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Who are the MHM Innovators?

Morgan Benson

On May 28, 2014, the world celebrated its first Menstrual Hygiene Day. Organized by WASH United, the now-annual event is part of a burgeoning focus in international development on menstrual hygiene management (MHM) and its impact on the lives of women and girls. Like Family Planning 2020 (for which the first convening was also held recently, in 2012), this focus on MHM is rooted in the growing movement towards gender equality worldwide.

Within the WASH Impact Network, there are at least 29 innovators (almost one fourth of our total first cohort) working in MHM, each testing different methods of enabling women to manage their periods and have equal access to education, health, and other opportunities in life that might otherwise be at risk. Of these programs, 16 are operating in India, 12 in East Africa, and 1 program (WASH United) works in both. So what can we learn from a look at this cohort?

  1. They are young.  Over half (59%) of the innovative MHM programs in the Network have been founded in the last 5 years. This trend would suggest that innovators either are enabled or triggered to focus on a particular issue, given sufficient prioritization of attention and resources.
  2. They are producing environmentally sustainable pads. Of the 29 programs that focus on MHM, 18 are involved in the manufacturing of sanitary pads, many of which incorporate various methods of ensuring environmental sustainability. It is vitally important to consider the environmental impact of MHM interventions, especially in high population density settings, such as in many regions of India. Without reusable MHM products, roughly 305 million women and girls in India would be throwing away disposable pads into already overburdened solid waste dumps. As disposable sanitary products become increasingly popular over cloth rags or other informal methods, the amount of waste produced will also increasingly become a sustainability issue in itself, and innovators within the Network are experimenting with alternative methods.
    • Many are developing reusable, washable pads, such as Uger Menstrual Pads in India. Jatan Sanasthan partnered with Vikalp Design to offer a new (“uger” in Mewadi language) way to think about and manage menstruation, which takes into account the environmental impact of the harmful plastic options that had been and continue to be on the market. Similarly, some programs, such as Aakar Innovations also in India, produce a compostable option.
    • Some programs also use recycled materials to produce their pads, whether that is through leveraging leftover factory textiles, such as what Eva Wear is doing in Ethiopia, or local agricultural products such as banana tree fiber in the case of Saathi Pads in India.
    • Finally, programs are promoting sustainability by using local production methods. By producing pads in-country, programs not only create livelihood opportunities but also cut down on the environmental impact of transporting the pads internationally. Dignity Period partners with Mariam Seba Sanitary Products Factory, which employs 42 local women to produce 600,000 low-cost, environmentally friendly, washable, and reusable pads per year for girls across Ethiopia.
  3. They are integrating with other sectors. In addition to prioritizing environmental sustainability, MHM innovators are integrating their programs with other sectors for increased impact.
    • The Kasiisi Project Girls’ Program not only addresses the WASH needs of girls in schools as an integral part of their ability to manage their periods, by supporting safe water sources and girl-friendly toilets, but also integrates sexual and reproductive health issues more broadly. Kasiisi employs a local female Community Health Worker to educate girls at participating schools on relevant topics, and to set up peer education workshops, giving peer educators in schools the tools and knowledge to be effective role models.
    •  Like Kasiisi, at least 18 of the 29 MHM programs in the Network integrate their activities into schools. Many stress the importance of girls learning early how to manage their periods, particularly so that they are able to continue to attend classes instead of dropping out due to a lack of the necessary education or products to manage it. Jerusalem Children and Community Development Organization (JeCCDO) in Ethiopia supports school clubs to foster awareness and action on not only WASH and MHM issues, but also health, leadership, agriculture, and other issues relevant to their lives
  4. They are creating livelihood opportunities, especially for women. In addition to many programs creating jobs in the production of sanitary pads, many are supporting livelihood opportunities for community members in the sales of their products as well.
    • Vatsalya in India mobilizes existing female shopkeepers and other potential female entrepreneurs to sell sanitary pads in their communities. ZanaPads in Kenya partners with other NGOs to distribute their pads such as Marie Stopes and Living Goods, who operate networks of door-to-door saleswomen.
  5. They need government and financial support, as well as improved evidence generation. Compared to the Network as a whole, these innovators report the following trends in what their programs need to reach more people with greater impact.
    • Twenty-three of these 29 innovators spoke with the Network about the need for Operational Financing. Despite a trend toward this category amongst all 120+ programs, MHM innovators’ higher percentage suggests what Dignity Period reports from Ethiopia, that “donor funds are critical to reach hundreds of thousands more Ethiopian girls who are eager to stay in school free of fear and embarrassment.”
    • There was also a trend towards improved Monitoring and Evaluation. Nine programs (31%) reported M&E as a top need, including knowing what indicators to track, making sense of data already collected, and strategic planning for how to act based on that information.
    • Finally, 6 programs (21%) reported a need for increased Government Support for MHM, ranging from general advocacy among government officials to improved policy regarding how sanitary products are currently taxed.

