Well-functioning Markets as a Lever for Improving Menstrual Health

Status of Menstrual Product Markets

Menstrual health is essential for those who menstruate to participate fully in school, at work, and society. It is also crucial for realizing gender equality and attaining human rights.^[1] Over the last decade, recognition of this impact has led to an increase in multistakeholder investment in menstrual health.^[2] As a result, access to menstrual health supplies in LMICs has improved with nearly one in three people relying on purpose-made materials and the majority of them accessing them through markets.^[3],[4] For instance, in India, the proportion of girls and women aged 15-24 years using purpose-made materials increased from 57.6 percent in 2015-16 to 77.3 percent in 2019-20.^[5] This market growth is driven by private sector investment, the large number of users, and the increasing purchasing power of those users.^[6]

However, these markets are not yet delivering comprehensive or equitable access across diverse geographic and socioeconomic contexts. About 95 percent of menstruators in upper-middle-income countries (UMICs) use purpose-made menstrual products.This proportion is significantly lower in low-income (35 percent) and lower-middle-income (71 percent) countries.^[3]  While a plethora of novel menstrual products – reusable pads and underwear, menstrual cups and discs, and single-use products with new materials – have entered the market, the majority of users continue to use single-use products. This market failure results from information asymmetry, barriers to entry for innovations, restrictive regulations, and solutions that inadvertently undercut market demand.

This article argues that a market-based approach, focusing on addressing structural barriers and fostering informed consumer choice, is essential for achieving sustainable and equitable access to menstrual products in LMICs.

Types of Market Failure in Menstrual Product Markets

1. Information Asymmetry: Menstrual taboos and the prevailing narrative that single-use products are the only hygienic option to manage menstruation create an information vacuum. Users in LMICs lack access to the diverse product options available in higher income countries and to unbiased, comprehensive, and easy-to-access information about menstruation and the options to manage it.^[7] This limits their ability to make informed choices. For example, the stigma associated with vaginal insertion hinders the use of reusable menstrual cups, which can offer a cost-effective and environmentally friendly alternative to users. Stigma reduction, improved body literacy, and multi-category demand creation are essential precursors for market development.

2. Barriers to Entry for Market Entrants: New market entrants in LMICs require a supportive policy and regulatory environment to introduce novel menstrual products. However, they often face structural barriers to market entry, including a lack of national or international product standards, high import duties, lack of diverse financing options, and fragmented raw material supply chains.^{[8],[9],[10],[11]} While multinational companies have successfully created substantial category demand for single-use products, enterprises introducing novel menstrual products have struggled to build scalable business models, effective demand-generating strategies and viable distribution channels in a highly price-sensitive market.^[12] These companies struggle partly due to a lack of awareness of novel menstrual products. Additionally, many small-scale production efforts in LMICs have been reliant on initial grant support and are unable to build viable business models when funding stops. Grants for machinery without corresponding technical support and a lack of economies of scale have hampered or rendered unusable many such investments. Supporting the scaling-up of the start-up ecosystem can broaden the market, increase competition, and ultimately benefit users.^[13]

3. Ineffective Free or Subsidized Distribution: Free or subsidized distribution schemes, seen as a way to address unmet needs, can reach only a fraction of those in need^{[1], [2], [3], [4]}  in LMICs. These schemes are at the mercy of political will, budgetary reconfigurations, and competing priorities, far from guaranteeing structural access.^[5], [6]  For instance, covering the cost of menstrual products for all menstruating girls and women in LMICs who have an unmet need will require more than $9 billion in funding from governments and donors.^{[14],[15],[16]} This cannot be sustainable. These programs often target all users, irrespective of their willingness or ability to pay, increasing dependence on free distribution and distorting the market for local suppliers. This is especially true for novel reusable products. Pilot efforts indicate that users are willing to pay for reusable products if made available on local markets.^[17] However, free distribution schemes may compromise these promising solutions. Furthermore, they often end up offering single-product solutions, removing choice and being prescriptive rather than being catalytic. While free distribution schemes have a role to play in contexts where basic social security is missing, such as humanitarian contexts, prisons, and public spaces, they should be used sparingly.

4. Limited Impact of Tax Reform: While campaigns for zero rating or reduction of menstrual product sales taxes have been successful in many LMICs, they have often not led to the desired impact on access, as consumer product prices tend to be “sticky” downwards.^[18] Tax reform that considers the full schedule of levies, including import duties and taxes on machinery and raw materials, is critical. Additionally, regulatory changes that ease market entry, such as adopting harmonized standards, are also important for developing an investable market and increasing access.

A Market-based Approach to Menstrual Health

A well-functioning menstrual health market facilitated by collaboration between the public and private sectors, ensures that:

• Users and suppliers operate in an environment free from menstrual stigma, economic barriers (such as excessive taxes, poor regulations, and disproportionately high costs of financing), and misaligned incentives (such as expectation of free products) and have unrestricted access to market information to make informed decisions;
• Users have access to evidence-based, unbiased, and sufficient information about all products and services to make informed decisions;
• Users have access to a full range of affordable, quality menstrual products and services when and where they need them; and
• Suppliers can ensure access through a competitive market mechanism.

