Menstrual Hygiene: What does it cost Rural Women and Girls?

March 8th marks International Women’s Day which in Uganda will be celebrated under the theme “Empowerment of Rural women and Girls: opportunities and challenges.” This theme recognizes the contribution that rural women and girls could make to enhancing productivity and reducing poverty when accorded the environment and means to do so.

Although Uganda has committed to and taken several positive steps in achieving gender parity and empowerment for all women and girls, women continue to lag behind in many development processes due to often understated or overlooked gender challenges. One of the setbacks in this regard is for women’s progress in Uganda is the inadequacy of Menstrual Health Management (MHM) especially in rural areas.

Why is MHM important and what does it involve

MHM is a multidisciplinary and inter-sectoral concern. It directly influences development outcomes through its effects on education, health and participation in the economy. It affects educational aspects like school attendance, school performance and dropout rates.

Studies have shown that girls miss up to eight days of school every term and up to 30% of girls leave school because of poor access to sanitary products. At both the community and national levels there is not enough accurate information on MHM on the impacts of poor MHM.

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 hygiene right which sets a basis for life long reproductive health of a woman.

Beyond access to affordable menstrual ware 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.

Very often, it is other women in communities who perpetuate stigma and social limitations on girls during menstruation. This is usually a function of desperation and social cultural beliefs. 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 development.

What are the real challenges with MHM in Uganda?

Culture: Menstruation is linked 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.

Knowledge: 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.

Availability of Products: Disposable sanitary towels are often expensive and unavailable in some rural settings. In Uganda sanitary towels for one girl can cost up to 10% of household income (Averbach et al., 2009). In lieu of disposable sanitary towels the local materials used are non-absorbent, quite uncomfortable and unhygienic.

In many rural settings, women and girls recycle old clothes or use inappropriate materials which characteristically come with negative hygiene and health effects. In the absence of such poor quality material, girls withdraw from the public spaces- including school and community activities or face stigma, isolation, embarrassment and stress.

Improving MHM in Uganda

There have been a number of efforts to improve MHM in Uganda, these include: VAT waivers on imported sanitary towels, guidelines to separate stances for girls, the institutionalization of the senior woman position in schools and the local production of reusable sanitary materials through Makapads and Afripads.

However, in spite of these efforts girls and boys continue to share stances 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.

Many welcomed the shift towards result based budgeting as a tool for government to bring to the fore critical issues affecting outcomes of national programs. It was envisaged that this would be an opportunity for menstrual health as one of the factors affecting transition and high school dropout rates among girls to take centre stage.

In the 2017/18 budget, there was an attempt to incorporate menstrual hygiene under the pre-primary and primary education vote, within gender as a cross cutting issue and funds were allocated.

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 was 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.

Recommendations

Like water, food or medicine, tampon and pads are basic necessities. 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.

We implore government to intervene to complement ongoing efforts. Effective options for integrated menstrual health management include:

  • Increasing the availability and use of absorbent materials
  • Co-fund MHM by adequately providing for sanitary towels at primary schools (increase availability)
  • Reduce the cost of sanitary towels by eliminating all taxes especially on products used for local production of sanitary towels.
  • For sustainability, promote local healthy innovations for production of sanitary towels and equip teachers and community leaders to train adolescent girls in making reusable pads out of readily available material in their respective communities
  • Investing in changing and disposal facilities (Infrastructure)
  • Create privacy for girls
  • Address health and safety issues

A combination of policy oversight, societal stigma, insufficient infrastructure and poor access to sanitary materials has turned a normal bodily function into a financial and social burden for Ugandan women.

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 apparent however that for women in rural areas, the true cost of menstruation is the exacerbation and accentuation of many forms of inequality.

The Writers are Research Analysts at the Economic Policy Research Centre 

Child Marriage a Handicap to Female Labour Market Transition

Although Uganda has a fairly strong and enabling legal and policy framework, young females continue being propelled into early marriages and pregnancies and are often deprived of full education attainment.

This experience according to Gemma Ahaibwe, a Research Fellow at the Economic Policy Research Centre (EPRC) is likely to have lasting impacts on female opportunities, particularly, their engagement in productive and decent work.

Drawing from findings of the 2013 and 2015 school to work transition survey conducted across 4 districts from the East, North and Central Uganda, Ahaibwe warns that progression from primary to secondary school remains a challenge for females and this usually climaxes by failure to attain better employment.

In 2015, barely 31 percent girls attained at least some secondary education and only 16 percent completed primary. 53.1 percent either had no education at all or attempted only primary school.

According to the survey, girls drop out of school majorly due to early pregnancies, economic barriers and child marriages, with the latter being largely driven by social norms.

The survey explains that children sent to school with no books and pens feel out of place, going back to school after giving birth is looked at as a waste of money by most parents and many parents marry off their daughters early to acquire cows, which they feel may reproduce faster and create wealth.

 

Gemma Ahaibwe (holding mic) takes part in a panel discussion duirng the 2018 GrOW Policy workshop held in Uganda. Photo by Mouris Opolot

Ahaibwe was presenting- Education, marriage, fertility and labour market experiences of young women in Uganda, during the GrOW Policy workshop held at Lake Victoria Serena in Wakiso on March 11, 2018.