The responsiveness of these innovators to the world’s burgeoning focus on MHM is encouraging; however, there is still much work to be done. The WASH Impact Network will be working to connect these innovators with each other and with other resources they have identified as key needs for their programs.

For more information, read the Network’s interview with Kathy Walkling, founder of EcoFemme in India; check out Spot On!, our Regional Partner Dasra’s in-depth look at MHM in India; or contact us at

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A Call to Action for Menstrual Hygiene Management Enterprises

Emily Endres

Two MHM programs in the WASH Impact Network teamed up to imagine a better way of working together.

While the development sector and private sector may be perceived as operating under two different sets of rules, the “markets” that exist within the development sector create competition similar to that found in the private sector. Development organizations have revenues in the form of incoming funding, and expenses for running an organization and implementing programs. Just like a business, a development organization must have a greater or equal amount of revenue than expenses to stay afloat. Two organizations offering a similar “product”—for example, water filter distribution, behavior change communication programs, or technical assistance services—must compete for limited resources to fund operations and growth. And while “collaboration” will likely be cited as a core value by program managers and funders alike, in reality this can be challenging in such a highly competitive environment. Organizations, therefore, are incentivized to protect their intellectual property in order to maintain a competitive edge.

Two visionary leaders of innovative WASH programs in the WASH Impact Network are calling for a different way of working together in menstrual hygiene management (MHM). Rachel Starkey is the Founder and Chief Visionary Officer of Transformation Textiles, an organization that produces reusable menstrual products and trains women entrepreneurs to sell their products, and Megan White Mukuria is the Founder of ZanaAfrica, an organization that works with community-based organizations to educate young girls and women on reproductive and sexual health and ensures access to disposable menstrual products. Together, they wrote the Global Alliance of MHM Enterprises (GAME) Manifesto. The GAME Manifesto is a call to action for MHM enterprises to partner and share information in order to give women and girls access to a robust market of MHM products where they can choose the option that works best for their unique needs.

Rachel Starkey of Transformation Textiles spoke to us and explained how the GAME Manifesto was created and the problem that Starkey and Mukuria aim to solve.

Results for Development Institute (R4D): How did the conversation between you and ZanaAfrica begin?

Transformation Textiles (TT): Do you know that Dr. Seuss story about the Star-Belly Sneetches and the Plain-Belly Sneetches? That’s how it is with MHM programs. Either you are in the reusable camp, where you think disposables are evil because they’re bad for the environment; or you’re in the disposable camp, where you think reusables are evil because they’re unhygienic or they require access to water. And while this “good guy/bad buy” debate is going on, there are lots of women out there without access to the products they need.

ZanaAfrica is in the disposable camp and Transformation Textiles is in the reusable camp. But we started talking because we realized we both want to help these same girls and women.

We started asking ourselves, why does it have to be one or the other? Women should have choices. Why are we choosing to stay in our separate camps? Why don’t we build a bridge? Why don’t we band together and create a spectrum of choice? I like to go to the supermarket and choose what I want, but can you imagine if you didn’t have that choice? If someone told you what your choice was? We might not be able to offer them everything, but we can offer them some options. That’s dignity.

R4D: What do you want to see change in the MHM sector?

TT: As recently as 2013 and 2014, nobody was really talking about periods. But in 2008—well before it was ‘in vogue’—ZanaAfrica was working with the government of Kenya to write MHM programs into their budget. I learned about ZanaAfrica, and was really impressed with their vision, and the fact that they were on a long-term path. They’re saying, let’s not just give them pads, but let’s talk about communication and education and measuring impact and writing policy and advocacy. It’s about more than just pads.

