MENSTRUAL HEALTH MANAGEMENT POLICY

Abstract

Significant obstacles to high-quality menstrual hygiene management (MHM) exist in Kenya and remain a problem for low-income women and girls in rural areas. Research shows that girls face monthly challenges, with 65 percent of Kenyan women and girls unable to afford sanitary pads and about 50% of girls say they’re experiencing school menstruation (McMahon, Winch, Obure, Ogutu and Ochari 2011.) This high cost of sanitary pads has led them to opt for alternatives such as torn pieces of cloth, using mattresses and old rugs to manage their Menstruation.

Around 32% of rural schools have a private place for girls to change menstrual products, and only 12% of girls in Kenya are comfortable getting information from their parents (McMahon et al. 2011). More startling statistics also indicate that Menstruation is connected to more specific risks and gender inequality issues, with studies showing that 2 out of 3 rural girls in Kenya have obtained menstrual products from sexual partners, and 1 in 4 girls do not equate Menstruation with conception (McMahon et al. 2011).

While Kenya’s work highlights the problem, there is limited evidence connecting the impact of poor menstrual health, an expansive word for menarche and MHM, on critical outcomes (McMahon et al. 2011). Current studies involve small sample sizes and rely on retrospective, self-reported or empirical evidence, making it hard to generalize findings across different types of teenage populations and regions of different cultural and socioeconomic backgrounds (McMahon et al. 2011.)

Background Information

Among women and adolescents, menstrual hygiene management (MHM) is a primary health aspect during menarche and menopause. While in the menstruating age group, MHM is often overlooked in post-disaster responses (Korir, Okwara and Okumbe 2018.) Therefore, menstrual treatment is limited in humanitarian settings.

About 800 million women and girls around the world have their Menstrual periods each day. Yet, many face significant obstacles in handling their periods safely and in a dignified way (Korir et al., .2018). Women and girls require clean, private sanitation facilities in both home and public institutions, with easy access to water and handwashing stations, as well as a place for disposal of used menstrual products (Korir et al. 2018)

Menstrual health and hygiene (MHH) encompass all MHM and broader social aspects linked to wellbeing, gender equality, education, fairness, prosperity, and democracy. United Nations Educational, Scientific and Cultural Organization (UNESCO) summarized these structural factors as accurate and sufficient knowledge, available, safe and affordable services, qualified and comfortable professionals, referral and access to healthcare, sanitation, and washing facilities, positive social norms, health and hygiene, advocacy and regulation (Korir et al. 2018)

It also means creating and cultivating spaces in which girls feel valued instead of experiencing constraints, humiliation, and bullying. Building girl-friendly sanitation facilities (Korir et al. 2018) However, accessibility to menstrual products differ globally. Countries, for example, the USA, have broader access to these products, unlike developing countries e.g., Kenya still faces challenges in Menstrual Health Management. (MHM)

Problem description

Although Kenya has a growing evidence base on menstrual health and associated inequality, current data is sparse (Korir et al. 2018). Research has a small sample size and primarily focuses on observational self-reporting and simple data techniques, rendering generalizations, thus making it challenging to measure, considering Kenya’s overwhelming diversity of adolescent girls (Korir et al. .2018). Nonetheless, few studies quantified the impact of insufficient MHM on the wellbeing, development, and empowerment outcomes of Kenyan teenage girls and results are not statistically significant and mostly inconclusive.

Kenya also has a shortage of data documenting trends in menarche age. A small study in urban elementary schools found that 10% of girls had early menarche, where the rate of early menarche among girls with higher socioeconomic backgrounds had increased (Korir et al. 2018). In addition, the academic performance of girls who had undergone early menarche decreased by 54% compared to girls with a typical menarche period. There are early signs that a positive MHM climate influences girls’ risk-taking behavior in sexual and reproductive health (Korir et al. .2018)

In rural western Kenya, two-thirds of girls and young women between 13 and 29 years of age using sanitary pads reported receiving them from sexual partners (Korir et al. 2018.) There was a greater likelihood of getting pads if respondents had more than one sexual partner, placing girls at higher risk of HIV or unwanted pregnancy (Korir et al. 2018). The incidence of sex for money to purchase pads was highest among 15-year-old girls, with a six-fold higher likelihood of participating in this activity than older respondents.

