Menstrual health: Breaking the silence on menstrual struggle

I ask a colleague in Nairobi: “Why should we care about menstruation?”

“As a father, whether I like it or not, I have to provide my daughter with pads. That is my responsibility. As to other concerns of why we should care, I don’t know,” he responds.

I pose the same question to Emily Chebet who lives in Eldoret, Uasin Gishu County. She says: “It's unfortunate that many girls have been sexually violated for lack of sanitary towels. We should care about menstruation because it is a fundamental aspect of reproductive health rights and gender equality issue.

"Different societies hold different social and cultural views around it. Sometimes it is associated with stigma, which can impact individuals negatively. We should have much needed conversations around it to challenge harmful norms.

“Sometimes issues such as conflict and poverty limit access to menstrual health rights. It is critical, therefore, that we ensure access to products, facilities and information.”

Last December when doing a story on the mental health of teenage mothers, I interviewed a 17-year-old whom I named Esther. She told me one of the reasons she got into early marriage is the need for sanitary towels, among other necessities.

The mixed understanding and experiences of the Kenyans aforementioned expose the public’s little awareness of period poverty and the trickle-down effect of lack of pads, with Esther mirroring that reality.

The Journal of Global Health Reports defines period poverty as a lack of access to menstrual products, hygiene facilities, waste management, and education.

Also read: Uhuru bag tampon: Tale of period poverty among street women

Sadly, this lack leaves women and girls with physical, mental, and emotional challenges, according to the United Nations (UN) Population Fund—the UN’s sexual and reproductive health agency.

In Kenya, only 46.1 per cent of women report having menstrual hygiene materials they need to manage menstruation, going by a 2016 study by Performance Monitoring for Action. This year, the world marks Menstrual Hygiene Day under the theme: ‘Making menstruation a normal fact of life by 2030’.

Why normal?

On Tuesday, Sicily Kariuki, who formerly served in three ministries as Cabinet Secretary (CS), put this into context: “A woman in Kibra cannot go out to work because she is on her menses. But she has to work to feed her children, so she decides to use unclean pieces of mattress. This leads to a urinary tract infection. Then she uses all the income to treat the infection and in the meanwhile, stay off work to heal.

“And since her children have no food, the son resorts to mugging people and the daughter engages in transactional sex. You see?” she says, in an interview on Kenya’s progress in addressing period poverty.

“We cannot talk about periods as a standalone issue. This is an issue that affects other aspects of a woman or girl’s life. Consider school going girls; it’s an absolute injustice when girls miss school because of menses while the boys continue learning.”

Data from the Ministry of Education indicates that a girl in primary school loses 18 learning weeks out of 108 weeks in a year during her menses.
As a CS for Public Service, Youth and Gender Affairs between 2015 and 2018, Ms Kariuki was faced with a hard-hitting reality.

Conversations focused on women’s economic empowerment, leadership and the two-thirds gender principle. But those on addressing period poverty were “hush hush”.

“There were barriers that exist to date. Period is taken to be a taboo such that the discussions around it are limited to the private space. That should not be the case,” she said.

“Age-appropriate information on menstrual hygiene should be accessible in schools, churches and the media. Every leader in public or private space, villages, churches, and journalists like you have a role to play to end the stigma associated with periods.”

In 2015, Guttmacher Institute conducted a study of sexuality education in Nairobi, Mombasa and Homa Bay counties. It found that 86 per cent of adolescents attended primary school. Of these, 96 per cent received some level of sexuality education in school. But more than two-thirds wished they had more information and hours dedicated to sexual education topics.

Statistics

While Alexander Kelly and others established, in their 2014 study, that 50 per cent of Kenyan women and girls openly discuss menstruation at home, only 12 per cent of the girls were comfortable receiving menstrual information from their mother.

Nevertheless, Kenya has shown the will to address period poverty. In May 2020, the Ministry of Health launched the Menstrual Hygiene Management Policy (2019-30). The framework has Ms Kariuki’s signature on it. She served as Health CS, but the policy was rolled out four months after her redeployment to the Ministry of Water, Sanitation and Irrigation by then President Uhuru Kenyatta.

When she got to the Health docket in 2018, Ms Kariuki said talks on establishing the policy had already started. She catapulted them by establishing a technical team to draft the policy.

She said by the second quarter of 2019, the policy was ready. She took it through Cabinet approval upon which she appended her signature. But just before she would officially launch it, she was moved to the Water, Sanitation and Irrigation ministry in January 2020. “I lost a moment to push for the implementation of the policy,” she says.

One of the five targets set out in the policy is the government’s commitment to ensuring water, sanitation and hygiene facilities are provided in all households, learning institutions, public places,  workplaces, and healthcare and correctional facilities. Ms Kariuki says little has been done to actualise the policy.

“This policy anticipated an overarching national taskforce to ensure seamless implementation of the recommendations. That has yet to happen,” she said. “I really urge the government to activate the interventions that were anticipated in that policy.”

In 2004, Kenya repealed its Value Added Tax (VAT) on pads and tampons to lower the prices of the menstrual products. Seven years later, it launched a sanitary towels programme managed by the Ministry of Education through which vulnerable girls would be supplied with sanitary towels.

In 2016, the Treasury, through parliamentary approval, removed 16 per cent VAT and 25 per cent excise duty on raw materials used to manufacture sanitary towels.

In the 2017/18 financial year, the programme was moved to the Ministry of Public and Gender Affairs, only for it to be moved back to the Education ministry in late 2019, following hiccups in tendering and distribution.

