Billions of women and girls get their periods every month. For some of us, it’s little more than a bothersome time filled with fatigue, food cravings and cramping. For others—women and girls in poor countries—it can mean being ostracized to a shack until their periods end, missing school, contracting reproductive diseases, and even violence.
A U.N. study found that one out of three girls “knew nothing about menstruation prior to getting it.” That same study showed that 48 percent of girls in Iran and around 10 percent of those in India “believe that menstruation is a disease.” If those findings aren’t alarming enough, on MH Day 2015, The Guardian’s Ellie Mae O’Hagan reported that in India, 70 percent of all reproductive diseases are a result of poor menstrual hygiene. Other studies have documented just how much school girls miss because they can't properly manage their menstruation, and how this challenge can also hold them back at the workplace as well as limiting their mobility in countries without adequate restrooms for females.
A simple truth is that it's hard to empower girls and women, a goal that many funders have lately embraced, without making big strides in menstrual hygiene management (MHM). Yet there's not as much money and attention focused on this area you might think. We keep waiting for that to change, with more funders grabbing an opportunity to work a vital but neglected issue.
In 2014, WASH United mounted a global campaign to bring menstruation in the global health and developing spotlight by initiating a Menstrual Hygiene Day (MH Day). Last week, NGO’s, government agencies, the private sector, the media and individuals observed the third MH Day, which is less of a celebration and more of a global moment to build awareness about the critical role that good MHM "plays in helping women & girls reach their full potential.”
In 2015, 127 organizations announced MH Day events in over 30 countries. The MH Day Alliance now has over 400 partners and this year’s MH Day resulted in 180 events around the world.
Still, despite signs of growing momentum, menstruation remains one the back-burner as a global health and development challenge. Surely, there are a number of contributing factors as to why this is so. For starters, even the most pragmatic global health and development experts can get a little bit uncomfortable whenever the conversation turns to periods. What's more, this issue is often seen as a niche concern (as opposed to one that affects 2 billion women every month), and tends to fall through the funding and policy cracks.
Lisa Schechtman, director of policy and advocacy at WaterAid America once wrote on Gates Foundation’s Impatient Optimists blog, says,
Menstrual hygiene management (MHM) rarely appears in donor strategies, national government policies or advocacy agendas. On a good day, it might be a component of national sexuality education curriculum, but this presumes kids are going to school and are able to get this information.
Schechtman also asks, “If we get menstrual hygiene right, what else will have changed in the process?” The short answer is everything—from improving gender parity to breaking generational cycles of poverty.
Not everyone is ignoring the problem, as evidenced by the increased number of MH Day partners each year. Additionally, there are some funders who totally get it.
Among them is the Caterpillar Foundation, which concentrates its funding on the root causes of global poverty. Since 2010, the foundation has distributed over $30 million in support for female empowerment, WASH, microfinance, and energy programs. The foundation ties menstrual hygiene into its WASH and women and girls empowerment funding.
Michele Sullivan, president of the foundation, noted in an interview with IP that menstruation can effectively prevent young girls from attending school due to the lack of access to bathrooms. And we don’t have to tell you that the less education a girl receives, the higher her likelihood to marry early and get pregnant at a young age. Pregnancy is among the leading causes of death worldwide for girls ages 15 to 19.
The Gates Foundation is also taking on the menstrual hygiene on a few different fronts. While this isn’t a major funding focus for Gates, it has invested close to $3 million over the past few years in a variety of related projects ranging from the development of a reusable, self-decontaminating sanitary pad to developing and improved understanding of menstrual management to inform WASH planning in developing countries.
The U.K.-based Waterloo Foundation is another big player in this field, awarding grants ranging from $80,000 to $160,000 in support of projects that “specifically seek to address menstrual hygiene management.” Longtime grantee WaterAid is currently receiving a generous £300,000 per year of unrestricted funds toward a number of intiatives to “lead the way in harder to fund WASH elements, such as menstrual hygiene.”
While there are big outfits like WASH United, WaterAid, and Plan International leading the charge, there are some smaller groups that are punching well above their weight in this space as well.
Last year, the Nairobi-based ZanaAfrica, secured a $1 million investment from Grand Challenges Canada in support of its transition from pilot to proof-of-concept. The nonprofit, founded by Harvard grad Megan White Mukuria, is on a mission to keep Kenyan girls in school with a three-pronged approach: delivering reproductive health education, advocating for widespread, systematic change though policymaking, and delivering sanitary pads.
Another nonprofit that’s leading the charge in the field is Sustainable Health Enterprises or SHE. Established by Elizabeth Scharpf and a small team of MIT students, SHE is providing access to affordable menstrual pads for women in Africa. Scharpf stumbled upon the period problem while working for the World Bank in 2008. While in Mozambique, Scharpf learned that at one factory, around 20 percent of employees regularly missed work to the tune of up to 30 days per year. According to SHE’s website, the main reason behind the lost work days was because “pads cost more than a day’s wages.”
SHE is a social venture that helps local women “jumpstart social businesses” that produce and distribute affordable menstrual pads made from materials that are sourced locally. SHE also provides training to community health workers on the company’s decentralized distribution system as well as training regarding how to educate girls and boys about puberty and menstrual hygiene. On the policy front, SHE is advocating for government leaders to waive the value-added tax on sanitary pads. With the help of partners like the Segal Family Foundation, Grand Challenges Canada, and the United Nations Children’s Fund, the company continues to build the blueprint to take its approach to scale globally.
AFRIpads is another social enterprise that is working to break down barriers built by menstruation. The group is on a mission to “empower women and girls through business, innovation, and opportunity.” Similar to SHE, AFRIpads manufactures affordable and reusable sanitary pads locally. The company’s menstrual kits are then distributed to women and girls around the world. This simple kit keeps women and girls in school, prevents them from missing work, and gives them the ability to engage in their normal daily routines and responsibilities.
When it comes to menstruation in developing countries, there are more than a few barriers to change beyond gaining access to health education and sanitary pads. There are also long-held traditions and beliefs, which may be among the most difficult to change. But they need to. We all know by now that when you hold girls and women back from progress, you hold the world back.