Research in the same area showed that supplying sanitary pads and menstrual cups to 14–16-year-old adolescent girls’ in-school decreased STI prevalence and menstrual cups lowered the prevalence of bacterial vaginosis (Korir et al. 2018). Assumed causal links between MHM and educational outcomes, though, motivate innovation and MHM-related programmatic initiatives. Free Sanitary Towels Program of the Ministry of Education was established to enhance girls’ educational outcomes (Korir et al. .2018.)

The emerging study, however, showed that supplying teenage school girls with sanitary pads and menstrual cups had no significant impact on school dropout and no influence on self-reported school absenteeism (Korir et al. 2018). Anecdotal and limited observational studies suggest a correlation to empowerment outcomes like self-confidence, autonomy, and resource management. In rural western Kenya, girls reported surprise, frustration, embarrassment, and anxiety during menarche due to a lack of available and accurate information regarding early adolescence sexual maturation (Korir et al. 2018).

Currently, through menstrual health programming, Plan International USA seeks to ensure that girls and women can manage their periods confidently and comfortably. Their guiding principle is developing girl-friendly services in schools, health clinics, and neighborhoods. Women and girls often have no access to quality, hygienic menstrual hygiene items. The plan works to improve the availability, affordability, and range of menstrual hygiene products by partnering with social enterprises and private sectors to address Menstruation and menstrual-related challenges facing low-income women and girls. (Korir et al. 2018)

Despite the support from Governmental and Non-Governmental Organizations, Menstruation is still stigmatized through societies, and it is defined as something’ bad’ or’ impure’ and veiled in secrecy. Menstrual sexism was a common effect on women and girls. This said menstrual issues weren’t discussed openly, making it difficult to obtain accurate information or seek support (Girod, Ellis Andes, Freeman, and Caruso 2017). Negative menstrual behaviors were internalized and expressed through various concepts portrayed, including self-imposed requirements to hold menstrual status concealed, and guilt and anxiety at the possibility of revealing menses (Girod et al. 2017).

Restrictive gender roles, cultural perceptions, and social support have affected menstrual experiences (Girod et al. 2017). Perception of women as property and women’s and girls’ ‘positions throughout life as children, partners, and mothers with limited resource exposure and out-of-home care activities, engaging with more direct contributors of menstrual experience (Girod et al. 2017)

Communities uphold taboos and myths around Menstruation that limit the independence and behavior of girls during Menstruation (Girod et al. .2017). While these activities differ through regions and communities, common discriminatory practices involve claiming that menstruating women and girls are contaminated limits on the type of food they should consume (e.g., menstruating women cannot eat meat), and limited interaction between adolescent girls and males (Girod et al. .2017). The extent and degree to which taboos occur are partially determined by the provision of high-quality MHM education and awareness. Taboos play a stronger role in remote and rural areas. For starters, menstruating women and girls are not permitted in goat pens or milk cows in the semi-nomadic Masai area for fear of contaminating the product (Girod et al., .2017).

Although the Kenyan government mandates puberty education in schools, the program focuses primarily on biological rather than physiological improvements, including the hygienic use and disposal of sanitary pads (Girod et al., .2017). While some curricula use a gender equity perspective and explore power dynamics in intimate relationships, the program commonly used in public schools does not address these issues

While teachers are meant to be trained on how to deliver puberty education, studies have shown that teachers find the subject of Menstruation embarrassing to be discussed in a classroom setting and will often provide their specific point of view rather than the official curriculum (Girod et al. .2017). The research study found that teachers frequently miss puberty lessons as they have too many other required subjects to discuss and are expected to teach and prepare pupils on a variety of topics (e.g., how to use toilets). Experts suggest teachers may choose to skip puberty education because, unlike most other mandatory subjects, it is not tested, and thus less accountability exists.