Her presentation originates from the 2016 study titled “An Assessment of Early Labour Market Transitions of Women in Uganda: A Descriptive Approach”, which she co authored with Sarah Ssewanyana, and Ibrahim Kasirye.

The study explored the inter-linkages between the transitions from school to work or motherhood and/or marriage and the ensuing effects on future labour market outcomes and choices.

The report quotes a female participant cry that “those who drop out of school before completion are less likely to access formal employment opportunities.”
“Unpaid family labour is more likely to be the first activity for most young people particularly uneducated women,” another female participant said.

Ahaibwe calls for sensitization programs to break cultural norms and keep girls in school, provision of second chance programs for teenage mothers and strengthening of enforcement and awareness of legal sanctions against child marriages.

Source links: Economic Policy Research Centre

Lessons learned: how to set up a village savings and loan association

After setting up a successful savings group pilot in the Arapai Sub County, Soroti, SCOEN share tips for other NGOs starting a VSLA

After it generated more than an average 40% return on investment for savers, showed evidence of benefits for women and reducing tension between ethnic groups, we are scaling up our pilot village savings and loans association (VSLA) programme in the Soroti District.

Despite our successes, the pilot didn’t run perfectly, so we want to share what we learned in the hope it might be useful for other NGOs entering this field with little or no prior experience in running VSLAs.

Research and observe

We spent a long time researching different microfinance and microcredit models before opting to explore the VSLA model after concerns about the overheated income-generation claims associated with microfinance. We reminded ourselves that our goal was to include the most disadvantaged groups in the region, people without assets for security, access to social relations, markets and financial literacy.

Savings and loans models were the best option, but we knew there was an “off-the-shelf” attitude to this approach. Having the opportunity to visit local VSLA groups cannot be underestimated – as with many complex programmes, it is only through observation and discussion with participants that one starts to gain a greater understanding of how the ideas can transfer to a different context.

Recruit the right team

The major expenditure related to VSLAs is staff costs. Unexpectedly, we found the appointment of three good field agents (FAs) more important than a strong team leader. The FAs need to have expert knowledge of local power dynamics, and be able to gain the respect and trust of local communities. However, as VSLAs are self-managed, they must also be able to guide rather than impose. Interestingly, we found that recruiting those with too much local influence can result in an awkward power dynamics.

For example, we recruited a well-educated, very thoughtful and well-connected local man who also happened to be a customary chief (local leader).In hindsight, he shouldn’t have been recruited – his role as leader came before his VSLA work. It created a hierarchy with VSLA members defaulting to him, rather than feeling comfortable in their own leadership. The other two FAs were younger, from the area, but with no customary leadership roles. The dynamics of these groups were much better.

Tap into the VSLA community

There is a global VSLA community – tap into it. VSL Associates and Savings Groups are the two major VSLA platforms – on these you will find ready-made training materials and online discussion groups. Seek out local VSLA programmes and see if you and your project team can visit them too.

Take a patient, open approach

We stuck very rigidly to the pure VSLA approach, but when we realised the pilot was taking longer than we had planned, we extended the time limit, rather than rushed to complete before we were ready. Our communities have coped with conflict and displacement, so are very resilient and are used to living with little or no state support, but it still needs to be clear what is expected of all parties. When we visit groups there is still often a request for us to ‘help’ by topping-up the kitty. This underlines the importance of open dialogue right from the beginning.

Dedicate time and money to monitoring, evaluation and learning

Because we wanted to track not just economic and membership data but impact on nutrition, shelter, education, health, women’s empowerment and social status, – monitoring, evaluation and learning has been the heaviest time burden on the team. It definitely needs to be planned and budgeted for.

Scaling up, we have invested in an assistant team leader to support this process. But as field agents built up excellent relationships with VSLA members, the learning gleaned is second to none. Qualitative assessment produced the real surprises, showing there was a consistent shift away from men dominating household decision making to joint decision making between husband and wife. The social benefits of the VSLAs in terms of social cohesion and intra-communal solidarity also seemed to carry as much weight as the financial benefits. And curiously, social norms of who owns livestock appear to be breaking down, with women and Ipei groups aspiring to own household development.

Getting feedback from participants also has showed us that we previously had a very limited view of how people manage their financial affairs on the plateau. Other credit and perhaps savings arrangements exist within the communities, and the key thing next is to understand is how VSLAs can improve the process of managing and planning complex lives, rather than imagining VSLAs replace them because they are better.

What was our impact?

Social impact is a notoriously tricky area to measure, and we feel we have only just started to scratch the surface through the findings mentioned above. How did our pilot compare to the performance of VSLAs elsewhere? This is difficult to say. Pilots tend to be more resource and support intensive, and perhaps coax out better performance than full scale programmes.

We know that there is a conditional VSLA programme also currently in the region that is linked to sending orphans to school. This is not a direct comparison to ours. We had toyed with the idea of explicitly linking the VSLAs to child wellbeing and education, since this reflects our mission as an organisation, but concluded pilots need to be stripped of unwarranted assumptions and external demands.

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