Meseret Mulle rises before dawn in the crowded quarter around Golagol Tower, waking her two sons, aged 13 and eight, in the single “kebele” house they share. At 35, she cleans homes in Gerji, a two-hour walk each way when she cannot spare the fare.

Her monthly wage is about 4,000 birr, or roughly 30 dollars at last week's exchange rate by the Central Bank, and 450 Br a month of that vanishes on transport, even though she often makes the boys walk beside her and pays only for the taxi ride home. The hidden cost is invisible. Meseret bleeds heavily regularly, sometimes going through four packs of sanitary pads.

“It is a constant worry," she told Fortune. "How will I manage today? The bleeding never stops. I can’t afford the pads I desperately need.”

A 500 Br stipend from Bole District Wereda 04’s Women & Social Affairs office lasts less than a week. The rest comes from friends, credit at neighbourhood kiosks and rags at night.

Her dilemma sits at the intersection of a quiet but widening “period-poverty” divide, where the price of managing menstruation often eclipses rent, milk or schoolbooks. Only 28pc of Ethiopian women say they have everything required to manage their monthly cycle, according to the Performance Monitoring & Accountability 2020 survey. A quarter use nothing designed for the task, substituting rags, newspaper or even cloth stuffed with ash.

Pads and tampons carry 15pc value-added tax (VAT), and although import duties on finished pads fell to 15pc and the 10pc surtax vanished in 2022, a directive from the Ministry of Finance in June last year granting VAT holidays on basic goods left menstrual products off the list.

The mismatch between tax policy and lived reality is clear to Kaleab Getaneh, co-founder of "Mela for Her," a social enterprise in Addis Abeba that began selling reusable "MELA Pads" in 2019 and secured full registration by March 2020. The MELA Basic, Premium, and Eco lines are pitched as eco-friendly and long-lasting, but production costs have far outpaced their price tags. Imported fabric now costs seven dollars to 10 dollars a kilogram; plastic snaps cost about seven-tenths of a U.S. cent each; sewing thread is 50 cents a roll.

Local fabric prices have jumped 95pc in the last three years and 60pc in the two years. An increase of roughly 35pc pushed administrative overhead more than 50pc higher; electricity bills have quadrupled; fuel inflation is felt on every truck. However, MELA Basic jumped only to 300 Br from 190 Br in 2001, and MELA Premium climbed to 405 Br from 300 Br, a respective gain of 57.9pc and 35pc.

Mulunesh Weldemariam feels the pressure of the price each payday. The 45-year-old janitor at Haddis Alemayehu Secondary School, on Mickey Leland Street, earns 3,000 Br a month, while her husband works nights as a security guard. Rents in Bole Arabsa, Lemi Kura District, consume a substantial portion of their income. Milk for their year-old son comes next. A single pack of pads costs 75 Br.

“I prioritise my daughter’s needs over my own,” she said of her 17-year-old. “Sometimes, I buy pads for her. However, I use sheets. It’s hard, but what can I do?”

Supply shocks also ripple through the private sector. Ruby, a pad brand launched in mid-2023 by two businesspeople, imports finished goods from Jackson Care Product in Jaipur, India. Ashenafi Zemichael, a shareholder, lists a 35pc import tariff, costlier raw materials, higher shipping rates and compliance fees that drag on every box.

“Despite these difficulties, Ruby remains committed to providing high-quality products at affordable prices," he told Fortune. "It's actively working with partners and regulatory bodies to address these challenges effectively.”