"We Are Trying to Move Away from the Old Ways of Our Village": Menstruation, Collective Action, and Community Care in Nairobi's Informal Settlements

Background and Purpose: Each month 1.8 billion people around the world menstruate—a natural biological process shaped by gender, poverty, and stigma. For millions, menstruation is not only a health issue but also a source of vulnerability. The World Bank estimates that 500 million people globally lack access to adequate menstrual products and facilities to manage their menstrual health and hygiene (MHH). In Kenya’s informal settlements, challenges related to privacy, sanitation, and waste management are compounded by widespread stigma, making menstruation both materially and emotionally difficult to navigate. Existing MHH research focuses on the physical infrastructure, such as toilets or product availability, rather than the social and emotional dimensions of menstrual management. Even fewer studies explore how menstruation intersects with collective action and knowledge-building in marginalized urban contexts. This study aims to understand how women living in Nairobi’s informal settlements experience and respond to barriers to MHH, and how community-based strategies might reduce stigma and promote empowerment.

Methods: This mixed-methods study draws from two datasets collected between December 2022 and January 2024 in Nairobi’s informal settlements of Mathare and Kibera. The qualitative dataset includes in-depth interviews with 144 women, originally conducted to explore climate resilience and mental health using a phenomenological approach. Utilizing this data, one team member extracted all menstruation-related narratives from the transcripts using thematic coding based on a collaboratively developed resiliency codebook. To supplement this work and these insights, we analyzed quantitative data from 800 women surveyed monthly for 18 months. These surveys tracked mental health and wellbeing, substance use and interpersonal violence using a causal pathways framework to understand the interconnections between climate stressors, well being, and social determinants such as MHH.

Results: Preliminary results indicate that affordability, limited access to menstrual products, lack of private toilets and persistent stigma all compound and constrain women’s ability to manage their monthly cycle safely and with dignity. Yet, participants also shared community-driven responses, such as sharing products with neighbors, building informal networks of support and organizing local waste collection programs to increase privacy and connectedness. These grassroots strategies reflect a broad ethic of care and solidarity, and suggest that collective action can play a powerful role in lowering menstrual stigma, building empowerment-based menstrual education within the community, and improving mental health and well-being.

Conclusions and Implications: MHH in informal settlements must be understood beyond hygiene—it is deeply social, shaped by collective resilience and gendered expectations. Our preliminary findings suggest communal resilience and collective action around MHH might improve mental health outcomes, physical health outcomes and perceptions of stigma. Informal support like going to one’s neighbor for an extra pad, or teaching a friend about menstrual products contribute to a community of care rooted in collective action. Findings suggest that interventions aiming to improve MHH should not focus solely on individual behavior change or infrastructure, but also invest in community-based strategies that build on existing networks of care. Supporting school-based menstrual education, expanding access to free products, and strengthening women’s groups may offer pathways toward more just, stigma-free menstrual experiences.