Improving Menstrual Health in Uganda Using a Market-Based Approach
Women’s Global Health Innovations (WGHI)
“While I was using pads I would not play while I was on my period because I was not comfortable, but with the bfree cup, I now can play football with the boys.”
19-year-old Bfree Cup user, Boroli
In Uganda, 90.5% percent of girls do not have access to menstrual products. This can lead to increased school absenteeism or dropout rates for girls, while some become vulnerable to sexual coercion in order to access menstrual products, leading to higher incidences of pregnancy and sexually transmitted infections. Other women frequently miss market days, food distribution days, or other community events because they have no way of managing their menstruation.
Women’s Global Health Innovations (WGHI) is fighting to end period poverty.
A social enterprise focused on market-based solutions in the menstrual health management (MHM) sector, WGHI tested an innovative solution aimed at improving livelihoods for Uganda’s most marginalized girls and women. From October 2020 until December 2021, their team tested the innovation in rural communities of Adjumani District. The innovation identified 29 sales “champions” who were trained as menstrual health and hygiene educators and microentrepreneurs who would sell the BFree Cup, the world's only physically antibacterial menstrual cup.
The BFree cup reduces the impact on water resources as it does not need to be washed or boiled between menstrual cycles. The cup can be left in place for up to 12 hours before emptying - a major benefit for girls at schools where sanitation facilities may not be available.
The impact of this innovative approach was threefold: income improvement; improved access to menstrual equity; and gender equality. However, for the microentrepreneurs to succeed in BFree cup sales, a shift in perceptions and understanding of menstrual health management had to occur first.
Overcoming Myths and Negative Perceptions about Menstruation and the Bfree Cup
A menstrual cup is a new and unfamiliar method of managing menstruation in Uganda. Some of the myths and fears about the cup included the cup “disappearing” inside the body, causing infertility, and breaking a girls’ virginity.
“My brother refused me to use the cup in the beginning, he said it will break my virginity but then stopped talking negatively about it when our mother told him that she was using the money to buy us food instead of buying pads.”
16-year-old user, Boroli block B
In community discussions lead by local organizations WoMena Uganda and Public Health Ambassadors Uganda (PHAU), these fears were discussed. Local community structures were found to be an effective way of promoting good MHM and product marketing, as they hold knowledge about their community attitudes and practices, share a common language, are trusted and have previously introduced and promoted several other products in the community. Community leaders including religious and cultural leaders, district partners, district officials and representatives from both the host and the refugee populations were invited to attend.
Engaging Men and Shifting Attitudes
Targeting male participation assisted in challenging entrenched stigmas, taboos, myths, perceptions, and attitudes towards menstruation as solely a woman’s issue. The conversation of MHM broadened to be inclusive of whole families and the community. A change in perception was noted by endline with men who initially had concerns. They reported changing their perception after hearing the experiences of their wives, daughters, champions, and other cup users. This gradual change in attitudes and perceptions helped to increase cup sales.
“I gave the cup to my wife, and I explained to her how to use the cup. She started using it, and she continuously shares her experience with me, which I use to convince other women to buy the cups.”
Champion – Bororli Block C during an in-depth interview
Empowering Women Through Access and Awareness
Bfree cup users reported economic empowerment as one of the benefits of using the product, as they no longer had to purchase pads each month. Additionally, women emphasized that with cup use, they did not have to worry about leakage and felt free and confident during their periods because they could wear what they wanted and did not have to worry about stains. They also mentioned moving more freely.
“I am confident, whenever I am using the cup, I don’t have to worry about the cup leaking since it's easy to feel when the cup is full. The BFree cup has helped me, I no longer get rashes, irritation I used to get from using sanitary pads. Right now, I can talk to people confidently without fear about the BFree menstrual cup and I no longer have to spend about 10,000 Ush every month to buy pads since I used three packets of sanitary pads every month. Right now, I save that money in a savings group and some of it I invest in my business.”
27-year-old Bfree Cup user, Pakele sub-county
Women no longer had to miss community events, food distribution days, and market days. Additionally, school age girls were empowered to attend school and be confident while menstruating.
“The school incinerator is in an open space where boys stand and laugh at girls who always come to dispose of their used pads. But now with the bfree cup, they boys never know when I am on my period, and this has made me more comfortable in school and also boosted my confidence in school.”
19-year-old Bfree Cup user, Boroli block A
Uniting the Community to the Benefit of All
The innovative approach engaged the whole community to better understand the barriers that girls and women experience while managing their menstrual health in a climate of taboos, shame, misunderstanding and lack of social, economic, and emotional support. The demand for the innovative Bfree Cup is growing in Uganda and around the world.