Menstrual Hygiene in Ethiopia – the Importance of Including Boys in the Discussion

By Jane Bevan and Kalkidan Gugsa

ADDIS ABABA, 30 May 2017 – Daniel Worku, a 12-year-old from Sheno Primary School in Oromia region, admits he did not know much about menstruation and thought it only an issue for girls and women to discuss. “The [menstrual hygiene management (MHM)] education in the school helped me to know more about it and how to be supportive of girls. I am a member of the MHM club, motivating my peers, particularly boys to be part of it too.”

Daniel and three courageous female students were telling their MHM experiences to a crowded room of health sector and development partners in Ethiopia. The advocacy event was held on global Menstrual Hygiene Day and organised by the Ministry of Health, in partnership with UNICEF and other MHM partners – Splash, WaterAid, SNV, Care and World Vision.

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Left to right: Daniel Worku, Hiwot Werka and Simret Hailu, students from Sheno Primary School in Oromia; and Zinebech Daniel from Bole Primary School in Addis Ababa share their experiences about menstruation during the Menstrual Hygiene Day event. ©UNICEF Ethiopia /2017/Tadesse

While menstruation is biologically a female issue, UNICEF’s recent knowledge, attitudes and practice (KAP) baseline survey of MHM in Ethiopia found that teasing from boys was a major reason that girls often skip school while menstruating, sometimes resulting in dropping out of school altogether. Thus, the involvement of boys in education about menstrual hygiene is key to improve understanding and reduce teasing, and thereby the retention of girls in school.

The KAP study found that over half of schoolgirls in Ethiopia knew nothing about menstruation prior to menarche, leaving them shocked and frightened and less than half of the girls in the county are taught about menstrual hygiene in school. The majority of adolescent girls never discuss menstruation with another person. On average, 11 per cent of girls miss school for reasons related to their periods – this is as high as 46 per cent in some regions. The main reasons for missing school were cited as pain/discomfort and teasing.

The study found there is a common misconception in Ethiopia that girls are no longer virgins because they begin menstruating and have been at times punished by parents who blame them for having sex or being raped if blood is seen on their clothes. These misunderstandings, in addition to teasing and bullying, cause girls to feel shame and isolate themselves.

“The girl who menstruates stays in a corner of the classroom or stays at desk until all classmates are gone because she does not want to be bothered by anyone,” said Hiwot Werka, grade 7.

Breaking the silence around menstruation and educating boys and men about this natural bodily function is seen as key by UNICEF to reduce harmful teasing. In schools, this includes male teachers’ awareness and sensitivity about MHM to ensure girls receive the support they need in school.

UNICEF Ethiopia’s MHM programme, funded by the Netherlands Government, began in 2016 and is piloting girl-friendly water, sanitation and hygiene (WASH) facilities in 96 schools across six regions. The facilities include more privacy, water for washing, safe spaces for girls to rest and change pads or clothes as necessary. The programme also developed and adapted educational material such as the Grow and Know booklet, a social and behavioural change tool which is being translated into local languages. The booklet targets girls, ages 10-14 years old and contains information on their changing bodies, including MHM.

A community-level component of the programme supports local women’s groups to produce reusable sanitary pads, which are sold to women and girls at an affordable price.

At the national level, UNICEF and partner agencies have worked closely with the Ministry of Health and Ministries such as Education and Women and Children’s Affairs to develop a national MHM guideline, which was also launched at the 30 May event. The guideline provides detailed guidance about the role of stakeholders in supporting women and girls with MHM. It also provides standards, for example regarding MHM kits for schools. The WASH Facilities in Schools construction manual is also being revised by the Ministry of Education to incorporate MHM facilities.

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Launching the national MHM policy and implementation guideline on Menstrual hygiene management day: “Let us break the silence about menstruation”, Capital hotel, 30 May, 2017 (Left to right: Dr. Zufan Abera, Ministry of Health, Jane Bevan, UNICEF, Bethlehem Mengistu, Water Aid, )© UNICEF Ethiopia /2017/Tadesse

Through the initiatives described above, the aim of the UNICEF MHM programme is to improve girls’ attendance and retention in schools.  By promoting understanding of MHM and finding solutions to the challenges faced by girls in schools, the unnecessary silence surrounding menstruation may be lifted. Including men and boys in the discussion is a vital aspect of equalizing opportunities and improving the future for girls.

