Menstruation is one of the single most commonly shared experiences among women of all races, religions, and ethnicities. Most women menstruate for an average of 40 years. Throughout those 40 years, each woman will use more than 11,000 sanitary pads and tampons, spending approximately $5,600 on those hygiene products.[1]
For a woman in a developed country like the United States, menstruation can be a significant financial burden and an inconvenience. For a woman in a developing country, however, menstruation can be an unbearable hardship that drastically affects her ability to attend school and, consequently, her opportunity for a better future. Access to education for girls in the developing world can be improved by increasing accessibility to sanitary products and increasing the number of girls’ school bathrooms with safe water and sanitation. Success can be measured by the decrease in rates of girls’ absenteeism from school, a decrease in the girls’ dropout rate at the secondary level, and an improvement in girls’ exam scores and academic performance.
Foundation for African Women Educationalists discovered in rural Uganda that a “culture of silence” surrounding menstruation resulted in it being ignored in families, schools, and communities.[2] Up until recently, even Western researchers have failed to acknowledge that menstruation could explain the significant discrepancy between primary and secondary school enrollment rates for girls in the developing world. In sub-Saharan Africa, 57% of all girls are enrolled in primary school. At the secondary level, however, this percentage drastically plummets to a mere 17%.
There are many factors that contribute to girls in developing countries dropping out of school. Some post-pubescent girls drop out of school because they gain additional household responsibilities, receive familial or societal pressure to get married, incur a premarital pregnancy, or suffer parental concerns about their safety at school (as mature girls are often targeted for sexual abuse or rape from male classmates and teachers). Additionally, some parents in the developing world may choose to channel limited funds toward the education of their sons, who have a greater chance of achieving financial success and supporting them in their old age.[3]
The beginning of menstruation, however, is a significant factor that is often ignored that undoubtedly affects secondary enrollment rates for girls in the developing world. In a 2011 study, many girls in Kenya stated that they preferred to experience their periods at home and viewed menstruation as “the most significant social stressor and barrier to schooling.”[4] In fact, according to the 2015 United Nations Children’s Fund, one in ten girls in Africa miss school days during her period, and some of those girls drop out entirely.[5]
It is unacceptable that in 2015 girls around the world are still being deprived of their right to education because of something as basic and human as menstrual health. The ignorance and inattention toward menstrual hygiene management is a blemish on the international community. Only once menstrual health is prioritized and addressed can we begin to dream of achieving universal secondary education and gender equality.
The first step that the international community must take to improve girls’ access to education is increasing accessibility to sanitary products. Millions of girls and women in the developing world can not afford the steep prices that come with purchasing disposable sanitary pads and tampons. To put it in perspective, sanitary pads in Kenya cost about 65 to 120 Kenyan schillings, which converts to roughly $0.79 to $1.45. This is an unaffordable price when many Kenyan families earn an average of only $1.00 a day, and those wages must cover all their basic needs.[6] As a result, Kenyan girls are forced to miss an average of 4.9 days of school a month.[7] The World Bank reports that if a girl misses four days of school every four weeks due to her period, she will miss 10-20% of her school days.[8]
If you can’t afford disposable sanitary products, the logical solution would be to do what women did for hundreds of years before Playtex and Always started mass producing feminine hygiene products: use reusable materials like cloth rags to soak up menstrual blood. The Kenyan NGO Kisumu Medical and Education Trust, however, reports that while some Kenyan girls use materials like cotton or wool as makeshift sanitary pads, those resources can still be considered expensive and inaccessible for families living below the poverty line. As a result, many will use alternatives like plastic bags, dried leaves, cow dung, and paper. These materials are often not properly sanitized, increase risk of infection, cause physical discomfort, and leak during the school day. School days are long in Kenya and many girls are unwilling to risk the public shaming and embarrassment that arises from leaking through their homemade pads and staining their uniforms.[9]
Even girls who do have feminine hygiene products or who use reusable resources still cannot attend school because their schools do not have private restrooms or proper sanitation where they can clean and change their sanitary products. Of the 30% of Nepalese girls who miss school due to menstruation, 41% do so because they do not have private school bathrooms for cleaning sanitary products.[10] 83% of girls in Burkina Faso and 77% of girls in Niger likewise do not have a school bathroom to change their sanitary materials.
