March 19, 2023
This piece originally ran on Nation.
By Janet Mbugua, Founder, Inua Dada Foundation and Odette Hekster, Managing Director, PSI Europe
When Senator Gloria Orwoba walked into Kenya Parliament with blood-stained trousers, it was in solidarity with so many girls, to end the shame associated with menstruation. Her ouster by fellow MPs only proved her point that menstruation, albeit a normal biological process, is still shrouded in stigma and discrimination.
Regardless of one’s stance on what transpired in Parliament, it was yet another missed opportunity to address an often overlooked health issue that impacts countless women and girls in Kenya. Menstruation, like abortion, menopause, and infertility, while critical aspects of women’s holistic health and well-being, are often buried in secrecy and shame.
Healthy women are the backbone of a resilient, stable, and thriving society, yet prioritisation of women’s health remains largely ignored.
Worldwide, women and girls experience a lack of access to menstrual products and broader menstrual health concerns, such as lack of family planning and menstrual-related discomforts and disorders. Health concerns affecting the female reproductive system are particularly neglected or often misdiagnosed. Menstrual or hormonal disorders like fibroids, endometriosis and polycystic ovary syndrome are woefully under-researched, with their causes and treatments insufficiently understood.
As evidenced by Senator Orwoba’s statement in parliament, these health problems do not exist in a vacuum, but are part of our healthcare ecosystem. Businesses can help change this.
No business can flourish when held back by an unfavourable investment climate, obstructive laws and policies, and insufficient capital. Similarly, a healthcare system cannot serve the people who need it effectively if access to this system is obstructed or hindered by social barriers and stigma, or if the healthcare journey is fragmented and leaves people behind. Yet this is the reality for Kenyan women – the entire health ecosystem does not meet their needs.
Consumer insights gathered by Population Services International (PSI) demonstrates that for Kenyan women, navigating their healthcare journey is often confusing, far from seamless, or stigmatised. Reliable information, particularly about sexual and reproductive health, and respectful, confidential, and objective advice, are often difficult to come by. At Inua Dada Foundation, we see this every day: Girls who find themselves in unbearable situations due to a lack of information.
To be clear, this is not just about health. It’s also about economic vitality. Women constitute half the population and a large portion of the customer base. Investing in women’s health means healthy female consumers, improving public health, strengthening communities and social fabric, and igniting economies.
For example, improving access to affordable menstrual materials and healthcare can help improve girls’ and women’s access to education, the job market, and entrepreneurship, thus unleashing female contributions to the overall economy.
Feminine health and hygiene products are a multibillion-dollar industry, which, if designed to suit women’s diverse needs and properly tapped into, can generate income for many and significantly boost economic growth, according to the World Bank.
An ongoing, ground-breaking study by PSI Europe and the UN Sanitation and Hygiene Fund promises to show the benefit of menstrual health interventions, as far outweighing the costs. The study results can help convince funders and investors to close the global menstrual equity gap.
Is women’s health only a woman’s concern? No, it’s everyone’s business to address the gaps that plague the system. One significant barrier is research and development efforts to advance treatment options for women.
Worldwide, investments in healthcare research and innovation in female-specific conditions beyond oncology amount to only one percent of all investments. This is captured in several studies (Evaluate Medtech (accessed July 2021); Global Burden of Disease Study 2019, Institute for Health Metrics and Evaluation, 2021; Pharmaprojects (accessed July 2021); Report of the Advisory Committee on Research on Women’s Health, Fiscal Years 2017–2018: Office of Research on Women’s Health and NIH Support for Research on Women’s Health, National Institutes of Health, Office of Research on Women’s Health, October 2019).
According to global healthcare company Organon, in 2022, of the 37 total prescription drugs approved by the US Food and Drug Administration, only two were for female-specific health conditions. In the Netherlands, it takes an average of seven years to diagnose a person with endometriosis, a menstrual disorder in which tissue similar to the inner lining of the uterus grows outside the uterus, causing intense pelvic pain and an irregular menstrual cycle.
A recent (2023) study in Kenya revealed that women’s shared experiences with endometriosis are: (1) stigma and disruption to quality of life; (2) barriers to acceptable healthcare; and (3) reliance on self-efficacy and social support to cope with the disease. (Bergen S, Murimi D, Gruer C, Munene G, Nyachieo A, Owiti M, Sommer M. Living with Endometriosis: A Narrative Analysis of the Experiences of Kenyan Women. International Journal of Environmental Research and Public Health. 2023; 20(5):4125. https://doi.org/10.3390/ijerph20054125)
An estimated $300 million global investment in research focused on women could generate a $13 billion economic return, reduced healthcare costs, a better quality of life, and years of productivity returned to the global workforce (The WHAM Report, April 16, 2021).
In Kenya, meeting the unmet need for modern contraception among adolescent girls would cost $20 million annually. Fully meeting this need would lower pregnancy-related costs by $46 million (Guttmacher, 2018). We can all do the math.
But it doesn’t end there. Policymakers must strengthen the enabling environment by addressing the critical social and structural barriers that obstruct the system so that women can use it to meet their needs.
Private sector actors, particularly businesses, must play a role in holding governments accountable. Companies should combat workplace stigma and discrimination toward women’s health issues perceived as sensitive or taboo. Corporate social responsibility must go beyond simple gestures like donating menstrual pads to impoverished communities. Businesses can also support organisations like Inua Dada Foundation and PSI to help governments to strengthen public and private health providers and entire health (eco)systems to make systems work for women and thereby embrace their potential in society. We need bold investments in holistic health solutions and not piecemeal contributions.
When it comes to sexual and reproductive health, we are falling woefully short and failing women and girls. But we can turn the tide.
Inua Dada Foundation and PSI have joined forces in Kenya and globally to address these challenges. And there is room for other actors also to play a decisive role – from investing in women’s research to fighting workplace stigma and discrimination, and engaging in collaborative efforts involving other actors.
There is much to gain from investing in making the healthcare system responsive to women’s needs more holistically. It saves women’s lives and can benefit entire nations and economies. More responsive health systems can even help address emerging challenges like future pandemics.
We need businesses to do better than stand by and allow the healthcare system to fail half of our nation. It’s time to translate corporate social responsibility into concrete action. It’s time to fix the social levers of the system within which we do our daily business. Investing in what matters to all is the right thing and the smart thing to do.
Janet Mbugua is the founder of Inua Dada Foundation, whose mission is to create a supportive and accessible environment primarily for school girls in Kenya. She is also a Media Personality, Author, and Gender Equality Advocate with a focus on Menstrual Equality.
Odette Hekster is the Managing Director of Population Services International (PSI)-Europe, an international organisation that uses evidence and consumer insights to urge governments to address urgent health issues. She is a women’s health and rights advocate.