As Maria Carmen Punzi and Mirjam Werner explore in Chapter 60, social enterprises and businesses are increasingly active in the areas of menstrual health and menstrual product distribution. Motivated by social missions but with for-profit models, these companies reflect a new way of doing business where positive social change and financial profit are not mutually exclusive. These hybrid ventures and commercial businesses have emerged as key actors addressing the diverse needs of women and girls, menstruators and those who don’t menstruate, in a range of communities. Their recent proliferation, particularly in the menstrual health “space,” raises a range of questions and avenues for analysis regarding their approach and contributions to the sector as a whole.

This dialogue features reflections by those working in the private sector whose products and services address a broad range of menstrual health needs in countries around the world. They discuss how they understand their work, their contribution to communities, and their role in a larger movement for menstrual health equity for all. What are their goals? How do they balance the demands of making profits and promoting social change, especially where these goals may be in tension? How do they understand their mission differently than the traditional Femcare corporations? How do they measure their success beyond profits?

While many praise the rise of private sector actors within this space for their innovative approaches, as Punzi and Werner point out, they also face critiques, which can come from both mainstream Femcare corporations and menstrual activists. The Femcare industry questions the sustainability and scalability of the social enterprise approach and products, while menstrual health advocates question whether social enterprises and commercial businesses are truly committed to social change. Is their aim to change the discourse around menstruation or are they co-opting feminist politics for a marketing agenda? Proponents of the private sector’s increased role argue that their approach allows them to out-innovate the big corporations, focusing locally and listening to their customers to provide products that fit their diverse needs. At the same time, their marketing provides a platform to change the discourse around menstruation and their for-profit model allows them to sustain this work. Unlike NGOs, companies are not restricted by the politics of foreign aid and financing and can more readily and iteratively respond to social problems. But the question will always remain, what are the consequences of addressing social problems through private sector approaches?

The three companies represented below focus on improved menstrual health outcomes for their customers (and women more broadly) as central components of their business models. Within each of their contexts, menstrual health education and advocacy are fundamental to not only the acquisition of new customers, but also to a broader movement around health and gender equality. With social enterprises, start-ups, and large corporations all capitalizing on the market and social opportunity of women’s bodies, we have to ask: is this a good or bad trend? Does reframing consumption and consumer choice as activism actually undermine the effort needed to achieve gender equality? Or are we witnessing the rise of a new form of activism that works to achieve social change and improve the lives of women, girls, and their communities by means of business innovation?

These are tricky questions and the dialogue below tackles them head-on. Each of the contributors has different understandings and answers to these complex questions, but all are committed to providing girls and women with positive, shame-free experiences of their bodies and periods. Together, they tell a story of how corporations can care, with a focus on how designing products that meet the needs of underserved and neglected populations is a valuable market and social opportunity. Each is thoughtful about their roles and responsibilities in this hybrid space between traditional Femtech corporations and the broad range of activist and nonprofit approaches.

Mana Care: Ethically Sourced and Environmentally Friendly Solutions to Menstrual Health in the Pacific

Authors: Isabella Rasch and Angelica Salele

Location: Samoa

Mana Care Products is a Samoa-based social enterprise that provides women and girls with affordable, safe, and environmentally friendly menstrual products.

Why Femcare/Femtech?

Women and girls (especially those in developing parts of the world) have specific health needs that have not been met due to a number of reasons: negative cultural norms, menstrual taboos, and broader systemic gender equality issues. Increasingly, it has become more and more relevant to talk about Femcare or develop Femtech products, because slowly but surely societies across the world are beginning to allow for safer places and conversations where women’s and girls’ needs can be brought into the light. These conversations would have been nearly impossible to have ten or fifteen years ago, because people and society were not ready to tackle these issues. At Mana Care, we believe people from diverse backgrounds are ready to engage with taboo topics and tackle menstrual health because there is greater awareness of its impact on women’s and girls’ lives. We choose to build Mana Care because we believe women and girls have suffered in silence for long enough.

The idea to build a company focused on sustainable menstrual products in Samoa was driven by an environmental perspective on women’s and girls’ health needs. Our desire was to create a product that did minimal harm to the environment. From this point of view, we began researching and engaging in conversations to understand both the environmental and socioeconomic impact of menstrual health in Samoa. We found that access, or more accurately a lack of access, was a clear barrier to menstrual health, with women and girls in Samoa and the Pacific commonly using cloths and rags to manage their periods. By understanding this context, we sought to create an improved product that would meet their needs.

What do you do differently compared to others in the space?

