Banana plantations stretch as far as the eye can see, covering the rolling hills. At the end of a red dirt track sits a rectangular building with walls painted an eye-wateringly bright shade of blue.
It is an hour’s drive from Rwanda’s capital, Kigali, to get here to the eastern Ngoma district.
So many visitors flock to the unassuming blue building – including Rwandan government officials, scientists and engineers from the United States and representatives of multinational companies – that one person has been designated tour guide.
Marie-Louise Umurisa leads guests into a workshop where a dozen or so women in safety goggles and overalls are working at stainless steel benches. She picks up a handful of fluff. It’s pale brownish grey, odourless and rather nondescript but Umurisa talks about it in a tone approaching reverence.
The fluff is processed from banana fibres, a waste product from the thousands upon thousands of banana plants that are cut down when they are harvested. The stalks of the banana plants are worthless and would normally either be fed to animals or left to rot on the ground where they emit greenhouse gases and disease can spread.
But in this rural workshop it is spun into a product that, according to Umurisa, is worth its weight in gold: the core of ecofriendly, cheap sanitary pads that rival imported products with big brand names.
One man's trash: Waste products from nearby banana plantations are spun into a fluff that will become ecofriendly menstrual pads. (Sustainable Health Enterprises)
Since she first started menstruating, Nicole Uwase has skipped school every month when she had her periods. Now 22 and in her last year at the Ecole Secondary De Musanze in Rwanda’s Eastern Province, Uwase says she must have missed at least 500 days of school because of her periods. That is a year and a half of teaching that she lost out on.
How many of Uwase’s peers also miss school because of menstruation is hard to know, because there are no official figures. A 2008 survey of 500 girls in one area in Rwanda, conducted by the international women’s organisation Sustainable Health Enterprises campaign, showed that close to one in four girls in the country miss between three and four school days a month as a result of menstruation.
But those results cannot be generalised to the rest of the country. It’s therefore impossible to know how many menstruating schoolgirls in the country miss school days.
When she had her period, Uwase – who is tall and athletic – did not even consider playing sport. She simply couldn’t afford sanitary pads. They cost about $1 for a box of 10 and are taxed at 18%.
Many girls use rags when they have their periods but the pieces of cloth are difficult to clean and therefore unhygienic. They feel uncomfortable drying the washed rags in the sun where anybody can see them. Some even use bark or mud to stem the flow.
Like Uwase, they dread stains on their clothes or the slightest hint of a “smell” and so rather stay at home than risk being ridiculed by their classmates.
In Rwanda, stigma around menstruation forces people to stay indoors while on their period. (Sustainable Health Enterprises)
In 2005, Elizabeth Scharpf was a bright-eyed intern at the World Bank in Mozambique when the young American was told there were women who couldn’t work while they were menstruating because a small pack of commercial maxi pads cost more than what they earned in a day.
It was the first time she had heard of this: at the time, hardly anybody was talking about menstruation. The topic was taboo and avoided because of the “ick factor”, but there was also little emphasis on how the prohibitive cost of expensive sanitary pads and a lack of knowledge were shaming girls into skipping school and women into taking time off work.
Scharpf’s initial shock turned to outrage, she wrote in 2016 on the social action platform Global Citizen. She went back to the US to finish her joint degrees at Harvard University’s business and government schools, but continued to ask about women’s experiences in other parts of the world. When Scharpf realised this was a global problem, she decided “to do something”.
“Most of the efforts to respond to this problem [of not being able to afford sanitary pads], as well as most problems in resource-poor settings is charity,” Scharpf wrote in a Harvard Business School blog for its Alumni for Impact series, published in September last year. “But charitable efforts alone are not enough to address the breadth and complexity of socioeconomic and health problems that exist in developing and developed markets.”
Donating pads is not a long-term solution, she argues. Besides, she wanted to create jobs. So, instead of a charity, Scharpf started an organisation not only to develop affordable maxi pads locally but also to help girls and women to set up their own businesses to make and distribute pads. In 2008 Sustainable Health Enterprises (SHE) was born. The idea was to use a business approach to solve social problems, she explains in a video posted on the organisation’s website.
