Menstrual Health

Menstruation is a natural bodily process of releasing blood and associated matter from the uterus through the vagina as part of the menstrual cycle. Menstrual Health and Hygiene encompass both menstrual hygiene management and the broader systemic factors that link menstruation with health, well-being, gender equality, education, equity, empowerment and rights. UNESCO, (2019) have summarized these systemic factors as accurate and timely knowledge, available, safe, and affordable materials, informed and comfortable professionals, referral and access to health services, sanitation and washing facilities, positive social norms, safe and hygienic disposal and advocacy and policy.

A UNESCO report has shown that most women and girls from developing and underdeveloped countries cannot manage their menses and associated hygiene with dignity and ease. Especially those living in rural areas and the urban poor. This results from a lack of finances to afford menstrual products, illiteracy, lack of awareness of menstrual health hygiene, inadequate facilities, poor infrastructure, and cultural and social menstrual beliefs.

In Kenya, for example, in Communities living in the coastal Kenya and Eastern region like Wajir, Turkana, Mandera and Marsabit, Maasai and Samburu communities, menstrual health and talks are still considered taboo. To date, these cultural and social influences are a major barrier in ensuring that girls and women access proper knowledge on menstrual health and hygiene. Unfortunately, they are forced to isolate themselves from everyone during their menstrual days as they are perceived as unclean and embarrassing. Hence, prohibiting them from their day-to-day activities such as schooling and working. In sub-Saharan Africa, one out of ten girls do not go to school during their menstrual cycle, with some dropping out of school entirely after getting their first cycle (UN report,2016). Some are forced to stay in the bushes until the last day of menstruation and are purified before returning home. This predisposes them to various health risks since they do not shower, cold chilly nights, risk of being attacked by wild animals and even rape. Basically, in these communities\’ menstruation, a natural and healthy process comes with rules, restrictions, and isolation.

The societal perception that menstruation should be a secret is also a limiting factor. This \’menstrual etiquette\’ encourages discomfort communicating to girls the importance of menstrual health hygiene, hiding from men and boys due to fear or embarrassment on their way to purchase menstrual products. Most girls find it challenging to share their experience, especially the first time they experience this process.
Persons living with disability are highly disadvantaged when it comes to access and use of menstrual products depending on the disability. Those living with a disability or mentally challenged often need help and a lot more care during this period, limiting them from experiencing the process with dignity since their privacy is invaded.

Menstrual Products

Women and girls around the world use various products to help them manage menstrual periods.

Holes on the ground
According to research done by Water Aid, women of the Karamoja region in Uganda dig holes in the ground during their periods and sit on top of the hole to collect blood. In Wajir, Turkana, and Samburu, their girls and women stay outside until their cycle is over.

Goatskin
In some African communities, women use goatskin to trap the blood, which they then wash away privately with cow ghee. They claim that the goatskin skirt works for the whole day and is economical compared to other menstrual products.

Cow Dung
Women and girls from the pastoral communities in Kenya and other African communities collect cow dung from surrounding fields and use a pestle and mortar to grind it down to a fine powder before stuffing it into a pouch which they use to absorb blood. It is a method that has been passed through generations.

Lint Cotton
Lint cotton is the short fibers that cling to the seed after the lint is removed. The cotton can attract insects, is sometimes itches and irritates the skin when used as a menstrual product. Unfortunately, some women and girls in Africa still use this due to a lack of finances to purchase menstrual products.

In western countries, there are a plethora of options for managing menstruation. This is not the same case in underdeveloped and African countries.

Sanitary pad
They are the most commonly used period products. over the decades,
the design of disposable sanitary pads and reusable pads has evolved to a much more comfortable and absorbent nature, with a wide range of suit all flows from light flows to heavy flows.
The downfall of disposable pads is that they are not environmental- friendly. They must be changed after every 4 hours to prevent bacteria growth and odor. This means that they are expensive as one may need a packet or two every month. On the other hand, reusable/washable sanitary towels are much more environmental- friendly and cost-effective as they are reused multiple times.

Tampons
A tampon is used internally by insertion into the vaginal canal. Most users prefer using tampons to pads due to their small nature and are not visible on underwear, and they feel comfortable while sitting. Since they are disposable, they not environmental-friendly neither are they cost-effective.

Some tampon brands and specific materials are linked with Toxic Shock Syndrome. This happens after tampons absorb the vagina\’s lubricant and bacteria in the process of absorbing blood. One is advised to use the lowest absorbency rating possible to suit their menstrual flow.

Menstrual cups
It is a small silicone or latex cup that works by being folded and inserted internally to rest on the vaginal wall, where it collects blood. It takes time to master the correct positioning, and it usually is very comfortable once the technique is mastered. It stays in for up to 12 hours. It is then removed, emptied, rinsed and sterilized in hot water and re-used. They are one of the most eco-friendly and wallet-friendly options. The downside of these cups is that they require a high standard of hygiene to prevent bacterial infections. There have been cases where the cup gets stuck in the vagina if wrongly places and not recommendable for virgin girls.