Not having a sanitary bathroom during menstruation is a serious problem and can lead not only to embarrassment, but also detrimental long-term health concerns. In India, 70% of all reproductive diseases are caused by poor menstrual hygiene.[11] In 2010, girls in Tanzania reported that menstruation was particularly challenging due to structural sanitation difficulties within their schools. They advised improving latrines, water supply inside latrines, and cleaning equipment to help future girls trying to receive an education while navigating through menstruation.[12]
Critics have argued that girls in the developing world face an array of challenges and that menstruation is an insignificant, almost imperceivable factor. A study conducted in 2013 by the Adolescent Girls Empowerment Program would seem to confirm this argument at first glance. Of the 5,241 Zambian girls who were surveyed by the program on their school absenteeism, only 1% reported that their absence was related to menstruation. The number one reason, cited in 54% of responses, was illness.[13] In the 2014 study in Kenya, however, researchers found that while the “illness” response to absenteeism covered a wide range of sicknesses from malaria to gut infections, “illness” or “sickness” was often times being used as a euphemism for menstruation and menstrual cramps due to the embarrassment and stigma surrounding the monthly occurrence.[14]
It’s highly plausible that this phenomena of referring to menstruation as an “illness” skewed the results of the Zambian study as well. Consequent studies, including one by Anne Mutunda in 2013, have concluded that menstruation is a significant obstacle for girls’ education in Zambia. Mutunda wrote that the 51 girls in her study “had difficulties in maintaining proper standards of hygiene during menstruation due to inadequate water and poor and gender unfriendly facilities in the school.”[15]
The Ministry of Education Management Information Systems confirmed this observation when it estimated in 2008 that only 9% of the schools in Zambia met the World Health Organization’s standard pupil to toilet ratio, of 25 girls per toilet.[16] Mutunda’s study went on to say that the poor sanitation, coupled with gender discrimination, was “found to lead to poor menstrual hygiene and to contribute to girls’ poor school performance, as well as their high failure rates.”[17]
I identified menstrual hygiene as a significant challenge to Zambian girls’ education when I worked at Vision of Hope, a shelter for at-risk girls and women in Lusaka, Zambia, for a month over the summer. For a shelter that accommodates roughly 40 girls and women, menstrual hygiene management posed a significant challenge. The shelter was spending about 150-200 kwachas per month on disposable sanitary pads, roughly $20-26 USD. This was a significant chunk of their monthly budget. Often times, Vision of Hope could not afford to purchase sanitary pads for every menstruating woman, so the women would have to endure their period without sanitary materials. Not having sanitary materials during menstruation negatively affects a woman’s self-esteem and her mobility, as she may not be able to leave the house without fear of staining her clothing with menstrual blood. As a result, menstruation prevented the girls’ abilities to leave the shelter and attend school.
Poor academic performance and dropping out of school very significantly affects future opportunities for a woman and her ability to cease a cycle of poverty. When girls in Kenya must miss school days from menstruation, it “impedes their ability to compete in the classroom, leads to low self-esteem, higher dropout rates and, in many areas of Kenya, early marriage.”[18] After all, girls who complete secondary school are less likely to contract HIV/AIDs, contract malaria, die in pregnancy, or die in childbirth. They are more likely, however, to marry later, have higher incomes, have fewer children, have healthier children, educate their children, and escape poverty.[19] One additional year of primary education can increase a woman’s future earnings by 10-20%, while one additional year of secondary school can increase a woman’s future earnings by 15-25%. As a result, a 1% increase in women with a secondary education raises a country’s annual economic growth by 0.03%.[20]
Many nongovernmental organizations recognize the monumental importance of educating girls and how menstrual health plays a significant role in accessing that education. As a result, there have been good efforts to improve menstrual hygiene management in the developing world by increasing access to sanitary pad products.
