I was born and raised in a rural area among seven sisters. One morning, I noticed blood on one of my sister’s clothes and panicked, I thought she had been hurt. Only later did I realise she was menstruating. What stayed with me was not just the confusion, but the silence, the shame, and the struggle my sisters quietly endured every month. That early memory ignited in me a lifelong concern: Why should something so natural be a source of distress? Menstruation is a noble, and natural biological process, yet it remains shrouded in silence and stigma for many Rwandan girls. It should be accompanied by a comprehensive support system, adequate physical spaces, health resources, emotional backing, and education. Unfortunately, for many schoolgirls in Rwanda, menstruation continues to be a source of feeling embarrassed, social isolation, and school disruption. A recent study that I conducted in collaboration with the Rwanda Association of Midwives (RAM), has revealed a distressing yet fixable gap in Menstrual Hygiene Management (MHM) across Rwanda’s secondary schools especially for rural girls. The findings show both a deep problem, and echo a call for action. It’s time to eliminate the struggles surrounding menstruation ensuring it is safe, free of pain and stigma, and compatible with daily life. Among the 389 schoolgirls we surveyed, 85 percent had received some form of education on menstruation before their first period. A promising sign of progress. However, a closer look reveals severe inequities. Urban students reported significantly better access to sanitary pads and pain relief, while their rural counterparts continue to struggle. Just 4.2 percent of rural students reported having easy access to menstrual essentials, compared to a staggering 88.4 percent of urban students. These disparities come at a cost. Nearly one-third of respondents reported missing school due to period pain. Others stayed home out of fear of being teased, or simply because they lacked menstrual hygiene products. These are not just minor inconveniences, they are barriers to education, confidence, and long-term success. Every day a girl misses school because of menstruation is a day her potential is put on hold. Yet, there is hope. One of the most exciting findings from our study is the openness to alternative solutions, particularly menstrual cups. While 91 percent of students had never heard of them, more than 70 percent expressed interest in learning more, and nearly half said they would be willing to try or recommend them. Menstrual cups are cost-effective, environmentally sustainable, and suitable for both urban and rural settings due to their reusability and long lifespan. Despite being evidenced as a great alternative for MHM especially for rural communities, menstrual cups remain largely out of reach for the girls who need them most. Unless the government of Rwanda through its health and education investment partners can put this on an actionable round table to make it accessible, and affordable. It is crucial to recognize that poor menstrual hygiene management is not just a women's issue. It is a national issue. The World Bank estimates that Rwanda loses over $100 million annually in potential GDP due to school absenteeism linked to menstruation. This loss is not just financial; it's a blow to national development, gender equity, and the health and well-being of our future leaders. Our study also revealed that parents and teachers are the primary sources of MHM information for students. Yet, many adults especially in rural areas remain uncomfortable discussing menstruation or lack adequate knowledge themselves. This generational silence perpetuates harmful myths, taboos, and shame. If we want to break the cycle, we must equip not just girls, but entire communities, with accurate, open, and supportive education on menstruation. To truly support Rwandan girls and dismantle the barriers created by poor MHM, we must act on several fronts: Comprehensive Menstrual Education: Schools and community programs must provide accurate, age-appropriate education for students, parents, and teachers. Breaking the silence starts with open dialogue. Access to Sustainable Products: Make affordable and long-lasting options like menstrual cups available in schools and health centers, especially in underserved rural areas. Improved School Infrastructure: Ensure schools have clean, private, and well-equipped WASH (Water, Sanitation, and Hygiene) facilities where girls can manage their periods safely and with dignity. Nationwide Public Awareness Campaigns: Normalize menstruation through media, community leaders, and government messaging. Stigma dies when people speak up. Policy and Investment: Government and civil society must prioritize menstrual health in budgets, policies, and development agendas. MHM is not a luxury, it is a right. Menstruation should never cost a girl her education, her dignity, or her dreams. Our research shows that girls are not only ready for change, but more importantly they are asking for it. They want knowledge, products, and support. They want to feel safe, confident, and respected during their periods. Now, it’s up to parents, community opinion leaders, civil activists and advocates, policymakers, educators, health workers, and all of us as a society to deliver. Let’s end the stigma. Let’s make menstruation safe and shame-free. Let’s ensure every Rwandan schoolgirl, no matter where she lives, has the tools and support she needs to to live, learn, and thrive. The writer is a midwife, Health Services Coordinator at the University for Global Health Equity (UGHE), and Aspen Advanced Advocacy Fellow Class 2025.
