Menstrual Hygiene Management

It was 1968 when I started my period, and I was only 12. At that point in time, menstruation and sexuality were not surrounded by total silence in my rural corner of Denmark, but our mothers were not exactly chirping out information about budding teenage sexual desires and menstrual cycles. Menstrual hygiene management was focused on educational factors, however, many of that occurred beyond the household. We read books, heard about it from older sisters, girl-chatted among peers, and felt the vibes from the feminists who were burning bras, going to nudist island camps with their sisters, and championing the flower-power attitude towards sex. But without a doubt, the schools deserve most of the credit for educating us and keeping us safe from teenage pregnancies.

In Denmark, schools are not only meant to ensure academic qualifications, but they also play an important ‘civilizing role’ in that they are expected to provide the opportunity for all children to grow up as harmonious, happy, and genuine people for whom it is natural to consider other people’s welfare (Laura Gilliam and Eva Gulløv, Making children ‘social’: Civilising institutions in the Danish welfare state, Human Figuration, Feb. 2014). Source

Part of this paradigm is giving all students a profound knowledge of their bodies, respectful sexual relations, reproductive justice, STIs, contraceptives, and yes, basic information on vital menstrual hygiene management. Feeling a little bit awkward and mighty curious, we started sex education in sixth grade, and it was made very clear that teenage pregnancies reflected utmost stupidity and irresponsible behavior as we now had the knowledge to avoid them. I think my generation of teenagers – boys and girls – was the first to have the privilege of being empowered to control our own reproductive lives and understand the intricacies of desire, consent, and sexuality – the first generation of teenagers that was not told to abstain from having sex, but instead enjoy it responsibly, so our young lives, careers and dreams for the future would not be derailed by unwanted pregnancies or emotionally scarring abortions. Instead, we would be part of building a strong self, strong family, strong community, and a strong country.

DEFINITION: Teenage pregnancy or teenage childbearing is when a girl aged 15-19 is pregnant with her first child or gives birth.

Denmark’s sex education curriculum and even menstrual hygiene management are now among the most progressive in the world, so much so that the sixth week of the school year is dedicated entirely to all things sex and relationships. ‘Sex week’ — a play on the Danish homonym for ‘six’ and ‘sex’ — provides progressive and ambitious sex education to hundreds of thousands of young people. It is run by Sex & Samfund (Sex & Society), a non-profit dedicated to improving sex education in Denmark. And it works! Source.

This graph clearly shows how drastically the number of teenage births (Teenagefødsler) has decreased since 1973, and the teenage pregnancy and abortion rates are very low as well compared to most other places, including the US and many European countries.

 

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In 2017, only 474 children were born to teenage mothers in Denmark. The number of teenage pregnancies was, however, higher as some teenage girls chose abortion. In addition, the morning-after pill and pregnancy tests are available for over-the-counter purchase and very instrumental for early discovery of and prevention of pregnancy.

In the US, the birth rate has fallen dramatically over time as well.

 

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In 2017, the CDC reported that a total of 194,377 babies were born to women aged 15–19 years, for a birth rate of 18.8 per 1,000 women in this age group.  This is another record low for U.S. teens and a drop of 7% from 2016. Birth rates fell 10% for women aged 15–17 years and 6% for women aged 18–19 years.

menstrual hygiene management

The situation is very different in Tanzania. It has the 17th highest adolescent fertility rate in Africa, and according to the United Nations Fund for Population Activities, teenage pregnancy has increased 4% since 2010. In 2016, statistics showed that one in four teenage girls aged 15-19 had begun childbearing. In the Mara Region, where Maji Safi Group works, teenage childbearing is at a whopping 37%. Source

The many drivers and consequences of teenage pregnancy seem to be hopelessly intertwined protagonists in a vicious cycle, and their relevance to Tanzania seems taken straight out of a textbook: low education attainment, poverty (often resulting in transactional sex/prostitution), limited economic opportunities, gender inequality, male-dominated social norms, child marriage, and a dire lack of youth-friendly sexual and reproductive health services. It is also a huge problem in Tanzania that teenage mothers are not allowed to reenter the school system after giving birth.

