Menstruation is an integral and normal part of the female human life. Menstrual hygiene is fundamental to the dignity and wellbeing of women and girls and an important part of the basic hygiene, sanitation and reproductive health services to which every woman and girl has a right. More than one fifth of the world’s population consists of women of reproductive age. On average, a woman spends 7 years of her life menstruating, making menstruation a natural and essential part of the reproductive cycle. A girl’s menstruation in many cultures marks her transition into womanhood. With that transition comes a broader set of restrictions and roles that the girls is expected to adhere to. Interventions that aim to improve menstrual health and hygiene of girls and women can therefore be an opportunity to address a broader set of barriers that girls and women face.
The subject of menstruation, however, is often taboo, and has many negative cultural attitudes associated with it, including the idea that menstruating women and girls are ‘contaminated’, ‘dirty’ and ‘impure’. Women and girls in rural settings, particularly girls in schools suffer most from stigma and lack of services and facilities to help them cope with the physical and psychological pains they undergo during their menstrual periods. Some of the problems they face are: inadequate preparations for young girls not menstruating yet, lack of or inadequate access to clean water to wash their bodies and underwear, lack of materials for managing menstrual hygiene, no private space and wash rooms and inappropriate facilities for disposal of used menstrual materials (those using disposable sanitary pads). In spite of these issues, menstrual hygiene has been routinely ignored by professionals in the water, health and education sectors.
Over the past few years, menstrual hygiene has received increased attention in Uganda. The Speaker of Parliament, Hon. Rebecca Kadaga, launched the Menstrual Hygiene Charter to advance the rights and hygiene of Ugandan young women and girls. Strategies to improve menstrual hygiene management have been varied. Some institutions are focused on making in-kind donations of sanitary ware to vulnerable girls whereas others are using the social business model where pads are sold at a very low cost. As such, the number of social businesses working on menstrual hygiene has expanded significantly.
In the recent past, I interacted with a few colleagues and individuals who invited me to different charity events or on-line campaigns that were either collecting money or sanitary pads(disposable or reusable) to donate to ‘vulnerable’ young girls and women in ‘rural’ communities, schools or orphanages and children homes. Although these are good initiatives, the sustainability of these interventions is worrying. If you give a girl a pad this month will you be able to continually provide sanitary pads every month to the ‘vulnerable’ young girls and women next month and the following month and the next months for next 33 years? When I posed this question to a friend who had invited me to a charity soccer event organized to raise money to buy sanitary pads; one of the responses was, “The next month nga beyiya” meaning, “The next month they’ll hustle it out”. Is this what we want to achieve?
There was a project that kicked off in Karamoja and Busoga sub region where girls in schools received disposable sanitary pads, this kicked off well and the girls received the pads. Something unexpected occurred after a few months though. On reviewing the usage of the sanitary pads, the girls had not used the pads because some of them either didn’t have knickers or only had one knicker. Their access to water to wash the reusable pads was limited and they did not have the soap to use. So was the problem the sanitary pads or access to clean water or soap? Or both?
What can we do? We need to adopt transformative approaches to programming for menstrual hygiene and management. This means that we need to adopt holistic interventions that look at integration of the behavioral, social, cultural and religious contexts into ensuring menstrual hygiene and management. Transformative programming approaches look at process engagement aimed at behavioral change other than looking at one off interventions. This involves addressing the key determinants of poor menstrual hygiene management using the Web of Poverty in order to fully consider addressing cultural beliefs and social norms, ensure access to information, skills on making reusable sanitary pads, ensure access to Sexual Reproductive Health and Rights and Water Sanitation and Hygiene (WASH) services.
A multicomponent strategy has to be implemented and some interventions can include; awareness raising in schools and communities (including toilets and washing facilities), female entrepreneurs selling sanitary pads, evidence based programming, budget tracking for water facilities, teacher training, awareness raising in communities, national media campaign, advocacy on access to information and education on menstrual hygiene, water and sanitation, using biodegradable sanitary pads.
I believe that for us to ensure the continuity of sustainable menstrual hygiene programs where girls can access to information and education on menstrual hygiene including skills on making own sanitary pads, they need to learn about monthly periods before they reach puberty. It is also important that a girl knows what to do when she starts menstruating, how she maintains hygiene and how she can take care of herself. This will help take the fear and insecurity out of menstruation.
Lets learn to address the factors that contribute to the problem.