Locally Owned and Led Menstrual Health Enterprises
Uniquely Positioned to Drive Deep and Lasting Change
Sumitra (name changed), 28 years old and married at 17, lives in a rural community in Rajasthan, India with her three children, husband and his parents. The family used to earn $80 per month with almost all the adult members engaged in manual labor in stone quarries under dangerous and difficult working conditions. Sumitra would take care of all the housework, send the children to school and support her husband in earning daily wages by walking the 15-20 kms to the quarry under the desert sun. Five months ago, an organization working in the region on child labor and child marriage, set up a disposable pad production unit to address menstrual health and hygiene (MHH) issues for adolescents. Sumitra, along with four other women from the surrounding villages, were recruited and trained for making and selling pads. Now, she is able to earn an additional $40 per month working in safe conditions. Through provision of MHH education and quality pads, she has gained respect and recognition in her family and her village.
A continent away, the women of Amani Enterprise in Mt. Elgon, Kenya may seem unlikely candidates for trailblazing entrepreneurs. All three are elder widows who lost their husbands to regional political conflict, and did not have the opportunity to learn to read or write. Yet, these women are transforming their community by providing support to local menstruators, producing and selling washable pads. In Mt. Elgon, girls are isolated during their periods and menarche is often viewed as a sign of marital readiness, which hinders them from completing school and pursuing their goals. Having a deep understanding of their culture and knowing the importance of song in unity, and peacekeeping efforts after political conflict, the women of Amani integrate original songs about menstrual health and empowering the girl child into their business activities. As a result, Amani Enterprise has garnered buy-in from local government, community leaders, and businesses who are helping to positively shift norms around menstruation. Since the enterprise launch last year, Amani has reached over 2,000 women and girls in their community with menstrual health products and education.
A stealthy and formidable barrier to gender equity
Inadequate MHH is a stealthy and formidable barrier to gender equity, experienced by an estimated 500 million women and girls worldwide. MHH is not listed among the Social Development Goal (SDG) targets, yet is critically linked to seven of the 17 global goals. These SDGs have outcomes related to sexual and reproductive health and rights, gender based violence, equal opportunities for education and economic contribution and psycho-social agency and well-being., Comprehensive MHH is achieved when women and girls are able to decide if and how to participate in all spheres of life, free from menstrual-related barriers. Girls, women and all those who menstruate face additional barriers that limit the achievement of these outcomes. Addressing period poverty requires access to information, products, facilities, services and supportive social and cultural environments surrounding menstruation.
Mainstream interventions have focused on access to quality products at scale through schools and the private sector. Others have focused on addressing the stigma associated with menstruation. While being foundational, these interventions address only part of the picture. Menstrual health supply chains remain overlooked and under-served in the most vulnerable settings across low and middle income countries (LMICs). Often overlooked is the work of women-centered small businesses, like Amani Enterprises or the one that employs Sumitra, in championing MHH. It is well documented that when women are provided the means to contribute economically to their households and communities, they gain agency and power to break intergenerational cycles of poverty and violence. It is clear that social enterprises, especially when they are gender sensitive, are uniquely positioned to drive deep and lasting change.
Two organizations driving long-lasting change
The Pad Project (TPP) and Days for Girls (DfG) are international nonprofits that work to advance MHH globally. Both organizations incubate and support gender sensitive small scale enterprises in LMICs. These enterprises provide access to menstrual products while disseminating MHH related information to menstruators and their communities. The 141 enterprises supported by DfG across 33 countries produce and sell washable menstrual pads. The 20 enterprises supported by TPP across 10 countries vary in their operational model – with 12 engaged in production and sales of disposable sanitary pads and eight providing washable pads to communities. The incubation support is provided in the form of technical assistance across all activities of the value chain –selecting the type of equipment, product development, connecting with vendors for equipment and raw materials, capacity building on production and demand generation, quality assurance, record-keeping and business planning. The support is essential towards putting these enterprises on the path to economic sustainability. DfG’s model is centered around refining and replicating the operational model whereas TPP’s model is to provide small incubation grants along with technical support.
This support is critical in navigating challenges owing to the small scale of operations of these enterprises. DfG and TPP act as aggregators and provide critical mass through the network of partners they support. For instance, small scale enterprises are unable to get good raw materials at wholesale prices or ensure that materials are of required quality. Through aggregation, DfG and TPP partners are able to get certified materials at bulk rates, which contributes to lowering the price for the consumer, while ensuring quality. Aggregation through verified vendors ensures that small scale enterprises do not have to tackle complicated logistical challenges related to material imports. While DfG supports its partners in accessing quality materials (e.g. 100% cotton, flannel, and polyurethane laminate) for washable pads, TPP’s vendor partners like Saral Designs have helped many NGOs navigate import-export challenges for both machinery and raw materials for disposable pad production units. Both organizations also provide support for design and development of MHH education curriculum.