Menstrual discs
They are made of plastic or silicone, inserted in the vagina, and rests in the base of the cervix. It can stay in for up to12 hours and works by collecting blood in the disc. Most menstrual discs are not re-usable hence not environmental- friendly or cost-effective. They are also a bit complicated to use and not advisable for virgin girls and women.

Period underwear
They look like regular underwear, except they have a special absorbent layer that prevents leakages to clothing and is also washable. They are not the cheapest option. If not well cleaned or dried, one can be at risk of getting bacterial infections. However, they are environmental- friendly since they are reusable.

Despite most people being aware of sanitary towels, most people are not aware of the rest: tampons, discs, cups, and undies. Most insertable products such as menstrual cups and tampons are still considered taboo by most communities and are associated with women\’s purity and virginity. Period products are costly, and some people cannot afford them every month, especially those living below the poverty line. For the reusable pads, women and girls living in areas where water is scarce, e.g. Turkana, some parts of Laikipia, are likely to suffer from bacterial infections due to poor hygiene and reusing uncleaned pads. They also require soap for washing as well as private spaces for drying to prevent contamination. Due to the lack of Comprehensive Sexual Education (CSE), most rural communities choose to remain on traditional methods. They are less likely to know hygiene basics, such as how often to change products and the importance of taking a bath using soap and clean water.

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 Interventions On Menstrual Health In Kenya

Girl Child Network: -Teacher Training Program;

1. Support transition to puberty and support menstrual health management.
2. Supports girls/ boys health clubs.

Kenyan Ministry of Education: – National Sanitary Towel Programme has been in place since 2010.

1. Provides sanitary towels to school girls.
2. Trains teachers on unhygienic usage and disposal of sanitary towels,
3. Monitors and evaluates impact work.

WaterAid

1. Practical toolkit and education on resources for improving menstrual hygiene around the world.
2. Construction of gender-separated toilets.
3. Menstruation education to address taboos and misinformation.

WASH UNITED

1. Knocking down menstrual taboos in Kenya.
2. A game-based learning approach to menstrual health management education empowers girls to
3. overcome silence, shame and stigma.

Water Supply and Sanitation Collaborative Council

1. Menstrual Hygiene Management
2. Three pillar approach; breaking the silence on taboos, menstrual health management, safe reuse and disposable solutions.
3. Emergency workshops
4. Qualitative and quantitative research on menstrual hygiene.

Steps were taken to create a more supportive environment for menstrual hygiene. They include;
Several key government\’s ministries and NGOs are focused on improving the state of menstrual health education and awareness for adolescent girls: Political support garnered through civil society, parliament, the ministry of education, the prime minister\’s office led the national recognition of the need for puberty education, teacher training, and sanitary pads and allocational of additional funds for the ministry of education to implement the program.
Small and medium-sized products companies seek to provide basic education to girls such as Zana Africa through comic books, booklets, and in-person training. Ministry of Health is currently leading a collaborative process to draft national menstrual hygiene management.

In 2011, government policy allocated 240 million Kenyan shillings annually to provide free sanitary pads to girls in public government schools through the National Sanitary Towel Programme. Unfortunately, private schools do not benefit from this programme and some public schools, especially those in marginalized areas, barely get access to these sanitary towels. In some schools, teachers do not distribute the products to the students, and in some cases, these products do not last for the whole term and holidays.
The Kenyan government removed import duties and value-added sales tax on menstrual hygiene products in 2011.

Private sectors, NGOs, CBOs have also played a significant role in providing sanitary products and creating awareness. Various non-governmental organizations and community-Based Organizations are also playing a big part in combating period poverty countrywide. Some examples of these organizations include Sister speaks, Drawing Dreams initiative, Rays of Mercy Kenya and Inua Dada foundation. In 2016, Speak Up Africa created the \”No Taboo Periods\’\’ a campaign that focuses on ensuring that everyone in society understands the role of menstrual health management in enabling women and girls to reach their full potential.

The issue of menstrual health in Kenya has gained momentum over the past few years, with new supportive policies, an increase in advocacy and awareness, and growth within menstrual products. However, the most vulnerable girls are still not benefitting from these initiatives. Taboos related to menstruation are still common. Menstrual health products remain unaffordable and inaccessible to teenage girls, especially during school holidays or in COVID 19. There is still a lot that needs to be done by reaching out to the marginalized girls.

References

Delaney, J. (1976). The curse: A curse: A cultural history of menstruation. 1st ed.New York: Dutton.

Vastral, L. (2008). Underwraps: A history of menstrual hygiene technology. Latham editor. Lexington Books.

UNICEF. (2009). Guidance-menstrual hygiene-materials.