Further in 2017, Mr Kenyatta assented to the Basic Education (Amendment) Bill. Section 39(k) of the Act requires the government to “provide free, sufficient and quality sanitary towels to every girl child registered and enrolled in a public basic education institution who has reached puberty and provide a safe and environmentally sound mechanism for disposal of the sanitary towels”.

But the government has been reducing budgetary allocations to the sanitary towels programme. For instance, in the 2012/13 financial year, Sh300 million was set aside for the programme. This amount was reduced to Sh30 million in 2013/14.

In 2017/18, the programme was allocated Sh470 million. The following financial year, the budget was further reduced to Sh260 million.

Also read: Battle with period pains and hope for cure at last

The decline in allocation is the reason for Yasmin Nassur’s online petition pushing for increased funding for the programme. She is the founder of Superb, an organisation that advocates menstrual equity for girls in the informal settlements.

She started the petition in 2022 and, so far, has collected more than 5,000 signatures. She hopes to reach at least one million for it “to attract the attention of the government and legislators”.

“We get a lot of requests from girls in public school, which means they are not getting enough from the school, yet there is a law that mandates the government to supply them with the pads,” she says.

The programme has also been hit with integrity questions. Auditor General Nancy Gathungu queried the State Department’s payment of Sh104 million for the purchase of sanitary towels for public schools in the 2019/20 financial year.

Ms Gathungu noted irregularities, saying no document was provided to support payment, which was for pending bills brought forward from the previous fiscal period.

Rising costs of pads

Since 2004, when the tax on pads and tampons was lifted, the prices of the menstrual products have sharply risen. For instance, in 2020, a pack of seven to 10 pads sold for an average of Sh50 in major supermarkets. In 2022, the cost hit Sh80. Now, they retail at Sh85.

Ms Kariuki sees a solution to the high cost of menstrual products in the private sector - investing in affordable alternatives.

“We can have more of the reusable pads, although their use will be appropriate to women and girls who have access to adequate and reliable water,” she says.

Providing affordable pads isn’t enough. They need water to clean themselves as well as a private and safe environment to change and dispose of disposable sanitary towels.

Available figures show a huge gap in access to the menstrual hygiene infrastructure.

According to the World Bank, by 2015, only 30 per cent of Kenyans had access to improved sanitation facilities. There were, however, regional disparities, with those in rural Northern Kenya having the least access at 15 per cent compared to 99 per cent in Nairobi.

In my interaction with women in Turkana last year, I discovered that women have to compete for water with herders. This is after walking for more than 10 kilometres to the boreholes.

They also said they showered at the borehole as the water they carried home was limited to drinking and cooking. Drought worsens the situation, and they have to reuse soiled dried shawls.

Conflicts

Conflicts, too, including cattle rustling, complicate women’s and girls’ access to the necessities. The fights push them far from latrines, boreholes and shops where they can buy pads. Lack of latrines have led to closure of schools, yet this is where girls are expected to change the pads and dispose of them.

Last January, Ogada Primary School in South Kabuoch Ward, Homa Bay County, was closed for lack of proper and adequate latrines for the more than 400 learners. The existing ones were already filled up.

In the slums, it’s a triple tragedy, as the women have to spend an extra Sh5 or Sh10 to buy water to clean themselves—money that is rarely available because of low incomes or joblessness.

The latrines are either shared or located at a distance, where there is no proper lighting for the girls and women to feel secure, especially at night.

In less than a year, the country has witnessed interesting events exposing legislators' lacklustre attitude towards menstrual dignity.

In October last year when the National Assembly Committee on Appointment rejected the nomination of Peninah Malonza for being unable to manage the Tourism, Wildlife, and Heritage docket, South Mugirango Member of Parliament defended her on weird grounds.

Silvanos Osoro claimed Ms Malonza may have failed the interview because she was on her menses. No study has proved that women’s cognitive ability is diminished when they are menstruating.

Again, last February, nominated Senator Gloria Orwoba was ejected from the chambers for having soiled her suit. And it was her fellow woman nominated senator, Tabitha Mutinda, who first alerted the house to her situation and even criticised her.

In a subsequent interview with Nation.Africa, Ms Orwoba indicated that she had drafted a sanitary towels provision bill. She did not, however, immediately respond to our query on the progress of the proposed legislation.

Meanwhile, Busia County will host this year’s commemoration of the Menstrual Hygiene Day marked on Sunday (May 28). The main event will, however, be held on Tuesday at Busia Vocational Training Centre in Matayos, county executive member for health and sanitation, Beatrice Nakholi, confirmed.
The county will engage in sensitisation caravans in the run-up to the event, she said.

Ms Nakholi added that they plan to create awareness of the role of men in addressing period poverty.

In an earlier interview, Mary Makokha—director of Rural Education and Economic Enhancement Programme, a women and girls’ rights organisation based in Busia County—said boda boda riders, truck drivers and caretakers took advantage of girls who needed money to buy pads. She said the girls got as little as Sh50 in exchange for sex.

Last March, Governor Paul Otuoma indicated plans to engage the private sector to provide affordable sanitary towels to women and girls. He was not immediately available to speak with Nation.Africa.

As the world marks Menstrual Hygiene Day on Sunday, Ms Nassur remains worried about the government’s lack of commitment to addressing period poverty. She notes that many girls are left with no choice but to engage in transactional sex to afford necessities, pads included.

“It's unfortunate our government has not prioritised period poverty. Many girls in informal settlements or rural areas can’t afford pads. This is an urgent issue that needs immediate attention,” she says.

[email protected]