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 

Atelamoti Community Water Spring

Stories and Community Profile

Executive Summary

Atelamoti community members rely on Onganyakonye Spring, which has always provided water for people here. However, the water source is both a blessing and a curse to its dependents: Locals, especially children under age 5, constantly suffer from stomach-aches and diarrhoea.

Women and children bring their containers and dunk them until they are full. Some find bending over too strenuous, and instead step into the spring to draw its water. This activity is one of many that contaminates drinking water; waste is washed into the spring when it rains, and animals are free to come and go as they please.

Welcome to the Community

Onganyakonye Spring is located in Atelamoti Village where people are peasant farmers who grow maize, beans and cassava as their food crops. grain is also planted in small patches to attract income, however little, from grain market.

When people wake up each morning, their first activity is to walk to Onganyakonye Spring to fetch water for the day’s needs. Some residents sell firewood – harvested from their own family woodlot; some bake bricks or hire themselves for casual labour to make ends meet. The region is adorned with beautiful, picturesque and peculiar outcrops of large igneous rocks that not only provide resting places for the villagers, but also act as ecological niches for reptiles like geckos.

 Water Situation

Onganyakonye Spring is the exclusive source of water for 100 community households as well as the 300 students of Atelamoti Primary School.  It has well-preserved catchment areas that have kept it from drying up, despite seasons of drought that sometimes reduce other springs to dry ground. This makes it a life-giving spring for over 1,000 people. (Editor’s Note: While this many people may have access on any given day, realistically a single water source can only support a population of 350-500 people.  This community would be a good candidate for a second project in the future so adequate water is available.)

“During rainy season water is a lot, but the population is too high for the spring to accommodate all households and the school in its current state. Consequently, the trend has been that people line up to almost midnight and others fight due to overcrowding,” said Madam Jessicah, at 60. She was caught quarrelling with Ruth to give her a chance to fetch water as well, for she had waited in the line since 6 AM, but in vain.

People have suffered typhoid as a result of drinking this unprotected spring’s water – more so children whose immune systems are weak.  Many people in this village have had diarrhoea that can be attributed to unsafe water from the spring. The older folks are fairly resistant, but they too have to buy Water Guard and use it when they notice that the spring’s water is outright polluted, especially during the dry season when the spring is under more pressure from so many users.

Sanitation Situation

Under half of the homes in Atelamoti Village have their own pit latrines which are fashioned from logs and have no doors. The wooden floors become worn out, making them unsafe to use. These pit latrines are very difficult to keep clean, attracting flies which spread diseases.

Rubbish is either disposed of in the garden or behind the homes where chickens scramble for it.  Only 25 – 50% of the homesteads have clothesline and dish racks.

Plans: Hygiene and Sanitation Training

At least 15 community members and health workers will attend hygiene and sanitation training for two days where a water user committee will be established to oversee all operations around this spring.  The facilitator plans to use PHAST (Participatory Hygiene and Sanitation Transformation), CLTS (Community-Led Total Sanitation), ABCD (Asset-Based Community Development), group discussions, handouts, and demonstrations at the spring.

Plans: Sanitation Platforms

On the second day of training, participants will select five families – who suffer most from a shortage of sanitation facilities – to benefit from new latrines.
Training will also inform the community and selected families as to what they need to contribute to make this project a success. They must mobilize locally available materials, such as bricks, clean sand, hardcore, and ballast. The five families must prepare by sinking a pit for the sanitation platforms to be placed over. All community members must work together to make sure that accommodations and food are provided for the work teams.

Plans: Spring Protection

This water is not safe for human consumption, yet these people cannot afford to protect the spring by themselves. They are willing and ready to work with the organization to help them protect their water point. Users of this spring are ready to garner all materials required from their side for the protection of this source.

Protecting a spring often results in a stronger flow of water from it.  So, protecting Onganyakonye Spring will alleviate overcrowding and long lines and ensure that the water is safe, adequate and secure.  Construction will keep surface runoff and other contaminants out of the water.  So, the community of Atelamoti will be healthier, happier and able to spend more of their time and energy in school, at work and taking care of their families.

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