Dear All,

there were some very interesting presentations in the WSSCC global health and sanitation forum held in Mumbai on this topic. here are a few of the links.

How the private sector approach can reach the poorest, using the example of BRAC’s work selling sanitary towels to the bottom of the pyramid. Babar Kabir, Director, BRAC, Bangladesh wsscc-global-forum.org/wp-content/upload...C_Mumba_finalv2i.pdf Babar Kabirwho runs an NGO which is involved with sanitary napkin production spoke on keeping the costs low on generating competition to private sector.

Doing more than mentioning the unmentionable. Amuda Periaswamy, Commissioner, Government of Tamil Nadu, India wsscc-global-forum.org/wp-content/upload...he-unmentionable.pdf Amuda Periaswamy spoke on the challenges of toilet provision and menstrual health management and emphasized the need of the participation of the fathers in Indian society in understanding the needs of their daughters. She spoke of her successful campaign due to strong political will – lady chief minister, lady chief secretary of sanitation and lady implantation officer – the trio who could understand the importance of these needs. They have a setup of sanitary napkin units providing jobs for women and a new scheme will be launched in November where sanitary napkins will be brought from these production centres and provided free of cost to the poor. She also mentioned that it is easier to preach than practice and to break the taboos people should practice what they preach.

cheers

Rahul

Dear All

Since I started my work in public school toilets in 1996, I realized the issue of sanitary pads was as critical as access to toilet paper. The unavailability of these two basic comodities for girls in schools is and will remain a disaster in African Schools including black public schools in South Africa. These poor girls cannot afford these two important tools for maintaining better comfort and decency when at school or home. What I am still finding in South Africa today in township's schools is that girls are using newspaper as pads or toilet paper. That's why when I qive a quotation for repairing public school toilets I always include the price of toilet paper and pads in the quotation. All girls in a school who are seeing their period are given pads when in need irrespective of the number needed. Every pupil in the school receives his/her one toilet paper roll every Monday of the year which they carry in their school backs and are not allowed to leave the toilet paper at home because the mothers I employ to keep toilets at school clean will not allow a child in the toilet without showing a complete toilet roll (not just a piece of toilet paper), whether the roll has already started being used. What I found intersting is that these girls and boys appreciate these gestures and never abuse this favour. So, to answer Elisabeth all of you who are inquisitive. The girls will never take more than the pads she need. When in period, she is allowed to take one or two home till her cycle is complete. Just like the toilet paper, if not used the other pad at home, she brings with back to school the following day and she does not have to prove to anybody how she used the pad at home. It is disrespectfull to the girl. The African girls in South African schools I work with are also responsible people especially if their school toilets are kept clean all the time.

Guess what? In fact it is actually not expensive to provide free pads and toilet paper to students for free. It should be part of the school maintenance budget and there should no arguments what will happen next year. These things are needed to maintain quality education in Africa, so if government does not have a budget to look after its own children when at school is a stupid government, just like ours in South Africa. I am full time working in schools without even being paid a salary, sacrificing my family livelyhood and I find it uneccessary for us to be arguing about the sustainability of this basic human right, which is just like drinking water. school kids get free drinking water when at school, so I see no reason for not giving the free toilet paper and sanitary pads when in need. Most of the people in school toilet and sanitation lobby groups like this forum are theorists and postulators without being in the schools all the time like me. To tell you the truth, maximum cost of keeping a clean beautiful school with clean toilets, classrooms and yard in South Africa is R520.80 or US$65.10 or 50.08 Euros per school child per year. If for example the school has 1000 pupils, the annual budget to maintain this school clean is R520800.00 or US$65 100 or 50 080 Euros. The amount pays and covers for the following clean school maintenance costs: (A)One Toilet Paper Roll for each child per week (child is allowed to keep it at home if not yet finshed on Friday to give to their parents as an encouragement for parents to start buying toilet paper for home and parents are encouraged to buy toilet paper from school as our School Toilet Challenge Model demands that schools must sell toilet paper as a method to raise funds for the school maintenance budget supplement), (B)Supply of all sanitary pads to all girls who are menstruating (C) Pay for the purchase of all cleaning detergents/chemicals and cleaning equipment such as toilet brushes, brooms, cloths, as well as protective clothing for the school cleaners, (D) Pays for the salaries of at least 3 mothers/local women (men can't clean school toilets, only women can) whom the school employs as school toilet, classrooms and yard cleaners at R2000.00 or US$250.00 or 192.31 Eoros per month per cleaner. (E)Pays for general plumbing maintenance cost such as repairing leaking pipes (these cleaning women/mothers are taught general plumbing by The Clean Shop / Trevor Mulaudzi).

