Drowned out: The importance of menstrual hygiene management in achieving the SDGs

 

Figure 1 showing: Sustainable Development Goals 

To carry on the conversation of taboos from my last blog, let's talk about taboos of menstruation. In many countries in Africa, cultural perceptions surrounding menstruation commonly associate it with evil spirits and perceive women in their menstrual cycles as 'unclean'. This is why in Southern Nigeria, women and girls are forbidden to go to certain streams or rivers during their time of the month for fear of cursing the water. The same taboo exists in other countries including Zimbabwe, Rwanda and Congo (Akpabio & Takara, 2014). Cultural myths and taboos have created a stigma around menstruation, forcing girls and women to experience shame and embarrassment, and further placing emphasis on the need to maintain secrecy (Pouramin et al., 2020). The stigmatisation of menstruation has as a result, hindered the ability for females to practice healthy menstrual hygiene management (MHM) and has allowed poor sanitation practices to persist amongst women and girls. 

You may be wondering why I am talking about menstruation in a water and sanitation blog. To put it simply, Sustainable Development Goals (SDG 6) of achieving access to adequate sanitation and hygiene for all, will not be met until menstrual hygiene management is recognised as a crucial sanitation-related issue (See Figure 1). Let me explain why. SDG 6 aims to ensure the 'availability and sustainable management of water and sanitation for all', which includes 'paying special attention to the needs of women and girls and those in vulnerable situations' (UN Women, 2015). The limitation to this goal, however, is that the 'needs' are not clearly stated and there is no particular mention of menstruation.  

But what actually is MHM and why is it so important? Menstrual Hygiene Management (MHM) is 'the ability to manage menstruation safely and confidently' (Anjum et al., 2019). This includes making sure girls have access to information, clean water and sanitation products for hygiene, facilities for proper disposal and to resources for menstrual management (i.e. clean pads etc.). I have, however, identified two areas that have prevented females from practicing safe MHM. 

Lack of information about MHM

In a study done by Mason et al. in the Gem District in Nairobi, Kenya, it wasn't common for girls to have knowledge of menstruation prior to experiencing it (Mason et al. 2013) This lack of information shared about menstruation often stems from stigmatisation, which has turned it into a taboo subject that is dealt with at the individual level. Girls are therefore insufficiently informed on safe menstrual management, leaving them with the emotional burden of feeling shame, low self-esteem and feeling the need to hide during menstruation. Menstrual stigma has consequently forced girls to miss 10%-20% days of school worldwide (World Bank, 2005). Research has also demonstrated that the lack of preparation around menstruation and puberty leaves girls more vulnerable to unsafe sexual practices, leading to more earlier pregnancies (White, 2012). This reason has been directly associated with the key cause of schoolgirl drop-outs in high school being for reproductive and sexual health reasons (Hargreaves et al., 2008).

Lack of sanitary products

The same study also showed there was a lack of adequate sanitary protection such as clean pads (see Figure 2), forcing many girls to improvise with inappropriate resources including bedding (materials from mattresses), unclean cloths and leaves (Mason et al., 2013). Using unsafe sanitary products has proven to cause Urinary or Reproductive (UTIs or RTIs) 3 times more often than when using safe products (Khanna & Bhawsar, 2005). Poor sanitation-related MHM practices due to cultural and economic reasons have consequently  increased a female's risk of contracting infectious diseases, therefore threatening their reproductive health and well-being. There are also challenges over the lack of bins or unwillingness for community toilet caretakers to remove sanitary products. This not only reinforces shame but also exacerbates unhygienic conditions.  

                Figure 2 showing: Overview of appropriate menstrual material (UNICEF, 2019)

Women consequently face greater sanitation struggles than men. Providing the right menstrual hygiene resources is therefore instrumental in firstly allowing women to manage their cycles safely and with dignity, and secondly for allowing them to gain educational, employment and financial capacity. This is why MHM is not just a women's problem but a socio-economic problem, which needs to be acknowledged in the SDGs if we are to remove the sanitation-related barriers that women face. The MHM gap in SDGs have also shed light on the larger issue at hand, which is that gender disparities have not been fully recognised. A reassessment of the targets behind our goals must be taken on if we are to achieve the SDGs by 2030, and it must start with tackling the taboo behind menstruation.