Outline
Introduction
In the interconnected complexities of global health and development, Menstrual Health Management (MHM) has emerged as a significant area of focus, particularly in emerging economies, and countries in Africa are no exception. For a long time, the silent struggle of adolescent girls experiencing the onset of menarche in hostile environments has remained unnoticed and unaddressed. As societies awaken to the echoing cries of these young girls, policies and initiatives aiming to improve MHM, have begun to take shape, transforming the landscape of education and health outcomes for girls across the continent.
One significant intervention that has proved game-changing in many countries, including Rwanda, is the establishment of menstrual hygiene rooms in schools. Backed by international organizations such as the World Food Program and World Vision, these rooms offer a beacon of hope and an avenue of privacy, safety, and cleanliness previously absent for many girls during their menstrual cycles.
The present discussion explores the evolution of MHM, discussing its cultural implications, the catalytic role of menstrual hygiene rooms in schools, the strides made in policy implementation, and the urgent need for cohesive action among all stakeholders. To adequately address this broad topic, we will tap into experiences from different African countries, emphasizing Kenya due to its pioneering role in MHM policy-making.
Empowering Girls Through School Hygiene Rooms
The prospect of a girl dropping out of school due to her menstrual cycle seems unthinkable, yet this harsh reality afflicts numerous adolescent girls in many African societies. Often shrouded in secrecy and shame, menstruation remains a taboo topic, complicating the lives of young girls navigating the physically and emotionally intense journey of adolescence. The introduction of menstrual hygiene rooms in schools has offered these girls a new lease on life, providing a haven where they can manage their menstruation privately, safely, and hygienically.
These rooms, equipped with clean water, soap, sanitary products, and a change of clothes, are more than just physical spaces. They are symbolic representations of a societal shift towards accepting menstruation as a natural and integral part of a girl's life. They play an indispensable role in empowering girls, giving them the confidence to attend school without fear of stigma or embarrassment. Consequently, these rooms not only support the girls' educational journey but also reinforce their right to dignity and health.
Moreover, by their very existence, the menstrual hygiene rooms challenge the silence surrounding menstruation, leading to broader conversations about menstrual health. They have initiated a powerful ripple effect, contributing to a societal reevaluation of deeply ingrained cultural beliefs about menstruation and catalyzing a paradigm shift that recognizes the importance of MHM.
Cultural & Social Influence on MHM Evolution
Despite the advancements in MHM, the journey has not been without obstacles. One of the key challenges lies in the societal and cultural perceptions surrounding menstruation. For centuries, menarche, the onset of menstruation, has been tied to cultural narratives that signal a girl's maturity and readiness for marriage or increased familial responsibilities. In many African societies, these perceptions have often led to an abrupt change in family relations and a significant increase in household responsibilities for the girl. This sudden transition, coupled with the physiological changes during menarche, can be overwhelming, adversely affecting school attendance and academic performance.
In addition, the lack of accurate information about menstruation and the consequent spread of misinformation pose significant challenges to MHM. Often, cultural taboos and religious beliefs prevent open discussions about menstruation, leading to the propagation of harmful practices and beliefs. Due to fear and a lack of knowledge, many girls resort to managing their menstruation in unsanitary and unsafe ways. Unfortunately, this scenario is all too common in many African societies, with detrimental effects on adolescent girls' physical and mental health.
Socio-economic Factors and MHM
The socio-economic background of girls also significantly influences their ability to manage menstruation hygienically. Period poverty, defined as the inability to afford sanitary products, is a growing crisis that disproportionately affects girls from low-income backgrounds. The severe implications of period poverty are evidenced in school absenteeism rates during menses. In rural settings, girls often resort to reusable, non-commercial sanitary products due to the lack of access to affordable sanitary products. While reusable absorbents may seem feasible, they require clean water and soap for proper cleaning. The lack of these essential items can lead to unhygienic practices that pose health risks to the girls.
Furthermore, the correlation between poor access to Water, Sanitation, and Hygiene (WASH) services and instances of assault and, at times, rape, when girls move in the nighttime, cannot be ignored. Case studies have shown that the lack of safe, private sanitation facilities can lead to instances of gender-based violence, further complicating the lives of girls and women. Substandard WASH services also lead to adverse health outcomes, such as urinary tract infections, further underscoring the need for a comprehensive approach to MHM.
