Market-Based Menstrual Solutions Can Unlock Options for Women and Girls

In the heart of Cox’s Bazar, Bangladesh, Monowara Begum sits at her sewing machine surrounded by fabric. Some of the items are clothes that she’s tailoring, but she also has raw materials for her other venture—reusable menstrual pads. As a mother, Monowara knows the challenges that menstruators face in her community. Disposable pads aren’t always easy to find and even when they are, options are limited and they are too expensive for many.  Often, they may be sold by a male pharmacist, making buyers uncomfortable due to the social stigma around menstruation. After opening her shop and meeting iDE, Monowara saw an opportunity in the market and began making reusable pads and selling disposable ones. She also became a menstrual advocate, setting up community meetings and visiting schools to educate people about menstruation and offer her products as a solution. She is part of a new wave of entrepreneurs who focus on menstruation—filling an urgent need for half the world’s population. 

Changing the narrative around menstrual health

The silence and stigma around menstruation is slowly changing as everyone from champions like Monowara and institutions like the United Nations speak up about it, acknowledging menstrual health as a human right. Even so, 1.8 billion monthly menstruators can attest that their period, and attending to the needs it creates, can be a challenge. In low-income countries, the challenge is even greater. In these areas of the world, many individuals lack access to affordable and reliable menstrual products such as pads, tampons, or menstrual cups. This can force people to resort to unhygienic alternatives like rags, which increases the risk of infection and discomfort. Even when menstrual products are available, they are often prohibitively expensive for individuals living in poverty. The recurring expense of purchasing menstrual supplies can strain already limited household budgets, leading some to prioritize other essential needs over menstrual health.

In addition, access to private and clean toilets, sinks, and disposal facilities is often inadequate in low-income communities. This makes it challenging for individuals to manage their menstruation discreetly and safely, especially in public spaces like schools or workplaces. And that discretion is key because many social norms reinforce menstruation as impure or shameful, leading to social exclusion and discriminatory practices against menstruating individuals.

Market Opportunities for Menstruation

At iDE, we power entrepreneurs to end poverty, including period poverty. In this space, our goal is equitable access to menstrual health and hygiene products and services through market system creation to drive choice and dignity for women, and enable them to thrive in their communities. To be successful, it is essential to create an ecosystem of products and services that are designed by women and menstruators for women and menstruators. 

To start, across many of the markets that iDE works within, there is limited manufacturing of a range of high-quality period products due to limited availability of raw inputs. Importing drives additional costs, creating another barrier for social enterprises. iDE is working with local entrepreneurs like Monowara to create and promote reusable, sustainable menstrual pads as another option. We do this by aiding in the search for material sourcing, offering business training on things like bookkeeping, and building behavioral change campaigns to raise awareness about healthy period management options. Market linkages are also made to suppliers of disposable products that are more accessible and affordable for people like Monowara to buy and sell.

Even when products are available, they may not be equally available to all. In Ethiopia, for example, around 80% of the commercial market is limited to Addis Ababa leaving the rest of the country with limited or no coverage.  Our work in Ethiopia involves partnering with these social enterprises to build the business case for rural distribution and connecting them with rural entrepreneurs to promote access to the menstrual products necessary for a dignified and healthy period. Some recently trained sales agents also mentioned that they had never seen some of these products and had never learned about menstruation so holistically. This means we have an opportunity to share information and knowledge around menstruation with entrepreneurs and customers alike.

There is an urgent need and huge market opportunity to unlock for women, both as actors in women-centered markets and as consumers to assert agency for desirable, safe products. Leveraging the power of markets, we can drive innovation and demand for culturally appropriate, environmentally friendly, and safe solutions for dignified menstruation. We know our efforts to grow rural markets is just one component of menstrual health – but we see the promotion of a wide range of products and informed choice as a critical avenue to change behavior over time. 

Women Centered Design

A well lit room, a locking door, a place for product disposal—these things are important for menstruators to have in their bathroom facility but are not always considered. 

When we design for ‘humans’ in human-centered design, we need to rethink who we consider to be a typical human. By default, this human is often male. That means the design solutions are usually not built for women, be it their bodies or their preferences. And treating people the same does not result in equal outcomes for all. 

To combat this “one-size-fits-men” approach, design needs to meaningfully understand and address women’s unique lived experiences and needs. 

A woman-centered design methodology aims for equity, considers different body types, considers social, emotional, and environmental contexts, and considers the invisible, unpaid work that women often participate in. 