I think this is not expensive at all as it allows all the kids to come to school everyday including all the girls on period or menstruating who would normally be absent from school for 3 to 5 days during this menstrual cycle/period.

If the South Africa Government can have school maintenance budgets like the ones I am explaining in this discussion and the schools start selling toilet paper to local communities, then this argument is over and evrybody will be proud of healthy school girls and boys who are productive and will take Africa from poverty in the near future.
After all lack of money is a nonsensical excuse, one South African politician spends more R520.80 per week on useless luxuries like big houses, expensive luxury government cars, business class flights, eating out at expensive restaurents and as well as entertaining girl friends and toy boys while the school girls are being denied free sanitary pads and toilet paper. Above all these their schools' toilets being filthy and disgusting.

Trevor Mulaudzi, The School Toilet Revolution Leader in Africa

Friends

I apologize sincerely if I sound and look like I am making you feel sick about this picture. It is because it 2.33 am and I have up almost all night thinking about these poor African School Girls. The picture tells the real current sitution in South Africa. You can see the Sanitary Bin has been supplied by a big company called Steiner who gets government contract to maintain this issue, but see what is happening in the picture. Bureacrazy at play, Bureacraps getting rich, african Children dying of disease everyday caused by these conditions. Those schools girls who are still alive, when confronted by these toilets everyday, they resort to smoking cigarettes and marujuana in the school toilets (see cigarette bud in the toilet bowl). No wonder I sound rude, I am just angry with what South African politicians are doing to our kids.

Good school toilets I provide in the schools are like these at Thabang School, In Soweto, Johannesburg. At this school, The Clean Shop renovated 4 Ablution Blocks in just 2 weeks. We started the renovations on 1 November 2011 and finished the work on 14 November 2011, and handed the New Beautiful South African School Toilet to the school on 17 November 2011 as World Toilet Day 2011 celebrations. We had to celebrate WTD on a Thursday as 19 November 2011 was on a Saturday.

Good Night and Good Morning at the same time.

Signing Off. Trevor.

Dear Trevor,

Thanks for providing all this first-hand information! Unlike me, you are confronted with these realities every day (whereas I just sit in front of a computer and write and speak to people) - so I really appreciate it that you take the time to share your thoughts, experiences and - above all - your honest opinion on this discussion forum! I am sure by now you must be running for a political position, at least in local government if not higher...?

Anyway, back to the topic of free sanitary towels (isn't it funny that there are all these different terms like pads, napkins, towels, ...).

Did you see the query by Claudia above, do you have an answer for her?
Here is what she said:



As to the other points you raised in your e-mail, I will ask you about them in a separate discussion thread (link) in an attempt to keep this thread here purely on the menstrual hygiene issues.

Regards,
Elisabeth

As a small UK charity working with partners in East Africa, we will very shortly be launching a girls' education campaign to ensure the provision of sanitary towels to adolescent girls in some of the schools we support in and around Thika in Kenya.

Lots of elements for consideration based on our own feedback and these discussion boards...

I was hoping this forum might be able to give some advice about the Kenyan Government's initative to support the provision of sanitary towels to girls through their schools. At the end of October, I read that "Prime Minister Raila Odinga has directed the Education ministry to start distributing sanitary towels to schools across the country by the start of November". The schools we support have not received any sanitary towels through this initiative but I wondered whether anyone has any news about whether the distribution has started anywhere.

@Doreen - you had some very interesting statistics about the number of girls needing help vs the number of girls covered by the scheme. We're looking at funding options at the moment and I wondered if you would mind letting me know where these figures came from?

With regards to sustainability, we are looking to provide biodegradable sanitary towels - unfortunately a large proportion of the children in the schools we support don't have access to running water at home so there are hygiene factors to take into consideration with regards to reusable resources. We have also received anecdotal evidence that the existing outdoor drying of rags and the like that are currently used, can result in teenage girls being perceived as 'sexually available' and lead to further exploitation.