Markets and Menstruation

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Women sell local products in Wukro market, Tigray region. ©UNICEF/2016/Carazo

By Blanca Carazo

WUKRO, TIGRAY, 6 December 2016 – It was Monday morning when we came across the bustling market in Wukro. Tomatoes, onions and cereals are weighed and sold by women sitting on the ground, many of them wearing traditional white shawls.

Crossing through the market stalls, we entered a small office, which operates as a factory and shop as well. Helen Hailu’s open smile welcomed us to this all-in-one space where she and two other women have launched an innovative and ecological business: they produce and sell reusable sanitary pads.

In Ethiopia, as in most countries, menstruation remains a taboo topic, often causing girls and women to be excluded from school and other activities. In Wukro town, this is changing. An integrated water, sanitation and hygiene (WASH) intervention being implemented by UNICEF, through its partner, World Vision, is raising awareness about menstrual hygiene among teachers, girls and boys in schools. The programme also promotes businesses such as Helen’s, to ensure that adequate and affordable products are available in the local market.

Helen and Meaza Gebregzabher proudly explained how they were chosen by a women’s association and trained by World Vision to produce reusable sanitary pads before receiving sewing machines and materials. They decided to call their business Raig, the Tigrigna word for ‘vision’.

Starting a business is always challenging, and this business is no exception. “It’s difficult right now to get money,” said Meaza, “some of the materials are bought in Addis Ababa and are expensive. We’re expecting you to raise awareness.” she added, kindly pressuring us, the visiting colleagues from UNICEF and World Vision. Perhaps business will pick up once the urban WASH water scheme is fully functional later this year, allowing easier access for women to clean the reusable pads. Also implemented by World Vision, the UNICEF-funded, Government of Ethiopia-designed programme will provide 100 per cent water coverage in Wukro and five satellite villages.

An agreement has been signed between Raig and seven schools to provide 600 pads, and they aim to also sell to local women. “They are for schools, but also for the people in the village,” said Helen.

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Meaza Gebregzeir shows the materials and the three-unit set they sell, while Helen Hailu sews a new product. ©UNICEF/2016/Carazo

I buy a packet of three reusable sanitary pads for 30 birr (US$1.30) and I’m offered a free sachet of detergent. “It’s a promotion.” explains Meaza. They have to compete with commercial one-time-use pads that are sold at 20 to 30 birr for a packet of ten.

Helen and Meaza’s raig is that girls and women in Wukro use their ecological, effective and handmade sanitary pads while they’re menstruating; with the added benefit of ensuring business for the women.

UNICEF’s raig is that all girls and women have the knowledge, environment and materials they need to have dignity and safety when menstruating. Promoting income-generating activities like this not only contributes to that aim, but it also offers sustainable opportunities for brave women like Helen and Meaza.

Nowhere to go – School Toilets

By Hiwot Ghiday and Raymond Kennedy

EAST BADEWACHO, SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S (SNNP) REGION, 13 February 2017 – Langano Primary School is located in the southern Ethiopian countryside around 17 km east of Shone town and has been open since [2004]. Until 2016, this bustling school of over 1,300 students had only one traditional latrine – shared by boys and girls alike.

Habtamu Pawlos
Habtamu Pawlos, 13-years-old, in front of the new boys’ latrine. ©UNICEF/2017/Ghiday

Habtamu Pawlos is 13-years-old and currently studying in grade eight – the highest level offered by Langano School. He explains, “Previously there was only one latrine at our school and since the number of students are many it was difficult to access when needed.” He thanks the donor for providing a block of four new latrines for each gender, complete with a handwashing facility and says it has solved the problem.

Habtamu is being gracious – while he knows that four boys’ toilets is an improvement on what they had before – it is still not many to share between over 700 male students at the school.

When there are not enough toilets to go around – it is not surprising that children resort to unsanitary practices. Estimates are that only 42 per cent of primary schools in the SNNP region are free from open defecation[1].

The lack of toilets in Langano Primary School caused particular problems for girls.

“Most of the time, the boys go first and we have to go back to class before we get to use the toilet,” Tsehay Moges, a 12-year-old girl who recently entered grade five explains. “Privacy was also a problem.”

