Sylvia Egar was 13 years old in 2017 when she started her period for the first time. Her mother had never discussed the menstrual cycle with her, so she thought the painful, bloody discharge meant she was going to die. When her mother returned from the market later that evening and heard what had happened, she and a friend explained what having a period meant, they then bought sanitary pads for Sylvia and showed her how to use them.
“When it started, I felt messed up… I was irritated seeing blood coming from my private area,” Sylvia said with a grimace.
At 15, unlike most girls her age, Sylvia who lives in the heavily populated suburb of Mabushi in Abuja isn’t shy to talk about her menstrual cycle. She is now quite comfortable with the idea of having one. A challenge, however, is that she can’t afford to buy sanitary pads every month. When this happens, she is forced to use an old piece of cloth as a makeshift pad. This is very uncomfortable as it doesn’t provide the protection that a cotton pad offers.
“While in the classroom (during my period), I either kneel or stand, to avoid getting stained. And whenever my friends ask me to sit, I tell them I prefer to kneel down,” Sylvia said. She doesn’t like the fact that she lies to her classmates, but she says she does that to keep them from feeling sorry for her.
The dire state of menstrual health in Nigeria
Nigeria is one of the many countries where menstrual products are taxed, putting further strain on women and girls from underprivileged communities. A major constraint to effective menstrual hygiene management is the high cost of sanitary pads which cost an average of N471.90 ($1.30) per pack.
While the sub-Saharan African sanitary pad market is projected to reach $ 779 million (N282bn) by year 2022, creating what has become known as “period poverty”. An estimated 87 million Nigerians live in extreme poverty according to the World Poverty Clock. But a total population of 120 million people is projected to live under 1.09 $ per day by 2030, if the current trend continues.
A 2016 report released by WaterAid Nigeria on Menstrual Health Management (MHM) reports deeply rooted negative attitudes and myths about menstruation in parts of Nigeria, including an erroneous belief that a menstruating woman or girl carries bad luck and should not be allowed in public gatherings.
The United Nations Children’s Fund (UNICEF) in its 2015 study in three Nigerian states — Katsina, Anambra and Osun — revealed that menstruating school girls face great discomfort during their menstrual period. They often experience anxiety, abdominal pain and cramps, nausea and vomiting, dizziness, and a loss of appetite. As a result, many of the girls miss classes and even when they manage to attend, they are distracted.
The research revealed that school Water, Sanitation and Hygiene (WASH) facilities were inadequate for menstrual management; up to 41.7% of toilets had functional locks with just 25% of the schools having handwashing basins and soaps. Most of the toilets or latrines were dirty with broken doors and poor ventilation, and none of the schools met the World Health Organisation (WHO) standard of pupil to toilet ratio.
Bose Ironsi, Founder and Executive Director of Women’s Rights and Health Project, a nonprofit promoting reproductive health, rights and development for women and girls across Nigeria, says access to sanitary products is a woman’s right. “A poor woman with heavy flow will have to manage to use one sanitary pad a day, to cut cost,” she said, adding, “This creates room for irritation that causes itching and would lead to bacteria, and then an infection, which may lead to other reproductive health complications.”
Reshaping the menstrual health narrative for girls in the FCT
Pad Up Africa, an Abuja-based NGO that focuses on empowering women and girls with menstrual products and information, is working to break the culture in some rural communities where menstruation is associated with religious and cultural taboos. They are also addressing women’s menstrual hygiene challenges with a Triple A approach on menstrual health — Access, Awareness and Affordability. Pad Up Africa has reached 11,084 adolescent girls and teenagers within the FCT with a total of 11,084 sanitary pads and over 400 pieces of underwear. Fifteen-year Sylvia is one of the beneficiaries.
Last year, Sylvia met the NGO during its PantToHold outreach in her school -- Government Senior Secondary School, Mabushi, where most of the toilets are in a deplorable condition, with no pipe borne water. Thanks to the sensitisation and awareness campaign by the organisation on menstrual health hygiene management with some free PantsToHold pads, she can now use sanitary pads without being helped by her mother who used to explain the techniques of wearing sanitary towels and how to clean up during her menstrual period.
