Hey Naomi,

I am very much looking forward to work together with you and will get in touch with you again very soon.

Thanks for making the connection, Doreen!

Maxie

Hey thanks for connecting me to the forum. Great to hear so many people care about this issue. Surely in this day and age we need to get over this hurdle. As you mentioned the GoK should get the schools such as Magadi the pads, but sustainability will be anoother issue. I mean unless they propose to have it in the budget every year.

I will definitely be in touch with Magadi school, i am so interested. Imagine if we could get the number of girls missing school down OR we even make an impact that more girls enroll in the school. I am keen to see what we can do in Magadi.

Dear Maxie,

Yes of course you may have the contact details of Ms Mbuthia, the teacher at Magadi Secondary School. Naomi also asked me for her contact details. I have sent it to both of you via email. I am so happy that you had positive results at Wamba Primary School in Samburu with the menstrual cup albeit issues of FGM in the area as you posted here:
forum.susana.org/forum/categories/24-men...ya?limit=12&start=12

This is welcoming news! I am also happy that you are laying a lot of emphasis on capacity building. Emphasis on capacity building is vital in ensuring enlightenment, encouraging ownership, increasing confidence, self esteem and sustainable MHM.

Please continue to keep us informed through the forum.

We are always happy and excited to follow your progress.

Best regards

Doreen

Hey,

I would like to comment on the following post by Doreen, "I explained to the teacher about the Ruby Cup (menstrual cup) and she told me that it sounds interesting but another major hurdle is that most of the girls have already undergone FGM (Female Genital Mutilation) which is still very prevalent with the Maasai. This happens when they are in Standard 8 (Year Eight) There are different types of FGM. The one the Maasai go through consists of cutting the clitoris (the one the Muslims go through consists of stitching). The Maasais however would be very sceptical about inserting anything. She told me that she thinks it could be a possibility, but it would require a lot of education, explanation and understanding for something like that to be tried in Magadi."

I would like to ask you if it is possible to provide me with the contact details of the teacher in the Maasai community. We have obtained positive results from Samburo girls, a sub tribe of the Maasai, where we provided Ruby Cups and where FGM is equally practised. It would be inteersting to talk to the teacher and to see whether or not Maasai girls would like to try Ruby Cup. Especially for Maasai girls, who have to walk long distances and who live in water scarce areas, I could imaginge Ruby Cup to be the best solution amongst existing menstrual hygiene products. I agree, however, that education is crucial when reaching out to this particular group of girls and women.

Thank you in advance!

Maxie

Hi All,

All the girls I worked with wore some protection, except one girl who told me she thought she was ill when she started her periods, and wore extra underwear, rags and tissue paper for several months before telling somebody.

The girls who wore cloths with no underwear did it this way. They tied a string around their waists. The folded cloth was then looped around the string back and front, going between the legs. Often they would knot the two looped pieces between their legs as well, to keep the cloth better in place. Obviously, walking to school, or sitting on the schoolroom floor, was very uncomfortable or just too much trouble. They had been told to wash 3 times a day, which was impossible in a school with no water.

The girls who wore cloths WITH underwear, just put the folded cloth in their pants. They said it sometimes fell out - at school, in front of the boys, who on one occasion snatched it and waved it around.

The girls who wore pads wore the big, bulky kind with an adhesive strip to attach it to underwear. The girls I met in the rural school did not know what sanitary pads wore. They used a menstrual cloth - with or without underwear.

Hope this explains it a bit better. I want to get my thesis out soon.

Kind regards,
Sally

Thanks so much for your posts here, Doreen and Sally. I am so happy that with the help of this forum, we can finally share openly information about this mega-taboo topic!! (slowly the taboo is breaking down, at least in development cooperation circles, which is a start)

I just have one quick question back to you, Sally. You wrote:

Of the girls I worked with, 60% used a menstrual cloth - many of them did not have underwear.

I am confused: so what exactly can a girl without underwear do to keep clean? Can she somehow wrap the coth around, a bit like a nappy, is that what you mean? Or are you saying 60% used menstrual cloth and the other 40% nothing (or they stayed at home?).

Will your thesis become available after that report by WaterAid has been published? You are getting us all very curious.

28 October 2011

Dear Doreen,
What a great post. Here are some thoughts.

Yes girls in Malawi are facing these problems every month and they are struggling, on their own, with nobody to turn to and few who care. That is why I used girls voiced concerns as the basis for my research and asked them what they wanted. Their needs were so simple – working toilets; doors on toilets; water for washing; soap; painkillers – but above all they wanted pads. Has anybody any experiences of the pads produced in country, which not only makes them cheaper, but provides employment as SHE, Afripads, BRAC and MAKA have demonstrated?

