Demystifying Private Sector to advance action on and investment in Menstrual Health and Hygiene

Publication date: 2024

Demystifying Private Sector to advance action on and investment in Menstrual Health and Hygiene Private sector actors play diverse roles, and are important contributors and allies to achieving a “Period Friendly World.” In this brief, we attempt to demystify private sector engagement for menstrual health and hygiene (MHH), as a part of the Global Menstrual Collective’s ongoing exploration of this issue. What or who is the private sector? The private sector comprises individuals and organizations that are neither owned nor directly controlled by governments, who typically provide products and services, often with a profit motive. The landscape is rich and wide, especially for the private sector engaged in health (including menstrual health), and encompasses diverse stakeholders across the value chain including but not limited to: large conglomerates or corporate entities, product manufacturers and those engaged across the supply chain, academic and research institutions, healthcare service providers, pharmaceutical companies, financial institutions, employers and worksites, and even the media. The private sector can also include nongovernmental organizations, civil society organizations, and social enterprises who often seek to balance profit with social impact. What role does the private sector play for MHH? Broadly, the private sector is relevant for MHH in four ways: MHH PRODUCTS AND SERVICES MHH RELATED RESEARCH AND DEVELOPMENT DONORS AND INVESTORS EMPLOYERS Enabling greater access to a wider range of menstrual health products and services (including education and awareness). Leading research and development of products, services, and processes focused on, or related to, menstrual health. Financing menstrual health interventions as donors and investors. As employers of a female workforce. 1 2 3 4 Private sector actors can expand access to products and services, and support research & development Menstrual products Period products, period trackers, menstrual health chatbots, hormonal contraceptives to manage menstrual disorders, period pain patches, and deodorizing and sterilizing dustbins for discarded pads and tampons are all examples of menstrual health products and services offered by the private sector. Menstrual products are, perhaps, the most prominent role and contribution of private sector actors to menstrual health. With an estimated 1.8 billion menstruators (UNICEF) across the world, meeting menstrual needs – and preferences – through menstrual products and health services is key. A vast majority of purpose made menstrual products (designed specifically to absorb or collect menstrual blood) have been researched, designed, manufactured, distributed and sold by different private sector actors along the value chain. These stakeholders contribute to a rich landscape, and include large multinationals (e.g., P&G), mid-tier and white label manufacturers, social enterprises (e.g., Aakar Innovations), and even micro- enterprises like self-help groups. Products are typically sold through physical or online retail channels, with decentralized access models providing community- based and door to door sales. A few companies may provide products for free as a part of their corporate social responsibility agendas. Additionally, the private sector is the primary supplier or vendor for government-led period product distribution efforts in most countries. The private sector has also been a catalytic game changer for innovative products, such as menstrual cups, menstrual discs, washable pads and period panties, and single use products made from natural materials. These innovations have expanded the An estimated 1.67 billion people who menstruate live in low- and middle-income countries, where the unmet need for purpose-made menstrual products (designed specifically made to absorb or collect menstrual fluid) is high. The private sector can bridge this gap through collaborations with governments, UN Agencies, INGOs, civil society organizations (as vendors), and through direct sales and distribution efforts to end users. THE NEED � �� �� �� �� ��� ��� ���������� � �������� � ������� � �������������� � Source: LEAP 2021 period product basket beyond the standard single use pads. Innovations have further manifested in the form of improved product design. Compostable single use pads and seaweed tampons are notable examples of how standard single use products were made with different types of raw materials to make them safer to discard and manage as waste, while overcoming health concerns regarding plastic, chemicals and additives in standard commercial products. Product innovations are not only critical to meeting the needs and preferences of menstruators around the world, but also, addressing key concerns around waste management and climate change. In the Global South, local NGOs improved upon the basic menstrual cloth used by girls and women, to make stitched cloth pads that offered greater security, leakage