The Menstrual Cycle is Essential to Women's Health. So Why Isn't it Central to Philanthropy?


March 6, 2022

This article was originally published on Inside Philanthropy.

By Milena Bacalja Perianes, Managing Partner of Strategy, Madami and Founder, Menstrual Health Hub; and Odette Hekster, Managing Director, PSI-Europe

January 18, 2022 — Why is it so bloody difficult to find money to fund periods? Year in and year out, a growing number of educators, activists, entrepreneurs and NGOs (aka. “the menstrual movement”) have poured their blood, sweat and tears into making menstruation matter, yet very little has changed in terms of increased funding moving into menstrual health (MH).

By 2025, the number of women* of reproductive age will reach 2 billion, and these women* will all have diverse menstrual needs. Reports currently suggest that in low-income settings alone, there are 500 million women* and girls globally who lack access to the basic infrastructure, water and products needed to take care of their periods. This conservative estimate does not consider broader menstrual health concerns such as family planning, pain and menstrual-related discomforts, conditions and disorders (i.e., fibroids, endometriosis, polycystic ovary syndrome), or menopause, all of which are connected to the menstrual cycle and key components of menstrual health.

Education about the menstrual cycle can be a powerful entry point and a vital sign for the health and well-being of women*, girls and those who menstruate. That understanding can then inform health decision-making more broadly. A lack of cycle literacy follows a girl across her lifetime, leading to reduced bodily autonomy and agency as she navigates more complex relationships with her health as well as those around her.

It is important to note that not all women menstruate, and not all those who menstruate identify as women. We use women* and girls (with the asterisk) to denote all people who may experience menstruation over the course of their lifetime regardless of their gender identity.

Improving women* and girls’ access to the information, products and health services they need to manage menstrual health across the lifecycle can reduce sexual and reproductive health and rights (SRHR) vulnerabilities, promote healthier outcomes and lead to greater participation in educational and economic opportunities.

An investment in menstrual health IS an investment in gender equality

Investing in menstrual health is an investment in global health, gender equality and our ability to achieve many of the United Nations’ Sustainable Development Goals (SDGs). Menstrual health is about far more than periods. It is the key to unlocking positive gender outcomes across the lifecycle. MH poses a unique opportunity to change the trajectory of women* and girls’ lives whilst simultaneously advancing many of the SDGs—six in total.

How can girls go to school, or focus at school, when they are worried about bleeding through their uniforms? How can young women* make informed reproductive decisions when they don’t know about fertility windows? How can young adolescent girls be safe when they have to engage in transactional sex to obtain sanitary pads? How can women* be expected to use water, sanitation and hygiene (WASH) services when they lack lockable toilets or running water to manage their periods? How can women* go to work with debilitating menstrual pain that goes undiagnosed and untreated?

Whilst there is a clear impact case for investing in menstrual health linked to improved SRHR, WASH, educational and economic outcomes, there remains a lack of concerted action and prioritization of MH from the global philanthropic community. Considering that the menstrual cycle is the “lifeblood” of women’s* health, why isn’t it at the center, or even included, in philanthropic agendas?

Menstrual health is a matter of smart economics

Growing evidence suggests that there is an economic case for investing in menstrual health, and an opportunity cost to economies for failing to meet MH needs. Unaddressed menstrual health directly decreases GDP output as well as workplace activity. Failing to meaningfully address menstruation in the workplace leads to an estimated mean loss of 23.2 days per year of productivity. Poor hygiene and sanitation facilities also decrease the ability of women* and girls to manage menstruation in the workplace and in educational facilities. In Southeast Asia, this lack of infrastructure is estimated to lead to a loss of USD 9.2 billion per year, or 2% of combined GDP in the countries studied.

Absenteeism and reduced productivity have economic consequences for companies and society as a whole. If women* participated in the global economy at the same level as men, the annual global GDP would increase by $28 trillion. The truth is that poor MH facilities, a lack of accessible menstrual products and timely diagnosis of menstrual-related pain and disorders, and unintended pregnancies, are key hurdles standing in the way of women* and girls’ full potential as social and economic beings.

Investments in MH hold the promise to relieve this economic burden in unprecedented ways. Menstrual health is not a woman’s issue, but an economic one.

Investments in MH remain sporadic and lack systems-level attention

The systemic neglect of MH in philanthropic conversations is detrimental to the health and well-being of half the world’s population. With many current conversations circulating around feminist foreign policy, gendering philanthropy and gender-lens investing, why is menstrual health still missing from the agenda?

Historically, MH interventions were delivered from the WASH sector under the umbrella of “menstrual hygiene management” (MHM). However, more recent investments have come from SRHR funders who have also sought positive outcomes through investments in MH programming involving, predominantly, in-school interventions. Funders have also demonstrated some interest in market-based approaches, particularly the production and distribution of period products. However, many areas remain sorely underfunded, such as comprehensive and community MH programs, last-mile or enhanced distribution models, and advocacy focused on ensuring that period products are mainstreamed into the supply of essential reproductive health commodities.

Unfortunately, both SRHR and WASH funders have failed to make the systemic and “at-scale” investments needed to meaningfully and strategically end period stigma and improve the ability of women*, girls and those who menstruate to manage their menstrual health across the lifecycle.

We would be remiss if we did not mention that over the years, there have been some investments in menstrual health. The most notable earmarked funding comes from The Case for Her (a Swedish investment collective), one of the few funders investing in direct opportunities (such as programs and/or businesses) and moving unrestricted funding into essential movement-building efforts, such as Menstrual Hygiene Day led by WASH United, or efforts by the Menstrual Health Hub.