Of the girls I worked with, 60% used a menstrual cloth - many of them did not have underwear. For those who used pads – of the same kind that you find in Kenya - pad disposal was difficult. There were no bins in any of the schools I visited (causes given were financial and theft) and, as you say, who would empty them and where? Girls would not walk across the recreation ground with a bin full of smelly pads – I witnessed bullying and worse from boys on several occasions. One school of 281 girls had an open pit which was visited by dogs who distributed the pads around the school. The girls themselves were responsible for managing this. The Community Day Secondary Schools had not heard of incinerators and one head teacher told me her girls did not need them, as cloths were perfectly adequate – not the opinion of the girls at all.

Girls were supposed to clean the toilets. In most schools this was given as punishment duty, so was done with resentment with woefully inadequate materials. I love Doreen’s idea of a school prefect. Hopefully one would find a model young woman with “a sympathetic friendly personality”. In one boarding school, which had a sanitation prefect, the girls I was working with said the prefect used her “power” to get back at the girls she didn’t like. Pride in school toilets has to be implemented through school sanitation clubs in secondary as well as primary schools – so we are back to hygiene promotion and MHM awareness. With training, the sanitation prefect could be educated and conscious of her vital role with clean toilets and accurate puberty education. This would have to be repeated every year with change of prefect. Many of the girls I worked with had never talked to anybody – not even their peers - about menstruation. Erroneous beliefs, some harmful, around menstruation were widespread.

There was also an issue around menstrual blood being seen in the toilet bowl or around the pit latrine – which was another of the reasons the girls did not like using any toilet during menstruation. Fear of witchcraft was very real. No toilet paper was available. In many toilets there was no water anywhere – even in the “flush” toilets - so could not be in to rinse off the blood. Unfortunately, I saw no UDDTs or EcoSan.

The main points of my thesis will be published as a WaterAid paper, which I will post here as soon as it is available.

As for menstrual cups, I posted in the other post.

Sanitary waste disposal – covered incinerators, or even metal dustbins punched with holes - very close to girls’ toilets. Theft could be a problem. Alternatively – biodegradable pads.

Stakeholders – Ministry of Education, CBOs, NGOs, Teacher training institutes, Communities and Village Heads as well as educating boys in schools. Girls in secondary and primary schools would benefit from female, puberty educators.

I hope to start work on the puberty booklet for Malawi as soon as I get agreement. I am aware of both the other booklets and the girls in Malawi requested one specially for them, after they had read Marni Sommer’s booklet for Tanzania.

I am eager to continue to bring the problems around MHM to a forefront. I have a small charity in Laos working in school WASH and am looking for funding to research MHM there, as I feel a comparison between an African country and an Asian one could be most instructive. Any ideas anybody?

Kind regards,
Sally

Dear Sally,

Thank you very much for your contribution.

From the points that you have provided, the challenges that are being faced in the schools in Malawi almost mirror the challenges in Magadi Secondary School. This further proves the urgency of the situation and the importance of prioritising MHM. There simply needs to be a paradigm shift on how MHM is handled. Month after month, girls are facing the same problems.

You are right. The more you understand the challenges, the more you come to realise that it’s not just about the construction of toilets. Girls should be put into the forefront right from the initial stages during the decision making process. If we all just took the time to listen to them and ask them what they want, we would then be able to tackle this issue in a sustainable manner.

1. Operation and Maintenance and sanitary towel disposal are definitely top priority when it comes to ensuring sustainability of MHM. The aspect of sanitary towels blocking toilets is a real predicament and a lot of women and girls seem not to know that sanitary towels can block the toilet. The sanitary towels offered at home in Kenya for example that the school girls can afford are not the nice fancy folded up thin ones you find here in Europe but the big thick long ones that are quite uncomfortable and can be a bit itchy because some parts of the material are a bit rough. So definitely throwing just one down the toilet, would immediately block it because of their sizes.

2. Regarding school sanitation, we recently had this discussion concerning school girls throwing their sanitary towels in the faeces chambers of UDDTs and the difficulties in removing them later on because of their non- biodegradable nature. I think that if schools have UDDTs, they should consider the aspect of having sanitary bins in each cubicle to assure that the girls don’t throw their towels in the faeces chambers. Christian pointed out that the issue is often that the disposal is done in an open pit which is embarrassing to the girls. In addition, incinerators don’t work due to lack of burning fuel or wet pads which don’t burn well. So the girls rather throw the sanitary towels in the UDDTs. He also pointed out that it is crucial that bins are emptied on a daily basis. Next question: Who empties the bins?