prevention and comfort. Social enterprises took this idea even further - refining the design, using better or new materials/ fabrics, facilitating streamlined and quality manufacturing (both decentralized and centralized) (e.g., AFRIpads, EcoFemme, Days for Girls), and contributing to quality standards for this product category (e.g., Real Relief, Livinguard Technologies). Some enterprises even solved supply chain constraints by providing safe raw materials to decentralized units for last mile manufacturing and reach (e.g., Safepad). Others have worked to create access to a wide range of menstrual products (e.g., Be Girl, Inc). Social enterprises have also often coupled their menstrual health work with economic opportunities for women, employing women in the production and sales of products or in education and awareness campaigns. Beyond the supply chain, period product companies have tackled menstrual stigma and taboos through compelling advertising and messaging (e.g., Proctor and Gamble’s campaigns; Sirona’s campaign for menstrual cups; ZanaAfrica’s chatbot and hotline, linked on their Nia Pads), with recent research reiterating their pivotal role in challenging stigma and harmful gender norms. Social enterprises are great partners for catalyzing social impact. Why? Because their business model is based on understanding and meeting needs of the local population, and ensuring equitable, context appropriate and responsive solutions. When set up well, it’s their goal to operate sustainably and reinvest their profits to further their social mission. AFRIpads illustrates this very role of social enterprises in accelerating social impact for menstrual health and hygiene through: Understanding user needs to sharpen program delivery and access - Using evidence, community knowledge and care for the girls and women who use AFRIPads’ reusable pads, can ensure MHH (or related) programs are focused on the right activities and can potentially have better outcomes in a shorter time period. Passing benefits on to women and girls - Working directly with local social enterprises can ensure they thrive to be able to provide the highest quality products and services at the best possible prices. This helps to solve issues around access and affordability. Reinvestment - This benefits the community through job creation and women’s economic empowerment. Ultimately increasing their SROI. Read more advice here from AFRIpads on how to work with local social enterprises to accelerate impact on MHH. ILLUSTRATION 1: CATALYTIC ROLE OF SOCIAL ENTERPRISES FOR MHH Healthcare and MHH Healthcare services for menstrual health is a critical, though grossly overlooked, untapped, and under-funded intervention area. Evidence and field insights highlights menstrual issues and concerns such as contraceptive induced changes to the menstrual cycle, menstrual irregularities, discomfort and infections resulting from unhygienic management of periods, menstrual problems and disorders (e.g., endometriosis, polycystic ovarian symptom and disorder), abnormal uterine bleeding, perimenopause, and menstrual cycle related mental health concerns. The need for health services for menstrual health can no longer be ignored - and the private sector can play an important role in awareness generation, health tracking and symptom identification, behavioral nudges for healthy practice or to seek health care, as well as diagnosis and treatment of concerns or disorders. In several low- and middle-income countries, the private sector is a significant healthcare provider, for a range of sexual and reproductive health issues from family planning and contraceptive care, safe abortion care, and maternal health services. These existing services and provider networks have potential for expansion to address menstrual health needs as well. Menstrual health also creates a natural entry point to broader education around and access to sexual and reproductive health supplies and services. Understanding the menstrual cycle is not only a critical component of understanding family planning, but for many, conversations around menstrual health create a safe space to begin discussions around family planning and broader sexual and reproductive health issues. Technologies for women’s health or Femtech is a growing and promising contribution of the private sector in response to menstrual health care needs. Femtech for menstrual health include apps (e.g., OKY, Clue,), chatbots (Probahini, Ask Nivi), non- app related digital trackers (e.g., IMMI Watch), and wearables. Femtech offerings not only help to track ~10% OR 190 MILLION of women of reproductive age are affected by endometriosis (WHO) > 300 MILLION women of reproductive age use hormonal contraceptives (UNDESA); contraceptive induced changes to the menstrual cycle can affect uptake of and adherence to hormonal contraceptives. 