The world is changing very fast. Water and sanitation have become a human right since 2010; there is more freedom to speak on gender issues than before. The world has recently reflected on the work done since 1990 to half the number of people without water and is happy that the milestone is achieved. Unfortunately, this has just revealed major disparities that exist in the WASH sector. Sanitation the sister MDG target to water is way behind schedule. 2.6 billion people in the world do not still have access to improved sanitation. Most of those still affected are women and children particularly girls. Linked with women and girls is the issue of menstruation which is a forgotten challenge to achieving improved access to sanitation particularly for women and girls.
Menstruation is a major part of life for millions of young girls and women worldwide. It is a normal, natural process that occurs in all healthy adolescent and adult women who haven’t reached menopause. Girls begin to menstruate normally between eight and twelve years. In the life time of a woman, she has to manage 3,000 days of menstruation. For her basics schooling period ranging from the fifth grade to the 12th or 13th grade the number of such days is 450[i]. According to UNICEF[ii], one in 10 school-age African girls stays home during her period or drops out entirely. In countries where menstrual hygiene is taboo, girls in puberty are typically absent for 20 percent of the school year. Nor is this quandary limited to adolescence; working women also lose productive time during their periods. And even women who attend classes and jobs despite a lack of access to sanitary protection often substitute materials such as bark, rags or mud, with detrimental health consequences. Women become prone to more infection if they do not maintain a proper hygiene during the time.
However, the needs and challenges faced by many young women and girls as they struggle to manage their menstrual hygiene are largely ignored, especially in Sub Saharan African communities. This situation persists despite new developments in the hygiene and sanitation sector in recent years.
Addressing this issue is complex and dynamic; there is so much secrecy about this issue. There is the embarrassment that prevents young girls and women sharing their questions, the shame often associated with menstruation, and the cruelty of people laughing at young girls and women when they find out they are menstruating. This situation gets even more complicated if young girls and women have to go to schools or other public places where there is no toilet or no hygienic toilet, no water and soap, and no facilities for disposal of materials.
A review of the menstrual-related evidence from African countries remains limited in terms of specific research conducted on menstrual hygiene and women linked with their rights to WASH. There exists a body of literature on topics that are more indirectly related to the question of menstrual- hygiene management but are few. Such research includes the literature on adolescent sexual and reproductive health (SRH), such as the school-based intervention explored by Plummer et al (2006) in Mwanza, Tanzania that provides insights into young people’s SRH beliefs and practices; the randomized health education intervention initiated by Mbizvo et al (1997) in Zimbabwe which provides evidence of the need for early school-based reproductive health education; and the mixed-methods research conducted by Munthali and Zulu (2007) in Malawi, exploring the timing and role of initiation rites in preparing young people for adolescence. All of these, and related studies, provide insights into gaps in girls’ SRH knowledge, and potential intervention approaches for enhancing existing knowledge.
From the work done so far on this issue, it is evident that menstrual hygiene management has long been taboo in many countries of Africa. Only a limited work has been done in Africa mainly in schools. Largely there is need to break the silence on the topic, work with women and girls more to ensure menstrual hygiene management needs are addressed through WASH programs. Available evidence on menstrual hygiene largely comes from Asia particularly India and Bangladesh. The African context has its own intricacies that are still largely unknown and secretive.
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