Period Poverty: The Hidden cost of menstruating in rural Uganda.

Menstruation is a natural process, the onset of menstruation does not indicate a girl is ready for marriage as perceived by some unfair and unjust ancient African cultural norms, beliefs and societies.

Why is MHM important and what does it involve

Menstrual Health Management (MHM) is a multidisciplinary and inter-sectoral concern. It directly influences development outcomes through its effects on education, health and participation in rural economic structures. It affects educational aspects like school attendance, school performance, education stigma, mental health and dropout rates. Studies have shown that girls miss up to eight days of school every term and up to 30% of girls drop out of school due to poor access to sanitary products. At both the community and national levels, there is still very inadequate information on the impacts of poor MHM in rural schools.

Menstruation is often a taboo topic and remains a distant discussion from both domestic and public debate. In addition to its effect on education, access to good MHM is a basic hygiene right which sets a basis for life long reproductive health. Beyond access to affordable menstrual necessities for girls, availability of private toilet facilities and societal stigma are the other factors that hinder good MHM. In fact, Poor MHM may be a precursor for psychological stress in settings where communication is suppressed. Poor MHM propels inequality by limiting the extent and ways in which girls and women can participate in the public sphere. In this way, Inadequate MHM not only has a negative effect on girls and women but it also frustrates inclusive long term societal and community development.

What are the real MHM challenges in Uganda?

Managing menstrual health in rural schools presents several challenges that can significantly impact the well-being and education of young girls:

1. Lack of Access to Menstrual Products: Many rural areas lack access to affordable and reliable menstrual products such as sanitary pads or tampons. Girls may resort to using unsafe alternatives like cloth, which can lead to infections. Disposable sanitary towels are expensive and unavailable in some rural settings. In Uganda sanitary towels for one girl can cost up to 10% of household income. it should be noted that most households in Uganda live on a household income of less than $1 a day.
2. Limited Water and Sanitation Facilities: Rural schools often have inadequate or poorly maintained water and sanitation facilities. This lack of infrastructure makes it difficult for girls to manage their menstruation hygienically and comfortably. Most rural school use boreholes as the main water source and girls lack any water source in the shared toilets they use while at school. These boreholes are also used by the general community which leads to constant breakdowns and ineffectiveness.
3. Stigma and Cultural Taboos: Menstruation is still stigmatized in many cultures, including rural areas. Girls may feel ashamed or embarrassed about their periods, which can lead to absenteeism from school during menstruation. Some cultures link Menstruation to maturity and is often taken as a marker of adulthood for girls. This may propagate early marriage and some communities especially in rural areas. In setting where women are considered inferior, it also perpetuates social, financial and academic inequality.
4. Lack of Education and Awareness: There is often a lack of comprehensive education about menstruation in rural schools. Both girls and boys may not fully understand menstrual health, leading to misconceptions and perpetuation of stigma. Health education is focused on reproductive health and family planning while MHM if very often an after-thought. Mothers are typically the main source of information on menstruation and this can be problematic when information received by girls is linked with mothers’ level of education or in the absence of a mother figure.
5. Limited Healthcare Access: Rural areas generally have limited access to healthcare services, including reproductive health services. This makes it difficult for girls to seek medical advice or treatment related to menstrual health issues.
6. Limited healthcare facilities in rural areas may mean fewer options for seeking advice or treatment related to menstrual health. Rural Healthcare providers may have varying levels of training, menstrual resources and impacting knowledge towards the quality of care and advice given to rural girls.
7. Financial Constraints: Families in rural areas may struggle to afford menstrual products regularly. This financial burden can further limit girls’ access to education if they are unable to manage their menstruation effectively. Poverty in the rural and urban areas, had driven a number of girls to use anything that can absorb blood as a sanitary towel. Girls have been known to use banana fibers, pieces of paper stacked together, and dirty rags, all of which can have adverse effects on their reproductive system and self-esteem.
8. Inadequate Policy and Support: Government policies and school programs often do not prioritize menstrual health management in rural areas. There may be insufficient funding or support for initiatives that address these challenges effectively. There have been numerous promises from the Ministry of Education, Parliament and Politicians towards MHM improvement in schools but no implementation or positive action has been effected in any aspects.

Addressing these challenges requires a multi-faceted approach that includes improving infrastructure, increasing access to affordable products, educating both students and communities, and challenging cultural taboos surrounding menstruation. Efforts should also focus on empowering girls and ensuring that they have the resources and support they need to stay in school and thrive despite menstruation.

