Developing a Holistic Menstrual Health Program

A group of girls in Splash vests smile and giggle in front of a yellow wall at school in Addis Ababa, Ethiopia.
A group of girls proudly wearing Splash vests in Addis Ababa, Ethiopia. Image by Make Beautiful.

Menstrual Health… in WASH?

In recognition of Menstrual Hygiene Day, hear directly from our team as they share the genesis of Splash’s MH approach, the lessons we’ve learned, and our exciting plans for the future.

Where It Started

Initially, Splash solely focused on delivering age-appropriate education to children in primary and secondary schools to normalize periods, reduce stigma, and address common misconceptions. Our first iteration of the menstrual health program involved trainings on the practicalities of managing menstruation and maintaining personal hygiene. While we still have this girl-facing program at the core of our MH approach, we have expanded our horizons.

When we integrated sanitation into our overall programming in 2015, we specifically ensured sanitation facilities for girls would enable safe, hygienic, and discreet menstrual hygiene management.

What we have learned over the years of implementing and refining our program is that menstrual health is more than simply having access to information or receiving guidance around menstrual hygiene management; it requires involvement from everyone across the entire social ecosystem. Splash has recently spent more than two years taking a deep dive into an adolescent girl’s experience — unpacking the social norms, perceptions, and emotions that can accompany menstruation and puberty.

The Learning Process

We conducted focus groups, direct observations, in-depth interviews, human-centered design sessions, and demographic surveys — facilitating more than one hundred data collection events. In Ethiopia and India, we talked with girls (menstruating and pre-menstruating), boys, mothers, fathers, teachers, janitors, and school administrators to gain a comprehensive understanding of the MH landscape and map how each stakeholder contributes to the experience of young girls during puberty.

For menstruating girls, much of the experience they were willing to share focused around the challenges of managing personal hygiene during their period, often without safe, clean, and private bathroom facilities. They shared insight into just how challenging it has been to adjust to this huge life change, and even a sense of nostalgia for the carefree childhood they feel as though has been left behind.

“I used to play with my friend at any time like jumping a rope before I start to see my menses. But now, I’m not that much comfortable to involve in such playing if I’m on menstruation.”
—A young girl in Addis Ababa, Ethiopia.

Girls who had yet to start menstruating shared feelings of fear and apprehension, and they were often unaware of the changes that their body will undergo and how their role in family and social surroundings may change, too. These shared insights made one thing clear: girls feel as though they will face one of life’s biggest developments without the support they desire or need.

“Before I had my first period, I had no idea what happens when period comes. Even when I had pain, people always told me that it is for a while or that it might just be some bacterial infection or food poisoning.”
— A female student from Addis Ababa, Ethiopia.

Two girls chat and smile in a hallway. Both hold water bottles and are wearing Splash vests.
Two girls laughing in Kolkata, India. Image by Shivam Pandey.

The Splash Approach




“Last year, when I was in grade 7, I saw some male students teasing a female student by brandishing sanitary pads found from her purse to other class students.”
—Male focus group participant.

By building knowledge and creating gender equity champions, Splash hopes to foster more empathy toward girls and their puberty experiences among all students and adults.

A diagram of the social ecosystem surrounding menstruating girls.

Hindsight and Horizons

We couldn’t do this work without the support we have received from an engaged community of people like you, and we are excited for what’s to come.

Where We’re Going

We have also learned a valuable lesson throughout COVID-19: when schools shut down, we can’t. Splash needs to keep reaching students to ensure they are supported during this critical development period. Remote education and digital engagement are the next frontiers for Splash, and we are excited to share more of that journey with you in the future.



Clean water, clean hands, clean toilets, and menstrual health support for kids in urban poverty — co-developed with local governments.

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Clean water, clean hands, clean toilets, and menstrual health support for kids in urban poverty — co-developed with local governments.