#8: Period poverty and Menstrual Health Management

Period poverty is the lack of sanitary products, menstrual education, toilets facilities and/or menstrual waste management (Global Citizen, 2019). Period poverty is an important part of the water and development agenda as women face increased hygiene requirements whilst menstruating. Consequently, women are even more vulnerable to health risks from poor water, sanitation and hygiene (WASH) facilities (Kayser et al., 2019). Barriers faced by African women menstruating due to poor sanitation and water facilities (SDG 6) triggers the need to target multiple SDGs to improve the well-being (SDG 3), education (SDG 4), employment capability (SDG 8) and equality (SDG 5) of women. In this post, I will introduce some problems faced by women menstruating in Africa and solutions implemented to improve their menstrual hygiene management (MHM). Critically, period poverty not only implicates a woman's reproductive health but also has wider implications upon their socio-economic development. Subsequently, when targeting MHM, approaches need to consider a humanist approach as encouraged by Amartya Sen, including women’s choice, rights and abilities, towards the effective reduction of period poverty.

When going through menstruation, I can’t imagine the struggle that African women face without the products and knowledge needed to manage a period. Yet, period poverty in Africa means many women are unable to afford menstrual hygiene products and use make-shift menstrual absorbents such as cloths, rags, newspapers (Cobulrn and Hildebrand, 2019). Relying on these make-shift products, using unhygienic WASH and menstrual waste disposal facilities increases the risk of health issues like reproductive and urinary tract infections. Some women even use a contraceptive injection to unnaturally prevent menstruation which further worsens bone health for women. 

Period poverty has also meant that schoolgirls in particular lack menstrual absorbents and private, clean toilets WASH facilities at school. Schoolgirls are embarrassed about menstruating, especially if at risk of leaking through their clothes and teasing from their peers (Sommers, 2010). As a result, one in ten African girls miss days from school period; these girls may drop out of school, increasing their risk of child marriage and teenage pregnancies. As a result, women may remain in the period poverty trap, lacking educational qualifications, preventing movement from domestic and low-income labour to more tertiary and secondary forms of higher paid employment. Hence, period poverty inhibits women’s long-term capabilities and freedoms; elements that Amartya Sen considers critical to sustainable development (Sen,1999). 

 

Alongside improvements to WASH facilities, an adequate supply of affordable and practical menstrual products is critical to target MHM (UNFPA, 2017). NGOs like ActionAid have taken the initiative to train women to make reusable, cheap and biodegradable sanitary pads from home. Women can sell extra sanitary products on the market, promoting income and skill development, contributing to alleviating period poverty. For example, in Malawi, ActionAid provided communities with sewing machines and the training to make and use around 3,000 reusable pads (Figure 1).  

 

Figure 1: Ruth in Malawi sewing reusable menstrual cloths

Source: Action Aid

The use of menstrual cups has also become a popular, cost-effective, practical and sustainable solution to manage menstruation (Kaiser, 2019). Menstrual cups need less replacement than sanitary pads therefore young girls are less likely to feel anxious about menstrual leaking in school and can use it from their homes. These two products are not an exhaustive list and are just some of the menstrual hygiene products that are promoted towards MHM for African women. However, the choice of sanitary products is critical as it concerns a women’s personal cultural environment, affordability and comfort. This takes me back to my earlier post about participatory development as it highlights that any strategy supporting women’s sanitary needs should directly involve women in discussions and decisions (Kaiser, 2019).

 

Furthermore, period poverty is worsened for women in Africa as some social-cultural norms perceive periods as unclean and a taboo (Abrhams, 2011). Often, mothers and teachers can feel uncomfortable discussing menstruation with their children so young girls are perplexed at their first period (Higgins, 2017). In slums in Nairobi, women expressed their discomfort when changing their sanitary pads as their male neighbours would be “knocking on the door rushing [them]”. Women menstruating experience anxiety and shame, restricting their social well-being and a barrier to long-term development. This lack of normalisation of periods in African communities perpetuates period poverty due to the disinvestment, adequate support and sanitation for menstruating women (Theil, 2018). 

 

Subsequently, whilst the provision of sanitary products and promotion of hygienic WASH facilities will contribute to MHM, I believe education is a significant driver for MHM. Women will struggle to manage their period if they “do not understand what is happening to [their] body and don’t have basic information about reproductive health”. This was demonstrated in Malawi when an NGO built girl-friendly bathrooms to support menstruation, but girls were still reluctant to wash their menstrual cloths as they still believed that menstrual blood should not be seen by others (Pillitteri, 2012). Reproductive health education in school (Figure 2) or from parents to children will increase awareness of how and why women menstruate, aiding to break these taboo surrounding periods (Kirk and Sommers, 2006). This education will further assist in the adequate design of WASH facilities given that men may be more considerate of women’s menstrual needs and construct private, gender-segregated WASH facilities with locks, lights and menstrual disposal facilities (Kuhlmann, 2017).  

Figure 2: Students in Tanzania reading girls puberty books

Source: Grow & Know

 

For example, the Grow & Know organisation publishes puberty health related books for both men and women in developing countries, distributed at a macro and micro level through governments, NGOs and UN agencies. All Grow & Know books are developed conducting participatory research to capture the lived experiences of young women and men alongside printing factual information. For example, 140k copies about 'Growth and Changes' for women and was distributed in Tanzania in 2011 alone. 

Figure 3: Grow & Know books available in Tanzania

Source: Grow & Know

The book was only distributed after first studying the pre-existing menstrual health knowledge and experiences of women, teachers and mothers in Tanzania. The book was field tested and evaluated for improvements, using participatory development activities to raise the voices of Tanzanian women.

 

To conclude, I believe the WASH developments and an increased provision of menstrual absorbents are inadequate alone to achieve sustainable development. Better MHM for African women will undoubtedly occur if both men and women in Africa are educated on what menstruation is and how best to manage it. I believe this conclusion highlights the message that I have been trying to explore throughout my blog; development for African women should encompass promoting the long-term capabilities of women rather than just considering short-term solutions that do not sustain development.