The Coalition and menstrual health supplies - Menstrual Health Workstream Factsheet

Publication date: 2020

THE COALITION AND MENSTRUAL HEALTH SUPPLIES The RHSC Menstrual Health Supplies Workstream aims to implement collective actions to increase, expand, and improve access to high quality menstrual health products. Globally, over 500 million people who menstruate1 do not have access to the most basic information and materials to effectively managethis essential biological function. Menstruation has been managed in isolation, in a climate of stigma, and without the necessary support and systems required to ensure healthy and dignified periods. The factors affecting effective management of menstruation are interdisciplinary and cross-sectoral. Global efforts to address these needs have focused primarily on access to water and sanitation, and on inequitable social and gender norms. Menstruation has been largely left out of the sexual and reproductive health and rights (SRHR)2,3 dialogue, in spite of being the starting point of the reproductive cycle. The supply chain is one aspect that is often ignored, as menstrual care products are not seen as essential reproductive health commodities, but as a nice-to-have item. A challenge not faced by other reproductive health supplies is that menstrual care products are usually purchased individually by consumers through commercial supply chains as opposed to being procured in bulk through medical/pharmaceutical supply chains by global health agencies and Governments4. The supply chain and eco-system for menstrual care products is fragile and not well understood. Equitable access to a basket of quality menstrual health supplies requires a dedicated supply lens. Address: Rue Marie-Thérèse 21, Brussels, 1000, Belgium Phone: +32 2 210 0222 E-mail: Web: WORKING GROUPS 1. Including girls, women, trans men and non-binary persons who menstruate 2. Amaya, L et al. Advancing gender equity by improving menstrual health: Opportunities in menstrual health and hygiene. FSG. 2020 3. Hekster, O. & Punzi, MC. Technical brief for the Integration of Menstrual Health in SRHR. Amsterdam, The Netherlands: Stichting PSI-Europe. 2019. Retrieved from: 4. The exceptions to this are for bulk purchase for humanitarian settings, often in dignity kits, or by those few governments (eg India and Kenya) who have committed to subsidize disposable sanitary napkins to school girls to help keep girls in school. 500M people worldwide do not have access to menstrual health supplies Given the massive potential market for menstrual care products, organizing collective purchasing power through public sector provision of health commodities and parallel social marketing programs can positively disrupt accessibility. Innovative private sector distribution models that leverage both consumer goods and health product supply chains also hold immense potential for enhancing access. Ensuring access to safe and reliable menstrual health supplies is critical for the reproductive health of menstruators. Currently, there is no global guidance on quality and safety of menstrual products, with wide variations in regional and country benchmarks. Evidence- based advocacy on creation of benchmarks and pathways for compliance by small and medium scale manufacturers are essential to address this gap. Informed choice in the safe, hygienic use of menstrual health supplies is as important as informed choice in sexual and reproductive self-care and contraceptive use. . Menstrual products are either disposable, as insanitary napkins and tampons, some of which are compostable, or reusable, as in cloth sanitary napkins, period panties, and menstrual cups. Where there is data, we see that product choice is often limited to disposable sanitary napkins. Studies in India, Uganda and Kenya have found that when offered with balanced information, menstruators prefer using different types of products in different contexts. Hence, no one product is sufficient and a basket of products is needed to meet the diverse needs of menstruators. Additionally, water, sanitation, hygiene, and weaknesses in disposal systems limit the hygienic use of products. Lack of information on environmental impacts and associated costs through the product life cycle (production, distribution, use and disposal), and limitations of waste management compromise the informed use of menstrual supplies. Innovations in product design, manufacture, and distribution have led to increased availability of quality products, but with limited reach amongst low-income and rural populations. Product affordability varies widely across geographies and socio-economic profiles. Mechanisms are needed to enhance innovation and scale. This can be triggered