3. To sustainably stop the girls from throwing the sanitary towels, there should be an emphasis on sensitising, behavioral change and development of a sense of ownership. This is possible only if the girls are enlightened and understand the importance of maintaining their toilets and the issue of sanitary towels disposal.

In my school in Nairobi, I remember we never had the problem of disposal because each cubicle had a bin that was emptied twice a week. It was not done by us the students but by the cleaners who were hired by the school. In rural areas or poor schools, that is not an option. The students have to do it by themselves. I do recall though that at some point they were not emptied for some days and some girls started carrying them in their bags or putting them in their tiny lockers in the class and they stunk and the boys were always "really clever" in tracing the smells and making fun of the girls.

Suggestions
My suggestion when it comes to school sanitation, regardless of whether UDDTS are in use or not, is incorporating a sanitation prefect who would be responsible for issues related to MHM and how to use the toilets in the school. In Kenya, prefects are normally students who are given positions of responsibility because of their academic achievements, maturity and good character. They represent the other students too and are quite respected by them. It’s a prestigious title in Kenyan schools. They normally get a certificate once the school year is over. Such certificates are great especially if you are applying to Kenyan Universities because they show that you were a bright student who was actively involved in their school. Most schools therefore have a head prefect, class prefect, dorm prefect, entertainment prefect, sports prefect etc, basically a prefect for pretty much everything

So how about having a sanitation prefect? The sanitation prefect would be an older girl and she would be responsible for monitoring the toilets. She would have a sympathetic friendly personality. That way she can be contacted by female students when it comes to MHM and other aspects of sanitation. Also if the girls are lacking sanitary towels or have really bad menstrual cramps and can’t concentrate in class, they could probably go to her and she can assist them with painkillers and towels. She would be sensitised on how to talk to the girls and assist them. I think a sanitation prefect would enhance understanding and the girls would feel more relaxed. I believe It is always better to talk to a fellow student about this issue than to talk to a teacher or parent.

Do you think a prefect is something that can be implemented also in the schools that you visited in Malawi? Did they have prefects in the schools you visited in Malawi? I will be in Nairobi in a couple of weeks and I am really thinking of following up on this and talking to some teachers and students and trying to find out whether it would assist them if an older student would take the role of enlightening and assisting the girls in terms of MHM and sanitation.

Another solution to promote sustainability and assure that girls do not throw any of their towels in toilets and bushes is to clearly indicate on the doors of the cubicles by the use of posters the importance of proper disposal in the bins provided for example. An issue with UDDTs and menstrual hygiene is that with UDDTs the girls feel shy using them during menstruation because of the traces of blood that can still be visible. In most areas, the girls don’t have tissue in the toilet to wipe the traces of blood they have left in the urine pan so always having the presence of a little water and cup to rinse will assist the girls to clean up the area a bit. A good reference on UDDTs and Menstrual hygiene can be found in the WECF factsheet: Ecological Sanitation and Hygienic Considerations for Women: www.susana.org/lang-en/library?view=ccbktypeitem&type=2&id=426

This problem can be solved if female users have access to a cup of water which they can use to rinse the urine separation section clean. This leads to a slight dilution of urine with water, which is not a problem due to the small amount. Alternatively, a damp cloth or toilet paper can be used for cleaning. Menstrual blood that mixes with urine or faeces during a woman’s menstrual cycle does not pose a threat to the hygienic condition of the urine or faeces, since the quantity and the pathogen content are negligible (WECF, 2006)

In addition a poster on how UDDTs function and what to do during MHM should be on every door. The information should be catchy, with girly colours, easy to read and immediately understandable.

I personally don’t think that throwing sanitary towels in an open pit is the solution especially if it’s a mixed school. It’s really embarrassing for the girls and looks horrible! This would definitely further perpetuate the notion that girls bodies are disgusting and would lower their self esteem. The teacher at Magadi school said that they burn all the sanitary towels together once a month. However, they are about 45 girls in her school. What happens when you have 200 girls in a school? Alternative approaches such as biodegradable towels need to be thoroughly investigated and implemented.

Therefore one cannot say that they have tackled MHM sustainably if they have not tackled issues related to O&M and addressed sanitary waste disposal. Cultural practices that can form barriers in addressing this issue should also be brought into the forefront as they can hinder sustainability. Therefore sensitising the girls to the importance of MHM would raise awareness and increase empowerment. In addition, the issue of girls not having underwear is a serious problem and needs to be solved.
The Magadi teacher told me, “it’s not only about sanitary towels; the Government of Kenya should also provide underwear for my girls”
See more information about the free sanitary towels approach in Kenya that is sponsored by the government on my post here: forum.susana.org/forum/categories/24-men...s-for-girls-in-kenya

How are they to hold up the sanitary towels that they are provided for if they don’t have underwear? Why are we solving the symptom and NOT the disease!