Tsehay admits that the lack of toilets made it difficult for her to attend class and concentrate on her studies. She says students sometimes became sick from infections due to lack of access to proper toilets.

A recent UNICEF study found that over a quarter of girls surveyed missed school during their periods[2]. One key reason for this was the lack of private spaces to change their sanitary materials and clean properly. In many cases, girls told us that they would be teased or harassed by boys if they knew they were experiencing menses.

Private, separate toilets for girls will help Tsehay and her female classmates manage their periods with more dignity and will help reduce the number of girls absent from school.

latrine school
The previous one-stall latrine. ©UNICEF/2017/Ghiday

The contrast between the new latrine blocks and the old unimproved latrine is stark.

Shared by both boys and girls, this latrine provided little privacy and was very dirty. The uncovered latrine hole attracted swarms of flies which buzzed around the user, contributing to the spread of diseases including trachoma, which can cause blindness. Additionally, there was also no handwashing facility for the children to use. Traditional latrines may also easily collapse when it rains as they are built out of mud and sticks. This is a danger to users and also exposes the community to open defecation until they are replaced.

Through generous funding from SIDA, the Swedish International Development Cooperation Agency, UNICEF is supporting the regional government in the SNNP region to ensure that school children can use safe, improved latrines with handwashing stations. This project is supporting 10 schools in total, and new toilets have been installed in six of them thus far.

While the population of students and teachers at Langano Primary School are fortunate to have a better sanitary environment, there is still work to be done elsewhere in Ethiopia. Even though has been significant progress in reducing open defecation, far too many children are using unsafe and unsanitary latrines – particularly in rural areas. The current coverage of improved latrines is estimated to be less than per cent in rural areas of Ethiopia[3]. There is a long way to go before all children in Ethiopia have proper access to safe and clean toilets at school.

[1] One WASH (Water, Sanitation and Hygiene) National Programme Draft Report 2016

[2] Menstrual Hygiene Management, Knowledge, Attitudes and Practices Baseline Survey, 2017; Afar, Gambella, Oromia and SNNP regions of Ethiopia.

[3] Ethiopia Demographic Health Survey 2016

Emergency Efforts Lend to Sustainable Water Sources

By Rebecca Beauregard

FEDIS, OROMIA, 31 May 2017 – “Our daily routines have changed. We used to give water to our animals every other day, now they drink daily. I used to bath the children once per week, now I have no idea how many times a day they wash because they always come use the tap on their own,” says Saada Umer, pointing to her 4-year-old, Anissey, who is near the tap.

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26-year-old mother of four, Saada Umer caries 2-year-old Sumaya on her back while tending to the livestock.  Saada and her husband are farmers living at the edge of Boku town, Fedis woreda (district) in Oromia region. ©UNICEF Ethiopia/2017/Rebecca Beauregard

Saada, 26-years-old, is one resident who benefits from the new water supply system in Fedis woreda (district). She and her husband are farmers and have four children, ranging from 2 to 9 years old. Rather than filling 20 litre jerry cans daily at a water point a few kilometres away, she fetches it from her front yard where the tap flows anytime. The impact is literally life-changing.

Ethiopia has faced devastating drought conditions for the past two years now, affecting different areas of the country in different seasons and creating rippling effects in health, education, the economy and development initiatives.

In times of crises, emergency action is required and often takes priority over development initiatives, understandably, to save lives and curb any potential disease outbreaks. However, one emergency action by UNICEF, with funding from the German Development Bank (KfW) and the UK Department for International Development (DFID), supported the Government of Ethiopia to address both the drought-related emergency water shortage affecting 8,600 people while also contributing to a more resilient and long-term supply of water.

In Boko town, the drought had taken its toll at the same time that the town’s water supply system had run its 25-year design course, leaving thousands without access to clean and regular water. In times like these, those who can afford pay for expensive water brought in by vendors and those who cannot afford, take from ponds and rivers.

UNICEF Ethiopia purchased a pump and generator to supplement the drilling of a new borehole the regional and zonal water office initiated, providing further construction support to complete the project. The emergency-funded project enabled the water office to make functioning a 122 metre borehole which, as of February, supplies fresh, clean water by keeping two town reservoirs filled. In addition, it supplies 24-hour water taps in about 800 households in Boko, with water points at the edge of town providing safe water for surrounding rural villages. The borehole also supplies a water-trucking point nearby, where currently four trucks carrying two 5,000 litre water tanks are filled daily and supplied to the nearby Midega Tola woreda, which is lacking a water system while grappling with drought.

