Students of Nansana C/U Primary School attending a Menstruation Hygiene Management session with support from PHAU and UYAHF team. Photo courtesy of Public Health Ambassadors Uganda

Menstruation Stigma: Why School-going Girls Prefer to Stay Home

Young leaders in Uganda demystify menstruation in schools through peer learning and other knowledge-sharing approaches

K4Health thanks Segawa Patrick, Founder and Programme Coordinator of Public Health Ambassadors Uganda (PHAU), for contributing this story to The Exchange.

Menstruation is an integral and normal part of human life — indeed, of human existence. Menstrual hygiene is fundamental to the dignity and well-being of women and girls and is an important part of the basic hygiene, sanitation, and reproductive health services to which every woman and girl has a right. Globally, approximately 52% of the female population (26% of the total population) is of reproductive age. Most of these women and girls will menstruate each month for between two and seven days.

Peer educators conduct a school outreach session on menstrual hygiene management at Wakiso Secondary School. Photo courtesy of Public Health Ambassadors Uganda.

Menstruation is a natural part of the reproductive cycle; however, in most parts of the world, it remains taboo and is rarely talked about. As a result, the practical challenges of menstrual hygiene are made even more difficult.

According to data from the 2015 National Population Census, Uganda’s female population was more than 18 million in 2012. Nearly 4.5 million, or 24.5%, of that 18 million were adolescents between 10 and 19 years old. SNV’s 2014 report Mapping the Menstrual Hygiene Market in Uganda notes that at least 84% of these young people live in rural areas and cannot reliably access and/or afford sanitary pads. Therefore, an estimated 3.75 million Ugandan girls are living without adequate menstrual hygiene management, mainly as a result of limited access to proper menstrual products. Many of them rely on traditional and crude materials like old clothing, pieces of foam mattress, toilet paper, leaves, and banana fibers to manage their periods — all of which are unhygienic, ineffective, and uncomfortable. Hence, they are discouraged from playing sports or walking long distances for fear these makeshift pads may fall out. Such circumstances have continued to deprived young girls and women of their potential to exercise their right to health, education and dignity.

Most schools lack sanitary facilities that have access to clean water points and soap, changing rooms, and disposal facilities. Because of this inconvenience, many girls opt to stay home during their menses, which has negative implications for their overall academic performance and achievement levels. The inability to effectively manage menstruation contributes to absences of up to 4 to 5 school days each month, equating to as much as 20% of the academic year intentionally skipped, simply due to menstruation. Eventually many of these girls drop out of school entirely, increasing their risk to the likelihood of early initiation to sex with associated risks of HIV, early pregnancy, teenage pregnancy with its associated maternal health complications, and further limiting their future career and economic opportunities. In fact, according to a study done by UNICEF in 2013, 1 in 10 school girls in Africa miss school or drop out completely due to lack of access to menstrual materials and other sanitary products.

“I missed classes for four days. When I came back to school, I found out that I had missed two topics, and I don’t have anyone to take me through.” — Flora, Student, Wakiso Secondary School

Menstruation is still seen as taboo in many African societies. Cultural practices and taboos around menstruation impact negatively on the lives of women and girls, and reinforce gender inequities and exclusion. According to the SNV study, at least 20% of teachers interviewed said that there said that there were still restrictive cultural beliefs surrounding menstruation. Twenty-eight percent of girls reported that people around them expect them to restrict their movement during menstruation. But menstrual hygiene cannot be left to women and girls to discuss in secrecy and isolation. It must be acknowledged as a subject for public discussion, and education regarding menstrual health should be offered to all students.

In the Central Region of Uganda, menstruation is referred to as ensonga, which means “the issue.” However, this does not reduce the cultural practices and social myths that make it difficult for both men and women to talk about menstruation.

It’s against this background that Public Health Ambassadors Uganda and Uganda Youth and Adolescent Health Forum is running a menstrual hygiene and health management project with support from Virginia Gildersleeve International Fund, Wakiso District Education Department. The “Ensonga Campaign” is aimed at breaking the silence related to menstruation stigma among girls, boys, parents, teachers, and the entire community. The project, whose slogan is #MenstruationMatters, aims to build awareness about the fundamental role that good menstrual hygiene management plays in enabling women and girls to reach their full potential.

