Embracing the Flow: How USAID is improving menstrual health and hygiene in East Africa


A student demonstrates how to fabricate and use a menstrual hygiene pad.
Photo credit: Daniel W. Smith, USAID

Five hundred million menstruators around the world struggle to manage their menses each month. This is due to lack of affordable and available sanitary pads, critical services like water or safely-constructed and private toilets, and sufficient information on menstruation. The absence of one of these key components of menstrual health and hygiene places menstruators at risk of infection, violence, shame, and embarrassment. For many women and girls, it means missing days of work or school or even dropping out entirely. 

A truly water-secure world - one in which everyone has access to safe and sustainable drinking water, sanitation, and hygiene, is also one in which menstruators can access water and latrines everywhere and any time they are needed. This allows menstruators to enjoy better health, pursue an education, participate more fully in the economy, build their social capital, increase their dignity, and reach their full potential. 

Thanks to USAID’s water and sanitation investments under the U.S. Global Water Strategy, menstrual health and hygiene is improving around the world. Read on to see how USAID is empowering girls to stay in school in Uganda, ensuring equitable and affordable access to menstrual products in Ethiopia, and breaking the silence around menstruation in Kenya.

Empowering Ugandan girls to stay in school 

In Uganda, ten percent of girls in primary school miss 4-5 days of school each month due to menstruation, contributing to 23 percent of girls between the ages of 12-18 dropping out of school altogether. 

Margaret Nantale, a student at Kangulumira Church of Uganda Primary School, explains how at her school: “We tried to keep proper hygiene when menstruating, but the toilet was not good…leading many girls at school to start feeling uncomfortable to use the toilets and as a result, many decided to stay at home and skip school.” Some of the girls who skipped did not return.

USAID, through its Uganda Sanitation for Health Activity, is helping students like Margaret manage their menses in school through improved and private toilets and social and behavioral change activities.

At Margaret’s school, USAID constructed a toilet block for girls that included a washroom, an incinerator for menstrual products, and a handwashing station. This provided a safe and hygienic space for girls to change and clean, with an adjacent private room for menstruating girls to rest when needed.

A student demonstrates how to use an incinerator for environmentally friendly management of used menstrual pads.
Photo credit: Daniel W. Smith, USAID

USAID also supported a “School Health Club,” where students promoted positive hygiene behaviors among their peers, such as handwashing with soap after using the toilet. Girls and boys also learned about menstruation in a fun and accessible way through jingles on puberty, the menstrual cycle, products and how to use them, and pain management.

And to challenge deeply embedded cultural taboos and stigmas related to menstruation, the training also targeted boys and male teachers to increase their understanding of menstruation as a normal biological process and how they can support their peers during their menstrual cycles. Boys also participated in hands-on sessions where they learned how to make reusable menstrual pads.

Students recite the Hygiene Pledge.
Photo credit: Daniel W. Smith, USAID

Now, Margaret says, girls in her class are feeling more confident and performing better at school.

“Ever since this toilet was built, the situation has changed. We now have enough space to accommodate more girls at school. The new toilet also has a good bathroom with provision for proper sanitary pads disposal. Girls now don’t have to go back home during their menstruation period… we no longer miss classes.”
- Margaret Nantale, student at Kangulumira Church of Uganda Primary School


Ensuring equitable and accessible access to menstrual hygiene products in Ethiopia

Imagine waking up one day and being faced with two unappealing options: staying home and missing school or work, or using rags, newspapers, or ashes as makeshift sanitary pads. This is not a fictional scenario but a reality for many menstruating girls and women in Ethiopia where more than 70 percent of women report not having access to the products they need to manage their menses and 25 percent of women do not use sanitary products at all. 

Although efforts by advocacy groups have successfully reduced taxes on menstrual hygiene products from 30 percent to 10 percent, many menstruators in Ethiopia still struggle to afford necessary menstrual hygiene products due to high costs. 