The effect of having household water has led to the creation of a town utility office, which records the water meters and collects payment for its use. Setting up this regular system has not only created more demand for household taps, it ensures steady water supply and a regular income to employ plumbers and maintenance crews for water system maintenance.

Hikma Mesfin is a 25-year-old Water Attendant at one of the town’s new water points. Her job is to open the point each morning, collect ETB 25 cents (US$.01) per jerry can from the users throughout the day, manage the site and close up each evening. Her salary is paid by the utility office, another regular income supported by the system.

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Hikma Mesfin, 25-years-old,  Water Attendant, Boku town, Fedis woreda, Oromia region. ©UNICEF Ethiopia/2017/Rebecca Beauregard

“I was happy to get this job. It was difficult when it first opened, because people thought it was like the old water pumps, thinking the water could stop flowing at any time and fighting each other to be first in line. Now they understand it flows every day and they can be at ease. Everyone will get their water.”

While emergency times call for emergency measures, UNICEF and the Government of Ethiopia collaborate to ensure the most sustainable solutions possible are implemented where it is most needed. As the effects of protracted drought continue to wreak havoc on lives across the country, UNICEF calls on the support of international donors to fund projects such as deep borehole drilling which build resilience in communities and offer long-term solutions for challenges facing communities across the country.

UNICEF Signs Ethiopian Fiscal Year 2010 Work Plans with Government

By Metasebia Solomon

ADDIS ABABA, 30 June 2017- UNICEF Ethiopia signed the Ethiopian Fiscal Year 2010 annual work plans with the Federal and Regional Government under the umbrella of the United Nations Development Assistance Framework (UNDAF 2016-2020).  The signing ceremony, held at the Ethiopian Ministry of Finance and Economic Commission’s office, was attended by Heads of United Nations agencies including UNDP, UNFPA and UNICEF and the implementing Federal and Regional Government offices as signatories of the annual work plans.

Mr Admasu Nebebe, State Minister for Ministry of Finance and Economic Cooperation, speaking after signing the work plans, said “Implementation of the signed work plans will contribute to the achievement of Ethiopia’s current Growth and Transformation Plan [GTP II]. The results and activities are linked to the Government’s priorities at all levels.” UNICEF Representative to Ethiopia, Officer-in-Charge, Ms. Shalini Bahuguna, applauded the Government of Ethiopia’s leadership in implementing the annual work plans, saying “A recent review conducted by UNICEF’s global team has identified the annual work planning process of Ethiopia as a model for other country offices, demonstrating principle of alignment with government policy and ownership by stakeholders.”

 

UNICEF signs Ethiopian Fiscal Year 2010 Work Plans with government
Ato Admasu Nebebe, State Minister for Ministry of Finance and Economic Cooperation shakes hands with Ms Shalini Bahuguna, UNICEF representative to Ethiopia, O.i.C after signing the Ethiopian Fiscal Year 2010 Annual Work Plan. ©UNICEF Ethiopia/2017/Zerihun Sewunet

The work plans were prepared under the logic that the accomplishment of activities will contribute to the achievement of UNICEF’s and UNDAF’s intermediate and higher level results, which are in support of GTP II.  A consultative process was followed during the preparation of the work plans at the Regional and Federal level.  This year, UNICEF Ethiopia signed 143 work plans with more than 140 Regional and Federal Government implementing partners. The work plans cover fifteen programme areas including:

  • Health
  • Nutrition
  • Education
  • Early Warning and Disaster Preparedness
  • Water Supply
  • Sanitation and Hygiene
  • Child Friendly Social Welfare
  • Social Protection
  • Adolescents and HIV/AIDS
  • Violence against Children
  • Ending Child Marriage and FGM
  • Birth Registration
  • Justice for Children
  • Child Rights
  • Public Finance for Children
  • Evidence and Coordination

The total budget equals US$ 74,867,075.  Implementation of the work plans will start on the 1st of July 2017 and will close on the 30th of June 2018, following the Ethiopian Fiscal Year.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea 

By Rebecca Beauregard

SOMALI Region, 20 April 2017 – When Basazin Minda was requested to support the acute watery diarrhoea (AWD) response in Somali region, he did not hesitate. In fact, within one week, he handed over his duties to colleagues in UNICEF Oromia team and was in Jigjiga office.