Improving MHM in Uganda

However, in spite of these efforts girls and boys continue to share stances( school washrooms) due to infrastructure shortfalls in many rural schools and some schools do not have senior women teachers. In addition the prices of sanitary materials are still prohibitive and despite the local manufacturing, usage of manufactured sanitary products remains low especially in rural areas and much of this is related to cost, awareness and availability.

Undivided attention of our society and government is necessary to foster an environment where menstrual health is not a barrier to any girls potential. Therefore, a call on all stakeholders to collaborate and affirm a collective responsibility in actualizing the right to Sanitary Health management for all is a MUST.

However, rather than a comprehensive approach, emphasis has been on the dissemination of manuals for menstrual hygiene management and funding is largely relegated to development partners. The limited resources restrict coverage, and the sanitary needs of eligible girls out of school – who are predominantly in rural areas are never addressed.

Besides questioning the sustainability of supplying hygiene materials given Uganda’s fiscal constraints, many argue that government promise to purchase pads for school going girls as an attempt to address menstrual health challenges has been shelved only used as a campaign and political talk.

Recommendations

Like water, food or medicine, Sanitary Pads for rural school girls is a vital necessity. The largely NGO driven menstrual health agenda in Uganda is insufficient and weakly institutionalized. Although the MoGLSD has developed the learners guide on menstruation, education about puberty and menstruation is insufficient to tackle the real constraints rural girls face.

Improving menstrual health management (MHM) in rural schools involves addressing several key areas to ensure that girls have access to information, products, and support. Here are some strategies to consider:

1. Education and Awareness:
   • Incorporate MHM into Curriculum: Integrate menstrual health education into the school curriculum to normalize discussions about menstruation and debunk myths and taboos.
   • Peer Education Programs: Train older students, particularly girls, as peer educators to lead discussions on menstrual health, hygiene practices, and available products.
   • Engage Parents and Guardians: Educate parents and guardians about menstruation to create a supportive environment for girls both at home and at school.
2. Access to Menstrual Products:
   • Supply of Products: Ensure a reliable and sustainable supply of menstrual products within school premises. This may involve partnering with local NGOs, government programs, or private sector entities.
   • Accessibility: Make products easily accessible, ideally free of charge, through dispensers in school bathrooms or designated distribution points.
3. Facilities and Infrastructure:
   • Sanitary Facilities: Improve and maintain clean and private toilets with adequate water and sanitation facilities that cater to the specific needs of menstruating girls.
   • Waste Management: Implement proper disposal systems for menstrual waste, such as bins with lids and regular collection.
4. Health Services and Support:
   • Access to Healthcare: Ensure access to trained healthcare providers who can address menstrual health concerns and provide appropriate guidance and support.
   • Counseling Services: Offer counseling services to address psychological and emotional aspects related to menstruation, particularly for girls facing stigma or discomfort.
5. Community Engagement and Partnerships:
   • Engage Community Leaders: Collaborate with local leaders, community health workers, and religious leaders to promote understanding and acceptance of MHM.
   • Partnerships: Forge partnerships with local NGOs, healthcare providers, and businesses to sustain MHM initiatives through funding, expertise, and resource sharing.
6. Monitoring and Evaluation:
   • Regular Assessments: Conduct regular assessments to monitor the effectiveness of MHM programs, gather feedback from students and staff, and make necessary adjustments to improve outcomes.
   • Data Collection: Collect data on menstrual health practices and challenges specific to the school and community to inform evidence-based interventions.
7. Policy and Advocacy:
   • Advocate for Policy Change: Advocate for policies that mandate comprehensive MHM programs in schools, including budget allocations for menstrual products and facilities.
   • Implementation Guidelines: Develop and disseminate clear guidelines for schools on MHM, including best practices for education, product provision, and facility management.

Implementing these strategies requires collaboration among school administrators, teachers, healthcare providers, parents, and community stakeholders. By addressing the multifaceted aspects of MHM, rural schools can create an environment where menstruating girls feel supported, informed, and empowered to manage their menstrual health with dignity and confidence.

Menstruation has only recently gained research prominence in the country and broader research on the cost of menstruation for girls is imperative as the full extent of the issues remains unclear. It is however apparent that for girls in rural areas, the true cost of menstruation is the exacerbation and accentuation of many forms of inequality.