”

The authors note that the challenges can “negatively impact sexual and reproductive health outcomes of adolescent girls but also affects their self-confidence and agency.”

Project Stree had lined up 13 workshops to be held in schools during 2020, but amid the spreading virus and the subsequent lockdowns, they shifted to outdoor workshops led by local volunteers.

“Menstrual health, in a lot of rural areas, was never really a priority. A lot of families wouldn’t really consider spending money on pads or even having those conversations,” said Soni. Now, “they can’t even go out to get groceries — sanitary napkins aren’t even on the list.” Programs like Project Stree are often how school-age girls access menstrual products. In the pandemic, they are cut off from that supply chain.

Project Stree says they are distributing pads through their volunteers and also running a social media campaign to encourage households to give pads to their female domestic workers, who may not be able to get supplies.

“It’s literally the same issues that we’ve been facing, just at a greater level because of the lockdowns. People are scared, they don’t want to leave their house,” Soni said.

The experience can cause further stress during what’s already an extremely traumatic time for many Indians, said Megha Desai, president of the Desai Foundation, a nonprofit that focuses on the health and education of women and children in India.

Even pre-pandemic, the majority of menstruating people didn’t have access to menstrual products, Desai said. “They’re using rags, or husk or ash, or whatever material that they can get their hands on. And 71 percent of girls in India don’t know what their period is before they get it. So the whole genesis of this experience is trauma,” said Desai.

“Then they’re told not to talk about it. Depending on what cultural background they come from, in terms of religion, caste, physical geography, they’re told a variety of different things. They’re told they can’t cook, they can’t pray, they can’t touch books. So there’s a litany of things of stigmas that have been created,” she said.

When Soni and Patel led their workshop last year, they said they asked the girls what they would do if they got their period at school. Many of the girls, they said, simply replied that they would go home and stay home for the duration of their periods. They worked with the girls to encourage them to keep pads with them in their backpacks.

“If a girl doesn’t have a safe place to manage her period, she’s missing five days of school a month,” said Desai. “By the time she’s in the sixth or seventh grade, she’s so far behind that she drops out. If she doesn’t have a safe place to change her pads, or feel comfortable purchasing pads, it’s going to hold her back from holding a job. This is not just a women’s issue, this is a GDP issue.”

And now, the pandemic is worsening these concerns, she said, while state and regional lockdowns to abate the crisis are making it harder for women to access sanitary napkins.

“With everybody being so close together at home in isolation or in lockdown, the person who goes out to get by the pads, whether they be male or female, the girls don’t have the confidence to say, ‘Hey, can you add pads to the list?’ That’s a huge problem for the long-term strength of society and specifically for women’s empowerment,” Desai said.

“We’ve heard so many reports of women being more embarrassed by their periods, because they’ve never been around their brothers or their fathers for this extended period of time while they’re bleeding,” she said. “They don’t have a private place to hang their rags or wash themselves properly. So the mental consequence is going to be a big one.”