1 BILLION WOMEN (ESTIMATED) have experienced menopause - The menopause transition or perimenopause can be challenging for several women, affecting their physical and mental health, and adversely impacting work and social spheres of their lives. Jhpiego’s WISH Innovators platform seeks to support health technologies in Africa and India. As part of Jhpiego’s USAID MOMENTUM Country and Global Leadership: Yash-India project, WISH Innovators is working with 18 enterprises to help catalyze innovative business models that will improve family planning, reproductive health and menstrual health outcomes. The program helps Femtech start- ups leverage partnerships with key public and private sector stakeholders and provide technical assistance, mentoring and training through Villgro India. THE NEED ILLUSTRATION 2: INCUBATING AND ACCELERATING HEALTHCARE & FEMTECH INNOVATIONS the menstrual cycle, identify fertile days, and facilitate period preparedness, they also provide information, help users identify irregularities, abnormal bleeding, atypical menstrual pain or other symptoms that may be indicative of underlying conditions, and support connections with peer networks, healthcare providers, and even mental health services. The value of FemTech can even go beyond health information and healthcare support - leveraging smartphone penetration among low-income youth, programs such as Game of Choice Not Chance use mobile gaming to help adolescents and youth navigate gender and social norms that influence their lives, relationships and health. While Femtech is often thought to cater to high income countries and populations, a growing number of solutions are specifically designed to cater to low- and middle -income countries and populations (e.g., IMMI, OKY, Ask Nivi, Game of Choice, Probahini). These programs are often offered through partnerships with NGOs and governments. In addition to this, in some countries, gynecologists and obstetricians have formed networks to provide health care for conditions such as PCOS and endometriosis, and even established menopause clinics or services. Recognizing the critical yet under-addressed issue of menstrual health and dignity, Population Services International (PSI) is further building the global momentum it has helped on the issue with a new strategic project. The Sang pour Sang (Unies pour la Dignité) project, an AFD-funded project that is implemented by an international consortium including PSI-Europe, embarks on this promising solution: empowering local social businesses to become champions of menstrual health dignity. The Sang pour Sang project supports local social businesses by providing small grants, as well as technical expertise to help these businesses scale up production, meet quality standards, and compete effectively. Navigating the regulatory landscape in the developing countries forms another hurdle as the regulatory processes and licensing requirements can hinder the entry of these new local businesses into the market. In the Sang pour Sang project, governments are called upon to streamline regulations and enable private sector investment. PSI-Europe believes that building a sustainable market requires long- term commitment that can be assured through partnerships between these local businesses, NGOs, the public sector, and the private sector to create a supportive ecosystem that fosters innovation and ensures consistent menstrual product availability. By working together, we can create an environment where menstrual health products are readily available, accessible, affordable, and of good quality, empowering all menstruators, with dignity and confidence through local business. Be Girl Inc., a social enterprise that exemplifies the multifaceted approach of the private sector through three key areas: � Product Innovation and Accessibility: Leading companies, like Be Girl, are going beyond basic products, focusing on affordability, sustainability, and robust safety standards. They are actively involved in setting global industry standards to ensure consumer choice and market accountability. � Education and Advocacy: Engaged private sector actors, recognize the importance of menstrual health education for lasting change. Be Girl collaborates with governments and NGOs to develop educational programs and integrate menstrual health into national curriculums. Additionally, they leverage technology and market knowledge to tailor educational materials for better outreach and engagement. � Data-Driven Impact: Companies are increasingly utilizing data to shape interventions and secure funding. Be Girl has strong data analysis capabilities, allowing them to generate impactful data narratives for advocacy efforts that unlock resources and drive real-world progress. Their partnership with UNFPA in Angola, started with a pilot in 2020 and after leveraging data for decision-based advocacy, UNFPA Angola secured World Bank funding for a nationwide intervention reaching 200,000 girls. This multifaceted private sector engagement, alongside development entities’ expertise, is crucial for ensuring everyone has access to information, products, and support for dignified menstrual management. ILLUSTRATION 3: CREATING PLATFORMS FOR COLLABORATIVE ACTION BY THE PUBLIC AND PRIVATE SECTORS ILLUSTRATION 