A systematic review on effectiveness, safety and adoption of reusable menstrual pads in Africa

Background Menstrual hygiene management remains a public health challenge in many African settings, where limited access to affordable menstrual products, inadequate water, sanitation and hygiene infrastructure, and stigma affect safe and dignified menstruation. Reusable menstrual pads have been promoted as a sustainable alternative, but evidence on their effectiveness, safety, and adoption remains fragmented. Objective This systematic review evaluated the effectiveness, safety, and adoption of reusable menstrual pads among menstruators in Africa, including comparisons with disposable pads and traditional materials. Methods A systematic review was conducted in accordance with PRISMA guidelines. Databases searched included PubMed, Scopus, ScienceDirect, Web of Science, Cumulative Index to Nursing and Allied Health Literature, African Journals Online, Google Scholar, Cochrane Library, and World Wide Science for studies published between 2014 and 2025. Outcomes included leakage, absorption, comfort, dermatological and urogenital health indicators, usage patterns, barriers, and facilitators. Study quality was assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Results Fifteen studies met the inclusion criteria. Reusable menstrual pads generally performed better than traditional cloth in reducing leakage, while laboratory studies showed favorable absorbency and strike-through performance for some designs. Comparisons with disposable pads were mixed, as user confidence and leakage experiences were influenced by fit, familiarity, and context. Safety outcomes depended strongly on washing, drying, and storage practices. Adoption was shaped by affordability, product design, water access, privacy, education, and adequacy of pad supply. Conclusion Reusable menstrual pads are a feasible menstrual management option in African settings, but their effectiveness, safety, and sustained use depend on supportive hygiene infrastructure, user education, and sufficient product provision. Context-sensitive implementation is necessary to maximize their public health impact.