We very much look forward to hearing the comments of the SuSanA community on this subject.

Dear Tamsyn,

Greetings from Nairobi. First and foremost I would like to apologise for the delayed response to your post. It has been quite a busy couple of weeks for me at work.

Great that you will be launching a girl’s education campaign to ensure the provision of sanitary towels to girls in the schools that you support. I wish you all the best with your fundraising. If I may ask, which schools are these that you support around Thika?

Yes you are right, the government did acknowledge that they shall start providing sanitary towels as of the beginning of the term this year (which starts in January) and they have in some schools.

They have not sent boxes of sanitary towels but they have provided money to the headmistresses and headmasters to buy sanitary towels. I contacted the headmistress of a school in a low income urban area here in Nairobi. The school is called St Elizabeth School and is situated in Mukuru kwa Njenga. The amount they received at the beginning of the year from the government was 1600 Kenya Shillings. There are 5 schools in Mukuru. All 5 received the money for the sanitary towels. The payment will be done twice this year meaning that they shall be given another 1600 Kenya shillings before the year ends. This money is not enough. In addition, Mrs Maina, the headmistress informed me that they have well wishers and donors who sent them 2 boxes of sanitary towels. There are 900 girls in that school. Approximately 500 girls have reached the stage of menstruation.

Unfortunately, not all schools are targeted; just a couple are receiving the sanitary towels. At the moment, I am unaware of the selection process. Even the school I mention in Magadi in the post below have not yet received anything

forum.susana.org/forum/categories/24-men...condary-school-kenya

Regarding the figures that I mentioned in my earlier post concerning the amount of girls in need of sanitary towels, these figures are from the Nation newspaper. The link is provided in that post. Back then in October, the government had promised that the supplies will begin as of October 2011 but they postponed to January this year. It was the education minister who mentioned in October that an estimated 2.7 million girls aged between 9 and 18 years who needed sanitary towels.

Here is the link once more: www.nation.co.ke/News/Girls+to+get+sanit...102j0dn/-/index.html

You have informed us that you are looking into providing reusable menstrual towels. Hygiene and the provision of water could definitely be a huge factor in the schools. Unfortunately this is something that is largely ignored but needs to be addressed. The girls need sufficient amount of water and soap to wash them. Are the schools that you are supporting mixed boarding schools i.e. with girls and boys?

Girls in mixed boarding schools normally have a huge problem hanging out their underwear’s to dry. This is because their underwear’s might still look “dirty” even after washing them due to the lack of sufficient soap and water. They then resort to hanging them under their mattresses or in dark areas so that they are not seen by others. Unfortunately that is still a very common practice in many schools.

It is a vicious cycle really. The girls don’t have sufficient soap and water to wash their towels well, they are then too embarrassed to hung them outside so they resort to hiding them in dark areas, they never get to dry very well thus leading to infections. In areas where they can’t afford sanitary towels, they then resort to using other things like old rags. In Mukuru, I spoke to some women who informed me that girls normally tear the sponge from their mattresses and use that to control their menstruation. It’s atrocious considering the bacteria that can be found in mattresses etc.

Sanitary towels are becoming more and more expensive in Kenya. At the moment they cost 100 shillings for a packet of 8. I know because I had to unexpectedly buy one in a kiosk about 3 weeks ago. I am now an ardent user of the menstrual cup so I have not had the opportunity to buy sanitary facilities in Kenya since I came back in December 2011. 100 Kenya shillings is a lot of money. I can tell you for sure that many Kenyan girls in low income areas will not be able to afford that. I talk about menstrual cups quite freely with ladies in Kenya from all walks of life (fellow GIZ colleagues, househelps, students, friends, mums etc) and they all seem to expressing genuine interest in the product. I can’t say that it will be the answer for all women in Kenya as it does need getting used to, however it is a promising solution for many girls and women in Kenya because it is simply sustainable, friendly to the pocket as it lasts quite a number of years and requires little water, definitely not as much water as a reusable menstrual cloth. It might be worthwhile for you to also promote it to the girls in the schools in Thika. The older girls might be quite interested.

