New Internationalist

Menstrual sanitation is not just a ‘lady issue’

School kids in uniform in Kenya [Related Image]
Students in Nairobi: poor menstrual provision can keep girls out of school kyhm54 under a Creative Commons Licence

Like many other Western countries, my home country of Australia is reluctant to support development in all its forms. We liberally support causes like AIDS or infant mortality prevention, but equally important issues like female hygiene and sanitation attract minimal attention.

Yet investment in projects that directly support women and girls is essential to reducing poverty. In 2012, the UN Secretary General Ban Ki-moon said that ‘the greatest return comes from investing in girls and women. When they are educated, they drive development in their families, communities and nations.’

A single year of primary education correlates with at least a 10-per-cent increase in a woman’s wages later in life, with the returns on a year of secondary education estimated to be double that. Moreover, educating girls remains the single best policy for reducing fertility.

However, in Sub-Saharan Africa only 57 per cent of all girls attend primary schools, with only 17 per cent enrolled at a secondary level. A UNESCO study has found that about 150 million children currently enrolled in primary schools globally will drop out before they finish. At least 100 million of those will be girls.

One reason young girls are not attending school is commonly overlooked: gender taboos and menstruation.

Ngeru, for instance, is a 14-year-old girl from Kenya. During her period, she has no access to sanitary pads. Instead, Ngeru will improvise with cloth, or bark tree lining, or mattress stuffing.

Needless to say, these DIY techniques are ineffective and humiliating. Health risks abound, including infections and genital sores. She will likely end up with blood on her school uniform or clothing, but attitudes to menstruation mean that Ngeru would rather drop out than confront the bullying of peers and male teachers alike. She enjoys studying mathematics, but her education is wholly subject to her cycle.

A study of the attitudes of Kenyan school-aged girls to menstrual health found that ‘one of the most effective ways to deal with menstruation is to go home’.

The Kenyan government, African women’s groups, NGOs and prominent UN bodies such as UNICEF and the World Health Organization have all publicly acknowledged that there is a significant link between the poor provision of menstrual hygiene solutions and female participation in education. The Kenyan government even dropped its import tax on female sanitary products in 2011 to help reduce costs by 18 per cent. Many NGOs across sub-Saharan Africa, including Kenya, have made the provision of sanitary pads their sole raison d’être.

But private attitudes toward menstrual health handicaps are very different. I recently met with the head of sanitation for UN Habitat in Kenya. Menstrual health was not mentioned in any of their policy papers. They awkwardly parried my questions about ‘the lady issues’. Similarly, the Inclusive Economic Growth & Social Development Unit said that they would not address menstrual health (although they avoided using ‘the m word’) because it was not part of their portfolio.

The attitudes of top UN policymakers toward this ‘lady issue’ in Kenya are disappointing. But when aid workers do turn their attention to female sanitation, they are often ineffective.

Bono-style charity models from yesteryear are not working. Donating pads is not a sustainable solution, especially when it only reaches a fraction of women and girls.

Organizations such as the International Monetary Fund, the International Development Association, the Asian Development Bank, and the World Bank all agree that to grow Human Development Indicators, we need to finance small emerging enterprises. These should be run and owned by local stake-holders who cheaply borrow capital and engage in long-term capacity building with lender organizations. This model should be applied to the provision of female sanitation.

In Rwanda, for instance, an organization called SHE has taken a business model approach to local sanitary pad production. While producing pads around 30 per cent more cheaply than commercial counterparts, women are creating jobs for themselves. Financial success is a further incentive, after the repayment of their microloan.

Models like these multiply the effects of sometimes meagre foreign aid. Although Australia’s commitment to aid has remained relatively steadfast, whether that continues after the September 2013 elections is questionable. Moreover, it’s pertinent then that in many cases, gender-targeted initiatives have disproportionate economic returns compared to those which are gender neutral.

Prioritizing women’s health in the Global South, so girls can attend school and enter the work force, just makes economic sense.

Female sanitation is not just a ‘lady issue’. We need to get our hands dirty, so to speak, with some of the less fashionable development issues. Female hygiene should be at the top of this list. It means getting people to talk openly about menstrual health – in all parts of the world – and adapting to new aid models which encourage small business enterprises like SHE.

If the rights of girls and women are properly recognized, this generation of sub-Saharan Africans could experience improved education, health, livelihoods and equitable economic growth. These outcomes will be multiplying and sustainable. And there is nothing more important to the development sector than that. Period.

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  1. #1 kang li 26 Jul 13

    I never knew about this issue. Thank you for bringing it to light!

  2. #2 Jennifer Turnour 26 Jul 13

    Thank you for explaining one of the key environmental issues that: ’Educating girls remains the single best policy for reducing fertility.’

  3. #3 Robert Stewart 27 Jul 13

    Kenya? Nigeria? Have a read of Islamia Anyone? on JustGrounds blog about the schoolgirl dragged off a bus by the Taliban and shot because she was outspoken about education for girls.

  4. #5 Geoffrey Kelley 28 Jul 13

    Caroline, I congratulate you. Not only have you reported on a problem that most of us were unaware of, but you have reported a solution. Thank you.