Out – of-school girls and particularly vulnerable groups (e.g., HIV+) have been largely excluded from menstrual wellbeing and MHM programs (Girod et al., .2017). The Kenyan government, Non-governmental Organizations, and corporate partners have so far focused on providing MHM education and information and MHM products as a way to keep girls in school (Girod et al., .2017). Nonetheless, few projects concentrated on serving girls who have already dropped out of school, immigrant women and girls, or offering advanced reproductive health education and awareness for special needs people.

For starters, 75% of Garissa girls who have experienced female genital mutilation experience greater physical pain throughout their time due to narrow vaginal opening arising from infibulation; moreover, they do not provide advanced menstrual health education to help them handle their unique needs (Girod et al. .2017). Many primary ministries and NGOs focus on improving reproductive health education and awareness for adolescent girls in Kenya.

Political support from civil society, the government, the Ministry of Education and the Office of the Prime Minister has contributed to national recognition of the need for puberty education, teacher training and sanitation, and the allocation of additional funds to the Ministry of Education to execute the program (Girod et al. .2017). Small and medium-sized product companies seek to provide girls with primary education, but rarely include boys and do not address the psycho-social aspects of puberty and healthy sexual development.

Around a dozen, small and medium-sized social companies entered the market (e.g., Zana Africa, Huru International) with the primary goal of providing women and girls with high-quality, sustainable MHM goods (Girod et al. .2017). Via books, booklets, and in-person workshops, these groups extended services to promote pregnancy and menstrual health education (Girod et al., .2017). To date, their size and scope remain small in delivering educational programming and how well drug companies can provide puberty education.

Extensive menstrual health education and awareness programs are among the most popular solutions to resolving low MHM among women and girls; however, more personalized support systems are required for girls and their influencers (Girod et al. .2017). Larger corporate corporations (e.g., P&G) offer one-time puberty preparation, of uncertain long-term efficacy and effects. The Department of Education and smaller Organizations are working with schools to either actively introduce programs or educate teachers and facilitators. Based on the organization’s context and primary goal, the MHM curriculum will take multiple intervention strategies.

Policy Options

While addressing the policy options are policy implications, community, and national level are to be considered — provision of teaching and open discussion about Menstruation. Information about Menstruation is beneficial. It will be essential to provide training, especially in schools, so that girls can learn about Menstruation. Open up discussions will allow girls to openly talk about Menstruation and remove the stigma linked with it (Rees 2008).

Menstruation would be ‘normalized,’ and girls would see no reason to be absent from school. The various methods of handling menstruation would be mentioned, for instance, how to wear a sanitary pad, and this would provide facts on a wide variety of choices to pick from and thus enable a girl to make an informed decision on their personal hygiene (Rees 2008).

Information on how to deal with pain and discomfort during Menstruation should be provided.

Institutions should also offer counseling services concerning Menstruation. The counsellor could explore issues further with the girls. This would be an opportunity to answer ambiguous sex-related questions left to girls to explore by their own (Rees 2008). Initiating guiding and counseling clubs enable girls to meet and openly discuss challenges experienced with Menstruation and how to overcome them.

Use of Menstrual cups

This is a cup made of medical silicone latex that is inserted into the vagina to collect menstrual blood. It is an alternative to one-use sanitary pads and can be worn up to 6–12 hours depending on the amount of menstrual flow, so it needs to be removed and emptied less frequently (Rees 2008). They are recyclable and environment-friendly. It offers sustainable, practical, and cost-effective alternatives where sanitation conditions are not good. Menstrual cups are perceived negatively despite being cost-effective (Rees 2008). In a study conducted in Western Kenya, there was fear that the menstrual cup would encourage teenage sex or lesbianism (Rees 2008). The insertion of menstrual cup involves

touching genitals, and this was feared since it is likely to arouse a girl sexually hence encourage them to experiment with sex in teenage or lesbianism.

