For some of us, menstruation is still a taboo topic that we’re embarrassed to talk about in public. However, in the more privileged countries, at least the hygiene aspect of periods has been dealt with. But many of us would probably be shocked to hear that in some parts of the world, women use dirty rags and leaves to prevent blood leakage, or they aren’t allowed to sleep with the rest of their family during menstruation. May 28th was announced by WASH United (an organization working towards realizing human rights concerning water and sanitation in South Asia and Africa) to be Menstrual Hygiene Day.
What are the main problems with menstruation for women in underprivileged countries?
A lack of proper sanitation facilities in households, public places (schools) or workplaces and a lack of access to proper sanitary protection.
According to UNICEF, at least 500 million girls and women lack a private place to change their sanitary protection during menstruation. Latrines are broken, have no doors and lack waste collection containers or access to tap water. Girls and women also sometimes can’t afford to buy sanitary pads, for instance, in Kenya, a package of sanitary pads costs half of the average daily wage of most unskilled workers. Due to these problems, they resort to using rags, newspapers, mud, cow dung, leaves or tree bark. Compared to sanitary pads, these alternative methods are ineffective in preventing leakage, they aren’t comfortable and may cause infection and diseases. What’s more, even if women use clean cloth that can be reused, this may be washed in dirty water or not dried properly – for instance hidden in a dark corner instead of being exposed to direct sunlight.
Social and cultural issues
According to Menstrual Hygiene Matters, girls and women suffer from negligence because of a lack of proper biological knowledge and education on puberty, menstruation, reproduction and sexual hygiene. They are often socially excluded from decision-making concerning, for instance, the women-friendly arrangements of sanitary facilities. They may also suffer from various cultural taboos concerning menstruation - prejudices or other cultural beliefs and restrictions that may appear to be harmful and oppressing. For instance, menstruating women aren’t allowed to partake in religious ceremonies in Hinduism, they aren’t permitted to enter a church in the society of Coptic Christians in Ethiopia, and 71% of girls in West Bengal can’t attend a religious function. Apart from religious exclusions, they may suffer from shame or embarrassment as menstrual blood is in some cultures associated with evil and impurity. Other restrictions may also be imposed on menstruating women as 28% of girls in Nepal have to sleep separately from their family and 98% of girls in Gujarat in India don’t wash their bodies (read more on Menstrual Hygiene Matters).
Organizations working towards improving this situation enumerate various negative consequences: from the most obvious - health endangerment, to psychological factors such as low self-esteem. No access to proper menstruation equipment may also affect girls’ school attendance, impairing their future education or job opportunities. For instance, 86% and 53% of researched girls in Garissa and Nairobi (respectively) in Kenya miss a day or more of school every two months, and in Ethiopia 51% of girls miss between one and four days of school per month because of menses (Menstrual Hygiene Matters). AFRIpads reports that 1 out of 10 African schoolgirls skips school or drops out of school entirely just because of poor access to sanitation and menstruation protection.
What can be done?
Menstruation management is a complex problem and tackling it requires introducing a proper education to increase knowledge and awareness among both men and women, improving WASH (water, sanitation, and hygiene) services along with waste disposal, providing menstruation products and supporting women in the manufacture of these products.
On a global scale, UNICEF has introduced the Menstrual Management Program. One of the main targets is to engage state governments or public institutions in integrating menstrual hygiene into their school programs in order to improve knowledge in this field, train teachers, and build girl-friendly bathrooms with compact electrical incinerators for disposing sanitary pads, as in Tamil Nadu, India.
On a more local scale, NGOs endeavor to donate menstruation kits to the most in need. They also engage in education, raise awareness, and trigger production of affordable sanitary products. For example, AFRIpads Foundation raises money to provide underprivileged girls in Uganda with special AFRIpad Menstrual Kits each worth 5 Euro. They last for at least 12 menstrual cycles and contains a storage pack along with 4 reusable sanitary pads. Apart from receiving a kit, a girl is educated about its usage, menstrual hygiene, and sexual and reproductive health. AFRIpads is primarily a social enterprise that employs mostly local women in Uganda to manufacture reusable sanitary pads. Days For Girls, a non-profit organization, works in a similar way - teams produce and distribute menstruation kits through local organizations to girls in need (how to do a kit). This organization is also building in-country programs to produce kits, train cooperatives in kit sewing skills, and provide reproductive health education and business skills. Days For Girls doesn’t only care about the functionality, durability and quality of a kit (it may last up to 3 years), but also cares about its esthetic value to fight shame and stigma.
Another option is menstrual cups donated by Femme International to girls in Tanzania and Kenya. They’re considered to be healthier than traditional sanitary solutions: they’re anti-microbial, protection is for up to 12 hours which is convenient if there’s no easily accessible latrine, a little water is needed to wash them and they can be re-inserted after only wiping them with a clean towel. They’re environmentally friendly as they last for up to 10 years (which is especially important in places where there’s no garbage disposal), and from the financial perspective they’re also the most economical solution. The only drawback is that they may not be culturally accepted. Apart from distribution of menstrual cups, Femme International organize a series of workshops on puberty, menstruation and sexual health that every girl receiving a cup should attend (analogical health management programs are also provided for boys). Cups are also provided by Ruby Cup, a German enterprise. For every item bought in their online shop they send an additional one to a school girl in Africa. Other organizations are Huru, Fields of Life, One Girl and SHE.
Check the interview with Elizabeth Scharp from SHE - Sustainable Health Eterprises