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.

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.

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.

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.