As the world marks International Women’s Day, Lisa-Anne Julien draws attention to the importance of menstrual health management.
“You’re a woman now.” For many of us, the first time we hear this phrase or give the concept any thought is at menarche, the onset of menstruation. Moving into a phase where physically, our bodies are capable of reproducing signals a transition into womanhood, an important rights-of-passage into maturity.
It should be a celebration.
Instead, in many parts of Africa, menstruation remains shrouded in shame and ignorance, impacting the health, education and dignity of women and girls.
It is encouraging however, that as a result of strengthened global and localised advocacy, menstrual health management (MHM) has gained greater attention in recent years as an integrated, cross-sectoral response involving sexual and reproductive health and rights (SRHR), education and life skills, water, hygiene and sanitation, and waste disposal, both in development and humanitarian contexts. This position is so clear that in 2013, the German-based NGO, WASH United, declared May 28 Menstrual Hygiene Day. It is a global movement to break the silence and create awareness about the negative social norms that surround menstruation is underway.
On a continental level, the first East and Southern African Symposium on Menstrual Health Management, convened by the Department of Women in the Presidency of the Republic of South Africa and the UN Population Fund (UNFPA) in 2018 is testament to SRHR being inherent to United Nations’ Sustainable Development Goals (SDGs) agenda. SDG 4 aims to “Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all”, while SDG 5 hopes to “Achieve gender equality and empower all women and girls”. A major achievement of the symposium was the agreement to establish the African Coalition on Menstrual Health Management.
Advocacy must, however, trickle down so that concrete changes are evident in the lives of women. An example of this is South Africa’s National Student Financial Aid Scheme 2019 decision to allocate R275 per month to students for self-care. Such policy decisions must become the norm.
Education, Interrupted
Financial constraints and its effects on the accessibility of hygienic sanitary products (disposal or reusable pads and menstrual cups) is a concept known as “period poverty” and can result in girls remaining at home from school during menstruation. According to the international NGO ActionAid, one in 10 girls in Africa miss school because of menstruation. Similarly, a study among 140 girls in a rural community in Rukungiri District of South-West Uganda found that two thirds of them were absent from school for some days in a month because of menstruation. This absenteeism was largely due to the lack of facilities at school, lack of awareness around menstruation, embarrassment, menstrual pain,and the inability to afford hygienic sanitary materials. The findings suggest that there is an entire ecosystem around MHM and the need for a holistic approach to improving it. According to the World Bank, an estimated 500 million women and girls lack adequate facilities for MHM.
“According to the international NGO ActionAid, one in 10 girls in Africa miss school because of menstruation.”
In response to period poverty, and recognising the need for an enabling policy and legislative environment, the Department of Women, Youth and Persons with disabilities (DWYPD) in South Africa launched the Sanitary Dignity Framework in June 2019. One of the main aims of the framework is to provide for an integrated and coordinated, responsive government programme aimed at the provision of sanitary products free of charge to indigent girls and women in South Africa. In addition to the sanitary products, the framework calls for the provision of menstrual information and knowledge, a clean and reliable supply of water, adequate and sanitary ablution facilities where there is access to toilet paper, and hygienic and environmentally friendly disposal systems for the used products. The last issue is particularly important as a sanitary pad can take 500-800 years to decompose.
Demystifying the period
The need for menstrual literacy and puberty education is central to a comprehensive response to the challenges around menstruation. Among both girls and boys and the broader school community, issues of menstruation, should, in theory, form part of comprehensive sexuality education. However, the quality of the education is still largely unknown. Information on the menstrual cycle and good menstrual hygiene, coupled with teacher sensitivity and the provision of psychosocial support where necessary, are important ingredients within an effective MHM approach at the school level.
At the community level, among parents, community and traditional leaders, there must be greater general awareness of menstruation as a natural, healthy part of physical development and not a vehicle that relegates women to an even further subordinate position vis a vis men.
The issue of menstrual pain and other illnesses associated with menstrual health has not been adequately researched, nor the extent to which girls and young women are able to access pain medication in countries with weak health systems. More also needs to be done to explore the potential of natural and traditional pain remedies during menstruation.
Product innovation
The current challenges relating to accessing affordable, environmentally-friendly sanitary products provide opportunities for innovation. The Ugandan-produced EcoSmart Pads made from sugar cane residues are one such example. In response to villages battling with severe development crises such as malaria and HIV, MHM was not prioritised and products not available. Similarly, Afripads, a reusable pad now available in Somalia, Nigeria,and South Sudan, has now reached 2.5 million girls on the continent. Through Afripad’s partnership with NGOs and academic institutions, schools have seen an increase in attendance.
Although the menstrual cup was developed over 80 years ago, it is arguably undergoing a renaissance. There are a number of studies underway on campuses in the KwaZulu Natal province in South Africa to determine the appetite of the menstrual cup as a cost-effective, environmentally friendly sanitary option that does not upset social and cultural norms.
Pulling together
With the recognition that MHM requires a multi-pronged approach, this presents opportunities for a range of players to get actively and meaningfully involved. Governments should continue to identify ways and develop strategies to provide free sanitary products to girls, particularly those from resource-poor communities. Parliamentarians can advocate for removal of duty and value-added tax on sanitary wear imports, ultimately making them for affordable. To date, in the East and Southern Africa region, sanitary products in Kenya, Lesotho, South Africa and Zimbabwe are VAT-exempted.
Civil society organisations can advocate for the rights of girls to access quality education and SRH. In their oversight role, they can also monitor policy and legislative commitments from governments on MHM. The private sector should consider supporting innovation relating to sanitary products.
Organisations working on MHM are encouraged to refer to Unicef’s Guidance on Menstrual Health and Hygiene (2019) and those working on product development to the African Organization for Standardization.
The promotion of the life cycle approach to MHM (from menarche to menopause) is key to elevating the management of menstruation. Experts have urged that the approach must move from adolescent girls in schools to all girls and women, including those with disabilities and people who menstruate such as transgender men and women.
For too long, menstruation was regarded as a dirty secret, discussed in hushed tones through a plethora of euphemisms. For too long, it was seen as only a woman’s issue, something to be borne in silence. Sustained advocacy efforts are revealing, finally, that MHM is a societal issue and, most importantly, a human rights one.
(Main image: A poster used to educate girls about menstruation and female reproductive system is seen on 21 February 2015 at the Madibane High School in Johannesburg, South Africa. As sanitary pads are too expensive for many teenagers in Africa, NGOs try to find solutions and local products are made. – Stefan Heunis/AFP via Getty Images)
The opinions expressed in this article are those of the author(s) and do not necessarily reflect the views of SAIIA or CIGI.
