Menstrual Health and Hygiene

Menstruation is a naturally occurring phenomenon; however, thousands of adolescent girls and young women in Kisumu, as well as nonbinary persons who bleed every month, are deprived of menstruating safely and respectfully. Those belonging to marginalized sections face the brunt of lack of access to water, sanitation, and hygiene facilities; affordable menstrual supplies; and inequitable distribution of menstrual health education and are victims of period poverty.

Period poverty disempowers adolescent girls and young women, disrupting their mental health and wellbeing. Thousands of vulnerable and at-risk adolescent girls and young women in Kisumu find it persistently challenging to access and afford menstrual products while deprived of menstrual hygiene education. These put them under immense stress and elevated financial liability, predisposing them to period poverty. The lack of means for hygienic management of menstruation can cause discomfort and psychological stress and can add to the shame and sometimes depression that adolescent girls and young women experience because of menstruation-related taboos and stigma. Despite efforts to include menstruation in these domains, period stigma, shame, and taboos are prevalent in all households, health centers, institutions, and public spaces. Period poverty inadvertently poses physical, mental, and emotional challenges for people who menstruate. Menstrual health and hygiene management is an impetus to achieving universal health coverage. Alleviating period poverty remains a social justice and human rights issue that needs to be endorsed and promoted by the governments, civil society, and, most importantly, the citizens.

Girls and women with disabilities face even greater challenges in managing their menstruation hygienically and with dignity. Thousands of adolescent girls and young women with disabilities in Kisumu City are denied the right to manage their monthly menstrual cycle in a dignified, healthy way. Girls and women with disabilities face a double stigma due to both social norms around gender and menstruation and having a disability.  A 2019 systematic review of menstrual hygiene management requirements, its barriers, and strategies for persons with disabilities found that menstruation challenges were a source of shame for girls and women with disabilities, with consequences including social isolation and even forced sterilization.

Menstruation poses a unique challenge to schooling, particularly as more girls remain in school at ages beyond the onset of puberty. In contrast to the potential link between the onset of menstruation and school dropout, popular and policy discourse has focused on the indirect ways that menstruation influences schooling attainment via absenteeism and the ability to learn. Menstruation creates a set of physical, socio-cultural and economic challenges that may interfere with a young woman’s ability to attend school or to participate fully in classroom activity. The lack of adequate sanitary materials may be one barrier to school attendance.

Commercially produced products may be unavailable in rural areas or prohibitively expensive for most families; for example, multiple studies in Nigeria found that fewer than one-third of urban adolescent girls used commercially produced sanitary materials. Reliance on cloth rags may restrict physical mobility, as girls may not have adequate supplies to prevent leaks or maintain hygiene. Cloth menstrual materials must be regularly washed, which becomes problematic for families who cannot afford soap, and the additional time required to launder rags may reduce time devoted to homework and studying.

 Available evidence suggests that, controlling for other measures of family socio-economic status, girls from households that have limited access to water are more likely to drop out of school post-menarche compared to girls from households with better access, due to difficulties remaining clean during menstrual periods. Girls’ school attendance might also be disrupted by the physical discomforts of menstruation, including menstrual cramps, headache, backache, nausea, and diarrhea. Pharmacological treatments, such as painkillers, may not be readily available and are likely too expensive for poor rural families The management of menstruation has recently emerged as a domain for interventions designed to maintain adolescent girls’ school attendance with the ultimate goal of reducing dropout rates and supporting adolescent girls through secondary school.

School facilities may also influence the regular attendance of female students during their menstrual periods. The availability and privacy of toilets on school grounds determine whether female students are able to change their sanitary materials and wash themselves during the school day. The absence of a sense of privacy and safety in the latrines means that menstruating students may be anxious that their condition will be discovered by other students, while inadequate water supplies may interfere with the ability to remain clean, prevent odor, and rinse away menstrual blood from the latrine facilities. Even when adequate toilet and water facilities are available, teachers, the majority of whom are male in rural Malawi, may be insensitive to the needs of female students and allow only infrequent toilet breaks. Class participation may also be interrupted during menstruation, as girls may be hesitant to stand up in class or go to the chalkboard for fear of revealing possible leaks or other evidence of their condition.

Better Futures for Children’s Menstrual Health and Hygiene (MHH) framework outlines four pillars of programming, underpinned by principles to achieve access to safe and dignified menstruation for all girls and women.  Our MHH programming are anchored on the four strategic pillars of the MHH framework:  building social support, improving knowledge and skills, providing facilities and services, and materials that support results in four key areas – together can help to ensure that vulnerable and at-risk adolescent girls and young women, especially girls with disabilities and adolescent mothers, are able to manage their menstruation safely and with dignity.  

Better Futures for Children generates evidence and learning around MHH for vulnerable and at-risk adolescent girls and young women, and address stigma and discrimination and empower family members to support girls with disabilities to manage menstruation safely and with dignity. We partner with adolescent girls and young women with disabilities and organizations of persons with disabilities throughout the cycle of MHH programming in identifying the needs of women and girls with disabilities and in designing or adapting inclusive and empowering MHH programs to be inclusive.