Girls at Nansana Church of Uganda Primary School demonstrate how to use a reusable sanitary pad at one of #Ensonga’s menstrual hygiene outreach events. Photo courtesy of Public Health Ambassadors Uganda

Public Health Ambassadors Uganda understands that knowledge changes lives. That’s why the Ensonga campaign will empower adolescent girls with menstrual health and hygiene management information, including how to use reusable sanitary pads, through the formation of sanitation health clubs. In addition to facilitating these opportunities for peer education, Ensonga will contribute to improved menstrual health and hygiene management among school-going adolescent girls by improving access to sustainable water, sanitation, and hygiene facilities within primary and secondary schools in Wakiso District.

On 4th August 2016, Public Health Ambassadors Uganda and Uganda Youth and Adolescent Health Forum launched Ensonga in two Wakiso District schools: Nansana Church of Uganda Primary School and Wakiso Secondary School.

Each school was taken through the introductory session about menstruation and puberty before being separated into focused group discussions.

The discussions provided a supportive environment for girls to speak and share freely about their views, experiences, opinions, and challenges related to menstruation. A question-and-answer session followed the discussions. Students asked questions like these:

“If I skip my periods this month or have them for three days, then I have them for five days next month, am I normal?”
“Sometimes when I am about to have my periods, I grow pimples. Then, the next cycle I do not have them; instead, I have stomach pain. Is it normal?”
Students engage in participatory learning at an outreach session on menstrual hygiene management at Wakiso secondary school. Photo courtesy of Public Health Ambassadors Uganda

The students were also sensitized on how to manage cramps and monitor their cycles using the calendar. Both boys and girls learned about different methods of menstruation management, including disposable and reusable sanitary pads, towels, tampons, menstrual cups, cotton and gauze.

Boys at Wakiso secondary school demonstrate to fellow students how to use a sanitary towel during the boys’ focused group discussion. Photo courtesy of Public Health Ambassadors Uganda

During pad demonstration sessions, students received practical instruction on the correct and consistent use of sanitary pads. The boys were encouraged to support girls before, during, and after menstruation. They were also counseled to stop mistreating or laughing at girls during their periods. The boys were also encouraged to support the Ensonga Campaign by lobbying parents and school authorities to create and ensure a supportive environment for girls during menstruation.

“We never heard anything openly like this about menstruation, but from today we will also tell our fellow girls who are not in the health club about how to be in school during their menstrual period.” — Scovia, Student, Nansana C/U Primary School

Project intervention schools have formed sanitation health clubs comprised of students from different classes. Members will act as change agents towards the adoption of good menstrual hygiene and sanitation practices and advocate for a supportive environment. The Senior Women or Senior Men are the patrons for the established school clubs; therefore, they will provide support, guidance, and mentorship to their members. Public Health Ambassadors Uganda and Uganda Youth and Adolescent Health Forum will continue to provide technical assistance to the clubs.

Sanitation Health Club members from Nansana Church of Uganda Primary School and Wakiso Secondary School pause for a group picture with PHAU and UYAHF team members. Photo courtesy of Public Health Ambassadors Uganda

To manage menstrual hygiene, it is essential that women and girls have access to correct and accurate information and to sanitary wear and proper disposal facilities. They need a private place to change sanitary cloths or pads; clean water for washing their hands and used clothes; and facilities for safely disposing of used materials or a place to dry reusable materials. Men, women, teachers, parents and communities need greater awareness and information on menstrual hygiene management.

Ensonga is working hard to meet these needs. So far, a total of 386 students have received accurate information on menstrual hygiene management, with an emphasis on reusable pads. Public Health Ambassadors Uganda and Uganda Youth and Adolescent Health Forum will continue to conduct routine follow-up activities in the schools to install talking compounds, or signs, with menstrual hygiene messages to provide an enabling environment for students to continue discussing issues related to menstruation.

To follow the project activities, check out our Facebook, Twitter, and YouTube accounts using #Ensonga and #MenstruationMatters.

Did you find this article helpful? Follow the The Exchange for more useful information on how to better curate, synthesize, and share knowledge.

The Exchange is a K4Health publication. The Knowledge for Health (K4Health) Project is supported by the United States Agency for International Development (USAID) Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13–00068 with the Johns Hopkins University.

The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the U.S. Government.

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