In a market-based approach, donors and governments focus on addressing barriers and expanding choice rather than intervening as a purchaser and distributor on behalf of vulnerable populations. Examples of donor and government strategies include:

• Investing in category awareness for reusable menstrual product options;
• Supporting the development and adoption of national or international standards for menstrual products;
• Integrating menstrual health into other health areas;
• Supporting the availability and diversification of raw materials through facilitating importation or local production;
• Providing technical assistance and high-risk tolerant grant funding for enterprises in the menstrual product value chain through incubation and acceleration programs;
• Advocating for comprehensive and harmonized product standards across LMICs;
• Facilitating linkages between product suppliers to last-mile distribution platforms;
• Engaging financial institutions and offering incentives to make financing available and affordable to enterprises in the menstrual product value chain;
• Using cash and voucher assistance (CVA) to incentivize information and supply of a basket of products, in the case of free or subsidized distribution; and 
• Generating evidence on the costs and benefits of strategies like tax reform, standards harmonization, small-scale access models, free distribution, and integration with other health programs. 

Menstrual health markets have significant potential due to their current value and reach. With half the population requiring regular access to a quality, affordable menstrual product, the need is all but guaranteed. With a menstruating population of 1.72 billion across LMICs, expected to grow by 9 percent in 2025 and with an estimated 613 million people relying on non-purpose made materials today, ensuring the availability of a range of quality, affordable menstrual products on local markets is paramount.^[19] Market-based interventions can unlock this potential by addressing the structural barriers that limit informed choice for users and inhibit suppliers from making these products available for users to exercise that choice. These interventions can also position LMICs not only as the fastest-growing consumer base for menstrual products but also as centers of innovation and manufacturing. Market-based approaches, therefore, have the potential to make LMIC markets more self-sufficient and less reliant on oligopolistic supply chains through the democracy of markets.

This article is co-authored by Tanya Mahajan, Co-founder at Menstrual Health Action for Impact, Lucy Wilson, an independent consultant working on sexual and reproductive health and rights, Adrian Dongus, Menstrual Health Markets Specialist at the United Nations Sanitation and Hygiene Fund and Diana Nelson, the Global Advocacy Director at Days for Girls. All co-authors are members of the Menstrual Health Supplies workstream of the Reproductive Health Supplies Coalition.

[1]  Hennegan J, Winkler IT, Bobel C, Keiser D, Hampton J, Larsson G, Chandra-Mouli V, Plesons M, Mahon T. (2021). "Menstrual health: a definition for policy, practice, and research." Sex Reprod Health Matters. doi: 10.1080/26410397.2021.1911618. PMID: 33910492; PMCID: PMC8098749.

[2]  Geertz A, Iyer L, Kasen P, et al. ( 2016). "An opportunity to address menstrual health and gender equity." Accessed here.

[3]  Weinberger et al. (2024). "LEAP: Landscape and Projection of Reproductive Health Supply Needs. Reproductive Health Supplies Coalition." Accessed here.

[4] Grand View research. "Sample of Feminine Hygiene Products Market Size, Share & Trends Analysis Report 2024-2030." Accessed here.

[5]  International Institute for Population Sciences (IIPS) and ICF. (2021). "National Family Health Survey (NFHS-5), 2019-21: India: Volume II." Accessed here.

[6]  Fortune Business Insights. "Sample of Feminine Hygiene Products Market Size, Share & Industry Analysis 2025-2032." Accessed here.

[7]  Mahajan, T. (2019). “Imperfect Information in Menstrual Health and the Role of Informed Choice”, Indian Journal of Gender Studies, 26(1-2), 59-78, https://doi.org/10.1177/0971521518811169

[8]  Mann Global Health. Landscaping Supply-Side Factors to Menstrual Health Access.  June 2021. Accessed here.

[9]  Mahajan T, Joshi S. (2021). Development and compliance of standards for menstrual products in South Asia and Africa. Development Solutions Inc. and Reproductive Health Supplies Coalition. 2021. Accessed here.

[10]  WASH United. (July 2020). "What impact does VAT/GST reduction or removal have on the price of menstrual products?"

[11]  Ross H and Bill & Melinda Gates Foundation, “An economic assessment of menstrual hygiene Product Tax cuts [version 1; not peer reviewed]”, Gates Open Res (2020) 4:137, https://doi.org/10.21955/gatesopenres.1116672.1.

[12]  Hystra. (October 2023). “A business case for selling reusable menstrual health products in the Global South.” Accessed here.

[13] Mann Global Health (2021).

[14] Calculated using unmet need and average single use menstrual pad prices. 

[15] Weinberger et al. (2024). 

[16] Mann Global Health (2021).

[17] Hystra (2023).

[18] WASH United (2020).

[19] Weinberger et al. (2024).