Feasibility and acceptability of menstrual underwear in a conflict and population displacement prone setting of Kalehe, Democratic Republic of the Congo

Menstrual hygiene management remains a critical yet often neglected issue in humanitarian setting. Reusable menstrual underwear (MU) offers a potentially sustainable and discrete solution, particularly where access to disposable products is limited. However, evidence of its feasibility an acceptability in low-income settings is scarce. This mixed-method study assessed the acceptability and usability of MU among adult women in five rural localities of Kalehe, Democratic Republic of Congo. Participants received four MU, a hygiene kit, and instructions and were followed up three months later through a survey (n = 124), and focus group discussions (n = 87). MU was highly accepted, with 94.3% of women reporting satisfaction and 98.4% preferring it to their usual MHM method. Participants praised MU’s comfort, hygiene, and ease of use. Key challenges included absorbance, insufficient quantity distributed, difficulties with drying, and concerns about product durability. Misinformation was reported but were largely mitigated by trust in MSF. Recommendations included improving MU quality, tailoring sizing, and expanding distribution—especially to adolescents. In conclusion, MU was feasible and a well-accepted MHM option in this low-resource, conflict-affected setting. This pilot highlights the importance of integrating user-centered feedback to refine design and implementation. Given the good acceptability in this community, the inclusion of MU in non-food emergency kits for internally displaced persons should be evaluated next.