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Three Levers to Address Global Menstrual Health Challenges

A few weeks ago, I was honored to moderate a panel at PeriodCon—a new conference, organized by students at Yale’s School of Management, that brings together industry leaders, policy makers, product innovators, community advocates, and practitioners to learn about and discuss common challenges and emerging innovations that address menstrual hygiene globally. 

As we discussed in An Opportunity to Address Menstrual Health and Gender Equity, challenges related to menstruation—especially for women and girls living in low- and middle-income communities—can create barriers to women’s and girls’ personal, educational, and professional development. These barriers include pervasive stigma, discriminatory policies, and a lack of access to products. 

FSG’s framework on the critical considerations related to menstrual health. Menstrual hygiene management, one piece of the framework, refers to the use of hygienic material to absorb or collect menstrual blood, access to private spaces to change these materials as frequently as needed, use of soap and water to bathe and clean MHM products, and access to safe disposal options.

In recent years, governments, private foundations, NGOs, and companies have gained a greater awareness of challenges related to menstruation and they are seeking new solutions through cross-sector dialogue, business model innovation, and policy development. 

I moderated a panel on these challenges and potential solutions with Chiara Bercu, program officer at Georgetown University’s Institute for Reproductive Health and Katy Linquist, head of communications at AFRIpads, a Uganda-based social business that manufactures cost-effective, reusable sanitary pads. 

We began our conversation focusing on the barriers and issues facing women and girls globally, with a specific focus on Central America, East Africa, and South Asia:

  • Adequate and safe sanitation access: Globally, 2.5 billion people lack access to improved sanitation. The lack of sanitation facilities disproportionately affects women and girls, especially as they reach puberty. Research shows that when gender-separate sanitation facilities are not available at schools, work, or in public places, women and girls may cope in 3 ways: choose to stay at home, use an isolated open space instead of using shared facilities, or choose not to use the facility and be uncomfortable. In specific geographies, qualitative research confirms that a lack of adequate and appropriate water and sanitation facilities contributes to absenteeism among school-going girls and overall constraints on mobility.
  • Education and mentor support on menstruation and puberty: Girls’ knowledge and understanding of menstrual health is important to ensure their well-being and healthy transition into adulthood. In many parts of the world, girls do not know what menstruation is prior to experiencing menarche. In Ethiopia, for example, 49 percent of girls report having no knowledge of menstruation before their first period. Many girls also don’t have safe spaces or access to mentors to ask questions about puberty or menstruation. In our 2016 research, we found that less than 25 percent of schoolgirls in Ghana indicated they were very confident talking about menstruation.
  • Sufficient engagement of family members including men and boys: Research has shown that involving key influencers, including boys, men, and older women, in conversations is critical to change social norms and properly support girls’ needs. Without these influencers, programs may help perpetuate the status quo and miss the opportunity to emphasize the importance of menstrual health and share ideas for how to support adolescent girls during this period of transition. Boys and men specifically should also have access to puberty education, which includes information that takes a gendered lens on menstruation and menstrual hygiene management and aims to create a less stigmatizing educational environment for girls. 
  • Positive messaging that breaks down stigmas: Many girls and her influencers follow cultural and other practices that perpetuate taboos and can restrict girls’ mobility and activity during menstruation. While these practices vary across regions and families, common discriminatory practices include restrictions on living and eating with and/or cooking for the family, visiting the temple, or using flowing sources of water such as rivers and streams. Marketing campaigns, use of role models, and other behavior change efforts can bring attention to the stigmas associated with menstruation, and show the dangers and implications these can have on girls’ development. 

The remainder of the conversation focused on some effective approaches and solutions to addressing these barriers. One common area discussed was that programs addressing menstruation challenges in schools—a common focus for many organizations—must look beyond school attendance issues and consider how menstruation affects girls’ confidence and school performance. Chiara previously worked as a consultant to Save the Children and contributed to their efforts to design metrics that considered the effect of menstruation on girls’ ability to pay attention in class, confidence, and participation, which all contribute to school performance.

Developing innovative private sector solutions, as AFRIpads has done in Uganda, can help to create economic opportunity for communities. In addition to manufacturing and selling menstrual hygiene products that women around the world can afford and access, AFRIpads employ women in the communities they serve, creating a virtuous cycle of economic development. 

Cross-sector engagement is critical to addressing broader systems challenges related to product access, sanitation product and service design, and inclusive policies and practices at the national and district levels. Few governments, corporations, or NGOs are looking at menstrual health as a systemic problem, and thus, they are missing the opportunity to address the problems sustainably and at scale. 

Alexandra Geertz, Katy Linquist, and Chiara Bercu in conversation at PeriodCon.

It’s notable that the conference was hosted by Yale’s School of Management, as historically issues related to menstruation have largely been addressed by nonprofits and NGOs. I am thrilled to see the conversation expanding and I commend the organizers for bringing people together across sectors to have needed conversations on this multi-disciplinary issue. I truly believe conversations like this one will propel change and impact for women and girls around the world. 

Learn more about FSG’s global health work >

Read An Opportunity to Address Menstrual Health and Gender Equity >

Alexandra Geertz