AFRIpads, a Ugandan business, found that disposable pads were not the best practice in Uganda because the women could not afford them and because disposal systems could not handle the strain of all the thrown-out pads–two common obstacles to sanitary pad access in developing countries. To solve this, AFRIpads worked with Ugandan girls and women to create reusable sanitary pads from textiles that women can wash and use again for at least a year.[21]
At Vision of Hope, the shelter I worked at in Zambia, I co-founded an initiative along with two Northeastern students to produce reusable sanitary pads. After extensively researching the best model for a sanitary pad and creating prototypes ourselves, we taught the women at the shelter how to make sanitary pads using simple, inexpensive materials, like cotton and waterproof fabric, that we purchased at a local market. Each woman made multiple pads for each day of her period and we taught them how to take care of and clean the pads. If done correctly, the women could use their reusable sanitary pads for 3-5 years, which would significantly improve their mobility and ability to attend school. In addition, it promoted menstrual hygiene management and female empowerment by teaching the women a valuable, money-saving skill that they could use for a lifetime.
In addition to improving accessibility to sanitary products, many NGOs are also trying to improve accessibility to girls’ school bathrooms with proper water and sanitation. In a 2011 case study, researchers discovered that in Kenyan schools that weren’t affected by post-election violence, introducing proper water and sanitation decreased girls’ absenteeism by 58%. This effect on the absenteeism rate, however, was not reflected in the male population.[22] A conclusion from this study is that girls, upon gaining access to proper sanitation facilities, were able to attend school during their periods because they had a place to clean and change their sanitary products.
WaterAid helped bring water and sanitation to 176 schools in Tanzania. Prior to WaterAid’s initiative, Mpalanga Primary School, one of the biggest schools in the Dodoma district of Tanzania, had 1,022 students and only 10 pit latrines. Now, there are twenty unisex drop hole latrines, six urinals for girls, eight urinals for boys, and a changing room for menstrual hygiene management. According to the study, “girls have attended school more consistently and more frequently as the new facilities give them privacy and enable them to manage their menstrual hygiene.”[23]
Still, there is much more work to be done in the developing world to ensure that girls and women can practice proper menstrual hygiene management and receive an education. The education of women in the developing world has individual, national, and global implications. An educated woman can earn more money and receive better healthcare, ensuring a better future for herself, her children, and multiple generations after that, while breaking a longstanding cycle of poverty. In turn, the national economy improves and, as a result, the global economy and global efforts toward improved literacy, healthcare, and gender equality benefit as well. When girls must miss precious school days because they can not afford hygiene products or do not have access to sanitation facilities, their education suffers, their futures suffer and, ultimately, the world suffers.
References:
[1] Schumacher, Anna. “Women spend hundreds of extra dollars per year. Here’s one easy out.” Groundswell, November 5, 2014. http://groundswell.org/women-spend-hundreds-of-extra-dollars-per-year-heres-one-easy-out/
[2] Jewitt, Sarah and Ryley, Harriet. “It’s a girl thing: Menstruation, school attendance, spatial mobility, and wider gender inequalities in Kenya.” ScienceDirect, September 2014. http://www.sciencedirect.com/science/article/pii/S0016718514001638
[3] Sommer, Marni. “Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and school in Tanzania.” Journal of Adolescence, 2010. http://www.ncbi.nlm.nih.gov/pubmed/19395018
[4] McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A., and
Rehnigans, R.D. “The girl with the period is the one to hang her head: Reflections on menstrual management among schoolgirls in rural Kenya.” BMC International Health Human Rights, March 2012. http://www.ncbi.nlm.nih.gov/pubmed/21679414
