On May 28, annually, Uganda joins the rest of the world to celebrate the International Menstruation day, as a way of breaking the silence about the obvious (menstruation hygiene) and building awareness about the fundamental role that menstruation hygiene management (MHM) plays in enabling menstruating women and girls reach their full potential.
Menstrual Hygiene Day (MH Day) is a global advocacy platform that brings together the voices and actions of non-profits, government agencies, individuals, the private sector and the media to promote good menstrual hygiene management — MHM for all.
Menstruation is a natural part of the reproductive cycle during which blood is lost through the vagina (Mohammed, 2020).
Most adolescents experience their menstruation between the ages of 11 and 14 years.
However, some girls start as early as 8, while some at 17, or older.
During one’s menstruation period, hygiene is considered a principal requirement to the dignity and well-being of women and girls.
In fact, it becomes an issue that every girl has to deal with once she enters adolescence, around the age of 12, and until she reaches menopause.
Studies indicate that MHM is a largely overlooked issue in the water, sanitation, and hygiene (WASH) sector.
In fact, menstrual hygiene products such as tampons, sanitary towels, menstrual caps, cloths, paper, or plant material, are used by women and girls to absorb menstrual blood and maintain personal hygiene during the menstrual period (Mohammed, 2020).
In developing countries like Uganda, menstruation is strongly associated with school attendance.
Evaluation of a menstrual management intervention that addresses both psychological (e.g., self-esteem and attitude), as well as physical (e.g., management of pain, use of adequate menstrual hygiene materials, improved water and sanitation facilities), aspects of menstruation are needed.
In the absence of suitable and affordable menstrual care products, some women and girls are compelled to resort to inappropriate products such as rags, mattress cuttings, newspapers, paper material, dried and green leaves, or underwears to collect menstrual blood and manage their periods.
A study in Mali, for instance, reported the use of old cotton fabric (pagnes) to absorb menstrual blood amongst adolescent girls. Equally, findings from a study in Ethiopia indicated that 35.4% of students used sanitary wear, 55.6% used home-made cloth, while 9% used underwear as absorbent materials for menstrual blood (Mohammed, 2020).
Despite the fact that studies on health risks of poor menstrual hygiene practices is inconclusive, it is believed that hygiene practices during menstruation have far-reaching effects, since the risk of reproductive and urinary tract infections is higher than normal during menstruation.
Poor, unhygienic, and unsafe sanitary materials used to absorb menstrual blood, therefore, predispose adolescent girls to reproductive tract infections with potential long-term effects on their reproductive health. The United Nations International Children Emergency Fund (UNICEF) suggests that, during menstruation, girls and women need to change their sanitary towels regularly, more so, in the first 2-3 days (UNICEF, 2016).
According to Sommer & Connolly (2012), it is recommended that menstrual absorbent materials should be changed 3-4 times a day, and that women and girls should wash their genitals at least twice a day with soap and water. Globally, menstruation and menstrual hygiene insecurity contribute to school absenteeism of millions and millions of girls and women, and also increase school drop out.
The United Nations Education Science and Cultural Organization (UNESCO) (UNESCO, 2014), postulates that many adolescent girls stay home from school, due to menstrual cramping, deficient menstrual hygiene products, absence of water and sanitation facilities in school, unsupportive environments, and fear of a menstrual accident.
Some girls also shun standing up to answer questions in class, due to fear of leakage, smell, or discomfort, whereas others hesitate to write on the board for fear of menstrual accidents.
There are those who also fear seeing blood on their clothes and the subsequent shame and embarrassment this causes. Tegegne & Sisay (2014), established that sometimes girls are compelled to miss exams in school, when the date of the exam coincides with their menstruation days.
This limits the right of women and girls to get access to education, as expected, and also contribute to maintaining gender inequalities between school girls and their male peers.
Additionally, inadequate social support and presence of taboos can also lead to psychological consequences of menstruation, including shame, fear, anxiety, and destruction (Sommer & Connolly, 2012).
These can potentially prove to be a hindrance to the girls’ ability to thrive and succeed within the school environment. To the extreme, girls completely drop out of school, because of the stress embarrassment associated with managing menstruation in a school environment.
With accessible water and adequate sanitation facilities that are safe, socially and culturally acceptable within the school premises, women and girls are in position to manage menstruation in privacy with dignity and do not have to miss out on their studies, when they menstruate (Mohammed, 2012).
In Uganda, the government is considering prioritizing improvement of MHM among girls and women. To achieve this, in 2015, government launched the Menstruation Hygiene Charter (MHC), in which it (government) and the civil society organizations committed they would work together to promote MHM.
Unfortunately, this has not yielded much yet. In Nepal, Morrison et al. (2016), found that during their menstruation days, most girls are uncomfortable taking up the front seats in the classroom, and would never raise their hand to answer questions, or write on the board. This is due to the menstrual pain experienced, fear of staining clothing, and fear of being teased by colleagues. A study conducted in Ghana reported 40% menstrual-related school absenteeism (Mohammed, 2012).
Cost-effective sanitary towels, be they re-usable, or disposable, are a timely, simple, and innovative means of improving menstrual hygiene and of addressing a broader set of challenges related to menstruation hygiene management. Aware of the fact that menstruation does not wait for pandemics, war, or anything, we cannot have the luxury of waiting for the establishment of a sanitary towel manufacturing industry, for us to start making available these basic requirements (sanitary towels) to our girls and women, particularly those with humble backgrounds.
And as already noted, these towels should be changed frequently, as failure to change them frequently enough, especially if they are inserted into the vagina, can introduce, or support the growth of bacteria. In India, for example, Torondel et al. (2018), found that frequent changing of absorbent material was protective against bacterial vaginosis.
For this reason, government should look no further, but consider availing the girl-child with sanitary towels, with the urgency it deserves. Further studies about the subject matter can still be undertaken to deepen our understanding of the menstrual hygiene management of adolescents and the impact of menstruation and menstrual hygiene practices on school absenteeism and academic performance amongst girls, with specific reference to the rural communities.
This way, the plight of our girls and women shall be greatly uplifted, and in due course, women empowerment will be attained.
I, therefore, wish to call upon each one of us, particularly women in positions of authority, to rise up and fight for the plight of the girl-child, for she deserves better.
Jonathan Kivumbi, Educationists 0770880185