  5. #6 Beck Beatrice 06 Aug 13

    What a great article, so glad to see the menstrual sanitation and development link made in this blog. It strikes me that addressing women's sanitation through practical (pads etc) and educational means (that blood is clean and healthy!) is a big confidence builder for female teenagers in particular.. In supporting women's enterprise, a small business in menstrual pads could be one way to go.. but there are a few issues to consider 1) in some developing countries it is not always possible to discreetly dispose of rubbish - trying to get rid of disposable pads might cause anxiety for some teens, dropping them down a composting toilet is bad for the system.. 2) Can girls/teens afford to buy monthly pads? I appreciate that the price might be brought down, but where is the money coming from? 3) If pads lead to increasing land fill this is not ideal - can lead to unsanitary conditions where people live near/search rubbish dumps and poor environmental impact.

    Perhaps, the current situation in Kenya could be seen as an opportunity, not only for new female enterprise and women's empowerment more generally, but also to implement more innovative thinking about how to 'deal' with menstrual blood. Here is one inexpensive, hygienic and environmental option being sold in Australia right now: could such a product be made in Kenya? Inserting a forign object may not appeal to local people ant that is fair enough if so, but consider a more holistic perceptive in thinking about the solution here..

  6. #7 SK 10 Aug 13

    Though I am glad you bring this surprising and important issue to light, I agree with Beck Beatrice. Using disposable pads is not sustainable in any country, let alone an impoverished one lacking most of the necessary resources to create, purchase, and dispose of pads. There are numerous menstrual cups in production (including the lunette which I use), and these countries could easily make a create a mold and use their own resources to manufacture inexpensive, re-usable, sustainable cups. In addition, like the projects giving goats to families so they can produce their own milk and cheese, using animal wool or cotton pads that can be washed and re-used is also something that can be done on a very local level - and that is also cheaper and both economically and environmentally sustainable. These are two solutions that are actually preferred by many educated women in the U.S., including myself and there are many companies on-line that sell them (such as glad rags, skoon, etc), as well as many women who make them at home. Women have taken care of their own menstrual needs since time immortal. We could simply assist in further education and show them options and assist them to get something going. But, promoting disposable pads, tampons, or other economically and environmentally damaging options seems unhelpful at best and disastrous at worst.

  7. #8 Sally 20 Aug 13

    Check out ’Days for Girls’ at or on facebook

    They provide girls with hygiene kits that include 8 reusable liners and 2 waterproof shields so girls don't have to drop out of school! They also provide hygiene education when kits are distributed and teach women how to make additional products for themselves and others in their communities.

  8. #9 Julia San Juan 11 Nov 13

    I think the largest problem with menstrual hygiene awareness is simply that it is not the most visible of issues (as is the case with infant mortality, hunger etc.), but of course that by no means lessens its importance. The problem is more than menstruation management: it is gender equality, body image/confidence and access to education.

    I work with Ruby Cup, a company that produces sustainable menstrual cups and leads health & menstrual hygiene education in Kenya. We believe strongly in our mission for education and body awareness, and think that menstrual cups are with no doubt the most economical and sustainable way to go.

    Would love to speak with you further about this if possible.

    With <3,
    the Ruby Cup team

  9. #11 George mulaku 07 May 14


    The dire need of sanitary pads by our girls in Kenya hence the substitution of the pads with use of other un-hygienic paraphernalia birthed Ecopad Africa.

    Ecopad Africa is a group of young people that has come up with an idea whose aim is to manufacture low- cost reusable (washable) cloth sanitary pads in Kenya. The aim is to mitigate the problem of high rates of menstrual related absenteeism among primary and secondary school girls in rural Africa.

    The pads are made by local Kenyan women, giving them the opportunity to generate an income and send their kids to school. At the same time, our menstrual kit provides school girls with affordable, environmentally friendly menstrual flow protection for a longer period as compared to commercially available disposable sanitary napkins.

    Ecopad is a sustainable solution for girls and women in developing countries. The use of hygienic sanitary pads greatly enhances their health. It provides them the opportunity to continue to work and school during their monthly period, thereby improving their future progress and development.

    Some of the founders of this organization have themselves grown up from the rural parts of the country that are economically disadvantaged and hence have experienced the problems school girls undergo during the menses. This was one of the major driving forces in coming up with the idea of the reusable pads.

    Following previous work with SPG Campaign and Ansell Pharmaceuticals at Raila Educational Centre in Kibera – Nairobi and Eldepe Osinya Primary School in Marigat-Baringo County, and several other schools we found out that there are more girls who need help with regard to Menstrual Hygiene and girl-child education issues.

    Target Beneficiaries
    The main beneficiaries of this project include both the primary and secondary school girls in Rural Kenya and some part of the urban Kenya who are financially disadvantaged.


    The cloth pads are re-useable for between One and a half to Two years which makes it a cheaper alternative to the disposable option that is used once and disposed. It has got no chemicals hence can be used by everyone and good for our health too.

    The kit consists of two straight, three winged, two holders and a zipped bag for packaging.

    For more information please call George on +254 729 675125 or
    Lucy on +254 722 403 667 [email protected] and ecopad africa on facebook

  10. #12 Kelitu Katheu 24 Sep 14

    This is an issue we must tackle. Being a ’Woman’ should not be the determinant of how a woman ends up. Thank you for this post. I will share it on my website.

  11. #16 Vanessa Mbuma 17 Aug 15

    this is a great read. I am part of an initiative called ’mrembo safi’ in Kenya, we are still on our teething stages but we are all about sustainable and affordable menstrual hygiene solutions for girls and women. We hope to apprehend these ’lady issues’ that most find as taboo for the betterment of the future of the girl child.

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About the author

Caroline Marohasy is a student at The University of Sydney’s Faculty of Arts & Social Sciences and was a Global Voices youth delegate to the Nairobi Study Tour on Sustainable Development.

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