Complex emergencies are not new to him. He was in Gambella when a South Sudanese refugee influx necessitated immediate WASH response. And when an AWD outbreak threatened lives in the southern cross-border town of Moyale, Basazin led the AWD WASH response and coordinated joint Kenya and Ethiopia control mechanisms. This is part of why he loves working with UNICEF – there is full support and resources to take quick action as well as the flexibility to respond where needed when communities are facing crisis, such as the AWD outbreak.

One lesson he learned from those past emergencies was that to have an impact, it required extensive human resources in the affected areas. Recently hired WASH Information Management Officers (IMOs) were available to support his team and he soon learned about UNICEF Health section’s C4D (Communication for Development) consultants, which could help spread the critical WASH messages to stop the spread of AWD.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
On site community mobilization concerning poor drainage and optimal water collection methods. Lasoaano kebele, Shilabo woreda ©UNICEF/2017/Mualid

AWD describes infections that can result in easily transmitted and potentially deadly diseases. The spread of such disease is very high in areas with water scarcity and can have a devastating impact on children who may already be undernourished. Additionally, those living in crowded spaces with poor access to WASH facilities, like the many temporarily displaced families, also face a higher risk.

The recent AWD outbreak peaked in Somali region in February 2017 and now more than 50 per cent of the woredas (districts) are reporting active cases. Particularly due to the current Horn of Africa drought, there are refugees coming from neighbouring Somalia, as well as temporarily displaced Ethiopian Somalis, as people move in search of water, food and pasture for their livestock. The predominately pastoralist Somali region is the worst drought-affected area in Ethiopia with over 30 per cent of the region’s population requiring food assistance in 2017. Living conditions of these temporarily displaced people are often inadequate and widespread open defecation poses a risk of the spread of AWD, among other disease outbreaks.

Upon arrival, Basazin began a series of discussions with people from UNICEF, the Regional Water Bureau (RWB) and the zonal command post. What he learned immediately on the ground was a little different than he had prepared himself for. He came for mass chlorination of boreholes to stop the spread of AWD. However, he identified that boreholes are protected. “This is what can be so interesting about emergencies. You go in with one mind set and task and immediately are faced with a reality that may differ. The problem was not the water sources, so the contamination had to be happening at some point after water is collected, either during collection or storage,” Basazin explains.

Like detectives, Basazin and the newly formed team began contacting local water office staff and meeting with various community members to pinpoint where this contamination was coming from. The team concluded that contamination was occurring from water trucking, during the transport of water (usually by donkey cart) and at the household level, where dirty jerry cans were utilized repeatedly. Now the task has shifted to a multi-effort approach including mass chlorination of water trucks, community awareness campaigns to ensure clean jerry cans and training sessions for local water staff on chlorination standards.

The RWB staff know about chlorination, however at this critical time of drought and AWD, with a mobile team equipped with testing kits, jerry cans and barrels of HTH chlorine solution, everyone was eager to learn more from practical demonstrations. A key lesson that was missing before now was how to calculate correct measurements of chlorine according to the container size to ensure disinfection. Referencing UNICEF WASH guidelines, Basazin prepared a guideline of chlorination and turbid water purification with these specific calculations included and it was subsequently distributed to all water offices in the region.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
Basazin demonstrating residual chlorine with technical staff and community mobilizers at the Lasooano kebele health centre in Shilabo woreda ©UNICEF/2017/Mead

The feedback was positive after the training and RWB staff proliferated the learning by sharing demonstration photos through their Viber group, a mobile messaging application utilized by all Somali RWB staff.

One water office participant commented after a demonstration, “Assistance has come through here and sometimes guidance is offered, but not like this. Receiving evidence-based participatory training makes a big difference.”

Basazin did not always explain the calculations and guidelines. Another lesson his work has taught him is to tailor his WASH messages according to the audience. “AWD bugs will attack the water if it finds it without chlorine and consequently the attack will reach to human beings.” There was laughter when Basazin used this metaphor.

