Without the proper tools to deal with their menstrual needs, women and girls face significant barriers in accessing proper education and participating in the workforce.  With limited education and a lack of income-generating opportunities, girls and women become stuck in a cycle of missed opportunity and poverty.

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Menstrual health is a largely overlooked aspect of development and is a critical pathway for gender equality and female empowerment through integration with water, sanitation and hygiene (WASH) interventions. Addressing menstrual health enables women and adolescent girls to better deal with menstruation and acts as a starting point for discussions around Sexual and Reproductive Health and Rights (SRHR). When women and girls can better deal with their menstrual needs, they can go to school for longer, participate in the workforce more effectively and, contribute to their communities in more productive ways. 

Building upon a decade of experience delivering successful menstrual hygiene management programs in Pakistan and Burkina Faso, was a four-year initiative, completed in 2024. This project was implemented with the help of our partners in Burkina Faso, Liberia, Sierra Leone and Pakistan. The program provided quality, gender-responsive and age-appropriate menstrual health and hygiene education in vulnerable communities across four countries. Our approach to menstrual health education aimed to create conditions for girls to stay in school throughout menstruation and promote their body integrity. Importantly, supported women and girls to participate in daily life during mensuration without discrimination through improved social attitudes and an increased sense of personal freedom. With access to quality menstrual health, hygiene education,  and a reliable supply chain for menstrual products, women and girls were able to unleash their potential and change their lives for good.  

Women collecting water at the water bump.
Women from nearby villages wait their turn to collect water at a hand pump that was rehabilitated by WaterAid and it's implementing partners in Badin, Sindh, Pakistan.
Image: WaterAid/ Khaula Jamil

Increasing Government Responsiveness to the Menstrual Needs of Women and Adolescent Girls

Influencing all levels of government to recognize menstrual health created an enabling environment conducive to changing social norms and promotion of gender equality. Building responsiveness and political will for menstrual health acted as a fundamental step in  discussions of SRHR and addressing barriers to the empowerment of women and girls. Responsiveness facilitated menstrual health considerations in national policies, plans, and investments, such as those for education, school infrastructure and workplace standards. Through informing and engaging duty bearers on an often-held taboo subject, such as menstruation, discussions and recognition of the critical role of menstrual health as a foundation of health and gender empowerment occurred. As a result, an entry point to engaging discussions on other aspects of SRHR was enabled.

In Burkina Faso, Liberia, Sierra Leone, and Pakistan there is often a limited capacity to overcome barriers to meet basic rights, such as health, water, sanitation and education. The limited capacity of government can compound social norms and traditional gender roles that inhibit sexual and reproductive health and rights and the empowerment of women and girls. The project worked alongside civil society to inform, engage and hold local leaders accountable in terms of policy, investment and achievement of SRHR and human rights of women and girls. While issues of menstrual health are universal for the female population, the creation of enabling environments for inclusive menstrual health is unique to each country, cultural context, economic and social status and religious beliefs.

Teachers and students at a club members meeting.
Hema Marata, 37, and Coulibaly Maoua, 39, both teachers, during a meeting with Deen-Kan 'Voice of the Child' club members at Dofforé school, commune of Banfora, Cascades region, Burkina Faso.
Image: WaterAid/ Basile Ouedraogo

Improving sanitation and hygiene infrastructure 

In specific schools and healthcare facilities, WASH facilities – latrines in particular – were rehabilitated and adapted to enable inclusive menstrual hygiene practices. These facilities provided greater safety, health and comfort for women and girls menstruating. All construction work took into consideration environmental impacts and every measure possible was taken to reduce them, including proper disposal of waste and safe disposal of sanitary materials. In addition, when selecting the locations for construction, WaterAid took into consideration the  changing climate realities and used adaptive measures and technologies, where appropriate. 

Changing behaviors and attitudes 

School and healthcare centre staff were trained on menstrual health, including training support staff on the maintenance and utilization of menstrual health services and facilities. All students were sensitized on the topic of menstrual health and SRHR through peer-to-peer learning and curriculum. To this end, youth leadership training for adolescent girl students was undertaken and youth clubs in schools were established. Female students who participated in these clubs received training on how to use menstrual health management (MHM) kits by healthcare professionals. Youth (boys and girls under 25) within and outside of school settings engaged in knowledge sharing and discussion about menstruation. Specific tools and awareness-raising materials were developed for these purposes and healthcare facilities were leveraged to reach out to school youth. Critically, each country and its cultural context were receptive to this approach of focusing on menstrual health in education and healthcare settings.   

Student splashing clean water on her hands.
Samiratou, 17, student, splashing clean water with her hands at the school's manual borehole rehabillitated by HerWASH project, Tengrela high school, Banfora commune, Cascades region, Burkina Faso.
Image: WaterAid/ Basile Ouedraogo

The village of Phul Shoro, Pakistan

The remote village of Phul Shoro is one of the villages where the project activities was implemented. It is a farming village in Pakistan where both men and women work in the fields to make a living. The only source of water in this village is a contaminated canal that is used by villagers for drinking, bathing, and washing clothes. It is also used by animals for drinking and bathing. People in Phul Shoro do not have toilets at home and practice open defecation.    

In Phul Shoro women and girls are responsible for all household activities. Girls will stay home with their mothers, while young and adolescent boys go to school. Bilquees, a mother living in Phul Shoro, says that she keeps busy during the day by looking after cattle, washing, cooking and cleaning. Her daughter, Saleemat, helps her mother with the household chores and will sometimes help with harvesting. She has never gone to school, despite having an interest to attend. When asked what she uses during menstruation, Saleemat said that she has never been taught about menstruation or menstrual hygiene, and like her mother, does not use any menstrual cloth or material and wears darker coloured clothes during her period.    

Women in Phul Shoro with cattle livestock.
Image: WaterAid/ Pakistan
Girl preparing food in Phul Shoro, Pakistan
Image: WaterAid/ Pakistan

WaterAid and menstrual health  

was built on years of WaterAid experience improving menstrual hygiene management and menstrual health. WaterAid is a founding member of the Global Menstrual Health and Hygiene Collective, which aims to drive and guide investment in menstrual health and hygiene through evidence-based advocacy. We recognize that for communities to develop, women and girls must be able to reach their full potential; but with barriers inhibiting their capacity to properly manage their periods, that is impossible. As WASH experts, we clearly see how improving access to clean water, sanitation and hygiene provides a clear pathway to greater menstrual health and gender equality. For these reasons, menstrual health and the needs of women and girls are always prioritized in our projects around the world.