It is truly a plethora of challenges and issues that need to be handled and addressed symbiotically so that sustainable MHM can be achieved. I am really not happy when I read about NGOs that just go to schools, build latrines with no handwashing facilities close to the cubicles, no lighting or windows, no area for the girls to wash their menstrual clothes. They then hand out two packets of sanitary towels to each girl in the school and leave. That is quite absurd to me.

I think our discussion forum is fundamental in bringing this issue into the forefront and I urge you to further post any other aspects and information you might have about MHM. The more people know about the challenges, the more we can assist the girls in developing countries to be assertive, confident, educated leaders of tomorrow. Menstruation should never be a hindrance.

I am very much interested in reading your thesis if you don’t mind. Is it online somewhere where I can access it? If not, do you mind sending it to me via email? (Check my profile for my address).

My questions to you and everyone else involved in MHM

• Do you think there is a possibility to incorporate alternative approaches such as menstrual cups in schools with young girls?
• What is the best way to carry out sanitary towel waste disposal in schools?
• Who are the specific stakeholders that need to be considered in terms of breaking the bonds of cultural barriers that negate sustainable approaches towards MHM?

I look forward to further feedback and correspondence with you. In addition, we would be delighted to know when you start working on the puberty booklet so please do keep us posted! The more books there are, the better! Have you seen the puberty booklets in the SuSanA Library from Marni Sommer and Annie Kanyemba? I would highly recommend you to have a look!

Growing up at school by Annie Kanyemba: www.susana.org/lang-en/library?view=ccbktypeitem&type=2&id=1220

Growth and Changes (Vipindi vya Maisha) by Marni Sommer: www.susana.org/lang-en/library?view=ccbktypeitem&type=2&id=1150

Annie is going to translate her book in Shona and Ndebele. The translated versions will also be uploaded in the SuSanA library once they are available.

Best regards

Doreen

Hullo,

My name is Sally and Jane of WaterAid introduced me to the forum, so thank-you Jane. Elisabeth, we met at the dry toilet conference in Tampere.

My MSc thesis is Malawi was called “Toilets are not enough”, because the general consensus there seemed to be that building toilets was enough to address Menstrual Hygiene Management (MHM) in schools. I worked with girls in the third year of urban secondary schools, in order to have articulate informants who were able to voice their own MHM issues. My results found three intrinsically linked issues, which contributed to absenteeism at school. In one term, 104 girls missed more school due to MHM problems than malaria. None of these findings are ground-breaking. We could start with basic toilet design and maintenance.

1. Toilets were not used as they were so disgusting or poorly designed. There was little privacy, often no doors, no water or soap. Operation and maintenance was a major problem. So was the tendency to build flush toilets in areas with water systems that then broke down. Water shortages were common. In one boarding school the flush toilets had been blocked for 5 years. In another, the PTA had put up a basic pit latrine for more than 500 students and staff to replace the broken flush toilets – built and forgotten. It was so foul that girls used the bush or went home.

Nobody was aware that sanitary pads block flush toilets – but girls who used them had nowhere else to dispose of their pads. In schools with pit latrines, these were the preferred disposal method. Some schools had sanitary waste thrown into pits, then dogs, crows and people went through it, before it was burnt when somebody got around to it. In schools this was always the young girls – in a hazardous practice of dousing everything with paraffin and throwing matches in.

2. Cultural practices in Malawi around menstruation and puberty meant that many girls struggled with incomprehension from the community. Menstruation is seen as the end of childhood and girls in rural communities are removed from school, sometimes sexually initiated and married.

Most wear menstrual clothes, due to poverty, unavailability, ignorance and custom. Many have no underwear to keep these in place. Menstrual cloths are not washed at school, first because there is no privacy, no "special place", no water or soap. But girls said they would not use a “special toilet”, because then everybody would know they were menstruating.
The disgust and shame factor was significant. Most importantly, girls feared their cloth being stolen for use in witchcraft. This was a very strong and real fear which local CBOs are working to change through working with communities.

3. Lack of awareness and knowledge about menstrual health was rife amongst the girls, the community and stakeholders. Girls thought the blood came from the stomach or the ovaries, that it protected them from pregnancy, that if somebody saw a girl’s menstrual blood she could be bewitched and that painkillers made them sterile. Teachers were ignorant of girls’ problems around MHM, students needed puberty facts, and organisations lacked awareness. NGOs wanted more information about the importance of MHM in schools.