The team is working through Good Friday, the big Easter holiday and weekends to curb the outbreak and spirits remain high. Basazin’s energy and commitment to ensuring his work has impact is easily detected as he speaks. “I like to learn today and implement for tomorrow,” he says. “Perhaps another idea coming from this mission is that we should highlight a jerry can and water truck washing day, just as we promote handwashing day.” He is also quick to admit this is not a one-man show. With the UNICEF Jijiga and Addis team and the community, mass chlorination is taking place exactly where needed to curb the AWD outbreak.

“Everything has a solution,” Basazin declares.

 

Menstrual Hygiene Management Programme Kicked off with a Training of Trainers in Oromia and Somali Regions

By Kalkidan Gugsa

OROMIA and SOMALI, February 2017 – Poor menstrual hygiene management (MHM) negatively impacts the education, health and empowerment of girls and women, as well as the environment. The impacts are compounded during emergencies, such as the protracted drought crises across Ethiopia. What fuels these negative effects of managing menstruation are cultural taboos and other societal barriers.

Girls across Ethiopia face social, cultural and economic barriers related to menstruation which not only prevents their right to dignity, but often prevents their right to education due to inadequate menstrual hygiene education, insufficient WASH facilities and poor access to sanitary materials.

With support from the Netherlands Government, UNICEF Ethiopia, in partnership with regional health and education bureaus (RHB, REB), is implementing an MHM programme to break the silence and bring change in beliefs and attitudes towards menstruation. The programme aims to support girls and women across the country to overcome the barriers that prohibit them from managing menstruation with dignity.

Why MHM?

Menstrual hygiene management is a complex and sensitive issue that requires a contextualized, multi-sectoral approach to adequately support girls and women across Ethiopia. A package of services that leads to improved MHM includes private, minimum-standard toilets, handwashing stations and adequate waste disposal in addition to allowing the safe space for discussion to increase awareness amongst men, boys and girls utilizing social and behavioural change communication (SBCC) methods. In addition, improvements in the supply chain for sanitary pad production complements the community- and school-based efforts in MHM.

In collaboration with UNICEF, the Ethiopia Ministry of Health developed a national MHM guide based on the package of services, which is designed to address the topic across the contexts of schools, communities and workplaces as well as in emergencies.

By working with both the RHB and the REB, and supporting the development of a sanitary supply chain, improved MHM facilities and services will keep girls in school where they can reach their full potential.

MHM social and behaviour change communication materials in Amharic and Oromiffa languages
MHM social and behaviour change communication materials in Amharic and Oromiffa languages

On 15 February 2017, UNICEF kicked off the community- and school-focused MHM training of trainers (ToT) workshops for a total of 120 staff of the RHB and the REB in Oromia and Somali regions. These were the first of such trainings made possible by support from the Netherlands Government.

The TOT workshop established coordination between the education and health sectors and equipped focal persons with global, national and regional menstruation facts. It also introduced participants to the MHM package of services: SBCC activities concerning menstruation, establishing safe spaces to enable girls to receive peer support, counselling and emergency kits as well as improved WASH facilities and sanitary pad production.

Throughout the training, participants highlighted the lack of discussion on this important topic, with one male participant explaining, “In our societies, the lack of information about menstrual hygiene creates a culture of taboos and misinformation about menstruation and therefore potential health problems. Now we know what to do from this training and how to react.”

The regional and woreda (district) focal persons who participated in the ToT, in turn will cascade the training to health extension workers (HEWs), school management committees and school club coordinators (teachers). The trained HEWs and teachers will then facilitate activities for the Health Development Army and the WASH, gender and girls’ club members in their respective areas.

The sanitary supply chain

The sanitary pad supply chain component of the programme establishes women’s groups to produce reusable sanitary pads and provides support to local manufacturers through partnerships to improve the production, packaging, distribution and use of sanitary pad products in target regions. On the manufacturing end, partner companies will engage in backward integration of the production of raw materials such as absorbents and liners. On the sales end, pharmaceutical and family planning outlets, such as pharmacies, drug stores and clinics, will be utilized at local and regional levels to bring the improved products to communities.

Additional MHM training and launch workshops are planned to kick off in March and April 2017 in Gambella, SNNP and Afar regions. Together with Government partners, UNICEF will support the positive change in the dynamics of MHM in Ethiopia and contribute to better futures of girls across the country.