Transformation Textiles is also on a long path after we realized that underwear is a real unmet need. Everyone is talking about “pads, pads, pads,” but no one is talking about underwear. How do they strap these things to their legs without underwear? We wanted to do it sustainably and affordably, but underwear is taxed at 30% as a luxury item. So they looked for loopholes and found that menstrual items aren’t taxed.

We’re currently writing national standards for reusables for Kenya. They’re not ratified yet, but they talk about the need for undergarments that would be classified as sanitary towels. That will set a precedent so that period underwear will be able to come into the country duty free.

R4D: What were your goals for the GAME Manifesto? What do you want to accomplish?

TT: Let’s say I live in a village and I go to my local store to buy some pads. There are two brands to choose from: A and B. Product A has great branding and marketing, but the product itself is poor. Because I have a choice, it can spur product A to improve their product instead of saying, “this is good enough for them.”

So by building that bridge between the silos, it can help us make better products. We have to start working like an actual market. Like a real market. We can’t just keep our corners of poverty to ourselves. I want ZanaAfrica to sell my products and I want to sell their products. Let’s all offer a lot of different options. Let’s all grow up a little.

In addition, we hope that we can start creating standards for reusable products together. People have been trying to create a standard since 1985, but they always go it alone for their one product—never together. When I went to my first meeting, reusable companies guarded their IP and lab reports. But this is a new day. 2015 did a lot in bridging gaps between silos. In Uganda, on Menstrual Hygiene Day, the different enterprises came together to create a charter. It’s not a standard yet, but it acknowledged the need to work together. I reached out to manufacturers in Uganda and they shared a draft of what they were writing to form the basis of a standard, which we then took and blended with other standards (Canada and the US shared what they did with the Federal Drug Administration in setting standards for reusable menstrual hygiene products). So with all of these shared resources, we have created a draft standard that is being considered in Kenya.

R4D: Who else was involved in the creation of the GAME Manifesto?

TT: When I tried to reach out to other textile manufacturers, I was surprised at how siloed it was. There wasn’t a lot of sharing; there wasn’t a lot of collaboration because we’re all competing for money from the same funders and impact investors. But if you think about how many girls are in need, we need each other. We need the small rural manufacturer to reach those rural women, and the urban manufacturers to reach urban women, and we need people that are thinking about all those other women in between.

R4D: How did the GAME Manifesto spread?

TT: At first, the GAME Manifesto was just an internal document to say that Transformation Textiles and ZanaAfrica want to work together. ZanaAfrica does disposable pad giveaways and uses Transformation Textile’s tie-on underwear in the schools where they provide MHM education for girls. We also shared market research between our two organizations.

Then we then made the GAME manifesto more general and shared it with others to get feedback. It was immediately shared on WASH United’s global website. WASH United has over 300 partners and is a neutral body, so it becomes a powerful platform to create further buy-in.

R4D: What are your hopes for the future of the MHM sector?

TT: We hope that this spurs the recreation of the industry. I hope it will make us more intentional in our collaboration and allow us to create industry standards. It’s not just about products; it’s about education and overcoming taboos and having an industry of shared resources. By having a common watering hole that we all come to, we can share the resources that we create. That’s what an industry can do. We’ve started doing this on EVA Wear as a way to cross-advocate and open up our resources for anyone to use.

The Game Manifesto is a stepping stone that opened the door to say let’s work together.

Find out more and connect with the trailblazing teams at Transformation Textiles and ZanaAfrica by visiting their profiles. For more insights into the innovators in the MHM sector, read our blog here.

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A Snapshot of WASH Innovators in India

Erin Swearing

India faces several unique challenges to achieving its WASH goals. Currently, India houses the most open defecators in the world,  60% percent of the population lacks access to improved sanitation, and 76 million people are without a safe water source. Stakeholders in India have responded to these large-scale challenges with strong policies and innovative solutions from civil society organizations and the private sector. In October 2014, the government of India instituted the Swachh Bharat Mission (Clean India Mission in English), under Prime Minister Narendra Modi. Swachh Bharat is a national mission aimed at “cleaning-up” India by encouraging citizens to engage in tasks like maintaining clean streets and homes. As a part of The Swachh Bharat Mission, India also seeks to become Open Defecation Free (ODF) by 2019.