Our product is not only environmentally friendly but is aesthetically attractive to consumers. We use a variety of beautiful and fashionable prints to create pads that our customers purchase to help manage their menstrual cycle. Furthermore, we have built a business model with considerable thought to our brand and marketing. Our main target market is high-income consumers—women who are interested in products because of their aesthetic appeal, and as an environmentally friendly alternative to traditional products (single-use plastics). As part of our branding, we promote the idea that by supporting Mana Care, a social enterprise, customers are supporting their local community. Our main product (the reusable menstrual pad) is also hand made with love by local Samoan women, which makes us unique in this industry. With limited innovation around menstrual health in the Pacific region, Mana Care works to address the needs of women and girls in this regard. We also ensure vulnerable women and girls are able to access the products at a lower cost or through a donation model. At Mana Care, we fundamentally believe in creating a high quality, locally produced, and environmentally friendly product that makes women and girls feel more comfortable and prettier while on their period—and we think it works!

What marketing/communications choices does your company make to stand out from its competitors?

Our emphasis in marketing Mana Care and our products more broadly focuses on the environment and the “plastic-free” movement. We also have just launched a “pad for pad” marketing campaign, which enables us and our buyers to make an additional purchase for lower income women. This is supported by the purchase of limited-edition pads, custom made upon request, from high-end fabric stores.

What role do companies have in breaking menstrual taboos and the silence around women’s health?

Awareness-raising is an important part that companies can play in order to help break down menstrual taboos and encourage more open conversations around women’s health. As young women, particularly Pacific island women, we understand the challenges and struggles that come with menstruating and how it can be especially hard and confusing when you first get your period. We want to end the confusion, shame, and misinformation perpetuated by negative taboos and cultural norms, in order to allow women and girls to talk more openly about their individual needs. By reshaping the way women think about their bodies and natural processes like menstruation, companies have the power to increase the quality of life for many people, not just women and girls, because menstruation affects men’s livelihoods as well. We actively contribute to this process in Samoa and the Pacific region more broadly.

Can companies manage social and financial interests within this space?

We believe companies can do both by showing that there is an unaddressed need, identifying the needs of different market segments, and working to address them. The full social and financial interests within this space are still yet to be fully discovered because menstrual health management is a relatively unexplored area, especially in the developing world. We believe there are major technologies or inventions which could completely change the way women and girls manage their periods. We know there are certainly many that already do, but we are even more hopeful to see what is yet to be discovered.

How do you see new businesses and social enterprises challenging the big Femcare companies?

Buyers and consumers are becoming increasingly aware and cautious about where and how they spend their money. There is evidence to show that more individuals now want to invest or do business with smaller companies that have a social purpose and make positive changes to communities. There is a clear trend toward smaller, locally owned businesses. We foresee a massive change coming to the big Femcare companies because single-use plastic is unsustainable. As more and more consumers demand environmentally friendly products, they will be pressured to pivot or change their products. How long it will take is the real question, and whether they will recognize the need to do so quickly, because the patterns of change we are seeing today indicate that women and girls are going to start switching from the traditional products that are available on shelves today.

What are the biggest challenges facing social enterprises and businesses in the menstrual health/Femtech space?

Menstrual taboos remain a key barrier to improved menstrual health. While menstrual health poses a new opportunity, the negative cultural practices are still strong and taboos continue to exist. The initial investment or purchase price of a pack of reusable menstrual health products is also another issue, because while they are a good investment in the long term, the initial purchase is still very expensive compared to the cost of a month’s worth of single-use/disposable products. For some consumers, particularly low-income households, the initial price can be a deterring factor and discourage a good portion of one of our market segments.

MAS Holdings: Innovating in Femtech from the Global South

Author: Ginny Mendis

Location: Sri Lanka

MAS Holdings is one of Sri Lanka’s largest apparel tech enterprises, comprising an ecosystem of design offices and apparel-manufacturing facilities with an integrated supply chain. This operation is powered by over 98,000 employees spread across 16 countries. MAS is noted for its emphasis on ethical & sustainable work environments and is the creator of UK-based Become menopause clothing. MAS also developed patent-pending technology for underwear that can absorb body fluids, which is currently available online and in retail stores.

Why Femcare/Femtech?

At MAS Holdings, we see Femtech as a large market opportunity because women’s needs have remained mostly underserved and undervalued until now. We strongly believe in creating innovative, functional, wellness-oriented products and solutions across the Femtech space, drawing from our readily available apparel technology and over 30 years of expertise in the apparel and textile industry. As a largely female-powered enterprise, our auxiliary objective is to continue our efforts in women’s empowerment and utilize our proficiency to give the female consumer more control over their health, their bodies, and their lifestyles. Another benefit of the rise of Femtech is the greater awareness of women’s health issues, which is yet another reason for our enthused efforts in the space.

What do you do differently compared to others in the space?

