In rural Uganda, the topic of menstrual hygiene is often sidestepped in conversation. Whether the discussion is steered away by comic evasion or discarded as ‘women’s matters’, uncomfortable truths pertaining to mismanagement are avoided. During formative years of education, primary school girls experience this natural process in an environment that remains shrouded in secrecy. For many, this marks the beginning of a series of challenges that extend far beyond physical discomfort. Menstrual hygiene management (MHM) is often neglected, leading to significant psychological and social ramifications. The absence of adequate facilities and knowledge exacerbates these issues, fostering a fertile ground for stigma and absenteeism. As such, the trickle-down effects of poor MHM suggest that we cannot gender this information and more so that appropriate MHM could lend itself as good litmus paper for a well-equipped community.
Menstruation in rural Uganda is enveloped in secrecy and taboos, creating an environment where girls feel ashamed and isolated. This cultural backdrop perpetuates a cycle of ignorance and fear, as young girls lack the necessary information to manage their periods hygienically and confidently. The absence of open discussions about menstruation means that many girls resort to using improvised, unhygienic materials, increasing their risk of infections and other health issues. This secrecy is not a novel concept; it has been a longstanding issue in rural communities, further compounding the problem of menstrual-related otherness. This further begs the question whether exclusion of men and boys from menstrual management discussions heightens the issue?
Link Between MHM and School Attendance
One of the most pressing issues stemming from poor menstrual hygiene management is the high rate of absenteeism among primary school girls. When girls lack access to proper menstrual products and private spaces for changing, attending school becomes a daunting task. The fear of leaks, stains, and teasing from peers drives many to stay home during their periods. This absenteeism not only hampers their education but also undermines their self-esteem and overall well-being. Inadequate menstrual hygiene has been hypothesized to be linked to urinary tract infections which can cause significant discomfort, bothersome odour and unusual discharge.
The psychological ramifications of poor MHM on young girls cannot be overstated. The constant worry about odour, discharge, and the visibility of menstrual blood leads to significant stress and anxiety. These concerns are often exacerbated by societal attitudes that view menstruation as something dirty or shameful. The mental and societal confines that these girls experience are profound, affecting their ability to concentrate in class and engage fully in their education. The stigma surrounding menstruation also leads to exclusion from various activities, further isolating them from their peers and community. Additionally, the domino effect of urbanisation has seen manifestations in rural settings with tribal homogeneity and living as a community diminishing significantly. With growing numbers of single-mother households, single-father households, and nuclear families, the social Senga/ Shwenkazis[1] role is complicated. These further isolate young girls as discussions on sexuality and menstrual health are met with shyness with males and mothers, thus leaving the onus on Sengas.
The Knowledge Gap
Despite the importance of MHM, there is a significant gap in knowledge and education on this topic in rural Uganda. Many girls are unaware of basic genital care practices and the symptoms of urogenital infections. Current improvisations include using ebishaato[2] and dry skins to absorb menstrual blood, and sitting in sand basins as they leak. This lack of knowledge prevents them from seeking help or adopting proper hygiene practices. Educational interventions that cover topics such as hygiene, reproductive anatomy, and the menstrual cycle are crucial in equipping girls with information needed to manage their periods safely and confidently. Inclusive education that involves both boys and girls can help dismantle the stigma and foster a more supportive environment.
Furthermore, the importance of water, sanitation, and hygiene (WASH) services play a pivotal role in promoting menstrual hygiene management. In resource-poor communities, the absence of handwashing stations, private latrines, and access to water and soap exacerbates the challenges faced by menstruating girls. Such challenges include urogenital symptoms and odour which are aggravated by infrequent handwashing, unclean menstrual materials. Community planning and budgeting for proper WASH facilities are essential to create an environment where girls can manage their periods with dignity. These facilities not only support MHM but also help prevent communicable diseases and urogenital symptoms which benefiting the entire community.
MHM and Sustainability
The ripple effect of inadequate MHM extends beyond the individual, impacting broader societal goals. Poor menstrual hygiene undermines girls’ education and their educational outcomes, which in turn affects several Sustainable Development Goals (SDGs). These include Good Health and Well-Being (SDG 3), Inclusive and Equitable Quality Education (SDG 4), Gender Equality (SDG 5), Clean Water and Sanitation (SDG 6), as well as Decent Work and Economic Growth For All (SDG 8). Addressing the challenges of MHM is thus not only a matter of health and hygiene but also a critical component of sustainable development.
This incentive should propel local leaders to implement positive interventions that can significantly improve MHM in rural areas. Community-led initiatives such as reusable pad sewing sessions provide a sustainable and affordable solution for menstrual hygiene. These sessions can include comprehensive education on hygiene and puberty, reproductive health, self-defence, and care instructions for pads, that empower girls with the knowledge and skills they need. Additionally, involving community leaders and males in discussions about menstrual hygiene can help break down the barriers of stigma and misinformation.
Towards a Paradigm Shift
Menstrual hygiene management in rural Uganda is not merely a health issue; it is a matter of dignity, education, and equality. By breaking the silence and challenging the taboos surrounding menstruation, we can create a more inclusive and supportive environment for primary school girls. It is essential to rethink our approach, moving beyond simply what should be done to understanding how we can do it effectively and sustainably. Through community involvement, education, and improved WASH services, we can ensure that every girl has the opportunity to manage her menstruation confidently and continue her education without interruption. The journey towards achieving this goal, however, requires collective effort and a commitment to dismantling the mental and societal confines that have persisted for far too long.
[1] an aunt in Baganda & Banyankole culture
[2] a cloth material worn by Bakiga & Banyankole women of cow hides
Well written and informed article. Well done !