According to UNICEF, one in 10 girls in Africa miss school because of their periods each year. This is particularly notable in Uganda, where an estimated 60 percent of young women are affected by period poverty. Ugandan girls can lose up to four days of schooling each month. This amounts to losing 24 out of 144 weeks of learning in four years of secondary school; girls become school leavers even while still attending school.
For many Ugandan girls, unmanaged menstruation and poor access to hygiene facilities rob them of their chance to get an education. Because of the stigma around menstruation, many girls do not understand what is happening to their bodies at the onset of puberty.
Furthermore, the cost of sanitary pads — roughly 2 USD — is very high. Unable to afford to purchase pads, girls may use rags, old carpets, or leaves to protect themselves during their periods. In the Karamoja region of Uganda, girls even sit on heaps of sand to care for themselves during daylight hours.
Ultimately, experts in this field argue that girls who drop out of school due to menstruation are at higher risk of becoming pregnant or marrying early.
Introducing Africa Well Able (AWA)
In 2016 a group of Mastercard Foundation Scholars Program alumni from BRAC Uganda and the Forum for African Women Educationalists (FAWE), and graduates of the Jinja School of Nursing and Midwifery formed Africa Well Able (AWA), led by Tumuhairwe Derrick, a public health nurse and BRAC alum.
AWA has a simple mission: "To equip young people with skills that will help them to live a self-sustainable life even when they do not have a chance to finish school." They have the ambitious goal of providing two million girls with sexual reproductive health education, with a focus on destigmatizing menstruation.
Research in Uganda suggests stigma around menstruation is the cause of about 22 percent of girls dropping out of school, with poverty being an added factor.
Founder Tumuhairwe Derrick explains further:
"In Uganda, many parents are living below the poverty line. And that means they cannot afford day-to-day materials to sustain their lives. And if they cannot buy food then where are they going to get money to buy the pads? And many of these pads are very expensive in market. Many of them do not even want to talk about the subject [menstruation]. Because they do not even have the money to facilitate the whole process. So girls are left in [a] space that when they get these other symptoms that come along with menstruation [back pain, cramps, headaches wondering] 'why are we even going to school when we are cursed?'"
AWA helps break the stigma by going into schools and teaching girls and boys about menstruation: what it is, what it is not, and how to manage it. Derrick views this work as a form of medical care, protecting young people before they can become patients. They provide menstruation hygiene management modules and age-appropriate sexual reproductive health education. AWA also offers a pad-making workshop, career guidance, and entrepreneurship skills training.
Working in the Central and Eastern regions of Uganda, Derrick and his operations manager Nazziwa Jovia consult with regional District Education Officers (DEOs)using annual statistics to identify schools with declining enrollment due to teenage pregnancy, early marriages, and poor academic test scores. They then approach the headmistress at those schools and request permission to set up an AWA health club.
At AWA health clubs, students learn about menstruation and sexual reproductive health for the first time. As Tumuhairwe Derrick explains: "We are talking about menstruation, of course, it will be a shy topic, a very, very shy topic, it's stigmatized, and people fear talking about it. So, we make it a very friendly topic for people, where we laugh. We start with what is puberty, what is that transition between childhood to adulthood, what other signs someone will experience."
The AWA team uses games, songs, and quizzes to build trust and rapport with the students. Participation is rewarded with sweets and small gifts. By the fourth week, when the topic of menstruation is introduced, students are more at ease and keen to speak about it. Many in the club may know that periods are normal but because topic is associated with stigma this is the first time they can discuss it openly.
One of the consequences of this stigmatization is bullying, which can have a devastating impact on a girls' self-esteem and academic success. Classmates wrongly assume that a girl with blood on her dress has had premarital sex or an abortion. Without accurate information or access to pads, a girl may drop out because she is either told to stay home or she is embarrassed and ashamed. Some girls get pregnant, not knowing they can do so while they are on their period. In Uganda, one in four young women aged 15-19 are already mothers or pregnant with their first child. Here, understanding menstruation can be life-changing. Teenage childbearing decreases with increased education: 35% of young women with no education have begun childbearing, compared to 11% of young women with more than secondary education.
AWA teaches girls about proper hygiene while menstruating, and exercises to help relieve their discomfort. Both boys and girls learn how to sew reusable sanitary pads, that they can either use themselves or sell to make money. Christine, a teacher in Jinja sees the difference AWA has made in her classroom: "The coming of Africa Well Able in our school has helped us to retain and maintain our girls in the school," said Christine, a teacher in Jinja. "They are hygienically okay. They put on clean pads. They have been taught how to wash [them]. How to dry them up. So the girls are now staying in school."
