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It’s time for action. Period.

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School training on MHM in India. ©WASH United School training on MHM in India. © WASH United

Leading global development actors, philanthropists, and companies call for increased action and investment to ensure that women and girls are no longer limited because of their periods.

When the creators of Period. End of Sentence accepted their Oscar at the 91st Academy Awards, producer Melissa Berton ended her speech by declaring: “A period should end a sentence – not a girl’s education.”  This statement wasn't only a powerful end to an emotional speech, it touched on the far-reaching impact of menstrual hygiene management (MHM). Beyond the dignity and wellbeing of individual women and girls, MHM has wider social and economic effects at national levels, including on education. While the relevance of MHM is increasingly recognized, a significant increase in investment is required to address menstruation-related challenges faced by women and girls globally.

Khushi was on her way to school, as on any other day, when she felt something wet in her underwear. When she checked, she was horrified to find blood on her fingers. Khushi knew what this meant. She had cancer. She was dying. Panicked, Khushi started running, hoping that she would make it home in time to say goodbye to her family. When she finally got there, her mother reassured her that she wasn’t dying. She had just gotten her first period.

Khushi’s experience as a girl growing up in Northern Bihar, India is by no means an exception. Menstruation – a natural and normal biological process and a sign of good health – continues to be shrouded in taboos, myths, and misconceptions.  Millions of girls around the world have no idea what menstruation is, let alone how to manage it safely and hygienically when they get their first period. Negative social norms and practices result in girls being stigmatized and excluded, which undermines their social status and confidence in already turbulent times. This, in addition to limited access to hygienic menstrual products and period-friendly sanitation facilities in schools, means that periods are a significant obstacle for millions of girls to attend and perform well in school.

New research in Argentina, Brazil, India, South Africa, and the Philippines highlights the high prevalence of menstruation-related challenges girls face related to education. Amongst other things, we’ve found that in India, 70% of girls knew nothing or very little about menstruation when they had their first period. In South Africa, 76% of girls reported that they were afraid to get up in class when on their period. In the Philippines, 8% of girls reported missing school because of menstruation.

This confirms a growing body of evidence on the impact of period-related challenges on school attendance and performance. A girl that is empowered to manage her menstruation safely, hygienically, with confidence, and without shame is more likely to stay in school once she reaches puberty.  She is then less likely to get married early or have children when she is not yet ready. On average, she will have fewer children and her family will be healthier, wealthier, and better educated. Notwithstanding the remaining knowledge gaps, it is high time to step up efforts to address this critical barrier to girls realizing their full potential for themselves, their families, and their communities.


End Period Stigma poster. © World Bank


Investing in interventions to empower girls to manage their menstruation safely, hygienically, with confidence and without stigma, so that they continue to attend and perform well in school once they start puberty isn’t just the morally right thing to do, it also makes economic sense. “Investing in good menstrual hygiene management to enable women and girls to reach their full potential is a critical measure to build a nation’s human capital over time ,” says Jennifer Sara, Senior Director, World Bank Water Global Practice. “At least 500 million women and girls globally lack adequate facilities for MHM,” she adds. “Inadequate water, sanitation, and hygiene (WASH) facilities, particularly in public places such as in schools, workplaces, or health centers, can pose a major obstacle to women and girls. In many countries where schools do not have adequate sanitation facilities, adolescent girls are likely to miss school while they are menstruating.

“At the World Bank, we are working on providing safely managed sanitation and hand washing facilities, improving WASH in schools and health care facilities, as well as behavior change and other activities to improve girls’ and women’s access to adequate MHM, which can, in turn, result in higher school attendance and improved reproductive health.”

"A girl that is empowered to manage her menstruation safely, hygienically, with confidence, and without shame is more likely to stay in school once she reaches puberty."
Founder and CEO of WASH United
Thorsten Kiefer
Founder and CEO of WASH United

Unfortunately, menstrual hygiene is not explicitly included in the UN Sustainable Development Goals framework. Without an overarching goal and joint monitoring of progress, sector efforts have been fragmented, with many of the largest actors not reporting on how many girls they reach per year. To start creating a more coherent picture, WASH United carried out the ‘Action for Menstrual Hygiene Education’ survey to capture the overall efforts on MHM education in the run up to Menstrual Hygiene Day 2019. The survey – to which more than 300 organizations contributed by sharing their results for 2018 and goals for 2019 – shows a clear trend towards increased action on MHM education. While far from complete, it also offers a first baseline that can be used to fuel advocacy and accountability.

President of Global Feminine Care at Procter & Gamble Jennifer Davis welcomes the positive trend in MHM education and reinforces P&G’s commitment to it: “We realize there are many barriers to girls’ education, with MHM being a significant one. This year, our Always Puberty & Confidence Education program will not only reach 18 million girls around the world with quality MHM education, but also the boys, teachers, and parents that support them. Additionally, our global #EndPeriodPoverty program is on track to donating 40 million period products to help girls stay confidently in school and focused on reaching their potential. We’ll continue working to drive meaningful change, help end period poverty, and ensure girls have the MHM knowledge they need to become confident women.”

Cristina Ljungberg, founder of Swedish philanthropic collaborative The Case for Her is clear about what is needed to further accelerate progress on MHM. “We see a huge increase in the amount of talk about periods, and that’s fantastic,” she says. “But we still don’t see a comparable increase in funding. At this point, The Case for Her, a philanthropic initiative funded by two private individuals, has the largest portfolio of social impact investments for an issue that concerns half of humanity! There is not a single major donor that has MHM as an explicit strategic priority. We need some bold funders to come to the table now to help translate the increase in conversation into action. To the billionaire philanthropists, large foundations, and government agencies out there: here’s an opportunity to make a catalytic impact on an issue that affects half the world’s population! What are you waiting for?”

The topic of menstrual hygiene is achieving increased attention, but a lot more action and investment is needed to ensure that women and girls are no longer kept from realizing their full potential because of their periods. By addressing the challenges in MHM, we have the opportunity not only to empower women and girls, but to accelerate the overall development of their families and communities and build the human capital of entire nations.

It’s time for action. Period. 

World Bank Water Global Practice, Procter & Gamble, and The Case for Her contributed to this piece.


Thorsten Kiefer

Founder and CEO of WASH United

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