Menstrual hygiene management requires availability of and access to clean and absorbent menstrual material, privacy, water and soap, and disposal facilities for used menstrual materials. However, most schools and communities in developing countries, especially in rural areas, have inadequate facilities including water supply for girls and women to wash hands, external genitalia and soiled clothes. Nor do they have provision for privacy, soap, sanitary pads and disposal of soiled sanitary pads. Girls’ participation and psychological well-being while in class is affected when they do not have access to sanitary pads or adequate alternatives because they fear staining their clothes and subsequently being teased and humiliated by their classmates. It is not surprising then, that attendant hormonal disruptions notwithstanding, girls’ school performance has been noted to decline after the first occurrence of menstruation in Africa.

Education of girls directly impacts national health and national development as well as economic and social progress. Educated women tend to have fewer children, lead healthier lifestyles and raise healthier families by making more informed choices. Being more likely to practice and seek appropriate preventive and medical services such as personal hygiene, nutrition and immunization, they help reduce infant morbidity and mortality in the nation. This in turn leads to lowered fertility rates and higher market productivity thereby improving the national economy. In Africa, about 44% of girls are reported to drop out of school before completing their secondary education.  One reason for this interruption could be inadequate provision for menstrual hygiene management that does not allow all girls to attend school with dignity and comfort during their menstrual period.

Safe, accessible menstrual hygiene products have a considerable positive impact on women and girls’ occupational, social and educational capacity. A key barrier to access for girls is that facilities where menstrual hygiene products can be changed with dignity are frequently not provided in schools, or teachers may not grant students permission to use them. Women and girls who could afford to buy menstrual hygiene products may also be reluctant to do so from shops, which are often run by men, due to stigma. They may depend on their husband or father to provide them with funds to buy disposable pads, which may be withheld. 

The main menstrual hygiene products currently available are disposable pads, reusable pads and the menstrual cup. However, the cost of disposable pads often means that they are inaccessible to women and girls in resource poor settings. It can also be challenging to ensure a consistent supply of disposable sanitary products in rural areas, particularly those affected by conflict.

Washable, reusable pads are therefore a preferable alternative for increasing access to menstrual hygiene products as they are sustainable, low cost and easily accepted by women and girls.

For example, in Katsina State Malumfashi Local Government Area, UNICEF conducted training on Menstrual Hygiene Management (MHM) in 2017. Students and women were trained on healthy practices of menstrual hygiene management.

The MHM training, which was aimed at eliminating the barriers encountered by the girls and women due to poor menstrual hygiene, included a hands-on skill acquisition programme. The women and girls in Malumfashi were trained to produce reusable sanitary pads, thereby opening them to social and economic opportunities. The reusable sanitary pads are packaged as a kit. This kit is made up of 2 shields, 6 flannels, and 1 bag. It currently sells between N350 and N500. This is cheap compared to a disposable sanitary pad that costs between N550 and N800. At least 25 women in communities and 500 students – girls – in 5 schools (100 per school) were trained to produce these kits. They now share their knowledge and skills with others interested in learning.

The key methods to increase access to menstrual hygiene products are through improving their availability and affordability, and improving understanding of this topic in the community. To increase availability, various national and international initiatives have distributed free or subsidised menstrual hygiene products. However, while this approach can be used in the short term to quickly improve access to menstrual hygiene products in a community and is vital in humanitarian crises, in more stable development contexts it is not ideal as it creates dependency on external assistance. It is far more sustainable to work to ensure that an affordable and consistent supply of the reusable menstrual hygiene product(s) of choice is available which can be done through private sector development by working with local suppliers and supporting the supply chain with investment to overcome key bottlenecks and technical assistance to produce an effective yet low cost product where required.

Once the supply side is in place, the demand side can be built through education targeted, culturally sensitive education of men and boys as well as women and girls. It works to decrease stigma and increase understanding of the usage, benefits and cost effectiveness of menstrual hygiene products such as reusable pads and menstrual cups. Greater understanding also decreases the stigma that women and girls may feel regarding buying menstrual hygiene products from a shop, and increases the likelihood that men in charge of a family’s finances will provide menstrual hygiene products to their female family members. Improved awareness among teachers can make it easier for girls to change or empty menstrual hygiene products in schools, though support from donors may also be required to fund the creation of suitable toilet facilities in schools for this to take place.

Written by Genevieve Aito


  • Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls (Joyce ChinyamaJenala Chipungu,Cheryl RuddMercy MwaleLavuun Verstraete)

  • Sustaining Menstrual Hygiene Management Through Peer-to-Peer Mentorship (Job Ominyi, Jennifer Ehidiamen and Nelson Owoicho)

Challenges facing women and girls in accessing menstrual hygiene products in developing countries, and effective approaches to increasing their access (By Tessa Hewitt, Liverpool School of Tropical Medicine)

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