While both organizations vary in the way they support the enterprises, they are helping achieve some common outcomes:
Access to affordable and quality products for hygiene management
Most LMICs are highly dependent on imports from South-East Asia and China for both materials and menstrual products. Small scale enterprises are able to address both challenges. For instance, international supply chains were hit hard during the peak of the COVID19 pandemic. During this time, DfG Enterprises in Kenya, demonstrated an incredible readiness for production at scale: between 2016-2019, DfG Kenya Enterprise sales totaled 15,820 washable pad kits. However, in 2020 amidst the COVID19 pandemic, sales jumped to 41,131 kits, and in 2021 to 74,777. Fragmented last mile supply chains in LMICs also limit access. In such cases, these enterprises are also able to serve the communities’ needs. A TPP supported enterprise in the North Eastern state of Assam which started operating in September 2020, was able to cater to local demand for over 10,000 disposable sanitary pads within a span of three months.
Access to knowledge for hygiene management and sexual and reproductive health self-care
The education sessions conducted by the enterprises form the foundation for their work and help build trust with the community. Led by women and for the women, these sessions help them develop improved body literacy to know what is normal and when they need to seek support from healthcare providers e.g. when abnormal white discharge may be a symptom of an infection, using fertility awareness methods for contraception, symptoms for menstrual disorders and others. The knowledge also helps them adopt better practices related to hygiene management and tackle long standing myths around menstruation that compromise their health and well-being.
Income generation opportunities for girls and women
Each enterprise employs anywhere between one and 50 community based persons, many of whom are women. They are employed in activities related to management, production, packaging, quality control and sales. Many of the women get the opportunity to work within their own community, which allows them to navigate traditional barriers to employment. They are provided training on the supply chain and demand generation, thus improving their employability in the long term. The additional income also allows them to participate in family and community decisions for the well-being of all girls and women, for instance, budget allocations for essential health and education services. The first enterprise supported by TPP in South Asia was in partnership with Action India, an NGO working in Uttar Pradesh, the most populous state in India. The enterprise now employs almost 50 girls and women in production and sales activities across 60 rural communities in the region. Those selling are able to earn a margin of 25-30 percent on sales of disposable sanitary pads. Ahadi Pads, working across five low income communities in Kenya, is led by an inspirational 60 year old woman. The NGO employs six women for manufacturing washable pads and has reached 1,400 menstruators since the beginning of operations in May 2020.
Educating decision makers in communities, institutions and Governments on MHH
These decentralized MHH enterprises are also uniquely positioned to advocate for change at the community and policy level. They understand the cultural barriers surrounding menstruation and they know which local leaders can help to change the narrative. In many communities, this grassroots advocacy approach is key to success. DfG Enterprises in Malawi did just that. In five of Malawi’s districts, DfG Enterprises met with District Executive Committees and traditional authorities (TAs) to raise awareness about local menstrual barriers, and invited committee members and TAs to prioritize MH in their leadership. Following the meetings, TAs immediately invoked bylaws to abandon harmful traditional practices linked to menstruation; one bylaw criminalized the common practice of locking girls inside, alone, for seven days alone while menstruating. The new law, along with several others, has improved menstrual equity for girls in those communities.
Organizations like TPP and DfG provide pre-early stage startup training and ongoing technical support to enterprises, helping them navigate the business and regulatory landscape. They facilitate supply chain operations and connect enterprises with partnership opportunities. They also facilitate cross-enterprise learning, noting case studies for success (and failure) to share “what works” with regards to advancing MHH in diverse communities. Small scale enterprises – that are local – and are powered by women like Sumitra – are effective at engaging in conversations on menstruation with individuals, communities and local Governments, while providing access to MHH related products and services. These enterprises lie at the intersection of MHH and women’s empowerment and have the potential to deliver holistic, place-based solutions. They also have the potential to break the intergenerational cycles of poverty by putting women front and center of family and community decision making. The incredible victories like those of DfG enterprises in Malawi, and of TPP partners in India and Kenya are transferable and scalable to other MHH enterprises around the globe, but not without investment. As donors seek to identify worthwhile investments to advance MHH, they must consider bolstering incubation and technical support for gender sensitive small scale enterprises for sustainable, lasting change.
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