Scharpf had experience in the field, including with international pharmaceutical companies, and she had her contacts in academia but she also asked for advice from engineers, scientists, agriculturalists and, critically, women and girls she wanted to help.
“I headed to Rwanda with two engineering students, a tape recorder and a hand-held blender,” Sharpf wrote in Global Citizen.
They tested a variety of products to find an absorbent, widely available material for the maxi pads – from cassava leaves, banana leaves and fibres from banana plant trunks to foam mattresses and textile scraps. They would boil various natural fibres, let them cool overnight and then test them.
“We would drop Coke on it to measure absorbency,” Scharpf told the New York Times in 2010. “We saw, hey, those banana fibres really slurp up the Coke.”
For people who menstruate in rural Rwanda, these banana fibres are worth their weight in gold. (Sustainable Health Enterprises)
With the help of experts, Scharpf developed and patented the process to transform banana fibres into an absorbent material in the US. She also worked with professionals to build a production site in Eastern Rwanda.
SHE started lobbying the Rwandan government to drop tax on sanitary pads and a campaign called “Break the Silence” spurred the authorities to distribute pads to in-need schools. The organisation also worked to dispel myths and taboos about menstruation through health and hygiene education in schools.
But the aim ultimately was to get a scalable business model going that could be replicated in other countries.
Rwanda was an obvious choice to build the blueprint. Not only does it produce a lot of bananas – it is a staple crop – but the country is small, which made it feasible to get a sense of the market and who they wanted to serve, Scharpf told Euromonitor International in an interview published last year.
It was easier to get things done in a small country with a small population, Scharf said.
Rwanda is also business-friendly; when Sharpf registered her business, it took only 48 days to do so. These days it happens even faster. A business can be registered and ready to operate within six hours, according to the Rwanda Development Board.
In the latest World Bank report on the ease of doing business, Rwanda is ranked second in sub-Saharan Africa and is in 56th position out of 190 countries globally.
[Listen] Our Adri Kotze talks to PowerFM about the road to a better pad
Women-friendly policies also made Rwanda an attractive option. Not only are most members in Parliament women, it is also the first country in the world where the Parliament is dominated by women.
Women are viewed as key to the country’s recovery and development following the genocide, states a 2008 document by the World Bank Group’s International Financial Corporation, titled Voices of Women Entrepreneurs in Rwanda.
After the 1994 genocide, women made up 70% of households and found themselves the heads of families and the main income earners, also in farming. Laws were changed so that women could, for the first time, own land. But as the tiny country is densely populated and the average land holding is tiny, government has encouraged farming co-operatives.
It is with these women co-operatives they wanted to work, says John Uwayezu, managing director of SHE in Rwanda.
“We worked with the local government right from the beginning,” Uwayezu explains. “We asked them to approach the women co-operatives to establish who wanted to work with us.”
The farmers are shown how to extract the fibres from the banana trunks with equipment provided by SHE. The organisation then buys the fibres from the co-operatives.
One of SHE’s first suppliers was the Umunezero banana co-operative. Selling banana fibres to SHE contributes more than a third of their annual income, according to information on the SHE website.
This has since been expanded to four co-operatives, says Uwayezu. “This means there are more than 800 beneficiaries in the co-operatives.”
Local women make up the vast majority of the production team at the site. SHE partnered with the ministry of education in Rwanda and recruits graduates from a nearby technical vocation school, many of whom struggled to find work.
Godence Umugwaneza (27) used to work as a casual farm labourer: back-breaking, low-paid digging jobs. She now operates the machines that process the banana fibres. They are cut, washed, fluffed and solar-dried before they are compressed into the pads.
“Life was really bad without a stable job but now I get a salary at the end of every month,” she says. “We also try to become ambassadors in our areas and try to educate fellow women to use pads.”
