New Perspectives on Menstruation from Menstrual Health Management Trainers in the Rorya District
It was Maji Safi Group’s pleasure to provide a one-week Menstrual Hygiene Management (MHM) seminar to our partners in the Rorya District to expand awareness and education about this vital subject in the Lake Zone of Tanzania. A very big thank you to our two wonderful facilitators, Water Supply and Sanitation Collaborative Council (WSSCC) trainer Ms. Dhahia Mbaga (East Africa WASH specialist and MHM trainer) and Mr. Steven Kiberiti (career health promotion specialist and national MHM trainer)!
Menstrual Health Management (MHM) is now debated worldwide, including in countries like Tanzania, as an important aspect of public health, as a basic human right, and as a development issue. While the Millennium Development Goals (MDGs) did not make any reference to MHM, the Sustainable Development Goals (SDGs) do so – at least indirectly – under Goal 3 (Good Health and Well-being); Goal 4 (Quality Education); Goal 5 (Gender Equality); Goal 6 (Clean water and Sanitation); Goal 8 (Decent Work and Economic Growth); Goal 10 (Reducing Inequalities); Goal 11 (Sustainable Cities and Communities); Goal 12 (Responsible Consumption and Production); and Goal 17 (Partnering for Goals). The United Republic of Tanzania (URT) is one of the countries that agreed to the implementation of the SDG development agenda in September 2015 and prioritized it in terms of gender equality strategies and the improvement of access to basic human services under the National Five-Year Development Plan (2016/2017–2020/2021). MHM is a crosscutting issue that involves a number of sectors in the development agenda, especially water, sanitation, environment, education, health, industry, information and communication. If the service provisions are improved in all sectors aforementioned, menstruating women and girls will have access to clean menstrual hygiene materials, access to private and convenient toilet facilities with water and soap for cleaning their bodies, access to washing and drying their reusable pads discreetly, and access to disposing of used menstrual products safely in designated containers. In addition, the existence of good healthcare facilities with competent health professionals will ensure that menstruating women with complications are served appropriately to guarantee their well-being and good health outcomes.
Despite tremendous MHM work done in Tanzania by MHM stakeholders, including development partners on training, continued advocacy work with policy makers, open dialogue to abandon certain socio-cultural norms that discriminate against adolescent girls and women during menstruation, information sharing, and exchange on progress made so far on MHM in this country, there are still challenges in terms of reaching all peripheral regions in Tanzania, especially the Mara Region. It is for this reasons that Maji Safi Group (MSG) in the Rorya District of the Mara Region, a member of the Tanzania MHM Stakeholders Coalition Group, requested two consultants, Dhahia R. Mbaga, WASH specialist and Senior MHM Trainer, and Stephen Kiberiti, Health Promotion Specialist and MHM Trainer, to facilitate an MHM Trainers of Trainers (ToT) workshop for its staff and their working partners to support the implementation of the new MHM program in the Rorya District. The training focused on a holistic MHM approach with three main components: Breaking the silence, managing menstruation hygienically, and finding solutions to safely reusing and disposing of feminine hygiene products.
The training took place in Shirati, Tanzania, April 1-5, 2019. It brought together 66 participants (21 men and 45 women) from the Rorya District Council, Department of Health, Education and Community Development Office, teachers from secondary and primary schools, health workers from hospitals in Shirati, local entrepreneurs from the private sector, staff from Maji Safi Group (MSG), and other non-government organizations working in partnership with MSG in the Rorya District.
The new cohort of 66 National MHM Trainers of Trainers (ToT) joins two other groups that were trained from 2017 to 2018 with funding from the Water Supply Sanitation and Collaborative Council. Involved were: representatives from NGOs and CSOs, the education sector, the health sector, the water sector, members of parliament, participants from higher learning and research institutions, the private sector, media, and people living with disabilities. It is expected that the trained MHM ToTs will pass on the training obtained to their respective workplaces, i.e. districts, wards, neighborhoods, health centers, schools, faith-based organizations and congregations, local entrepreneur groups, youth groups in Shirati, and individual households.
The MHM ToT training objectives were:
- to create a cohort of trainers with knowledge and skills on inclusive WASH and MHM, who in turn will train others in workplaces, districts, wards, neighborhoods, and health centers as well as teachers, students, and peers;
- to gain knowledge and skills to address the challenges on Menstrual Health Management based on different training modules presented and visual aids used for training;
- to provide the opportunity for participants to bring positive changes, equity and non-discrimination to access to water, sanitation and hand washing to promote menstrual health management in the community;
- to support the Government of Tanzania with the implementation of National Health Policy, National WASH guidelines and other policies with strong links to MHM to ensure safe, sustainable and inclusive sanitation and hygiene for women, men, girls, boys and vulnerable groups; and to support government and partners in providing sustainable, inclusive MHM education with consideration of equity and non-discrimination to vulnerable and marginalized groups by changing mind sets at the national level.
Lessons Learned from the Training
The lessons learned from the MHM ToT Training were:
- The training was organized around a three-pronged approach: breaking the silence, safe and hygienic management, and the safe and hygienic disposal and reuse of feminine hygiene products. It was key to address the dignity of both women and girls and secure positive health outcomes in the Rorya District.
- The strategic step of engaging male participants was crucial for breaking the silence as fathers and brothers in the society need to understand that menstruating women and girls have needs that require additional resources to allow for hygienic management, access to menstrual products, and sanitation facilities that can accommodate female needs during menstruation.
- The strategic engagement of both male and female youths in the training was a step further in the Rorya District in terms of creating change agents on breaking the silence on menstruation and seeing it as a natural process, similar to wet dreams for adolescent boys, and therefore supporting adolescent girls during menstruation.
- Lack of appropriate information on menstrual management to adolescent girls prior to menstruation and delegation of parenting to aunties and grandmothers do not promote an enabling environment for girls to be open about menstruation.
- It is important to address gender inequalities in water and sanitation to ensure access to water services and user-friendly sanitation designs that can accommodate all age groups, are inclusive to people with disabilities, and can fulfil the needs of menstruating women and girls.
- Descriptions of first menstruation experiences shared during the training were associated with feelings of embarrassment, discomfort, shame and confusion, and they were characterized by pre-conceived notions of menstruation by peers and socio-cultural beliefs. We envision that with appropriate menstrual hygiene management education – both before and after the onset of menstruation – adolescent girls will change their perception of menstruation.
- Menstruation is still surrounded by myths, taboos, silence and secrecy across various cultures in Tanzania, especially Luo, Haya, Hehe, Kerewe, Simbiti, Kurya, Chaga and Sukuma, so there is a need to demystify those menstruation-related myths and taboos that compromise the dignity, well-being and safety of women and girls.
- During the training, it was noted that menstruating women and girls make diverse choices of menstrual products, including commercial products. However, the traditional reusable pads are widely used, so with support from Maji Safi Group, there could be a good business opportunity for a trained female entrepreneur group to make reusable pads that are safe for menstruating women and girls.
- It is important for Maji Safi Group to keep strengthening the collaboration with the District Council to mainstream Menstrual Health Management in district development plans and spread further training to other departments in the district, wards, schools, workplaces, institutions and among out-of-school youths.
- Evaluation carried out at the end of the training revealed that the Menstrual Hygiene Management Lab was the best tool and most liked by participants. In lieu of that, MSG could consider purchasing a mobile MHM Lab Tent that could be set up during Global Water Week, Toilet Day, MHM Day, national events, workshops, conferences, community meetings and market days. The MHM Lab could engage a large number of participants in a short period of time and provide an opportunity to transform menstruation issues from shame to pride.