Use of Reusable pads

These are sanitary options that must be hygienically washed and dried in the sun. Drying them in the sun sterilizes them for future use. Since they are reusable, it is cost-effective, readily available, and eco-friendly (Rees 2008). They are to be stored in a clean place when not in use to avoid contamination. Uhuru Kenya is an international organization that provides these reusable pads to girls in schools and women in communities (Rees 2008). These pads are made in Kenya and are proof- leak, comfortable, and can last for 18 months (Rees 2008). Despite the reusable pads being cost-effective and environmentally friendly, studies show that schoolgirls prefer disposable pads, especially in rural schools where tapped water is inadequate.

Improving infrastructure in schools.

Menstruation related issues received attention from governmental organizations, multinational sponsors, and local non-governmental organizations that made efforts to address menstruation issues in Kenya (Walker 2015). This was achieved by awareness-raising puberty, providing free sanitary pads, and creating school facilities. The efforts have affected women and girls, especially in rural public schools. Nevertheless, the problems remain.

As it is shown in many studies that in rural schools, despite having separate gendered toilets, most of them do not have locks (Rees 2008). Taps are far from toilets, and besides that, fewer schools have soap to wash hands after using the restroom (Rees 2008). Constructing infrastructure in schools is necessary but cost-effective, and the government is to provide funds for the construction. This project is faced with the mismanagement of funds by school stakeholders.

Policy recommendations

Maintaining the status quo

The menstruation topic received attention from governmental organizations, multinational sponsors, and local non-governmental organizations who rendered efforts to address menstruation problems in Kenya (Walker 2015). This was achieved through disseminating puberty awareness, providing free sanitary pads, creating school facilities. Regardless of the efforts, low-income women and girls, especially those enrolled in rural public schools, still face the challenges of dealing with Menstruation.

HIV/AIDS money

HIV/AIDS was identified as one of the challenges hindering the country’s economic growth. To address this problem in Kenya, International Organizations, through the government of Kenya, has sought several ways to prevent the virus (Walker 2015). These methods used include using protection, such as condoms, freely given in schools and health centers, and other methods known to reduce the spread of HIV. This dropped the new HIV infections to nearly half by 2018. This implies that many people in the country know and understand ways on how to protect themselves from disease (Walker 2015). Since Menstruation is a biological process that women and girls cannot avoid; I recommend that some of the money allocated for HIV/AIDS in the country can be used to provide sanitary pads for girls in rural areas or use the funds to improve infrastructure to enable accessibility of sanitary pads in local shops for girls, this will cut the transportation cost to nearby towns to get menstrual products like sanitary pads. (Walker 2015). Manufacturing and retail companies should be lobbied to add the number of pads found in a packet so that they may last the end-user for a more extended period.

References

Girod, C., Ellis, A., Andes, K. L., Freeman, M. C., and Caruso, B. A. (December 01, 2017).

Physical, Social, and Political Inequities Constraining Girls’ Menstrual Management at Schools in Informal Settlements of Nairobi, Kenya. Journal of Urban Health: Journal of the New York Academy of Medicine, 94, 6, 835-846.

Korir, E., Okwara, F. N., and Okumbe, G. (January 01, 2018). Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: a cross sectional survey. The Pan African Medical Journal, 31, 7, 132-345.

McMahon, Shannon A, Winch, Peter J., Obure A. Bethany, Ogutu James, Ochari Emily

(2011). ‘The girl with her period is the one to hang her head’ Reflections on menstrual management among schoolgirls in rural Kenya. BioMed Central Ltd.

Rees, M. (2008). Problem solving in women’s health. Oxford Clinical Pub.

Walker, A. E. (2015). The menstrual cycle. London: Routledge.