Improving menstrual health and gender equality: Water and sanitation in rural Tanzania

Dorotea Yusto, a 12-year-old from Kigoma, Tanzania, faces a monthly challenge that goes beyond the usual adolescent concerns. For Dorotea, a student at Katete B Primary School in Kigoma, menstruation is a natural occurrence but managing it can put her education, health, and future economic prospects at risk.

The economic impact of inadequate menstrual hygiene management (MHM) is profound. Poor MHM facilities within schools lead to lower school attendance and performance among girls, impacting their education and future job prospects. This perpetuates a cycle of poverty and reduced economic participation, exacerbating gender inequalities, and impeding national economic development. Therefore, addressing menstrual health management challenges is crucial for health, social justice, and economic growth.

To achieve menstrual health and hygiene women and girls need to be “accessing and using effective and affordable menstrual materials and having supportive facilities and services, including water, sanitation and hygiene services, for washing the body and hands, changing menstrual materials, and cleaning and/or disposing of used materials.” (Hennegan, et al, 2021) In Tanzania, the limited access to clean water supply, sanitation, and hygiene (WASH) facilities makes menstrual health a critical issue impacting women and girls. Health risks increase due to unhygienic practices during menstruation, leading to infections and other health issues.

A 2023 study (Oikos and the World Bank) examining the market for female sanitary pads in rural Tanzania shows that a major challenge to hygienic practices is the cost of Menstrual Health and Hygiene (MHH) products. Other challenges include menstrual cramps, customs and traditions restricting discussions about menstruation, and difficulties with homemade materials. Homemade menstrual materials, such as khanga and kitenge, are commonly used but have poor absorbing capacity and do not dry​​ in time to be reused during a girl’s cycle.

The report finds the average annual cost of disposable pads is 30,250 TZS ($12) per student. This cost is derived from the average annual consumption of disposable pads (11 packets at a price range of 2,000-3,500 TZS per packet). Depending on the number of menstruating women at each household, this can make up some proportion of the average household consumption expenditure (approx. TZS 4.3 million ($1,703) per year). Modern reusable pads have a lower annual cost of around 11,000 TZS ($4.30) and some of these products can last up to three years, bringing down the annual cost even more. These findings highlight the financial burden MHH products impose on families. The potential for modern reusable pads to be a more affordable and preferred option is evident, but their market availability and cost remain challenges.

The Tanzanian government, in collaboration with the World Bank, is actively addressing MHH through the Sustainable Rural Water Supply and Sanitation Program (SRWSSP). The program seeks to enhance access to rural water supply and sanitation services in participating districts and strengthen the capacity of sector institutions for sustained service delivery.

A significant part of the program is dedicated to promoting gender equality and empowerment. Specific actions have been taken, such as constructing or rehabilitating WASH facilities in 837 primary schools. These facilities now include separate latrines for boys and girls with lockable doors and washable floors, making girls safer and more comfortable. Additionally, for female students, changing rooms have been constructed, with incinerators attached, as part of the WASH facilities to allow girls to change clothes during menstruation and have adequate privacy to dispose of menstrual products. Each of these schools also has a designated and active menstrual counselor, a teacher, a female parent, or a community health worker who provides accurate, timely, age-appropriate information about the menstrual cycle and menstruation, as well as related self-care and hygiene practices for girls. This represents a significant step towards addressing the challenges of MHH in rural Tanzania.

The program is setting a foundation for healthier, more educated, and empowered girls and aims to improve immediate health and educational outcomes and eventually help break the cycle of poverty and drive socio-economic growth, paving the way for a stronger and more equitable Tanzania.

For more insights into these transformative efforts, visit this World Bank's feature on school toilets in rural Tanzania, highlighting the impact of improved sanitation facilities on students' health and education.