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

June 01, 2020

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.

Download Paper as PDF