Eco-friendly banana pads have inspired women in Rwanda to support other people who menstruate in their communities (Sustainable Health Enterprises)
A lot of research has gone into making a product that women and girls would want to use, says Uwayezu. “We made sure we got feedback from our customers. We found that they wanted pads that looked like the ones made by the established brands.
“So, at the beginning, the pads did not have wings. We added those in the design. We also asked them for input on our packaging. They wanted something bright and modern, with an English name.”
The pads are ecofriendly: no water is used in making them and also very little electricity. And, unlike pads made by established companies, the banana pads don’t contain any chemicals or non-biodegradable super-absorbent polymers.
But the high cost of production remains a huge problem, Uwayezu explains. It means SHE has been running at a loss. “Our biggest expenses are the salaries. If we manage to keep the number of employees and increase production, we can break even,” he says.
Just over 1 000 pads are made each day at the site. They want to increase this tenfold in May, Uwayezu says —– and by the end of the year reach 30 000 pads a day.
The project in Rwanda is not the only one making banana fibre pads: there are, for example, also small-scale operations in Uganda and a big venture in India.
The SHE team focuses on becoming sustainable: in 2015 the consumer giant Johnson & Johnson signed on as technical advisers, which boosted and streamlined production.
“We loved their approach of using locally sourced banana fibres for absorbency,” says Johnson & Johnson’s Michael Moscherosch.
The team brought experience in engineering, the making of sanitary pads and knowledge of absorbent products. They also built customised business tools for SHE.
The two technical teams are developing equipment that produces the pads semiautomatically, according to Moscherosch.
“If we can create a model [to profitably manufacture affordable sanitary pads in developing countries], we believe it can be adapted and replicated in many tropical regions where bananas are grown. Scalability for such projects is the Holy Grail.”
Market research showed people preferred pads - even locally made, ecofriendly ones - to have colourful packaging and an English name. (Sustainable Health Enterprises)
Olive Umuhoza’s small shop is a dazzling assault on the senses: sweets in shiny wrappers compete with biscuits, cooking oil, toothbrushes and Umuhoza’s bright smile for attention. Behind her, the shelves are stacked with the pink and green packages of SHE’s go! pads.
“Many clients used to complain about the high prices [of established brands of sanitary pad] and others would not buy but now they are willing to come and buy,” she says.
Umuhoza’s kiosk is one of the many that sells the banana fibre pads. A pack of 10 is sold for about R6.90 (58 US cents) — up to 50% cheaper than commercial pads. The go! pads are also distributed to schools and through nongovernmental organisations. Other sanitary pads at Umuhoza’s shop cost between R11 (92 US cents) and R13 (about one dollar).
Her customers include teenage girls and casual labourers. “Young girls are now more comfortable to ask for sanitary pads. I think they now understand it is okay to buy pads.”
Although the banana fibre pads were initially met with scepticism and Umuhoza sold only about 20 packets of pads a week, she now reaches that number in a day. She uses the pads herself, she says.
For the past three months, Uwase has not missed school. “When I discovered that there was a factory making pads in our area, I asked about the prices,” she says.
Her parents can afford to give her the 500 francs she needs to buy the banana fibre pads – the first time she can buy any sanitary products.
“They are very comfortable,” Uwase says. “I have now also started playing basketball and volleyball. It feels really good.”
Have something to say? Tweet us on @Bhekisisa_MG or Facebook us on @Bhekisisa.Health
Why you shouldn't be ashamed of your period
How your period could be messing with your mental health
Free pads: 'KZN girls miss three days of school a month because of their periods'
When it’s not just PMS: Could your period be affecting your mental health?
Period pains can be debilitating, but they can also be treated
Recent national and Gauteng memos demanding all foreign patients pay in full for services likely fell foul of the law.
We could be just hours away from knowing whether Depo-Provera use is linked to a higher risk of HIV infection in women. Find out how.
Bhekisisa's latest policy dialogue takes a deep dive into one of the biggest challenges facing SA's HIV response at the 9th Aids conference.
Bhekisisa means "to scrutinise" in isiZulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.