through supply side interventions like taxation and targeted subsidies. Bulk procurement and distribution through humanitarian agencies and public health supply chains can also facilitate equitable access. Reusable products face particular challenges for equitable access high upfront costs and because customers don’t always know or appreciate the added value of reusability. Awareness of reusable products and micro-financing strategies could alleviate these barriers. However, evidence and advocacy on the need and effectiveness of these strategies is necessary towards widespread adoption. As a workstream under the New and Under-Utilized Technologies (NURHT) Caucus representing more than 50 RHSC member organizations, we, the RHSC Menstrual Health Supplies Workstream, therefore focus our attention on the supply chain aspects of menstrual health and hygiene under the strategic pillars of RHSC. COVID-19 has highlighted this fragility with disruptions in raw material procurement, labor availability, manufacture of supplies, and distribution and retail of commercially available supplies. Because most menstrual products sold are disposable, the supply chain rupture has forced the use of traditional materials like cloth, but without appropriate knowledge of its hygienic use. The lack of privacy and access to water and sanitation facilities during COVID-19 has raised additional concerns for health and safety. These pre-existing challenges, exacerbated by COVID-19, call for solutions such as the integration of menstrual health commodities into global SRH supply chains, investment in regional production and distribution models, and the introduction of informed choice in method mix including long-lasting reusable products. AVAILABILITY CHOICE QUALITY EQUITY Fragility of the supply chain The RHSC Menstrual Health Supplies Workstream at a glance Goal: The RHSC Menstrual Health Supplies Workstream aims to implement collective actions to increase, expand, and improve access to high quality menstrual health products through the following outcomes: MENSTRUAL HEALTH PRODUCTS INTEGRATED INTO BROADER COALITION DISCUSSIONS ABOUT RH SUPPLIES To achieve this, we have three primary activities: conduct webinars; ensure coordination and outreach to other RHSC Implementing Mechanisms to share information about menstrual health products; and reach out to other key players in the menstrual health field to join RHSC and this workstream. O U TC O M E 1 [CHOICE] STAKEHOLDERS WHO PROCURE PRODUCTS HAVE ACCESS TO RELIABLE INFORMATION ON AND ARE AWARE OF THE RANGE OF MENSTRUAL HEALTH PRODUCTS AVAILABLE We have identified the following activities to achieve this outcome: disseminate and update one or more menstrual health product databases; develop a menstrual health product landscape; conduct advocacy to promote informed choice. O U TC O M E 2 [QUALITY] MINIMUM QUALITY STANDARDS DEVELOPED FOR ALL TYPES OF MENSTRUAL PRODUCTS In order to ensure the quality of menstrual products, we focus on the following activities: aggregate and share knowledge and stakeholder perspectives on performance, quality, and safety benchmarks; identify and facilitate standards development in areas where gaps exist, particularly menstrual cups; facilitate creation and dissemination of benchmarks at global levels; influence adoption of benchmarks for procurement. We also advocate for evidence and policies for the safe introduction and distribution of all menstrual supplies – disposable and reusable. O U TC O M E 3 [EQUITY] ACCESS TO AFFORDABLE, ACCEPTABLE MENSTRUAL HEALTH PRODUCTS INCREASED FOR ALL MENSTRUATORS In order to achieve this outcome, we will develop and share good practices to make menstrual products more affordable and accessible. These will include policy and program strategies for enhancing access and affordability including taxation and subsidies, disruptive supply chain innovations and others. O U TC O M E 4 [AVAILABILITY] IMPROVED UNDERSTANDING OF MENSTRUAL HEALTH SUPPLY CHAINS FOR INFORMING POLICY AND PROGRAMS AT THE GLOBAL AND COUNTRY LEVELS We aim to achieve this by: conducting a landscape analysis around menstrual health product supply chain; and developing and disseminating advocacy recommendations on menstrual health product supply chain. O U TC O M E 5 With the collective focus of partner organizations, menstrual products can be recognized as the essential commodity they are and access to a range of quality menstrual health products and information can be a reality for menstruators worldwide. For more information and to join the workstream, visit our webpage: newunderused-rh-technologies-caucus/menstrual-health-supplies-workstream/ Updated: August 2020

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