On May 28, the world marked the annual ‘Menstrual Hygiene Day’ under the theme, ‘No More Limits’. It is an awareness day to highlight the importance of good menstrual hygiene management, and an opportunity to address the plight of many girls around the world who do not have access to sanitary pads.

In some parts of the world, menstruation is ‘offensive’ and with this, girls are faced with a number of obstacles that not only affect them socially, but academically as well. Very many girls around the world also still struggle to get access to sanitary pads.

Statistics from UNICEF indicate that an estimated 1 out of 4 girls miss school every month because of menses.

In Rwanda, though a number of challenges still prevail, achievements have been registered regarding this issue.

Lydia Mitali, the officer in charge of Girl Education at the Ministry of Education, says the ministry has a budget line to support girls’ access to sanitary pads in nine and 12 year basic education.

"The Government, through the Ministry of Education, created the budget line for this; they find out how many girls a particular school has and then they provide money through the district for sanitary pads which are supplied. This was put in place to end absenteeism,” Mitali explains.

"The Girl’s Room” (Icyumba cy’umukobwa) initiative in schools, on the other hand, is making a huge impact on the lives of girls in school.

The room offers a safe space for girls to address any menstruation related issue. It is equipped with sanitary pads, towels, pain killers, a bed, water, and soap, among other things.

Mitali says that this initiative is making a difference, especially regarding performance.

"Before, the biggest issue was absenteeism. Girls would skip school due to stigma, they would stay home for that period but now, because they know they have a changing room nearby and have access to hygiene facilities, they come to school even in their period. This environment is friendlier,”  he says.

Why it is still a problem?

Julian Ingabire, the country director of Child Resource Institute, says menstruation, which is indicative of sexual progress of the female, is associated with negativity in several societies, sometimes requiring isolation as well as prohibition from engaging in normal daily activities.

She notes the issue of hygiene which poses health risks.

"Absence of appropriate sanitary materials to absorb menstrual flow does not only affect a female’s reproductive health, but her acquisition of education. However, many women and girls cannot consistently afford the monthly cost of menstrual products and revert to less hygienic solutions and poor hygiene practices,” Ingabire says.

Appropriate selection, use and disposal of sanitary materials as well as adequate body cleaning with soap, and seeking a suitable diet during menstruation, ensure good menstrual hygiene, she says.

"There is no doubt that a girl who remains in school will be more knowledgeable about menstrual hygiene which will also safeguard her health,” she adds.

Ingabire goes on to explain that it is critical for any programme aiming at support women or girls with sanitary protection material to involve them in the planning process and decision making about the materials and/or products to be supplied.

There are examples of small-scale local enterprises manufacturing low-cost pads. However, continuity and sustainability of supply is still a problem, she says.

Supporting low-cost local production offers a more sustainable solution than free provision of menstrual hygiene products, Ingabire says. Some ventures fail due to problems that include lack of standardisation, packaging, high production costs and high affordable raw material, as well as tax-free pads.

According to the initiatives in place, it’s mostly girls in school who benefit, leaving the ones out of school in an unfavourable positon.

Andrew Ndahiro, a gender activist and programmes manager at Rwanda Women Network, believes that catering for girls out of school as well isn’t a bad idea, but to some extent, it might encourage school drop outs.

"This is because if they can access all those services out of school they wouldn’t be motivated to go to school, yet what the government wants is for them to be in school,” Ndahiro says.

He, however, says that availing cheaper sanitary pads is another option for those who don’t have access to free sanitary pads.

"Rwanda Women Network has safe spaces in different parts of the country, we have a partnership and we use our volunteers to distribute the pads that are made out of organic materials and a packet is Rwf500. This makes access easy.”

Why a healthy menstrual state is important for girls

Ndahiro says that with safe spaces, women and girls have someone they can confide in. "I think a major issue for girls when buying pads is that they can’t get them from a place that is ‘private’.”

He says that one of the benefits of women having a healthy menstrual routine is the fact that they are able to build confidence, which in turn helps them be productive in society.

18-year-old Anna Murekatete, a senior five student, says that when a girl finds comfort in her period, her concentration in class improves, which improves her performance.

"For example, now that we have access to all sanitary equipment for our menstrual periods, it makes life easy knowing that you will do away with the bad odour and be able to maintain a good hygiene,” she says.

24-year-old Erina Mulisa says a woman who has good hygiene and access to sanitary pads makes menstruation a bit more bearable regardless of the pain and discomfort associated with it.

"A woman who has no tools to deal with her menstrual period shies away from the public and this affects her socially.  It would be fair if all women have access to sanitary pads,” Mulisa says.

How menstruation affects women’s health

A study conducted by Lena Marions, an associate professor in obstetrics and gynaecology and senior lecturer at the department of clinical science and education Karolinska Institute, revealed that about one third of over 1,500 women interviewed about their period aged 40 to 45, said they have heavy bleeding. Women who bleed a lot describe a reduced quality of life; where almost a quarter refrain from social activities because of bleeding, according to the study. Over 90 per cent of these women find the bleeding to be bothersome and a higher percentage feel shabby. Furthermore, 16 per cent of the women with heavy bleeding report that they are off sick from work due to this, some providing figures between six and 10 days per year. Even women who describe their bleeding as "normal” are affected, which was about 40 per cent of the study participants. Of these, about two per cent refrain from social activities and many are home from work for up to five days per year because of the bleeding. Nearly eight out of 10 women with normal bleeding find their period to be bothersome and even more say it makes them feel shabby. Besides messiness and practical problems, heavy bleeding can result in an iron deficiency. This in turn causes fatigue. Yet only one in four women with heavy bleeding have sought care.

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