“We are excited about the journey ahead. USAID will help us enter an established market with an existing supply chain, which will make it easier for us to reach consumers. The market-based approach to sanitation is unique and sustainable, and it's great to be a part of it.”
- Mickal Mamo, founder of Adey Pads

Mickal Mamo, founder of Adey Pads, discusses the concept of reusable pads and their significance.
Photo credit: Yonatan Tamiru

To address these challenges, USAID’s Transform WASH activity is working to build a sustainable market for menstrual hygiene products so that women and girls throughout Ethiopia, including in hard-to-reach rural and remote areas, can access and afford the products they need. 

Since 2020, USAID has partnered with local menstrual hygiene product manufacturers and retail business to increase the supply of reusable sanitary pads. Over the past three years, 18 business partners have sold more than 13,000 pads throughout Ethiopia. Most recently, USAID partnered with Mela for Her and Adey Pads, women-led organizations that produce reusable sanitary pads. Through partnerships with businesses like Mela for Her and Adey Pads, USAID is not only improving the lives of girls and women, but also paving the way for a more sustainable and equitable society.

These reusable pads are cost-effective and can last for years with proper care.
Photo credit: Adey Pads

Breaking the silence around menstruation in Kenya

In Kenya, 65 percent of women and girls cannot afford sanitary pads and do not have access to adequate disposal facilities. 

USAID is working to increase awareness of menstrual hygiene among younger generations to create demand for menstrual products, a key component of financial sustainability, and to increase awareness of locally-owned sanitation businesses, where customers can easily find and procure the products that they need.

Girls receive packages of menstrual products (left) and information booklets on menstruation (right). These girls live in an informal urban settlement in Nairobi where USAID’s Kenya Sanitation Enabling Environment Project combines increased access to menstrual products, services, and facilities with education and community training to reduce the stigma associated with menstruation. USAID has helped improve MHH for more than 1,000 girls and has reached more than 81,000 residents, including boys and men, with information on MHH.
Photo Credits: USAID/Kenya

USAID’s Western Kenya Sanitation Project works with menstrual hygiene champions to build awareness . Nurse Lucy Wanyama is one such champion. She recently participated in a USAID training-of-trainers, which inspired her to reach out to the nearby Yala Township Primary School to engage students on menstrual hygiene.

“After the USAID training on menstrual hygiene management, I felt charged to give back to the community. In groups and at 1:1 counseling sessions, I focused on breaking the silence and pushed the agenda for safe and hygienic management of menstruation, and safe disposal reuse.”
- Lucy Wanyama, menstrual hygiene champion and trainer


According to the school’s head teacher, few girls in Yala Township learn about menstruation at home, making Lucy’s training even more salient. During Lucy’s session, students saw, touched, and learned how to use sanitary products, many of them for the first time. Over the past year, USAID has reached 37,000 people like Lucy and the students in Yala Township with information, education and communication campaigns on menstrual hygiene management.

“This is a reusable sanitary pad. There is no shame in holding it and talking about menstrual hygiene. Menstruation is a natural phenomenon.”
- Dr. Paul Otuoma, H.E. the Governor of Busia County

Dr. Otuoma is governor in Busia County, Kenya, where USAID is implementing an MHH program. He is a local champion for menstrual health and hygiene.
Photo Credits: USAID/Kenya

USAID’s Commitment to Menstrual Health and Hygiene

Menstrual health and hygiene is a serious challenge in urgent need of attention and action. USAID is committed to building a water-secure world where individuals have what they need to manage their menstruation safely and with dignity. We invite you to read USAID’s Menstrual Health and Hygiene Technical brief to learn more about USAID’s approach for better and more inclusive outcomes for all menstruators.


About The Author

Lisa Schechtman

Currently serves as Senior Strategic Engagement Advisor in USAID’s Center on Water Security, Sanitation and Hygiene, where she guides the Agency’s water- and sanitation-related external and political engagements, including with bilateral donor partners, civil society, Congress, and the United Nations, to advance the U.S. Global Water Strategy and the Water for the World Act of 2014. She also serves as the Center’s Inclusive Development and Gender lead.

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