Who we are
We are a Coalition comprising individuals, groups and institutions aiming to strengthen coordination among key stakeholders and build on and support the evidence-base, to better transition research to action, and to support multi-sectoral policy making and scale-up of evidence-based and sustainable programmes that address the menstrual health management needs of girls, women and other people who menstruate throughout their menstrual lifecycle in Africa.
What we do
We are a Coalition of people with one purpose: to strengthen coordination among people working to address menstrual health issues such as governments, academics, technical experts, researchers, youths, national and international civil society organisations, private sector and faith-based organisations. We and build on, and support the evidence-base, to better turn research to action, and to support policy making that caters for the needs of every stakeholder. We aim to scale-up evidence-based and sustainable programmes that address the menstrual health management needs of girls, women and other people who menstruate throughout their lifecycle in Africa.
Following the successful hosting of the inaugural Menstrual Health Symposium for East and Southern Africa in May 2018, conveners and participants have come together to launch the African Coalition for Menstrual Health Management (ACMHM) for a more coordinated response to menstrual health management.
The Coalition provides a platform for strengthened policy dialogue, coordination and knowledge-sharing to more than 400 hundred menstrual health management practitioners from Africa and beyond. The Coalition is leading collaborative efforts for multisectoral responses to menstrual health management within development and humanitarian settings in Africa.
Our Vision, Mission and Priority Areas
Vision: By 2030, all women, girls, and people who menstruate are empowered to address the menstrual health challenges throughout their life cycle – from menarche to menopause in development and humanitarian settings.
Mission: To advance and sustain a collaborative platform for a diverse range of Africa-based actors working on menstrual health management. Through this platform, members will learn and share their resources, skills, and expertise to encourage consensus-building and evidence-based advocacy and interventions which bring about positive menstrual health management engagement and change.
Priority Areas: Anchored on its convening power to bring together stakeholders to prioritize menstrual health management across the continent, the Coalition has set these key priorities:
How we work
In order to advance the menstrual health management agenda, the African Coalition for Menstrual Health Management is positioned to strategically facilitate and enhance coordination among its members across Africa to meet Sustainable Development Goals in their respective countries and collectively. We achieve this by:
• Working with regional bodies like SADC to come up with menstrual health management protocols.
• Working with partners to improve quality and increase menstrual health data and information.
• Mobilizing resources for improved menstrual health management in Africa.
• Engaging in evidence-based advocacy with regional political leaders and donor agencies, including advocacy for continental VAT exemptions.
• Working with partners to develop menstrual health management standards, toolkits, and guidelines.
Establishing collaborative partnerships across Africa and beyond.
• We will work with regional bodies like African Union Commission (AUC), East African Community (EAC), Economic Community of West African States (ECOWAS) and Southern African Development Community (SADC) for the integration of menstrual health management as a development issue in key resolutions, protocols, strategic frameworks, and action plans
• We will support evidence-based advocacy with political leaders and donor agencies, including advocacy for continental VAT exemptions
• We will work to strengthen our engagement of traditional leaders, faith-based organizations, men and boys, marginalized populations and young people
• We will develop menstrual health management standards, toolkits and guidelines
• We will review and identify key indicators and improve menstrual health data management
• We will address issues related to the unregulated markets and how it impacts sanitary products value chain
• We will work to establish collaborative partnerships with menstrual health management product producers and social entrepreneurs
• We will position MHM as a key development issue on front pages of local and international media, including documentation of human interest stories and social media coverage.
• We will intensify resource mobilization for the ACMHM Secretariat, convenings and activities, aiming to advance the ACMHM agenda globally, regionally and nationally.
• We will develop and make available ACMHM information materials and contacts database
• We will work to expand the Coalition to West, Central, and North Africa
How we are funded
We are grateful to United Nations agencies, governments through their development agencies, international and regional organisations that have contributed to the establishment of the African Coalition for Menstrual Health Management.
Our resources are limited and we continue to seek funding for our menstrual health management work on the continent.