Seventy percent of our workforce are women, and women drive our Innovation Team. Our strategic goal is to create solutions that better address women’s unmet health needs, so our team continuously consults women at every stage of product development. Our core set of values encourages the discovery of each individual’s potential. MAS has imbued a culture of fearlessness and new thinking across the company, which has naturally led us to break conventional boundaries in product and solution development.

With women being both the creators and the beneficiaries of our unique products, we also take action on women’s empowerment as a core business strategy. Our program, which supports the skills and career development of women in our workforce, has made an unparalleled impact on female employees, the garment industry, and Sri Lanka generally in the last 15 years.

What marketing/communications choices does your company make to stand out from its competitors?

We are big believers in authentic marketing. With ‘Become,’ our menopause apparel brand, we wanted to build a narrative that menopausal women feel a part of and that spoke directly to their experiences. Generally speaking, apparel brands tend to focus on younger demographics and older women’s needs are regularly neglected. It is not often you see older voices or bodies reflected in marketing campaigns, let alone those which are not airbrushed to perfection. The women in our marketing and communications materials are “real menopausal women.” They are those who use our product and reflect diverse bodies and experiences. We are especially focused on building a community around menopause, much like that which has emerged around menstrual products. We have a Facebook group which has thousands of women sharing their stories. It is not just about selling a product, but also creating spaces for information-sharing and education.

What role do companies have in breaking menstrual taboos and the silence around women’s health?

We have worked in the women’s health space and across different issues for quite some time and have seen the role that companies can play in reinforcing stigma around “taboo” issues, but also the potential to break it. At MAS, we think companies have a responsibility to set a higher standard for how they choose to design and market products. Companies have a duty not only to solve the physical health issues or limitations but also to make an effort to normalize and engage with the emotional and social factors that impact women’s health. For us, we think cocreating products with our users and making room for women’s voices and real experiences is critical to this.

Can companies manage social and financial interests within this space?

For us, this is critical to everything we do. We are deeply focused on corporate responsibility because we believe being a good corporate citizen means actually supporting the communities in which we work. We consciously invest resources into our women’s empowerment programs, as well as the sustainability and environmental impact of our factories. This is both financially and socially prudent for us.

How do you see new businesses and social enterprises challenging the big Femcare companies?

As a diversified conglomerate, MAS Holdings has already embraced the entrepreneurial spirit of start-ups. Our Twinnery team is focused on innovation and design for those not served by current products. We think of ourselves as responsive to current trends as a result. There is more than enough room for a variety of small and large actors to create new products and services for women in this space. According to a recent market analysis, Femtech is emerging as the next big disruptor in the global healthcare market with a USD 50 billion market potential by 2025.

There are an incredible number of untapped markets and needs across women’s health. While menstrual products have seen a resurgence in innovation and popularity, many other issues such as menopause or incontinence are still taboo. Whether big or small, these issues pose incredible potential for market and social opportunities for everyone.

What are the biggest challenges facing social enterprises and businesses in the menstrual health/Femtech space?

Whether an enterprise or a company, we all need to make sure we are designing with our users. This seems obvious but is not always the case. Consumer demands, be it in the Femtech space or any other, can be distinctly identified and disruptive technologies—including big data, artificial intelligence, machine learning, and interactive digital applications—can be used to tailor solutions. The challenge lies in our desire to utilize these technologies to explore far greater potential in the space. For decades, healthcare products and solutions were designed and developed with minimum attention paid to the physiological differences between men and women. Today we see a shift in the industry to better serve women beyond products and services focused on maternal health and childcare. There is a greater need for differentiated products and the challenge is to keep up with the rapid pace of technological advancement and innovation, and apply it fittingly to meet our consumer demands.

Ruby Cup: Bridging the Gap between Customers and Beneficiaries

Author: Alfred Muli

Location: Kenya

Ruby Cup is a social menstrual health business that produces and sells menstrual cups around the world. Our mission is to provide sustainable menstrual health solutions to all menstruators regardless of their income. We strive to dismantle taboos surrounding menstruation by delivering sound education on reproductive health and menstrual care so everyone can live their periods with dignity, free of shame. We work in and distribute across 32 countries around the world. Our model is based on a ‘Buy One, Give One’ concept: for every cup that is purchased, another cup is donated to a girl or woman in need, mainly in Africa and South East Asia. We do this through strategic partnerships and with our colleague organizations based on the ground who implement menstrual health-focused programming.

Why Femcare/Femtech?

Initially this space was totally focused on hygiene. However, a great deal of evidence and data demonstrate the link between menstrual health and gender equality. This links back to the overall well-being of a woman or a girl. I think that is why Femcare and Femtech are gaining in popularity because it links back to so many other sectors and parts of women’s and girls’ lives. So if you are interested in education, menstrual health is relevant. If you are interested in water and sanitation, menstrual health is also there. If your focus is sustainability and environmental management, menstrual health is also important in this regard. But at the end of the day it is a business opportunity as well. It is a big money business and a good social opportunity, so that has brought a lot of innovation to the space. It is not just the menstrual cup, but period panties, for instance, that are examples of good innovation.