[5] O’Hagan, Ellie Mae. “We need to talk about periods: Why is menstruation still holding girls back?” The Guardian, May 28, 2015. http://www.theguardian.com/global-developme nt-professionals-network/2015/may/28/we-need-to-talk-about-periods-why-is-menstruation-still-holding-girls-back
[6] Jewitt, Sarah and Ryley, Harriet. “It’s a girl thing: Menstruation, school attendance, spatial mobility, and wider gender inequalities in Kenya.” ScienceDirect, September 2014. http://www.sciencedirect.com/science/article/pii/S0016718514001638
[7] O’Hagan, Ellie Mae. “We need to talk about periods: Why is menstruation still holding girls back?” The Guardian, May 28, 2015. http://www.theguardian.com/global-developme nt-professionals-network/2015/may/28/we-need-to-talk-about-periods-why-is-menstruation-still-holding-girls-back
[8] Oster, Emily and Thornton, Rebecca. “Menstruation, sanitary products, and school attendance: evidence from a randomized evaluation.” Poverty Action Lab, January 2011. https://www.aeaweb.org/articles.php?doi=10.1257/app.3.1.91
[9] Jewitt, Sarah and Ryley, Harriet. “It’s a girl thing: Menstruation, school attendance, spatial mobility, and wider gender inequalities in Kenya.” ScienceDirect, September 2014. http://www.sciencedirect.com/science/article/pii/S0016718514001638
[10] Hyatt, Loren. “Menstruation matters: How periods are keeping girls out of school in Nepal.” Huffington Post, November 18, 2014. http://www.huffingtonpost.com/loren-hyatt/menstruation-matters-how-_b_6174442.html
[11] O’Hagan, Ellie Mae. “We need to talk about periods: Why is menstruation still holding girls back?” The Guardian, May 28, 2015. http://www.theguardian.com/global-developme nt-professionals-network/2015/may/28/we-need-to-talk-about-periods-why-is-menstruation-still-holding-girls-back
[12] Sommer, Marni. “Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and school in Tanzania.” Journal of Adolescence, 2010. http://www.ncbi.nlm.nih.gov/pubmed/19395018
[13] Calder, Rebecca. “Bloody myths: Why I don’t think sanitary pads impact girls’ educational outcomes.” Triple Pundit, July 30, 2015. http://www.triplepundit.com/2015/07/bloody-myths-why-i-dont-think-sanitary-pads-impact-girls-educational-outcomes/
[14] Jewitt, Sarah and Ryley, Harriet. “It’s a girl thing: Menstruation, school attendance, spatial mobility, and wider gender inequalities in Kenya.” ScienceDirect, September 2014. http://www.sciencedirect.com/science/article/pii/S0016718514001638
[15] Mutunda, Anne. “Factors impacting on the menstrual hygiene among school-going adolescent girls in Mongu District, Zambia.” University of the Western Cape, May 30, 2013. http://akros.com/downloads/papers/mutunda-study.pdf
[16] Shatunka, Matilda. “Menstrual hygiene management among girls in primary schools and its effect on school attendance.” SNV Netherlands Development Organization, Zambia, 2013. http://www.unicef.org/wash/schools/files/MHM_Booklet_Final_HR(3).pdf
[17] Mutunda, Anne. “Factors impacting on the menstrual hygiene among school-going adolescent girls in Mongu District, Zambia.” University of the Western Cape, May 30, 2013. http://akros.com/downloads/papers/mutunda-study.pdf
[18] Jewitt, Sarah and Ryley, Harriet. “It’s a girl thing: Menstruation, school attendance, spatial mobility, and wider gender inequalities in Kenya.” ScienceDirect, September 2014. http://www.sciencedirect.com/science/article/pii/S0016718514001638
[19] “Girls’ education challenge.” Education Innovations, 2012. http://www.educationinnovations.org/funder/girls-education-challenge
[20] Kibesaki, Aya. “Girls’ education.” Global Partnership, 2014. http://www.globalpartnership.org/focus-areas/girls-education
[21] O’Hagan, Ellie Mae. “We need to talk about periods: Why is menstruation still holding girls back?” The Guardian, May 28, 2015. http://www.theguardian.com/global-developme nt-professionals-network/2015/may/28/we-need-to-talk-about-periods-why-is-menstruation-still-holding-girls-back
[22] Freeman, M.C., Greene, L.E., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B., and Rhenigans, R. “Assessing the impact of a school-based water treatment, hygiene, and sanitation programme on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial.” Tropical Medical International Health, 2011. http://www.ncbi.nlm.nih.gov/pubmed/22175695
[23] Mengistu, B. “Her right to education: How water, sanitation, and hygiene in schools determines access to education for girls.” WaterAid, March 2013.