When Maji Safi Group started working in Shirati in the Mara Region of Tanzania in 2012, menstruation was a taboo subject, and the access to female hygiene products and appropriate school bathrooms was so limited that menstruation contributed greatly to school absences and girls failing to succeed in school. We have helped change that!

Thanks to funding from private donors and grants from Beyond Our Borders and Dining for Women, we have built a nationally recognized Menstrual Hygiene Management (MHM) program that has taught thousands of girls about their bodies, puberty, menstruation, healthy relationships, etc., given them access to feminine hygiene products (pads, tampons and menstrual cups), and enabled them to look to our Community Health Educators as mentors with whom they can freely discuss and celebrate being young women.

Maji Safi Group’s approach is echoed in Tara Culp-Ressler’s suggestions of five simple strategies to reduce teen pregnancies:
1. Teach teenagers comprehensive sex education from middle school up.
2. Target messages to both teen boys and teen girls.
3. Involve the whole community.
4. Make contraceptives (especially condoms) widely available.
5. Encourage mentoring to create open discussion of sexuality and contraception.
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We teach both boys and girls at primary and secondary schools throughout the Rorya District. We involve the whole community by broadcasting shows about MHM on area radio stations.

We use singing, dancing, and street theatre to teach at large community events and our Dining for Female Hygiene get-togethers.
We paint community murals to educate all generations about MHM.

Through classes and Female Hygiene Health Clubs, our Community Health Educators mentor our students and encourage candid discussions of menstruation, healthy relationships, etc.

We give girls access to female hygiene products: reusable pad, tampons, and menstrual cups.

We refer people wishing to obtain contraceptives to the Shirati KMT Hospital in hopes that they will overcome old-fashioned cultural norms.

We are a member of the national Task Force on Menstrual Hygiene Management and attend many regional and national conferences.

We are having a profound impact on the MHM landscape in Tanzania, but it is a marathon, and we have not crossed the finish line yet! The ultimate goal is to create systemic change, so a progressive, comprehensive sex education program becomes a permanent component in all Tanzanian schools.

Maji Safi Group will continue to work towards that goal – because all young people should have the knowledge to control their own reproductive lives and fulfill their dreams.

menstrual movements tanzania

Period Poverty in Tanzania

Maji Safi Group seeks to empower young women in Tanzania to reach their full potential and see them become strong leaders in their communities. However, one of the main obstacles to the educational and professional growth of these young women is the traditionally taboo subject of menstruation. Period poverty in Tanzania affects many women and girls who don’t have access to safe, hygienic sanitary products, and who are unable to manage their periods due to community stigma.

PERIOD POVERTY IN TANZANIA STATISTICS

In 2018, Tanzania’s government reported that 60% of women live in “absolute poverty.”

According to UNICEF, 27% of those living in the least developed countries like Tanzania lack access to sanitation services like a handwashing facility with water and soap at home. Managing periods is a major challenge. As a result, 85% of girls are forced to use unhygienic solutions, including using strips of cloth which can spread fungi and infection. 

Other important figures include:

  • Water facilities not available in 38% of Tanzanian schools
  • Water facilities are not operational in 46% of the cases
  • 63% of school latrines don’t have a place to dispose of sanitary pads

As of 2018, only 44.2 percent of schools in Tanzania had teachers trained on WASH issues, with only 50.8 percent of those teachers providing some type of feminine hygiene products to young girls. Maji Safi Group is committed to helping end these barriers to proper feminine hygiene. But first, we must seek to understand the available resource options and the issues with making them available for these women.

SCHOOLING ISSUES DUE TO PERIOD POVERTY IN TANZANIA 

Due to the shame associated with menstruation, girls often isolate themselves at home during menstruation, even missing school. Promoting menstrual health with information helps to break the silence surrounding period poverty in Tanzania. According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), about one in ten African teenage girls in remote areas miss school during their menstruation cycle and eventually drop out due to issues that surround period poverty.

While most Tanzanians face water, sanitation, and hygiene (WASH) issues, there are specific struggles for women surrounding feminine hygiene. Especially in rural communities, menstruation is often surrounded by silence, leading to a lack of education and resources. Millions of girls know very little about their bodies and what happens when they menstruate. There is also a severe lack of access to proper sanitary materials, and available resources are often costly. The lack of resources often forces girls to use many unsanitary options such as leaves, pieces of a mattress filling, or used cloth.