The adverse effects of poor MHM on girls' education threaten this transformative power of education. The World Bank estimates that a woman's income can rise between 10-20% for every additional year of schooling. Furthermore, a 1% increase in the level of women's education generates 0.3% in additional economic growth that has a compounding effect. A study conducted by the World Bank in several countries, including Nigeria, Ghana, Panama, Bangladesh, and India, found that over one-third of girls missed school while menstruating due to the lack of proper WASH facilities. These statistics highlight the dire need for robust MHM interventions in schools.
Policy Implementation: Governments & NGOs
Recognizing the challenges girls and women face in managing menstruation, several non-governmental organizations (NGOs) have made strides in introducing and implementing MHM services. Starting in 2010, based on community feedback about the challenges they faced in managing menstruation, a shift in awareness occurred, and MHM began to be recognized as a global public health issue.
In collaboration with Columbia University, UNICEF organized the "MHM in Ten" meeting in 2015 to outline a focused agenda. The growing interest in MHM was demonstrated by the number of self-financed attendees and the increasing number of global, national, and local initiatives. This led to the inclusion of interventions addressing MHM in global health programs.
These interventions are often classified into two categories: 'software' interventions, which address knowledge deficits about menstruation and its management by providing education, and 'hardware' interventions, which improve access to WASH facilities, sanitary products, and disposal facilities for used sanitary products.
One organization that has taken a lead role in MHM in the Global South is WaterAid. It developed a comprehensive resource called "Menstrual Hygiene Matters," aimed at improving practices for women and girls by providing context-specific information. This resource advocates for all elements of MHM services as an intervention and promotes the use of locally available materials to reach a larger audience.
In East Africa, the Kenyan government has played a pioneering role in MHM management. It developed an official policy document on MHM, which envisions women and girls fully participating in daily life activities without stigma or discrimination. The policy highlights the need for MHM in learning institutions and provides a guiding framework that could potentially inform similar initiatives in other African countries, such as Rwanda.
However, despite the progress, gaps remain. A significant proportion of school girls in the Global South still report inadequate MHM, with girls in rural areas even more affected. While recognizing the need for proper MHM services, governments have a long way to go to integrate MHM into global health programs and school curriculums fully.
Future Directions and Conclusion
Improving MHM in schools is a multifaceted task requiring all stakeholders' involvement, from the girls to their parents, educators, policymakers, NGOs, and international organizations. The collective efforts should create a conducive environment for girls to manage their menstruation hygienically, safely, and with dignity. This involves not only providing sanitary facilities but also addressing the societal, cultural, and economic barriers to MHM.
The significance of united efforts cannot be overstated in the journey towards improved menstrual health management, a fact underscored by the African Coalition of Menstrual Health Management (ACMHM). The ACMHM, formed following the first-ever Africa Menstrual Health symposium held in Johannesburg in 2018, has taken a leading role in unifying and directing MHM initiatives across the continent
To this end, comprehensive educational programs are essential to break the silence and stigma around menstruation and provide accurate, age-appropriate information to both boys and girls. Governments should invest in MHM by providing adequate WASH facilities in schools, including menstrual hygiene rooms, and ensuring affordable and accessible sanitary products for all girls. Moreover, community involvement is critical to ensure the sustainability of MHM interventions and foster societal change. Engaging traditional and religious leaders can be particularly effective in dismantling harmful cultural beliefs about menstruation.
The echoes of change are resounding louder with each passing day as more stakeholders join the chorus advocating for improved MHM in African societies. While challenges remain, the transformational power of MHM, particularly in enhancing girls' educational outcomes, is undeniable. With sustained efforts and unified action, it is hoped that every girl in Africa will be empowered to manage her menstruation without fear, stigma, or barriers, paving the way for a future where all girls can realize their full potential.
Dr. Achieng' Aling' is a global health professional with a strong focus on health system strengthening and sexual reproductive health. Passionate about advancing global health, she is committed to knowledge sharing to drive positive change and promote healthy lives.
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