Conclusions
• Awareness of the problem is key
• An integrated approach has to be adopted urgently towards school MHM, and stakeholders have to coordinate their efforts.
• Support and finance Community Based Organisations (CBOs) who are stretched and struggling with this massive problems
• Build girl-friendly toilets.

Address issues around bullying by boys.


Girls want support, puberty facts and cheap pads – with appropriate disposable methods. They HATE menstrual cloths.

I have made a proposal to an NGO to write a puberty booklet for schoolgirls in Malawi, based on my research but they are still considering and it is a slow process. It would be such a shame if this information was lost. I am eager to continue in this domain, so would love to communicate with others who are also passionate about school MHM.

Doreen, everything you say about MHM in schools was similar in Malawi. Boys bullying was a massive problems and a big reason for absenteeism during menstruation. Awesome, I agree about the general feeling around tampons. In Malawi it was that they would stop a girl being a virgin, and were also thought of as disgusting by the girls and women I spoke to. The silicone cup may well meet the same reaction. My friends in Laos expressed horror at the idea of tampons or a menstrual cup. And where could girls wash it - or their hands? But it is well used in France by women who are comfortable both with their bodies and menstruation.

I look forward to more discussion.
Kind regards,
Sally

This past weekend I found out the challenges that girls at Magadi secondary school face in terms of Menstrual Hygiene Management. Magadi Secondary School has 45 girls and is situated in Magadi, a town in the Great Rift Valley, southwest from Nairobi. It is very hot. Temperatures can rise up to 45 degrees. It is mostly inhabited by the Maasai tribe
For the first time ever in Kenya, the finance minister has allocated almost $4m from the current national budget to provide free sanitary pads to schoolgirls. This is great news however the girls there are yet to see any of the sanitary towels (and how sustainable will this be anyway?...)
Some of the challenges the teacher told me the girls face are as follows:

• They just don’t have money for sanitary towels so during the days when they are on their period, they don’t go to school. Sometimes the teachers have to pitch in from their salaries to buy sanitary towels for the girls. They are still waiting for their local government to provide them with sanitary towels.
• Even if the girls get sanitary towels, most girls don’t have underwear! She said that the government’s campaign shouldn’t be just about getting sanitary towels; underwear’s should also be included! The girls sometimes use old rags, bits and pieces of jeans to hold the sanitary towels up. If they do have underwear, it’s the nylon type that really hurts them during the hot weather and a lot of friction occurs.
• The teacher told me that she normally goes to the supermarket and buys a couple of tiny bottles of creams that are cheap and mixes them up with liquid paraffin oil which is also cheap and can be bought in large quantities (I am assuming liquid paraffin oil is used like glycerin...) They stir everything up and that is what the girls use for their bruises. She normally keeps it in the teacher’s office and distributes it accordingly.
• The boys also tease the girls a lot because sometimes they smell and their clothes get stained. The girls are very shy about having their period. They have no idea about what is going on with their bodies. Their current biology class has one sentence about menstruation
• The girls who are predominantly Maasai are about 13-14 years old. Most already have one to two children and they will probably drop out by the time they are in Form 2 (Year 10)This is because their husbands would not allow them to be more educated.
• I explained to the teacher about the Ruby Cup (menstrual cup) and she told me that it sounds interesting but another major hurdle is that most of the girls have already undergone FGM (Female Genital Mutilation) which is still very prevalent with the Maasai. This happens when they are in Standard 8 (Year Eight) There are different types of FGM. The one the Maasai go through consists of cutting the clitoris (the one the Muslims go through consists of stitching). The Maasais however would be very sceptical about inserting anything. She told me that she thinks it could be a possibility, but it would require a lot of education, explanation and understanding for something like that to be tried in Magadi.
• Another issue is disposing the sanitary towels. The teachers and boys are tired of seeing sanitary towels littered all over the school and behind bushes. Before, the girls used to even throw them in the septic tank which would block the toilet. (They have a flush toilet with a septic tank). The girls are responsible for cleaning and maintaining their own toilets. If someone throws a sanitary towel into the septic tank, it’s the responsibility of the girls to fish it out. Therefore the teachers have now told the girls to collect all the sanitary towels they use in a month and bring them to her in a plastic bag. Once a month they burn the sanitary towels behind the school

The challenges in this region are enormous

Menstrual Hygiene Management has mostly been neglected in developing countries. It’s high time we incorporated it assertively into our agendas, into our school systems and embrace alternative methods, never forgetting to include the women in the decision making process.

I would be interested in knowing your thoughts about this.