Let's talk about menstruation.

With all the taboo and stigma surrounding sanitation (as per my previous post), the topic of menstruation and periods is a whole new ballgame of its own. In Africa, especially, misinformation and negative attitudes towards menstruation have put women and girls in vulnerable positions. Women on their menstrual cycles can be considered 'unclean', and since they are subject to ignorance and distaste by their communities, partake in activities that are strongly disadvantageous to their personal hygiene and health. Some communities can even keep them from touching water, cooking, attending religious ceremonies, or engaging in community activities (UNFPA, 2018). Some females even have to hide their used cloths in unhygienic areas, exposing and multiplying their risk of infectious diseases. 

In places like Southern Nigeria, tradition forbids a woman in her menstrual period to go into water bodies to have her bath, especially due to the cultural belief linking menstruation to evil spirits and curses (Akpabio and Takara, 2014). Nigeria is hardly alone in this belief. Discussing menstrual health has been considered private and shameful, and ignorance of these topics have been widely documented in young girls and women, as well as among parents and teachers (UNFPA, 2018). Even more unfortunate is that this hinders their education levels, which can catapult into further socioeconomic issues. 1 in 10 girls in Africa do not attend school when menstruating because toilets are inadequate, lack privacy or are shared with boys (Mathiesen, 2015). It is even reported that with boys having even more limited knowledge, they tease girls and is a factor in why girls might feel ashamed. Girls can lose approximately 1/5 of their attendance in school (ibid), and it is reported that 40% of girls missed school at least one day per month during their period (UN, 2015). 

The challenges for these adolescent girls and women in their management of menstruation presents other problems as well (Hoffman, 2011). For some, menstruation could signify that a girl is ready to be an adult, which can result in child marriages, and further worries of adolescent pregnancy and further infringement of human rights  (UNFPA, 2018). With the cost of menstrual products so high, transactional sex performed by underaged girls might also occur, which can lead to violence and diseases. With this whole stigma, it is no wonder that some of these communities continue their backward and unfair outlook of daughters being economically burdensome. 

Though it may be fairly clear that menstrual health and management should be more strongly discussed in policymaking, monitoring has been weak. A few countries have developed solid policy frameworks for this, including Kenya, Uganda and Tanzania, but more still needs to be done in majority of Africa (Akpabio and Takara, 2014). Other than women and girls, some groups have particular vulnerabilities, including girls out of school, those with disabilities, currently in or just out of jail, and the transgendered community (UNFPA, 2018). In Zimbabwe, women in prison had to resort to tearing up blankets/rags to use as pads, and they hardly have access to running water and sanitary bins. These further exposes them to health risks. Even if they were able to wash these, where would they dry them? This is a vicious cycle: lack of affordability and availability to appropriate menstrual equipment, making them vulnerable to HIV or other diseases, pushing them to think that their blood is infectious or unclean, and then afriad to talk to anyone about it (UNFPA, 2018). There is an urgent need for policymakers to standardize, mainstream and scale up policies targeting appropriate and accessible MHM facilities, or considerable numbers of women and girls will continue to be put at a disadvantage instead of their basic human rights.