Schools are an important setting when it comes to menstrual hygiene because of the lack of safe and private toilets, clean water for sanitation, and affordable and safe hygiene products prevents girls from safely managing their menstruation. This forces them to chronically miss school and sometimes drop out completely. As a result, these young women face long-term socio-economic and educational effects and sometimes teen pregnancy or social exclusion.

According to a 2015 study by TAWASANET Menstruation Health Management, the majority of girl students – or about 62% – miss school due physical illness that results from menstruation. In most cases, these young women miss between 1-3 days of class.

As of 2018, only 44.2 percent of schools in Tanzania had teachers trained on WASH issues, with only 50.8 percent of those teachers providing some type of feminine hygiene products to young girls. Maji Safi Group is committed to helping end these barriers to proper feminine hygiene. But first, we must seek to understand the available resource options and the issues with making them available for these women.

IMPORTANCE OF FEMALE HYGIENE

Period poverty in Tanzania generally refers to the inaccessibility women have to basic necessities when it comes to their menstrual cycles. Unfortunately, menstrual practices are still clouded by taboos and socio-cultural restrictions. As a result, adolescent girls remain ignorant of the scientific facts and hygienic health practices, which lead to adverse health effects. 

To combat these prevalent issues, organizations like Maji Safi are taking intentional strides toward the development and acceptance of female hygiene

There are bacteria that naturally accumulate around the time of menstruation. Women and young girls are susceptible to infections during this time. For example, when there’s an imbalance of bacteria, females may experience infections like bacterial vaginosis, which can require antibiotic treatment. Unfortunately, due to the issue of poverty, many women in the Tanzania region are unable to acquire such medicine and often succumb to other illnesses. 

Measure to take to ensure proper female hygiene include:

  • Changing period protection regularly
  • Washing to maintain health
  • Disposing of period products hygienically

Unfortunately, period poverty in Tanzania also means that many young women don’t have access to these types of practices. Maji Safi Group is working to address these common occurrences through products that promote general female hygiene. Options can be found below.

Disposable Pads: These are the most accessible hygiene products for women, but they are also the most expensive over time. Many families do not see the need for them, so it can be hard for girls to convince their families to make the purchase every month. The proper disposal of pads is also a barrier. The pads are often put into pit latrines, causing the latrines to fill up quickly and have a shortened life span.

Reusable Pads: These are harder to find but more cost-effective because they can last for a year or two. One barrier with reusable pads is where to dry them. Since menstruation remains such a taboo subject, many do not want these drying openly for others to see. Washing and sanitizing reusable pads also poses a problem due to the lack of clean water.

Tampons: These can be very difficult to find even in urban areas. When they can be found, the barrier women face is twofold: tampons have a high cost monetarily and culturally. Since they are so rare, supply chains charge a high price for tampons, especially in Tanzania. They are also not accepted culturally because of insertion.

Menstrual Cups: These are a great economical option for women. Menstrual cups last 3-5 years. Even though they may be expensive initially, they are a better option over time than disposable or reusable pads. Rural areas have a difficult time getting access to menstrual cups, and there are risks involved if a sterile water source is not available for cleaning. Menstrual cups also face the cultural barrier of having to be inserted.

Moving Forward: Addressing Period Poverty in Tanzania

Maji Safi Group is committed to providing proper education and access to resources surrounding feminine hygiene. One way we are accomplishing these goals is through Feminine Hygiene Groups where girls age 11-18 meet in after-school groups to learn about hygiene, health, and puberty. Participants in these groups receive reusable sanitary products, such as reusable menstrual pads and menstrual cups.

MSG’s Menstrual Hygiene Program is recognized as a founding member of the nationwide menstrual hygiene management coalition in Tanzania. The coalition is committed to improving the supply chain of menstrual products, educating girls and women on feminine hygiene, and breaking the silence of the barriers women face during menstruation. The young women in our programs have bright futures as leaders and change-makers, breaking stigmas and barriers surrounding menstruation and not letting this natural process keep them from reaching their goals any longer.