In addition to efforts in the public sector, India is also home to millions of civil society organizations that have achieved a number of social changes in the country in the last twenty years, including progress in the WASH sector. Taking a look at some of the organizations in the India cohort of our WASH Impact Network can lend insight to how civil society organizations are working to transform the WASH climate in India.

R4D works closely with our partner, Dasra--an India-based philanthropy foundation and impact accelerator focused on social change—to support WASH Impact Network members in India with valuable tools, resources, and learning opportunities.

Attributes of WASH Impact Network Members in India

Extensive Geographic Coverage

Fifty-seven WASH organizations in the WASH Impact Network operate in India. Organizations work all over the country, in 19 different states, including Delhi, Utter Pradesh, Tamil Nadu, and Karnataka, with thirteen organizations operating country-wide.


                                       Locations of WASH programs in the WASH Impact Network in India


Conventional Funding Models

Programs identify as not-for-profit, for profit, and hybrid organizations. Organizations classified as hybrid generate revenue through the sale of a product or service but are supported by donor funding. The vast majority of the organizations in India are not-for-profit. Only 10%  are for profit, and 5% are hybrid organizations.


Quick Look

Waterlife is a for-profit organization in India working country-wide. Waterlife is a provider of Community Drinking Water Plants that can process water that meet and exceed WHO and India government standards. Waterlife operates the plants for ten years after installation, and utilizes the help of government, NGOs and self help-groups to address issues of access to safe water.

A Mix of Ages and Sizes

The cohort also also varies in size and age. Organizations were established as early as 1968 and as recently as 2015, with 42 of the programs established within the last 10 years. From 2 to 700 plus staff members and budgets ranging from US $2,500 to US $1.2 million, programs in the India cohort also vary in budget and staff size.

Broad in Scope

When it comes to focus area, the WASH programs are even more diverse. Programs in India broadly focus on water, sanitation, and hygiene, but also have more specific focus areas. Some  programs address safe drinking water, menstrual hygiene management, water storage, waste management and disposal, policy and governance, water purification, and groundwater extraction.  


Although there is a lot of overlap, two of the most common focus areas among the India programs include menstrual hygiene management (MHM) and drinking water.

Quick Look

Reap Benefit is a hybrid organization working in Karnataka state focusing on sanitation solutions. They work with schools and government to encourage schoolchildren to problem-solve real-life sanitation issues in their communities. Reap Benefit has also developed sanitation products like a waterless urinal designed with recycled PET bottles and a grey water harvesting system. Their interventions reuse about 40% of water consumed on average.

India currently has the greatest number of people that lack access to clean water in the world. Although access to safe water sources has greatly improved in India, millions are still without the precious resource. Sixteen programs in our network address safe drinking water.

In India, MHM has received a great deal of attention from the national government. Guidelines to address stigma and promote health education for MHM are outlined in the Swachh Bharat Mission. Nineteen India WASH Impact Network members working to address MHM. Expertise ranges from reusable pad production and distribution to advocacy and education.

Quick Look

Aaina is a non-profit organization working in Southern India seeking to improve the health and well-being of adolescent girls through MHM. Aaina works with communities to encourage conversation around menstruation. They empower girls to become invested in their well-being and raise concerns about their reproductive and sexual health. Through meetings with schools, family members, and other school stakeholders, social taboos and stigmas are addressed, and adolescent girls are educated on proper menstrual hygiene practices.


India is in good hands

The organizations in the India cohort of the WASH Impact Network are only a small subset of the millions of civil society organizations working to address the needs of the 800 million people living in poverty in India. India has achieved a great deal of success in furthering progress toward WASH goals in recent years, but it will take time and investment and partnerships across sectors to continue this progress.  

Interested in learning more about programs in the WASH Impact Network? Check out the programs section of our website to see profiles of programs.

The WASH Impact Network also has a cohort in East Africa. Check out this blog post for a snapshot of WASH innovators in East Africa.

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