Our design research—so far conducted in Ghana, Bangladesh, Cambodia, Ethiopia, and Zambia—aims to uncover how menstruation influences and shapes a person’s experience of the world, from gender equity and education, to health, well-being, and autonomy.

iDE Hosts Menstrual Health Summit in Ghana

In March 2024, iDE brought together staff from our offices in Bangladesh, Cambodia, Canada, Ethiopia, Ghana, Nepal, the US, and Zambia to share learnings about our work in dignified menstruation and identify challenges for building women-centered markets that allow women and menstruators to design the most desirable options for them to use during their menstrual cycle. We know our programming is already influencing menstrual health, so the summit was an opportunity to ensure we do it intentionally and map a strategic course forward.  

Our Africa Regional Gender, Equity, and Social Inclusion (GESI) Officer Abigail Musinga explained,

Our key takeaways from the workshop:

1. Currently, there are limited models for small and medium-sized enterprises to sell directly to rural customers. Most models depend on selling B2B, with highly subsidized or free distribution of those products, usually through schools or NGOs. How might iDE help prove a market exists for menstruation? How can we partner with existing actors in the value chain to derisk entry into rural markets? 

2. Across iDE contexts, social norms, lack of hygienic washing and drying options, and disposal of single-use menstrual products were major barriers. For many of the communities our teams operate within, access to a range of appropriate and aspirational products in rural contexts is limited, and there are many financial barriers for local businesses to produce high-quality and desirable products. 

3. We need to start within our organization. We must continue to build the skills and awareness to analyze power and how it impacts the social fabric that shapes how we view menstruation. We continue to recommit to do no harm principles and ensure our staff and our engagement with community members and entrepreneurs are not reinforcing harmful social taboos. 

Leveraging our strengths in market facilitation and designing to context, iDE can work with existing actors—from private sector to community leaders—to overcome market barriers that limit how women and girls can make informed choices about their menstruation.

Shifting Behaviors Over Time

Existing norms and behaviors related to menstruation have a significant impact on individuals involved in all of iDE's programs. Stories have been shared about women missing work due to pain and fatigue, as well as societal norms discouraging women from tending to their fields out of fear that crops like groundnuts and chili might fail. 

In Zambia, community members collaborate through the Village Savings and Loans Association, with one group engaging in a collective vegetable garden for income. Each member takes turns watering the garden. One week, the garden became dry, leading the group to investigate. 

They discovered that a woman responsible for watering refrained from doing so due to a taboo against watering while menstruating, believing it would harm the plants. 

To challenge this belief, the group conducted an experiment allowing a menstruating woman to water a small section of the garden. To their surprise, after a few days, the watered area thrived, demonstrating the myth's inaccuracy.

This story highlights multiple taboos at play - working in the garden, watering plants during menstruation, and disclosing that you are menstruating. It also shows that taboos are flexible and it is possible to shift norms and behavior over time.

The Role of Men and Boys in Destigmatizing Menstruation

Engaging men and boys in menstrual health discussions is crucial for fostering gender equality and promoting a supportive environment for women and girls. By involving men and boys in these conversations, we can break down taboos surrounding menstruation and challenge harmful stereotypes. Educating males about menstrual health helps them understand the biological and social aspects of menstruation, leading to increased empathy and respect towards menstruators. During iDE’s human-centered design work in Ghana in 2023, married couples shared differing perspectives - husbands cited negligible costs for menstrual products, while wives discussed the lack of affordability. This highlights the work to be done to build understanding at the household level around MH. While we are working to build markets that center women as actors and consumers, we are encouraging men to become better allies to their wives, sisters, and daughters.

Menstruation and Climate Resilience

During an adverse weather event or crisis, access to clean water, hygiene facilities, and menstrual products becomes even more challenging as, for example, extreme weather events can damage or destroy water and sanitation facilities. Climate change is also leading to water scarcity, which can make it difficult to access clean water for drinking, bathing, and washing menstrual products. In the Tonle Sap region of Cambodia, an area that spends almost six months of the year flooded, we’ve heard from women how many challenges they face in disposing of their menstrual products during the monsoon season. While accessing menstrual products is not a limitation for most, they face more challenges around disposal, sometimes keeping used products in a trash bag in their home for months until the water recedes. Within our existing WASH programming in iDE Cambodia, our sales agents include key messages around menstrual health, including disposal, when giving sales presentations to customers. Further, during regular trainings with local government, dignified menstruation is included as a key training module. 

Working toward greater understanding and new solutions

Improving our understanding of menstrual health within the context of climate change in rural and low-income countries is imperative for advancing global population health and gender equality. 

Eliminating period poverty is a nuanced and complicated issue that requires market systems development, social behavior change, partnerships, and commitment from men, women, boys, and girls to create real and lasting change. iDE will leverage our existing commitment and experience in gender equity and WASH while continuing to learn about, explore, and design solutions for this emerging challenge.