4: THE POWER OF MULTIFACETED PRIVATE SECTOR ENGAGEMENT Private sector as donors and investors Another popular role of the private sector is that of a donor or investor. Financial support or investments from the private sector can take different forms - including corporate social responsibility funds, philanthropic funds including from philanthropic collectives, seed funds and venture capital. Private sector stakeholders support direct interventions or policy advocacy, research and development, innovations, and even capacity- building efforts. Insights from private sector engagement in family planning suggests that such investments and actions can free up public sector resources to meet the needs of the most vulnerable (Countdown 2030 Europe). Some private sector actors contribute in kind through technical support to Governments and NGOs (e.g., Dalberg, KMPG). The Reckitt Global Hygiene Institute (RGHI) is a private foundation that was set up with support from Reckitt LLC. RGHI is working to systematically close historical gaps in evidence through a program of neutral and scalable hygiene research. They have supported menstrual health and hygiene research in LMICs, encouraging both global and country based research to generate critical evidence. The Case for Her has invested approximately USD $21 million since 2012 to advance action on menstruation, female sexual pleasure, medication abortion, and related women’s health issues. Strongly, a significant portion of these investments has been towards global menstrual health. The Case for Her deftly demonstrates the role of private sector investors in spurring action on highly stigmatized and silenced women’s health issues, by providing “fast, flexible and highly risk tolerant” investments. They believe that by de-risking investments for certain underserved and overlooked women’s health issues, they contribute to a solid foundation for “next-scale funders.” In their 2023 report, The Case for Her Co-Founders, Wendy Anderson and Cristina Ljungberg, highlight several lessons they have learned over a decade of commitment to menstrual health: � Investing in education is key � Addressing stigma is a precursor to success � Product choice resides with the individual, not the funder � Apply a MH lens to existing programs � Organizations and institutions need funded mandates for MH � Investments are needed for sector building � Blended finance and flexibility are essential Read more here. ILLUSTRATION 5: PRIVATE SECTOR ENGAGEMENT TO FURTHER ROBUST RESEARCH AND EVIDENCE GENERATION ON MHH BOX 6: CATALYTIC INVESTMENTS IN MENSTRUAL HEALTH,to%20better%20diagnoses%20and%20treatments. Private sector as employers The recently published McKinsey report starkly highlights how half of the health gap for women occurs during their working years, during which they contribute about 80% to the GDP impact. Enabling gender responsive worksites is key to women’s equitable participation in the workforce. Investments in menstrual health have direct economic benefits that have implications at the personal, familial, community, and national levels. When women’s labour force participation and productivity is supported with good menstrual health, they miss fewer work days, are more productive, feel more supported at work, and have higher satisfaction at work. These positive changes in turn, bring higher income and higher revenue to companies, in addition to higher intake and retention of female employees (Reference). Some corporates have taken note of this, and have menstrual policies in place, providing period leave (e.g., Zomato, Nuvento, Modibodi); others have made the workplace more conducive to support people on their period through separate toilets for women, resting rooms or spaces, provisioning of period products (e.g., Period Positive Workplace), and conducting awareness sessions. Promising menstrual health and hygiene pilots have been implemented with female factory workers in Nepal and Kenya. Research suggests a potential $2 reduction in health care costs for every $1 invested in workplace interventions for MHH. The Period Positive Workplace (PPW) is a new global initiative that supports employers to become period responsive worksites. PPW supports organizations across the world to become period positive workplaces through three simple, yet powerful actions: 1) provide period products in the worksite; 2) have separate toilets for women that meet basic standards; 3) inform employees of the provisions available. PPW currently has 157 certified organizations across 37 countries, impacting 149,000 employees around the world! ILLUSTRATION 7: PERIOD POSITIVE WORKPLACE Engaging the Private Sector to support Menstrual Health for All Below is a summary of how private sector engagement can contribute to advancing and improving menstrual health: Ŕ Strengthen and widen the basket of solutions for menstrual health to enable and ensure equitable and sustained access to quality menstrual health products and services of choice to people who menstruate, enabling them to have access whenever and wherever