The problem is that so little research has been collected about MHM in Kenya in the past. Even In many traditional settings, a girl is deemed a woman once she begins her period and in many occasions is immediately married off once she begins her period.

Ok lets look at the pros and cons of reusable cloths

Advantages

a) Can be long lasting depending on the material used
b) They save money. Girls do not have to buy towels on a regular basis
c) Environmentally friendly as they are not disposed in toilets, behind bushes in schools etc

Disadvantages

a) It needs to be washed with adequate soap and water therefore it requires a constant source of water
b) If not properly washed, the girls could get bacterial infections
c) Girls in schools are shy about hanging them outside to dry especially if they are not clean. They then resort to hanging them indoors in dark areas such as under mattresses
d) The girls can get stigmatised if they are not maintained well i.e. cleaned well.
e) If the girl needs to change during school hour, where does she put the used menstrual cloth?

I know that I have not given you a direct answer. Unfortunately there is no one answer. It all resonates down to women’s preferences and what is available. If you are looking at a sustainable method of solving this issue, we clearly need to weigh the pros and cons to ensure that all factors are covered.

Another thing that I would advise you is to make sure that you talk to the girls. That way you are assured that they will tell you the problems that they have. Make sure that you address them sympathetically. I am sure you have noticed that many of the girls in Kenya especially from backgrounds where they do not openly talk about menstruation will find it very embarrassing, are shy and find it quite awkward to talk about such things.

Even with me as a Kenyan, I know this first hand when I addressed some women in Mukuru about the issue. They were uncomfortable. They even whispered to me the answers as if someone else was listening (nobody was) Their demeanour changed completely. I am not happy about that because it goes to show you how ridiculous it is that women could be ashamed of something that they can’t control, as if it is their fault that they are menstruating, as many of them do believe initially. Find someone who has a sympathetic ear so that they can open up to the girls in the schools in Thika and tell you what they need and want. Through this you will ensure that you are meeting their needs.

All the best and please do keep us informed through the discussion forum.

Best regards

Doreen

Dear Doreen and other,
I have not been following the discussion actively. However let me contribute a little on what I have come across. The NGO Wherever the Need has implemented a Sanitary Napin Dispenser, called Napi Vend, in one (or more?) of their projects. Here is a pictures from the Sri Ramalingar Secondary School in India, where for a coin (how much I am not sure) the girls can get a sanitary towel.

www.wherevertheneed.org.uk/projects/indi...ects/sri-ramalingar/



the machine needs energy supply, so it might be a problem for rural areas, but I am sure you can also create a manual one that can work as well.

Best regards,
Christian

Hamjambo,
here's a recent video on/from ZanaAfrica's PAD project (www.zanaafrica.org/) which I've just come across (via Twitter, btw):



And here is another one ex 2008:

Hey Everyone,

Thought I might add my insights and experiences to this conversation. I am part of Ruby Cup, a social business, that provides menstrual cups to girls and women in low income areas. We are based in Kenya but provide Ruby Cups world wide. Feel free to check out our website: www.ruby-cup.com

We have now successfully completed our pilot in various areas in Kenya testing the acceptability and feasibilty of Ruby Cups in various locations, both rural and urban.

Age
Specifically, we focused on investigating how girls and women of differnet ages like Ruby Cup. Our age group ranged from 15-35 and even the younger girls loved Ruby Cup (Kibera, Pamoja girls group). However, for very young girls just starting to menstruate, a menstrual cup may not be the perfect solution, since these girls often do not know their body well. Our experience has been to start with older girls (from age 15) as these know their body better. Re-usable pads or biodegradable pads can be a good solution for younger girls. Also, initially, these products are easier to use than a menstrual cup, which requires a learning period. Every girl and woman is different, we believe that the options for choosing should be there and menstrual cups come with a lot of benefits, especially in conditions where sanitation is inadequate.

Water scarcity
We investigated the feasibiilty of Ruby Cup in water scarce areas and I would like to share the follwoing with you.

When is comes to safe use and water, a menstrual cup is one of the best alternatives you can get. Unicef WaSH here in Kenya did a study with re-usable pads in Turkana and the experience was not successful. We have the same feedback from girls here in the slum areas. Re-usable pads requires a lot of water for cleaning, and they must be hung outside in the sun to dry. Often, and as Doreen already mentioned in many of her previous posts, the girls are embarrassed for others to see that they have their period and keep the pads inside where they remain humid and can collect bacteria.
Also, some girls do not have underwear and can thus not use pads in general. A menstrual cup can be worn without underwear.

