Let's talk about menstruation: Overcoming the taboo

Following my previous post on the menstrual concern in Africa, I wanted to dig deeper to understand what could be implemented to alleviate the situation. This ranges from individual menstrual products with varying degrees of success, to programmes and charities that work to intervene in this matter. 

Menstrual products

1. Disposable pad

Fig 1.: 'Always' by procter and gamble is an example of disposable pads which are preferred and distributed by charities 

Various menstrual products have been tried and tested to varying acceptance levels from girls with individual drawbacks, though most girls opt for the disposable pad as their ideal choice. Products such as that shown in Fig. 1 are widely available, convenient and prevent leakage, but may not always be reliable supply-wise. Though the provision of disposable pads saw improvements in attendance and grades, it is not a viable long-term solution as they are bound to run out. Though charities have actively been involved in providing sanitary items (Jewitt and Ryley, 2014), a disposable pad can still only be used once before rendered useless.

Obtaining these pads might also drive girls to perform transactional sex in exchange for money to acquire them (Mason et. al, 2013). Locally branded pads cost about US$1, and purchasing them competes with essential household needs, preventing girls from accessing them and thus having to improvise with inadequate methods of menstrual protection. This is a continual cost that often unfortunately cannot be met (Silverman, 2015).

Though environmental concerns may not be of priority to these girls when dealing with their menstruations, disposable pads are also unsustainable due its wasteful nature. This western-style of dealing with menstruation is not eco-friendly, and washable pads that can be recycled might be a more suitable option (Greed, 2014).

2. Reusable/washable pad

Fig. 2: Afripads are the leading manufacturer and largest commercial supplier across 30 countries in Africa for reusable and sustainable sanitary pads

There has been a rise in organizations shifting their focus to reusable pads, including Project Mwezi that uses participatory approaches to design reusable towels and provide menstruation-related education and training on sewing reusable towels by hand, using second-hand materials. This is a much more environmentally friendly method that also provides for a user-friendly, cheaper and long-term solution, as described in Fig. 2. (Jewitt and Ryley, 2014). Combining sanitary towel provision with health education helps to address key practical and cultural challenges surrounding menstruation and sexual maturity, further challenging "wider societal power relations" by tackling gender inequalities and longer-time job options (ibid).

A drawback of reusable pads, however, is that girls will need access to water and soap to keep their pads clean, and some have stated that this might pose as a problem for them as well since they need to discreetly hang their pads to dry or use household water and soap resources.

3. Menstrual cup

Fig 3: Menstrual cup that can directly catch blood and be left in for up to 12 hours at a time (Silverman, 2015)

Another alternative is the menstrual cup, which is described as safe, sanitary and comfortable, permitting women to continue their physical activities during their periods (Peña, 1962 in Silverman, 2015). Similar to the reusable pad, it is economically and environmentally friendly, and also contains none of toxic chemicals potentially found in pads. Studies conducted found these cups to be particularly good at "overcoming access and sanitation problems, and when presented with the proper training, improve health knowledge and help overcome taboos" (ibid). Though as reusable as washable pads however, these are less likely to be able to be manufactured locally. Some in Cameroon and Kenya, unlike in Western culture, also consider this to violate the virginity of adolescent girls and may hence be deemed inappropriate (ibid).

Menstrual education

Schools are urged to implement segregated toilets that are private and safe with water available for washing (Tamiru et. al, 2015).  Coupled with this, is the urgent need to integrate menstruation into existing school curricula and wider media, educating girls and boys, as well as both male and female teachers. Classrooms and facilities need to be a safe and welcoming space to educate and challenge the negative taboo and lack of awareness. Furthermore, teachings should move away from traditional anatomical explanations and towards discussions that encompass meanings and beliefs (Kirk and Sommer, 2006).

It was also found that schools and parents actually shift the blame of uneducating girls to each other, resulting in girls unprepared for and lacking the proper education from either party. Menstruation as a taboo topic at home prevents from girls to understanding that it is a natural process they should not be shameful of. Large-scale programmes such as Families Matter have tried emphasising parent-child communication on sexuality and health issues, and have successfully implemented education via government, school and health infrastructure (Mason et. al, 2013). This contributes to the improvement of children's reproductive understanding, creating a more progressive environment move away from taboo beliefs. However,  a considerable percentage of girls below age 20 are still vulnerable to sexual assault and underage marriages as a circumstance of their menstruation, presenting a deeper, underlying cultural concern. 

Menstrual health management cannot simply deal with the supply of materials. It is crucial to have a comprehensive and multi-sectoral approach that combines knowledge, family and community, sanitary material supply, and policy, linking physical infrastructure and sanitation projects to address menstruation in more holistic ways. Facilities are only part of the solution- girls need to know that they have secure and accessible solutions, and this can only come with an integrated program that includes further research, acceptance, and frankly, a much deeper sense of urgency.