they need it. Ŕ Fulfill unmet menstrual health needs through research and development of high quality and affordable products, services, and processes that meet people’s needs across diverse contexts. Ŕ Implement innovative financing mechanisms to reduce dependency on free products and services, while facilitating sustained access to affordable quality products of choice and services that meet expressed needs. Ŕ Support quality assurance efforts by contributing to the framing of regulations for menstrual health products and health services. Ŕ Partner /collaborate with Governments and NGOs to support action at scale to meet menstrual health needs where and when needed. The private sector plays a critical role in ensuring that people around the globe have access to reproductive health supplies, services, and information that meets their needs and preferences. Worldwide, most health systems are mixed, drawing upon both public and private sector providers for the delivery of health supplies and services. The role of the private sector is important for several different reasons: � First, many end users prefer to use the private sector and have demonstrated both a willingness, and ability, to pay for health services. Making SRH products and services available via the private sector not only ensures that end users can access these services via their preferred outlets, but also makes more efficient use of public resources, redirecting them to those who are most in need. � Second, youth and adolescents often turn to the private sector for SRH services, largely due to the flexibility and privacy that are often associated with private sector providers. � Third, the private sector plays a crucial role in the manufacturing of SRH products, including for menstrual health. Public-private partnership can enable better price efficiency and access to SRH products throughout LMICs. The menstrual health market is unique within the SRH landscape. Most SRH commodities are heavily subsidized – either by donors or by governments. Broadly speaking, menstrual health products are not. As such, menstrual health markets are largely consumer-driven, which can be both a challenge as well as an opportunity. The challenge is ensuring that menstrual products are available, affordable, and of good quality to all those who need them, creating significant concerns around equitable access. Menstrual health markets can potentially present opportunities to better leverage market dynamics to create a sustainable marketplace, and where needed, supplement the consumer-driven nature of the market with subsidized support. This creates a unique opportunity for public-private partnership, innovation, and a marketplace that is more responsive to the needs and wants of consumers. ILLUSTRATION 8: LEARNING FROM PRIVATE SECTOR ENGAGEMENT FOR SEXUAL AND REPRODUCTIVE HEALTH (SRH) Recommended resources on private sector engagement for menstrual health Ù Scaling Up Access to Menstrual Health in the Global South: Improving product quality and access to reusable options Ù A business case for selling reusable menstrual health products in the Global South Ù Scaling Access to Menstrual Products in the Global South: A Market-Based Approach Ù Landscaping supply side factors to menstrual health access Ù Making the case for investing in menstrual health and hygiene Ù Investing in Menstrual Health Is an Investment in Global Health Ù Innovative Investments Impacting SDG 6.2 Ù Putting Menstrual health on the global agenda Ù Localization: advice from local manufacturers to accelerate impact Ù RHSC LEAP Report Ù Menstrual Hygiene Management (MHM) in the Workplace Ù A Market Development Lens to Menstrual Health: Two-Part India Spotlight on Menstrual Products and Integrated Health Services Ù Locally owned and led menstrual health entreprises This brief was prepared by members of the Global Menstrual Collective (GMC) private sector working group. The GMC is a global advocacy network that drives action on and investment in menstrual health and hygiene. The private sector working group seeks to demystify private sector engagement for menstrual health, and bring light to how the menstrual health community can strengthen collaborations with private sector actors globally and in-country. This brief was authored by Arundati Muralidharan (GMC, MHAi); Priscilla Natukunda (PSI-Europe); Cynthia Waka (Be Girl); Sarah Webb (Reproductive Health Supplies Coalition); Michelle Tjeenk Willink (AFRIpads). Other members of the private sector working group include: Alexandra Knezovich & Maria Delfino (Toilet Board Coalition); Odette Hekster (PSI-Europe); Diana Nelson (Days for Girls International); Whitney Fry (Iris Group); Tanya Mahajan (The Pad Project, MHAi); Lyndra Gilby, Noelle Spencer, Jenni Martin (Menstrual Rights Global); Diana Sierra (Be Girl); Adrian Dongus (Sanitation and Hygiene Fund); Trine Sig (realRelief); Joris Boon (AFRIpads). Photos by the Reproductive Health Supplies Coalition. To learn more and engage with the group, contact

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