Social norms and poverty explain in part why taboos and myths around menstruation prevail. Parents may be reluctant to bring up periods either because they don't know the right terms to use or worry that they are introducing the topic of sexual reproductive health too early. To support parents, who may struggle to talk to their children about sexually reproductive health or lack the resources to support them, AWA routinely organizes regular forums, designed specifically for parents and community members where they can ask questions and hear what their children are learning in the health clubs. According to Tumuhairwe Derrick these forums have helped parents build stronger relationships with their sons and daughters.
Back in School Following Her Dreams
Thirteen-year-old Muhaye Zerida was at school the first time she got her period. Afraid that she was cursed or sick, she went home and asked her mother what was happening to her. She was relieved to learn that menstruation was normal. But the high cost of sanitary pads meant going without [it] during her period. The embarrassment she felt affected her self-esteem. She recalls, "My first day that I came to school when I had my period, I felt very ashamed because my friends could laugh at me. I can't sit together with them because they just go to another desk because they are seeing blood on my dress."
Zerida did what many girls who can't afford pads do, and used old clothes, sometimes from the rubbish pit. She was often sick as a result. Always a good student, her grades slipped, as did her confidence. Ashamed to come to school and unable to pay school fees, she was eventually taken out of school by her mother.
Stories like Muhaye Zerida's may be common but there are just as many teachers willing to advocate on behalf of their students. When her teacher learned that money for pads was keeping her student out of the classroom, she turned to AWA, who offered Zerida a scholarship covering the costs of school fees and lunches.
Pivoting to address the Pandemic
When the COVID-19 pandemic closed all the schools in Uganda in March 2020, Derrick and his team quickly began to provide COVID-19 safety information; make masks, soap, and sanitizer; drop off school lessons for students staying at home; and provide antenatal and psycho-social support to a growing number of pregnant girls.
Between March and June 2020, Uganda was under a full lockdown that devastated the communities AWA supports. Unable to earn an income, families struggled to buy food and necessities. People felt frustrated and suspicious, and many believed COVID-19 was something political. As respected healthcare workers, AWA was able to work directly with these communities and use the goodwill they had earned to provide accurate and reliable information on how to prevent COVID-19.
Muhaye Zerida became an ambassador for AWA, using her knowledge and skills to support her family and keep others safe. About her role, she said, "We went to villages, neighbourhoods to teach them about menstrual hygiene and how we can be safe. We didn't teach them about menstrual hygiene only but also taught them about hygienic practices that can prevent the spread of COVID-19 such as making liquid soap for hand washing."
She teamed up with Sarah, another AWA ambassador living on Buvuma Island. Before the pandemic, Birungi Sarah was teaching her friends in the village how to make their own reusable pads. AWA gave Birungi Sarah a sewing machine which she used to start sewing reusable face masks. "From the masks we made, we freely gave some to our friends, teachers, and sold others to make money. I sent some masks to my friend Muhaye Zerida. She also gave some to her friends and sold the others so that we share the profits and survive in COVID," said Birungi Sarah.
"With the money that I get I use it when I am going back to school, like buying books, buying pens and even I give some to my parents when there's something that they want to buy. Even when schools closed, Africa Well Able continued supporting us," said Muhaye Zerida.
The pandemic led to an increase in the number of teenage pregnancies in the towns and villages where AWA works. Many of these girls felt ashamed and were afraid to go to the hospital or mix with older women for fear of being stigmatized. AWA provided young moms with pyscho-social support and advice on how to stay healthy. They handed out "mama kits" stocked with gloves and sanitizer wipes to ensure a safe, clean delivery. After they had given birth, AWA provided the girls with milk and small stipends to help them in their early days. During the pandemic AWA supported 240 girls through their pregnancies.
[WATCH VIDEO: AWA providing support to young mothers]
Mastercard Foundation Scholars Program
The Mastercard Foundation believes that all young people, no matter their starting point in life, should have an equal chance to obtain a quality education and pursue their aspirations. The Scholars Program seeks to make this a reality for bright, young people with a demonstrated commitment to giving back to their communities. Through a network of universities and non-governmental organizations, the Scholars Program ensures that high potential students, including those from marginalized communities including young women, refugees and internally displaced persons, and those living with disabilities are equipped with the knowledge and skills they need to become the next generation of ethical African leaders.