Sex workers in India

In a street near New Delhi railway station in India, are 77 dark, cramped, unsanitary brothels. Half the 4,500 sex workers use menstrual rags, which smell and cause vaginosis. The organisation Katkatha ( held small meetings and distributed 189 menstrual cups donated by Sirona ( They expected an acceptance rate of 10%. But within four months, 150 cups were being used, and now most women are eager to use cups. “Sangita”, 45, is extremely satisfied and wants her teenage daughter to use one too. “Meena”, 23, suffered with rashes from rags, but now loves her menstrual cup and has educated 3 co-workers to use them. Sirona aims to reach all sex workers by end of 2019 and make the street completely ‘Pad Free’ by 2025. Even though 80% of Indian women have no access to menstrual products, India deals with over 15 billion menstrual pads every year. The recent ‘Sanitary Pad Revolution’ in India which has been publicised by BBC, Hollywood and Bollywood, has encouraged greater use of single-use, non-biodegradable pads, made from imported materials which only increases the environmental burden.

Girl Guide Leader and menstrual cup trainer

Guide camp 2017

‘Menstruation was one of the biggest reasons why girls missed and dropped out of school. Many girls did not have access to menstrual pads or cotton wool and often soiled their dresses or school uniform and boys made them a laughing stock,’ said Lucy Nkhoma, deputy Chief Commissioner of Malawi Girl Guides. A study run by the Malawi Girl Guides Association among schoolgirls, refugees and rural women found that most knew nothing about periods before their menarche, and believe that menstruation is an unclean, dirty taboo. ‘I organized the world’s first menstrual cup camp on World Menstrual Health Day in 2017. We sang Guiding and traditional songs round the camp fire. The girls were so happy, we ate, danced, played and joked together! We shared our stories of our first periods. This breaks the silence and the tension about the subject of menstruation. So, there were insights like, “When I first had my period I thought I am dying”, others thought maybe they have been cut.’ People in Malawi believe: ‘A menstruating girl should not add salt when she is cooking, enter her parents’ bedroom, or eat eggs.’ Or ‘Menstrual blood can be used for witchcraft, and will kill a man.’ After 6 months, 75% of women and girls were using their menstrual cups, and compared to pads or rags, found cups more comfortable, use less water, did not leak and saved money for school fees, books and food. Mothers said they would like their daughters and grand-daughters to use cups, “from their first period.” In 2018, ActionAid Malawi employed Lucy Nkhoma as their first menstrual cup facilitator, running menstrual health information sessions and distributing menstrual cups in schools. ‘With knowledge of menstrual health and cups my hope is that they will remain at school.’

Lessons from Chikarubi Prison, Zimbabwe

The women of the Menstrual Health Specialists Trust in Zimbabwe are honest about the work they do. They admit that introducing menstrual cups is not always easy, especially in a women’s high-security prison. After a disinterested start, with even nurses misunderstanding menstrual cups, they nearly gave up. Instead they went to the top of the police force. They met the Senior Assistant Commissioner Officer of Harare Province who asked if he could attend the next training himself, to ensure the project succeeds. Brilliant result! Maybe if they had begun at the top and then trained the prison wardens and nurses, then cups would be more easily accepted in prisons? See the full story here:

Teachers in Malawi

A schoolteacher in Malawi sent this encouraging message:
“The circles [menstrual cycles] of women and girls sometimes collide. Funny enough five lady teachers this month had our circle together and the wonderful story that we were sharing is about the CUPS. How smart, comfortable and cheap it is when one is using the cup. We were happy in our bright colours and free to move up and down without any precautions as before. One of them has told me that when ever she had her circle she could have sleepless nights because she was afraid of spoiling her bed. But this time she said she is having sweet dreams because of the cup. GREAT WORK YOU HAVE DONE TO US Thank you for partnering with us to help this happen.”

Research in Kenya

Ground-breaking research has been undertaken in western Kenya. A team from the Liverpool School of Tropical Medicine, UK, the Kenya Medical Research Institute, the Safe Water and Aids Project, Kisumu, and the Centers for Disease Control and Prevention, USA, have been researching the impact of menstrual cup provision to keep girls in school, and improve their life chances. There is increasing evidence that cups are acceptable and with the University of Illinois Chicago the team is validating how their use can lower the rate of infections, including bacterial vaginosis and so can help in the fight against HIV/AIDs. For more details see 6(11):e013229. doi:10.1136/bmjopen-2016-013229, 2016.

Teenagers running and singing

The Menstrual Cup Coalition supports the safe use of affordable menstrual cups by sharing knowledge and good practice globally.

All photos © World Menstrual Network unless otherwise stated.