Menstrual underwear and period stigma in the Democratic Republic of the Congo

In Walikale, in the Democratic Republic of the Congo (DRC), periods are often shrouded in stigma, affecting everything from education to economic independence. 

We spoke with Aly Beeman, a menstrual health expert at Doctors Without Borders / Médecins Sans Frontières (MSF), about why innovative hygiene solutions and education are the keys to restoring dignity and economic participation for women.

Key takeaways:

• Taboo and stigma: Menstruation is often treated as a source of shame in Walikale. This stigma leads to self-isolation, lost income, and missed school days

• The risk of makeshift materials: A lack of access to menstrual products often forces the use of unhygienic alternatives. These methods are not only uncomfortable but can also increase the risk of infection

• The period underwear solution: MSF’s distribution of washable, absorbent underwear significantly boosted female confidence and mobility during menstruation

• Menstrual health toolkit: Sustainable change requires more than just a product. To truly break the cycle of period stigma, menstrual health support must combine high-quality supplies with safe, private facilities and evidence-based education

In the morning at the Rusayo Camp, a group of displaced women gathers to perform dance and music sessions in order to share some moments of joy despite the difficult situation they're living in with their families in the camp.

1. Could you start by telling us a bit more about Walikale, where the project took place?

Walikale is in the North Kivu Province of the eastern Democratic Republic of the Congo (DRC), quite close to the borders with Uganda and Rwanda. The area has seen decades of conflict, which has weakened health and social systems. 

Many people have been forced to flee the fighting multiple times, often leaving their homes, their possessions, and their livelihoods. Women and children have been left especially vulnerable.

MSF has been the only organization consistently supporting reproductive health in the area since 2012. 

2. What does it mean to have your period in Walikale?

Our team consulted almost 200 people, including women and girls, as well as men and boys, in the community. They told us that at a girl’s first period, she might be welcomed into womanhood. But soon after, the silence sets in.

In Walikale, menstruation is pathologized as something “dirty” or “contaminating,” and talking about periods is seen as morally unacceptable, which leaves women and girls without accurate information or support.

 “I do not talk to anyone, I feel afraid, and I feel ashamed,” said one female participant 

The weight of secrecy really shapes daily life. Fearing leaks or ridicule, many women and girls are forced to withdraw during their menstruation, staying home from school, skipping church, avoiding markets or work.

They told us that self-isolation feels safer than the risk of exposure. But it comes at a high cost: lost education, reduced income, and separation from community life.

3. Are there any practical solutions that could help, like period products?

In Walikale, menstrual products are scarce, and choices are almost non-existent.

Women and girls often rely on old cloths or scraps of mattress foam instead. These makeshift materials are unreliable and unhygienic, potentially causing infections.

On top of this, there is also a lack of places suitable for changing menstrual products. A safe, private space with access to soap and water frequently wasn’t available for the women we spoke to, either at home or in community settings.

To manage their periods whilst balancing the pressures of the taboo, women and girls often try to find remote spots in the bush to change or adjust menstrual cloths. They do so quickly, without access to soap or water. This is neither safe, private, nor hygienic.

4. What did MSF do, and can you tell us more about the Menstrual Underwear Innovation Project?

Each woman and girl who took part in the project received four pairs of absorbent, washable menstrual underwear, alongside a hygiene kit consisting of a bucket, soap, clothesline, and pegs. 

Three months later, participants returned to share how well these new tools worked in their daily lives. 

For many, the underwear transformed their experience of menstruation. It improved dignity, reduced the anxiety, and allowed women to keep the “secret” of menstruation without carrying it as a heavy burden. 

Healthcare in Baraka, South Kivu. MSF teams distribute non-food items (NFI) to displaced people at the Kimanga internally displaced persons (IDP) camp, located 5 km from Baraka town centre, in Fizi Territory, South Kivu Province, DRC.

They described feeling more confident and freer to carry out daily activities, with less fear of leaks or stains. 

“I wore my underwear without any problem. I went to the field, I farmed, I carry baggage from the farm until home, I wasn’t afraid that I would bleed over. I was every day feeling myself free.” - Female Participant  

“I was able to do everything. No one could tell I was on my period because I could move freely. With the cloths [previous product used], everyone knew when I was on my period.” - Female Participant  

5. Can menstrual underwear help break the period taboo? 

The study in Walikale showed that new products like menstrual underwear can make a real difference, but products alone are not enough. To overcome fear and period stigma, and to maintain dignity, women and girls also need supportive environments, safe facilities, and accurate information.

That is why the next phase of MSF’s work on menstruation will focus not only on period products, but also on health education that can help to break the taboo.

MSF’s Inclusive Innovation team is now drawing on the lessons from projects like Walikale and in other different contexts to create a Menstrual Health Toolkit for humanitarian workers.

It will definitely include practical decision guidance on period products and facilities. But there will also be health education and behavior change approaches that can be adapted to different settings.

The goal of the toolkit is to ensure that menstrual health programming meets immediate needs but also shifts harmful norms over the long term. 

Dignity in menstruation means more than access to products; it means knowledge, confidence, and the freedom to live without silence or shame.

Learn more about MSF’s Menstrual Underwear Innovation Project in the DRC here.