Menstrual Health in Kenya Sponsored by the Bill and Melinda Gates Foundation

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Menstrual Health in Kenya | Country Landscape Analysis

Executive Summary:

Significant barriers to high-quality menstrual hygiene management(MHM) persist across Kenya and remain a particular challenge for low-income women and girls. Formative research shows that girls face monthly challenges, with 65% of women and girls in Kenya unable to afford sanitary pads. 1 Only 50% of girls say that they openly discuss menstruation at home. Just 32% of rural schools have a private place for girls to change their menstrual product. 2 And only 12% of girls in Kenya would be comfortable receiving the information from their mother. 3 There are also more jarring statistics signaling that menstruation is tied to more fundamental risks and issues of gender inequity, with studies showing 2 out of 3 of pad users in rural Kenya receiving them from sexual partners4 and 1 in 4 girls do not associate menstruation with pregnancy. 5 Although there is evidence in Kenya illustrating the problem, the evidence linking the impact of poor menstrual health, an encompassing term for menarche and MHM, on critical outcomes is limited. Current studies have small sample sizes, and they rely on qualitative, self-reported, or anecdotal data making it difficult to generalize findings across different types of adolescent populations and diverse regions which have different cultural and socio-economic contexts. Yet, MHM programs are designed assuming these linkages. There is a need for more research to understand the impact of MHM programs on life outcomes. A lack of alignment between diverse stakeholders and sector siloes is hindering progress on menstrual health. Immediate opportunities exist to better support adolescent girls’ MHM in Kenya, including improved access to timely menstruation and puberty education, improved product access and affordability for low income consumers, integration of girl-friendly features into sanitation design and infrastructure, and political advocacy for improved MHM at the district level.

This report seeks to understand: (1) the current state of girls’ experience with menarche and MHM in Kenya, (2) the donor, government, and NGO responses to girls’ needs, and (3) opportunities for research, advocacy, and programming to better address these needs. This complements a Global Landscape Analysis and is one of three Country Landscape Analyses focused on India, Kenya, and Ethiopia. This report provides an assessment of the menstrual health sector and identifies opportunities for the field to improve girls’ dignity and empowerment in Kenya.i It is the result of a review of over 50 peer-reviewed articles and grey literature; over 25 interviews with policymakers, researchers, and practitioners living or working in Kenya; and a review of relevant programming focused on menstruation, MHM, sexual reproductive health, and sanitation. The country research for Kenya was also informed by 36 interviews with adolescent girls from Kangundo in Machakos County and Kawangware in Western Nairobi County in the following categories: (1) early post-menarche 0 to 1 year post-menarche, (2) post-menarche 1 to 3 years post-menarche, and (3) late post-menarche 3+ years post-menarche up to 18 years old. Interviews were also conducted with 7 influencers including mothers, sisters, teachers, and community health care workers. The regions were selected based on the following criteria: (1) urban setting and rural setting for contrast, (2) proximity to Nairobi for feasibility, and (3) safety and access for trained moderators.