However, with Ruby Cup, you need clean hands before insertion and removal. You do not need to wash your cup when changing it, as it is only in contact with oxygen. After your period, you boil your cup for 5 minutes in order to sterilize it. Then you store it in its cotton bag in a secure space, and take it out again next month. The capacity of a Ruby Cup is 3 times of a pad. For many girls and women, this means they can go a whole school or work day without changing, allowing for changing in the privacy of your home, and avoiding the often problematic conditions in schools where there can be no water and no toilet doors.

Virgininty and Insertion:
We always get the question of whether you can use the Ruby Cup as a virgin, and our response is that you can, and that you will remain a virgin. However, anything that is inserted into the body can affect the hymen. If this is a problem for the girl or her parents, we respect that. But we have not come across it yet.

When it comes to finding an adequate solution, we must bear in mind that there a places where virgins will not be allowed to insert a product. If this is the case, a possbility is to make a small trial with some of the mothers. If they like it and understand it, it might be that this could demystify the virginity/hymen conversation. We do acknowledge and respect different cultural habits and traditions and a menstrual cup might not be for everyone on this planet.

I would suggest having a conversation with the girls and maybe also their parents about what it is, what it does, the benefits, etc. When full information and education is provided and the girls/her parents still prefer another menstrual hygiene solution that does not require insertion, that is completely ok.


FGM or female circumcision
Sadly, FGM is still practised in various communities in Kenya. We provided Ruby Cups to girls and women at Wamba primary school in Samburo, a region where FGM is widely practised. In that region we openly discussed the topic with the head teacher and the principal and their advice was to talk about FGM openly with the girls because there are many sensitisation projects on that topic and most girls and women are used to talk about it. So we did and we asked a small group of girls that have not undergone FGM to volunteer and test Ruby Cups (we are still very careful with suggesting Ruby Cups to this particular group, since it would require more research and studies and depends on the way FGM has been done).
Most girls in the class raised their hands and wanted to try Ruby Cup. We selected three lead users and one teacher. The girls have been monitored closely on a daily basis by the head teacher, the principal and the female teacher who also uses Ruby Cup. The results were very postive. We followed up with phone calls. One girl did not feel comfortable when removing Ruby Cup. As already indicated the backside of menstrual cups are probably that they involve a learning curve. Once you know how to use it, it´s easy. After explaining to her again how to remove Ruby Cup properly, she now has no problems at all and likes Ruby Cup very much. All three love Ruby Cup and the other girls keep asking when they can get one for themselves.

Education
When it comes to menstrual cups, education is key. Girls and women need to learn how to use Ruby Cups and part of our Ruby Cup package is educational material that contains various important points: how to use Ruby Cups, FAQs, education about reproductive health, menstruation, female hygiene and hygiene in general, anecdotes and a menstrual calendar. This way we aim at starting the conversation about menstruation. Part of our mission is to de-stigmatize the topic and we aim at doing so through the provision of Ruby Cups and educational material to girls and women that cannot afford existing menstrual hygiene products.

Please, if any of you has more questions on this topic or should you be interested in ordering Ruby Cups for girls in a particular school you can always contact me: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or post on this forum. We do capacity building and would assist you in educating the girls/women in the area where you work about the usage of Ruby Cup and menstrual hygiene in general. We can also send you our manual about introducing Ruby Cups to girls and women in low income areas should you be interested in doing the capacity building yourself.


Cheers,

Maxie

thanks maxie for this very valuable insights

i must admit, i have been sceptical if the CUP would be a "solution" or lets rather say an acceptable "product" for African girls and women.
But your results are very encouraging, and seeing your sensible approach, makes me rethink.
and absolutely agree that education and the choice of prefered product is key.
Best, Ina

I just found the ZANA Africa website and found an interesting tool to ensure the distribution of sanitary pads to schoolgirls in Kenya. Together with Upande Limited they created an Android app, the Nia Network.

www.zanaafrica.org/informing-policy-nia/

There are so many smart phones out there and so much potential to use them for sustainable projects..

