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.
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.