The cost-benefit and cost-effectiveness of providing menstrual cups and sanitary pads to schoolgirls in rural Kenya

Masih A Babagoli, Anja Benshaul-Tolonen, Garazi Zulaika, Elizabeth Nyothach, Clifford Oduor, David Obor, Linda Mason, Emily Kerubo, Isaac Ngere, Kayla F. Laserson, Rhiannon Tudor Edwards, Penelope A Phillips-Howard


Objective: To analyze the relative value of providing menstrual cups and sanitary pads to schoolgirls in rural Kenya.

Methods: From a healthcare payer or government program perspective, program costs were calculated for two interventions (provision of menstrual cups or sanitary pads) to girls (14-16 years old) in Kenya for one year. Cost-effectiveness analyses were conducted based on the health effects – in terms of reductions in disability-adjusted life years (DALYs) – and education effects – in terms of reductions in school absenteeism – of both interventions reported in a randomized controlled feasibility study. The health and education benefits were summed and compared to overall program costs.

Results: The cost of menstrual cups is estimated at $2,730 per year for 1000 girls, compared to $22,420 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, valued at $7,000) is higher than that of a sanitary pad program (0.48 DALYs averted, valued at $2400). However, the health effects of both interventions are not statistically significant, likely due to the limited power of the feasibility study. The menstrual cup intervention may be cost-effective in improving health outcomes ($2,000/DALY averted). The sanitary pad intervention has a costeffectivenes of $280/student-school year in reducing school absenteeism. Meanwhile, combining health and education effects, the sanitary pad intervention is cost-saving with a net benefit of $92,000.

Conclusions: The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. Provisions of sanitary pads is a cost-saving policy when considering health and education benefits jointly. This study outlines a methodology for future CEA and CBA on menstrual hygiene interventions and highlights several methodological challenges that need to be addressed before other similar analyses can be robustly conducted.

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