Other funders have included the Gates Foundation, Grand Challenges Canada, GIZ, the Dutch Ministry of Foreign Affairs, the Australian Department of Foreign Affairs and Trade, and Amplify Change (to name a few). Of these, only Amplify Change has provided transparency into the amount it has invested into MH—€3.7 million since 2018. For a full list of the funders who have dipped their toes in the MH sector, check out PSI-Europe’s important work Making the Case for Investing in Menstrual Health and Hygiene.

Whether due to tracking or transparency, there is no clear estimate available of how much money has actually moved into MH or the impact these investments have had. This makes it difficult to catalyze new investments into the sector. What we do know about the investments to date is that they remain siloed, sporadic and/or unsustainable.

Why isn’t more money moving?

Overwhelmingly, funders who have dipped their toes into MH report that “it never quite fits” into their existing portfolio or approach to impact. This has inhibited their ability to actively and continuously fund MH activity.

Funding for MH has been stifled by three major arguments:

  1. MH is non-life-threatening (compared to gender-based violence, unsafe abortions and HIV); therefore, a lower priority for funders.
  2. There is a lack of evidence demonstrating the potential impact from an MH investment.
  3. MH does not fit into funders’ existing portfolios or thematic focuses.

Whether MH should be a stand-alone sector such as SRHR, sanitation or girls’ education, or can be integrated into any of these portfolios, it is absurd that in 2022, funders can’t move money because of a limited investment thesis.

While MH may not be a direct threat to life, or as well-evidenced as adjacent priorities, if it goes unaddressed, it can lead to lifelong social-economic impediments, increased vulnerability and even morbidity. Women’s* pain and experiences shouldn’t be ignored because they don’t fit into an investment portfolio. An investment portfolio should address the health needs that exist and have the potential to radically improve a person’s well-being.

Expanding opportunities for investing in MH

Investing in menstrual health should not be cumbersome or considered yet another “issue area” jostling for funding. Often, moving money into menstrual health simply requires a shift in mindset. You don’t have to be a menstrual health expert to consider a menstrual health investment as a valuable addition to your portfolio. Below, we outline two investment approaches which can be used.

Funding for integration enables a donor to apply an MH lens to their existing investment approach within adjacent and connected sectors such as WASH, SRHR, gender equality and education. It could involve the funding of MH activity within an existing program or approach and includes opportunities such as:

  • Construction of period-friendly toilets (WASH).
  • Ensuring MH is fully integrated into comprehensive sexuality education activities (SRHR).
  • Expanding social norms work around harmful traditional practices to include menstrual stigma and related taboos (gender equality, child marriage, girls’ education).
  • Supporting healthcare service provider trainings around menstrual-related discomforts, conditions and disorders within healthcare systems strengthening programs (SRHR, health).
  • Advocacy and awareness to elevate MH in key policy conversations such as girls’ education and women’s rights (gender equality, girls’ education).

Earmarked funding focuses on intentionally deploying capital to create positive MH outcomes through direct investments in standalone MH activity, business or programs. It could include opportunities such as:

  • Social and clinical research to better understand the impact of MH on women* and girls’ health, well-being and participation.
  • Cross-sectoral and holistic community-based MH programming.
  • Women-led enterprises providing innovative menstrual products.
  • Advocacy efforts focused on MH policy change.
  • Enhanced distribution models and supply chains for MH commodities.

Prioritizing funding that integrates MH components into existing programs, or earmarking specific funding for direct investments, creates a valuable return on investment. Funders can either double their impact in their existing portfolio by applying an MH lens to their existing approach (for instance, ensuring WASH programs include MH education and period-friendly toilets); or directly investing in impactful MH programming (comprehensive school-based MH intervention) and market-based activity (female-led social enterprise providing MH products or services). There are both financial and social returns to be made by investing in MH.

MH is the new philanthropic frontier for greater impact

As a cross-sectoral issue, MH can accelerate impact across a number of SDG priority areas, and those who want to see measurable progress on a range of worthwhile causes—education, the environment, global health, homelessness, women* and girls, income inequality; the list goes on—should consider a key common denominator: menstrual health. Investing in menstrual health can address stigma and the intersectionality of many social problems—an approach that is required for true systems change around gender equality.

An investment in MH IS an investment in WASH outcomes.

An investment in MH IS an investment in girls’ education.

An investment in MH IS an investment in SRHR outcomes.

An investment in MH IS an investment in women* and girls’ economic freedom.

Philanthropy must consider the connectedness of social problems and the interdependencies of poverty. Menstrual health is not the first complex social problem that philanthropists have sought to solve. We cannot promote girls’ education if we don’t tackle barriers to educational access. We cannot promote the health of communities if we won’t consider the specific needs of women* and girls. We cannot support informed SRH decision-making if we refuse to acknowledge that menstrual cycle literacy is essential to women* and girls’ bodily autonomy.

Whether you integrate an MH lens into your existing investment approach or decide to fund stand-alone MH activities, you will achieve greater equitable outcomes for women* and girls when you put money into periods.

The best way to know whether MH can have an impact is to talk to women* and girls themselves. Putting our money where periods are means expanding opportunities for unlimited growth and the potential for women and girls.

A feminist future is not possible without periods. PERIOD.

The time for change is now. Will you move money into menstruation?

Milena Bacalja Perianes is the Managing Partner of Strategy at Madami and founder of the Menstrual Health Hub. She is the co-author of five chapters in the Palgrave Handbook of Critical Menstruation Studies.

Odette Hekster is the Managing Director of PSI Europe and an experienced SRHR expert. She was the lead author for Making the Case for Investing in Menstrual Health & Hygiene.

Madami and Population Services International (PSI)-Europe have partnered to advocate for greater support for the movement of greater capital into MH.

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