Why should menstruation be an embarrassing experience?

It's healthy. It is normal. Actually, if a woman or girl is not having this monthly natural flow of blood, then, you should worry.

Last week was Menstrual Hygiene Day under the theme ‘Education about Menstruation Changes Everything'. Young girls in Uganda are yearning for that time when they will easily walk to daddy or their male guardian and ask for pads or express their discomfort that usually comes with menstruation.

The sight of young boys of Achilet Primary School in Rubongi Sub County, Tororo district, making sanitary pads in an April story in New Vision was just one of hope. The devotion with which the boys were seen to be executing this role was just heart-warming.

The senior woman teacher Louisa Wankya explained how most of the girls were using pieces of cloth and dry leaves to soak up their menstrual blood. Since these could not hold the blood for long, many girls would stain their uniforms and that meant not returning to school due to the embarrassment and teasing from the boys.

"We were desperate. We tried involving the parents regarding the stigma, but many were uncooperative. We decided to introduce menstruation lessons in our debates. Boys would debate with girls on issues that affected them," Wankya noted.

Traditionally, menstruation is a woman's world. It's the mothers and female others that are expected to talk about menstruation. But what happens to single fathers? The girls live in the same environment as the boy, so who prepares the boys on how to react when a girl accidentally stains their dress or uniform?

"Seeing a girl with a dress red stained is fun to young boys. They will laugh and make all kinds of jokes about it. This is not only embarrassing for the girl but eventually keeps them out of school," explains Hellen Omoji of World Vision.

In Uganda, 1 out of 2 girls report missing one to three days of school per month due to menstruation.

But why should it be shameful to go through a process that makes one a normal woman?

Most of the interventions for menstrual hygiene management in schools have been found to primarily target girl students and female teachers. Yet, one of the critical challenges girls face at school in relation to menstruation is the fear of being teased by boys. This impacts their self-esteem.

"Boys make you feel ashamed. They are rough with us and go into our bags and would see our cloths if we brought them to school," said one girl.

There is just a lot of ignorance around menstruation. As explained by adolescent counsellor and team leader at Raising Teenagers Uganda, Hope Nankunda, parents and teachers don't want to talk about menstruation.

Education as the theme suggests, Nankunda says should occur in the different environments that the girl lives. This has to be for the boys and men as well.  

A 2014 United Nations Educational Scientific and Cultural Organisation's technical paper highlighted that teachers, particularly men, may not be adequately sensitized to girls' needs and therefore may not allow girls to visit the toilets, and may misinterpret girls' lack of participation in class during menstruation.

"Male teachers need to be informed and confident regarding menstruation and menstrual hygiene so that they can support female students and create a less stigmatizing environment at school. This is particularly important as there are far fewer female teachers in secondary schools in developing countries," read the paper.

As a single father, Rotarian John Bigyema, has had to deliberately make menstruation a household issue and not just the girls issue.

"Sanitary pads are always on my shopping list and even when it's the boys going out to do shopping, I have made them learn that they can buy pads for their sisters as well," he says.

Menstruation he argues is ‘not a woman's issue but it is an issue period'. That therefore means that everyone is supposed to contribute towards making girls have a smooth time when having their menstrual periods.

Reusable sanitary pads have provided relief to low income families.

"Boys must be deliberately mainstreamed in the issues of menstruation. We cannot afford to have another generation of men and husbands that frown at the sound of the word menstruation," Bigyema advises.

The parent as Nankunda explains doesn't have to wait for when the girl actually starts her periods. However, the information needs to be introduced to the children in an age appropriate manner.

"Children are starting their periods as early as nine years. They are unprepared and end up falling victim of this ignorance," she says.

Girls need to be helped to understand what the different stages of life present to them and how they can respond.

In a 2017 ‘Mapping the Knowledge and Understanding of Menarche, Menstrual Hygiene and Menstrual Health among Adolescent Girls in Low and Middle-Income Countries' by Venkatraman Chandra-Mouli and Sheila Vipul Patel, it was found that girls in many low and middle-income countries (LMIC) enter puberty with knowledge gaps and misconceptions about menstruation.

According to the study, girls are usually unprepared to cope with it and are unsure of when and where to seek help. This is because the adults around them, including parents and teachers, are themselves ill-informed and uncomfortable discussing sexuality, reproduction and menstruation.

As the researchers found out, far too many girls across the low and middle income countries are struggling with nearly complete ignorance of their normal biological maturation and its consequences, and when they do receive education, still struggle with inadequate sanitary materials and insufficient physical and emotional support.

In the absence of disposal sanitary pads

Despite the increasing campaigns to fundraise for sanitary pads by different individuals and organization, this can help as many girls.

Most girls from poor families are made more vulnerable to school dropout and teenage pregnancy due to lack of sanitary towels. An average of sh5000 a month for disposable sanitary pads is not only unaffordable but also unsustainable for most families. But even then it's not a priority.

Empowering school communities with skills to make reusable sanitary pads has as argued by Omoji been found to be more sustainable for cash constrained families.

"We need to help teachers, both male and female on how they can help their students, girls and boys on how to make reusable sanitary pads. This not only creates a strong social support system but is sustainable," she says.

As explained by the experts, no one should be left behind when it comes to menstrual health management.

"There has to be an inclusive approach where men and boys are equal partners. The involvement of men and boys through creating spaces for open dialogue enables them to appreciate menstrual hygiene management," says Omoji.

The biggest gap in the menstrual hygiene education has been the absence of men and boys. This is a critical component that must be addressed at the different levels-home, community and school.

Checklist for a conducive school environment for menstrual hygiene

• Clean toilet facilities along with water and soap
• Orient the school management and teachers on menstrual health management.
• Sanitary towel disposal facilities
• Let the boys be part of every initiative.