It is important not to underestimate the amount of global advocacy that has brought menstrual health to global attention and invigorated the Femcare/Femtech space. This championing by diverse groups, including feminists, practitioners, and activists, has been key in bringing all these players into this space and putting menstrual health on the agenda.

What do you do differently compared to others in the space?

Ruby Cup’s donation model is unique in that we provide education as well as a product. This has proven critical to our success. One of the challenges with product-based interventions—and let us be honest here, most people are just focused on the product—is the need for more than simply distribution of the disposable or reusable sanitary pad or the cup. We believe education is very important and our menstrual health workshops are critical to reaching our target audience.

We are well known for our country-based, national programming. We have worked hard to develop materials and educational workshops that are tailored to the needs of women and girls on the ground. Our approach of working collaboratively with partners is critical to our success. These workshops are run by our ambassadors, who are trained by us and are Ruby Cup users themselves. It is important to us that our trainings are conducted by someone who not only uses the cup but understands the challenges of first-time use. Ensuring that our trainers are also users helps with converting users and building authentic relationships with women and girls.

We also look at how we can sustain support beyond the initial training. This is rather unique! For instance, if you are a new user, you can call the trainer and say, “I don’t know how to use my cup” or “Today I’m having trouble with my cup,” and they continue to offer ongoing support and guidance. Our training and support is not just around menstrual health, but also puberty and social taboos.

What marketing/communications choices does your company make to stand out from its competitors?

At Ruby Cup, we let the community members tell their stories from their own experiences. So the stories do not come from us, they come from the girls and the women in the community. We are incredibly proud of the partners we work with, because they then become the drivers of our brand and business. We understand the benefit we have provided in the community in terms of the practical impact on women’s and girls’ lives. Choice is critical to our approach. We do not force any products on any users. Instead we ensure they have all the information they need to make the best decisions for themselves. Fundamentally, we want girls to have a choice. That is important to our communication and branding.

What role do companies have in breaking menstrual taboos and the silence around women’s health?

Addressing menstrual taboo is a big part of the responsibility of being in this space. When you produce products to help women and girls feel comfortable, you cannot make assumptions. Companies must listen to their users and understand what the users want, in order to produce products that the users want and need. We cannot just distribute a product and forget the rest. As companies we have to invest in understanding the reasoning behind women’s decisions, especially when dealing with a marginalized issue that is stigmatized. We have to work on some aspects of tackling taboos to do so.

This should not just be left to the small organizations. We all need to contribute. If you leave this all to the grassroots organizations, you will never be able to market or position your product. In the end, you will be marketing a myth, because myths are so prevalent around menstruation. You need marketing that is positive and recognizes that menstruation is a biological process and not anything to be ashamed or afraid of.

Can companies manage social and financial interests within this space?

There are a lot of social interests which are critical to business within the menstrual space. At Ruby Cup, we think companies have a responsibility to be more inclusive. They must also invest in research and development to create safe products which meet high standards for quality. We believe that every company should continually invest in, listen to, and learn from their users in order to develop eco-friendly, high-quality, sustainable menstrual products for all. It is doable for a business. It is what we do.

How do you see new businesses and social enterprises challenging the big Femcare companies?

The scale of the company is not what matters most. What is important is the participation and trust of users. While smaller companies will not have the financial resources of the big multinationals that can just flood the market with a particular product, their impact is just as important. The changes we make in a few lives are rewarding and long lasting. That is something large companies can learn from smaller ones.

Large companies have to continue investing in research and development to ensure innovation. While they have the resources, they are not always the first to release or market innovative products. The dynamics are changing in this regard. Look at Procter and Gamble, who just released a menstrual cup! They are learning from smaller social businesses like ours that there is a need and market for this type of product. Different options are important but so is having diverse companies and actors talking about these issues. It helps normalize it.

What are the biggest challenges facing social enterprises and businesses in the menstrual health/Femtech space?

There are a wide variety of challenges facing local businesses. Regulation remains a huge challenge across this space, especially around sanitary pads and menstrual cups. For social enterprises this can be a barrier to market access. Secondly, funding and investment at the early grant stage is an ongoing stress factor for any small enterprise or business. It can be difficult to convince investors and donors of the market opportunity that exists. As much of our work is focused on Africa, the affordability of our product in a small or emerging market can be a particular challenge. In Kenya, for example, the costs of raw or basic products are still very expensive and this affects the pricing. Social enterprises and businesses have to think carefully about how to price their products when working in these kinds of contexts.