PantToHold is a menstrual campaign programme through which Pad Up Africa sensitises and supports teenage girls by providing basic reproductive health education and donations of free sanitary pads. In July this year, it partnered with Sshhh Lingerie Boutique, a ladies underwear outfit, to provide free underwear, tights and brassieres for school girls who cannot afford them.
"During this sensitisation, we give them some underwear and after talking to them about menstrual hygiene, we give them some forms to fill and give their opinion towards alternative sanitary pads." said Ashley Lori, Founder and Executive Director of Pad Up Africa. She has a personal story of what it was like to experience her period for the first time without knowing anything about it.
Before going out on an outreach, Lori and her team first visit the community they hope to impact to carry out a needs assessment survey. She said they encounter several challenges in trying to educate women. "When we go into some communities to sensitise the women, the men practically stand with us and we are not free to talk because we could see that the women couldn't express themselves." Lori said.
As a result, Pad Up Africa developed a menstrual kit -- a small handbag that holds sanitary pads, a book for documenting the menstrual cycle, a clean pair of underwear, a shaving stick and toilet soap for washing of hands after changing of pad.
"With this, more men including boys, in urban and rural areas, have come to understand that menstruation is a normal and natural occurrence... They now understand the importance and equality of both genders and help them win together." Lori said.
Through their sensitisation visits and menstrual kit, PantToHold and CoverHerStain -- programs introduced by the NGO, are helping to change the conversation around the taboos and stigma often associated with menstruation.
Thanks to their work in a Fulani community in Gwarimpa, Abuja, where there was low awareness, access and affordability, many of the women are now empowered to speak about issues they were most afraid to discuss -- menstrual sanitation, lack of access to toilets and water-related issues.
In the past, thirty-year-old Rabbi used leaves and rags during her monthly period but, after the sensitisation and support provided by Pad Up Africa, she now knows how to use sanitary pads.
"Unlike before when I used to have stains with odor, my husband no longer knows when I am on my periods, but the challenge is that the market in Gwarimpa village is too far from us." Rabbi said, adding, "I am now passing the message on to my daughters who need to learn about menstrual hygiene."
Olachi and her team are now working to empower women in rural communities in Bayelsa State in southern Nigeria, teaching them to manufacture and sell reusable sanitary pads. If this works, it will be one sustainable way of improving menstrual hygiene, providing stable employment, and building a trusted network. They are however constrained by limited funds.
Beyond Hygiene: Improving outcomes for the girl-child in Africa
In Tanzania where education is free, 75% of the girls miss school during their monthly period; on the average, they miss five days of school a month — about six weeks of learning in a session. An education-based approach called The Twaweza Program introduced by Femme International, an NGO using education and conversation to dislodge menstrual taboos, is helping many school girls access menstrual health products and remain in school.
The program provides beneficiaries with a comprehensive education about their personal health, and gives them the tools to manage their bodies safely. Every beneficiary of the Twaweza Program receives a Femme Kit — which includes a reusable menstrual product: either reusable pads or a menstrual cup, as well as other aspects of reproductive health and empowerment.
In Kenya, the government in 2017 enacted menstrual health into its educational program. The policy states that menstrual health should be part of the curriculum, and there has to be a distribution of period products to primary school girls of menstruating age, with access to water, hygienic and suitable sanitation facilities.
For every Sylvia and Rabbi, there are many other women and girls in Nigeria’s capital who are unable to carry on their daily activities because they lack access to menstrual health products, services, and knowledge. NGOs like Pad Up Africa are helping to change this narrative. The FCT Administration should take a critical look at the cultural, sexual and reproductive health barriers that stop girls in underserved communities in Abuja from staying in school and design interventions that will empower them with the right information. So that they can gain a complete education and contribute their quota to building a great nation.