Mona

Dear all,

As always, vey interesting and topical discussions. We should continue the dialogue at the World Toilet Summit in Durban 3-6th December. Is anyone from this forum going to be there? world-toilet-summit-2012.co.za/

@Doreen: We saw the government tender about the provision of sanitary towels in the Nation and we have visited some schools that benefitted from the programme the previous year. Some rumors about the money never reaching the intended cause can therefore be falsified, however, I completely agree with your argument that the initiative means a drop in the ocean and lacks considerations about sustainability. We sent a proposal to the minister of education introducing Ruby Cup to the government of Kenya and the response was quite positive. In order for the government to consider purchasing Ruby Cups, however, we were informed that the law needs to be amended in the first place. This can take a while but I am very positive about the fact that the Kenyan government looked at menstrual cups in an open manner and we are working on getting Ruby Cup out there through either the government of Kenya, NGOs and other partners.

@Elizabeth: I agree with your poin that menstrual cups are not suited for each and everyone due to cultural and religious believes about insertion. But for at least 20% of girls (in our studies close to 90%), Ruby Cup has shown to be a sustainable solution that will help girls go through primary, secondary school and college without needing to worry affording menstrual hygiene products any longer. And for me personally, the biggest impact was receiveing letters from some of our users from Kibera, St Johns primary school, who indicated that Ruby Cup meant freedom, the ability to move freely as well as cutting the need to ask their "boyfriends" for pads anymore. The latter meaning that they do not trade their body for pads any longer. In this respect, I agre and it does not matter whether menstrual cups are a solution for 5%,10%, 20% of the girls or more. As long as they help one single girl stop trading her body for pads, we have made a huge impact.





The above point makes another thing very clear: discussing the correlation between menstruation and school drop-out is looking at MHM in a far too narrow way. If girls trade their body for pads, it implies many more problems, such as early childhood pregnancies, illegal abortions, increased likelyhood to get HIV/Aids and other STDs, disempowerment of girls and first step into prostition to name but a few. I would love the MHM discussion to embrace all these aspects as well beyond the sole angle of school drop out. Any thoughts on that?

I am so excited to see some of you in Durban and to elaborate on the discussions, to share experiences and to learn from you.

All the best from Kenya!
Maxie

PS: If you can not decipher the content of the letters, we have noted them down:

Annet Shilaho:
ANNET SHILAHO (15 years)
My first day when I started my menstruation period I used rugs because my father did not afford to buy me a pad. I did not have anyone to afford to buy for me cause my mother had been already dead. I felt ashamed of myself. I stayed for a week at home because I thought it was not normal. I was very funny because I went everywhere telling people that the bleeding is come out of my vagina. A few days later friend introduce me to their life skills teacher. I explained everything to her and at last she promised to provide for me pads.
My opinion about Rub cup is that it helps me a lot because before I was using two pads per day. I thank Moraa and Ruby Cup because they made my dreams come true. Cause once before she came I was ashamed facing my father asking him to buy me pads. Ruby cup is my number one choice cause it has help me a lot. Since I started used it I have seen changes. It has even help me saving my dad’s money. I don’t have much to say all I ask you all is to bring more ruby cup to help others a lot. The thing id good a lot if even you wear it nobody will notice.
I prefer Ruby cup than anything else.

Valentine Atiendo:
VALENTINE ATIENO (13 years)
Before I start using ruby cup I was using rages. Sometimes I was using pads I usually stay home until my menstruation stop because I become shy.
But by now I am using Ruby cup I can do anything I can jump but before I was asking money for my boyfriends sometimes I was asking my mother sometimes when my mother doesn’t have money I usually use rages and stay home I was ashmed to go to school because I became shy I am very glad to have ruby cup because by now anyone doesn’t if I am on my menstruation even my mother I like ruby cup with all my heart because it is helping me so much.
I am not even go to school because I thought that my friends will now that I am on my menstruation I become shy.
But by now I am very glad to have it because am stay with my aunt and she cant take proper care of me and I cant tell because I become shy I don’t have my real father who can give to me money to buy pads. I thank God because he saw me with my problems and bring for use ruby cup.
I have thank God to bring you here to help us.
I empty ruby cup in the pee poo bag and before I start using it I must wash my hands and then when I remove it I wash my hands again.