Mapema mwaka huu, ya Muungano wa Vifaa vya Afya ya Uzazi (RHSC) na Mann Global Health published “Landscaping Supply Side Factors to Menstrual Health Access.” The report summarizes findings on the main barriers to, and opportunities for, menstrual health product access. This post breaks down the key findings and recommendations in the report. It talks about ways that donors, governments, and others can ensure access to menstrual health supplies for all who need them.
RHSC and Mann Global Health conducted a mapping study. It looked at:
They selected four countries for deep dives into the MH market: Kenya, Tanzania, Nigeria, and India.
They conducted a literature review and key informant interviews with 20 individuals, focused on constraints related to supply (provision of MH products) and access (ability to obtain these products). In doing this, they identified constraints that affected menstruators’ access to quality menstrual health supplies. The resulting report is intended to inform programmatic decisions for MH supply interventions, which reflect current trends and needs for MH supplies.
More than 500 million menstruators globally lack access to the necessary supplies to manage their menstruation. This is equal to one-fourth of the global female population of reproductive age.
The MH market is growing rapidly and has huge potential for future growth. Kwa mfano, according to a report by Population Services International, sales volume of MH supplies in India is doubling every five years. Still, supplies are still only reaching about 10% of those who need them.
Urban, wealthy, and educated are most likely to use commercial MH products.
This is because of one or more of the following reasons:
This leads to limited use of commercial MH products.
It is expensive to maintain the equipment to produce mass quantities of MH products, and the raw materials are challenging to obtain.
Things like inefficient distribution, poor infrastructure, and the sheer space needed to transport bulky MH supplies are all challenges for the MH supply chain. Limited supply can also lead to higher retail prices for end-users purchasing MH products.
There is a general lack of awareness about different types, brands, and quality of MH products. Retailers will not carry what is not in demand by consumers. There is a general need for more consumer education around MH products—particularly for reusable options and less well-known options (like washable pads, period underwear, and menstrual cups)—to make sure menstrators are aware of their options, pros and cons, and how to use them.
Ideal MH products are easy to use and clean, high-quality, environmentally sustainable, nafuu, and acceptable. Current options meet some, but not all of these criteria. More research is needed to better understand consumer preferences and develop new and/or improved products that better satisfy the needs of menstruators.
Hata hivyo, they often operate on a small scale and face challenges regarding sustainability.
Hata hivyo, they require additional evaluation before promoting widely.
Like contraception, ensuring that the availability of a wider informed product choice is critical. Menstruators benefit by choosing among a range of options that allow for mixed use and better meet their needs.
“Mixed use” refers to using different types of MH products on different days—and during different seasons—of an individual’s menstrual cycle. Kwa mfano, using disposable pads some days, and menstrual cups or reusable pads on other days. Pia, reusable cloth or period underwear can be difficult to fully dry in rainy seasons, so alternatives are needed.
This report provided analysis regarding different business models—both upstream and downstream—and what type of MH products they supply. (Note that “upstream” here refers to the production of MH supplies, while “downstream” refers to distribution of MH supplies.)
They examined the following four upstream business models that were common across settings:
In terms of “downstream” business models, the analysis focused on last mile distribution. Specifically, they looked at direct-to-consumer models (kwa mfano, vending machines) and institutional free/subsidized distribution (kwa mfano, through programs in schools or in humanitarian settings).
The following are summaries of business models and product flow from the four focus countries in the report (click to expand):
The report analyzed the MH market in terms of products, access, price, and demand.
Products: Overall, disposable pads are the dominant commercial MH product, with global brands providing most of the supplies. Reusable products (kwa mfano, menstrual cups) are beginning to gain traction, but knowledge about these products remains low. Furthermore, more MH brands are coming on the market, but not all are high-quality.
Access: MH products are broadly accessible at retail outlets in urban areas. Hata hivyo, availability is limited in rural settings, particularly for reusable products. Retail prices are often high. Innovative outlets (kwa mfano, direct-to-consumer platforms like vending machines or eCommerce models) are promising, but they have mixed results. Free or subsidized provision of MH products—particularly in schools—is an important distribution route in many settings.
Price: Commercial MH products—especially reusable ones—remain too expensive for those in the lowest income brackets. Even when taxes and duties are removed on products, retail prices do not always come down. Many low-income menstruators prefer buying smaller quantities of products.
Demand: Lack of education and awareness about MH products is a big challenge. Many suppliers combine product promotion with school-based education about puberty and menstruation. Brands often target urban middle- and high-income communities. Misleading marketing claims are prolific (kwa mfano, claims that certain brands can relieve menstrual cramps). Further, stigmas and taboos associated with discussing menstruation are challenging for the MH market in most settings.
Cross-cutting Findings: Advocacy and coordination is important to ensure access to menstrual health products. Product quality standards are becoming more common. This is beneficial for consumers but can also allow for new product types to enter the market. Most donors have little interest in funding MH supplies. Hata hivyo, there is a strong commercial potential, which is attracting interest from innovative groups (kwa mfano, e-commerce groups and advocates for reusable products).
Note: This is a highly summarized version of the section on business models and market structure. See the full report for additional information. The report also includes a helpful tool—the MH Market Intervention Framework—to help improve provision of MH supplies.
The assessment led to four overarching recommendations for donors, governments, program managers, na wengine:
Ensuring that menstruators are aware of, and have access to, a full range of MH products is the first step to ensure product choice. Continued investments—by donors and governments—to develop and apply product quality standards can help ensure availability of a wider range of products. These investments can also encourage the design of innovative products and product improvements to reach more menstruators. Such innovations can be as simple as offering packages with smaller quantities of products that are more affordable to lower-income menstruators.
Investing in national or regional producers of MH products is a way to help ensure sustainability of MH products. From equipment to changes in tax policy, to technical assistance, there are a number of actions governments and larger companies can take to support more sustainable MH provision that reaches the last mile.
Support for innovative distribution models, like e-commerce and vending machines, can help improve access. And improvements to the supply chain overall can help keep costs lower for consumers. Free and subsidized distribution programs are still needed—for example, those providing MH products in schools.
Advocacy to improve promotion of MH products is important, in addition to stigma reduction programs, so more menstruators can discuss their needs more openly. This will lead to greater awareness, demand, and acceptability of MH products. More evaluation and data collection is also needed to inform future MH programs.
Increasing access to menstrual health supplies can change menstruators in a number of ways—from increased educational opportunities to greater gender equality and reduction in stigma. Program managers, policymakers, donors, and others can follow the above recommendations to include MH in SRH programs, therefore improving the supply chain and ensuring greater access to menstrual health supplies for all who need them.
Want to learn more about this topic? Further reading: Laura Amaya, Jaclyn Marcatili, Neeraja Bhavaraju, Advancing Gender Equity by Improving Menstrual Health: Opportunities in Menstrual Health and Hygiene (FSG, Aprili 2020).
The Reproductive Health Supplies Coalition is a global partnership of public, private, and non-governmental organizations dedicated to ensuring that all people in low- and middle-income countries can access and use affordable, high-quality supplies to ensure their better reproductive health. The Coalition brings together diverse agencies and groups with critical roles in providing contraceptives and other reproductive health supplies. These include multilateral and bilateral organizations, private foundations, governments, civil society, and private-sector representatives.