Access to Menstrual Health Supplies during COVID-19: what have we learnt?

By Charlotte Soulary, Advocacy Officer, Reproductive Health Supplies Coalition

“Many challenges existed before the COVID-19 crisis, in particular the difficulty to access menstrual products in rural areas. But the crisis has exacerbated these pre-existing challenges.”

COVID-19 has seriously compromised access to menstrual health materials.

From a supply perspective, the RHSC and our members face three main challenges: (1) a disrupted production of supplies, (2) many interruptions throughout the supply chains, and (3) delayed or failed product delivery. Production is disrupted due to reduced workforce at manufacturing plants because of social distancing requirements for factories; closure of factories; and the fact that production of personal protective equipment has taken priority for many small manufacturers. Supply chain interruptions are a result of grounded commercial flights; many ports not functioning at full capacity; and slots reallocated to emergency equipment shipments. The same disruptions have been observed at the country entry point: in countries where imports were/are restricted, it is challenging both for menstrual products and for raw materials for disposable pads. Road transport restrictions have constrained distribution in some countries, disrupting distribution at the last mile, as many retailers/distributors have paused normal retail operations. Lastly, product delivery is also often interrupted, when grocery and other shops are closed and delivery staff under lockdown. In countries where sanitary napkins are subsidized by the government, girls who would otherwise receive menstrual health products at school now do not because of school closures.

It is important to remember that many challenges existed before the COVID-19 crisis, in particular the difficulty to access menstrual products in rural areas. But the crisis has exacerbated these pre-existing challenges.

Furthermore, the current situation — and especially the lockdown measures — have huge economic impacts, and financial stress may lead families to prioritize other needs such as food or essential utility bills over purchasing menstrual health supplies.

Here are five key ways to move forward.

1. To avoid supply chain disruptions, it is critical that RH services and supplies, including menstrual health supplies, are declared essential..

…and integrated into a global COVID-19 response. When menstrual health supplies are listed as essential commodities, it removes some barriers to manufacturing and distribution. In India, menstrual health products were not considered essential supplies when the lockdown started, but thanks to menstrual health advocates, they were integrated into the essential list after one week of lockdown. In Uganda, reusable cloth sanitary napkins are classified as essential goods and services, so factories are open, and they are manufacturing at high speed to keep up with demand.

2. The same applies to humanitarian settings

It may require advocacy with governments to ensure the movement of humanitarian staff can continue during lockdowns so that they can still access field locations. As everywhere else, provision of menstrual health products is a non-negotiable minimum standard for humanitarian actors, so it must continue during a crisis. Periods do not stop for pandemics.

3. To mitigate supply chain disruption, collaboration is key

There are interesting learnings from the FP community, even if there are many differences between FP and menstrual health supply-chains. It is critical to be able to monitor stock levels within the global supply chain. Under the umbrella of the Global Family Planning Visibility and Analytics Network (Global FP-VAN), the RHSC is assessing the risk of supply chain disruptions on orders and shipments of contraceptives which requires manufacturers, procurers and country stakeholders to share data to ensure supply chain visibility. In the past, the RHSC has also successfully set up coordination bodies to anticipate and address distribution and organize stock transfers from one country to another when necessary. These mechanisms, the Coordinated Supply Planning group (CSP) and Coordinated Assistance for Reproductive health supplies (CARhs), have proved useful to mitigate contraceptive supply chain disruptions and could serve as a model for the menstrual health sector.

4. Adapt distribution

Manufacturers reduced the frequency of visits to suppliers and distributors by encouraging them to order stock via phone and online. Where schools and retail shops are closed, many partners have changed their distribution channels and offered door-to-door delivery of supplies, or worked with community health workers and mobile health units to get menstrual health included in the reproductive health services and products they deliver directly. These examples are also very relevant for the post-COVID-19 world as they demonstrate how integration can be beneficial.

5. When supply chains are disrupted, sustainable products are critical

In the COVID-19 crisis, the use of washable and reusable products such as cups or reusable cloth pads and period panties is even more relevant, as they are less dependent on the supply chain. There is considerable innovation taking place in this area. While motivated by the need to reduce the environmental impact and the costs of buying pads every month, reusable products are also useful to increase autonomy and avoid a monthly reliance on global and national supply chains. We have seen also a move towards use of home-made cloth pads. These methods call for critical information on hygiene. In response, there has been increasing dissemination of instructions for safe and hygienic reuse and disposal during the pandemic, largely through women’s networks and digital platforms.

Finally, it is important to raise the issue of period poverty. Many low-income women cannot pay the cost of commercial supplies. For example, research by FSG found that 65% of girls in Kenya cannot afford the menstrual products they need¹. With supply chains being disrupted, we can only expect unit prices to increase, and access to decrease. We must keep advocating for the removal of sales taxes from menstrual hygiene materials or for other mechanisms such as free distribution in schools to pass on the cost reductions to the customer.

As we look toward and prepare for a post-COVID-19 era, we must learn from the solutions we have found during this crisis, because they reveal some of the strengths and weaknesses of the menstrual health supply chain. As we have seen, some solutions help mitigate the impact of supply chain disruptions and should be strengthened in the world post COVID-19: integrate menstrual health in sexual and reproductive health programs; support sustainable, local/national production of quality products; develop reusable menstrual health products. And above all: consider menstrual health products as essential.

This blog derives from a presentation made during the web-dialogue “Menstrual health responses to COVID-19 pandemic in Africa : what have we learnt?”, co-hosted by the African Coalition for menstrual health management and Days for Girls on 27th May 2020.

¹ FSG, Menstrual health in Kenya. Country Landscape analysis, 2016, https://menstrualhygieneday.org/wp-content/uploads/2016/04/FSG-Menstrual-Health-Landscape_Kenya.pdf