The ACMHM Leadership comprises representatives from governments, development partners, academia, civil society organizations, youth networks, parliamentarians, traditional leaders, faith-based organizations, philanthropic foundations and the private sector. Within the Leadership are Leads and Co-leads of the Coalition’s task forces, coordinating work around the seven priority areas of focus.
The Johannesburg Call to Action – No more limits
We, representatives of Governments, Development Partners, United Nations, Academia, Civil Society Organizations, Youth Networks, Parliamentarians, Traditional leaders, Faith-Based Organizations, Philanthropic Foundations, Private Sector and media recognize our role as agents of change and providers of social services at all levels and acknowledge our responsibility to safeguard the sexual and reproductive health, rights and justice of all.
We note that the increased attention accorded to menstrual health management is now paving the way for it to be widely recognized as a component of the human right to health and a key building block for development, building on progress made in the African region to improve menstrual health management for all.
We acknowledge the importance of addressing issues of menstrual health management to support the achievement of the Sustainable Development Goals, the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), the Programme of Action of the International Conference on Population and Development, the Addis Ababa Declaration on Population and Development in Africa beyond 2014 and Agenda 2063: The Africa We Want.
We agree on the need to ‘leave no one behind’ and address menstrual health management issues of vulnerable and marginalized populations including young people, disabled, people living with HIV, transgender people, sex workers, prisoners, injecting drug users, female genital mutilation survivors, through ensuring participation, inclusive language and customised interventions.
We are cognizant of the limitations that poor menstrual health management place on people who menstruate in all contexts, in particular, those from vulnerable populations, low-income contexts such as rural, pastoral, slums as well as those who are displaced, homeless, mobile or in humanitarian settings.
We affirm the need for strengthening and harmonizing the policy environment on menstrual health management in the region including integrating menstrual health management into multi-sectoral and sectoral policies as well as ensuring sustainable financing and creating opportunities for small scale enterprises.
We understand the life cycle approach in how it supports menstrual health management as well as integrated approaches to providing age-appropriate information and knowledge of the menstrual cycle from pre-menstruation to menopause, ensuring bodily literacy of all people who menstruate.
We recognize the need to ensure access to supportive health services including those that address menstrual stigma, menstrual disorders, vaginal bleeding and psychosocial related issues.
We acknowledge the need to harmonize and develop guidelines and standards with minimum requirements for products, supplies, water, sanitation and disposal/waste management; adhering to the AAAQ framework – Availability, Accessibility, Acceptability and Quality.
We are aware of the influence that social, religious, cultural norms and stigma about menstruation have on self-esteem, agency, and basic daily practices of people who menstruate throughout their life.
We emphasize the role of communities, parents, men and boys in overcoming social stigma and creating a supportive and gender-equitable environment, by promoting knowledge and enabling environment around menstruation as normal and healthy, and providing guidance on the appropriate methods to manage menstrual health and hygiene.
We highlight the role of the education and health sectors in improving the quality of MHM education in- and out- of school as an entry point for comprehensive sexuality and life skills education, thereby replacing beliefs and misconceptions with accurate and age-appropriate information.
We recognize the need to undertake systematic efforts to improve water and sanitation facilities including environmentally friendly disposal and waste management in schools, communities and workplaces.
We are cognizant of the need to increase efforts in generating systematic evidence and promoting innovative approaches and documenting best practices as well as developing and using any evidence generated and disaggregated data to support policy and programming on menstrual health management, especially in relation to its links with education, empowerment and mental health, and sexual and reproductive health outcomes.
WE COMMIT TO
Breaking the silence on issues of menstruation.
Establishing an Africa Coalition for Menstrual Health Management with the aim of sharing experiences and available evidence, and coordinating efforts to address menstrual health management issues in Africa. Strengthening national efforts to support policy reviews and/or policy development to promote and integrate menstrual health management. Strengthening integration and coordination of menstrual health management matters into existing development and humanitarian programmes in areas such as health, including sexual and reproductive health and rights, education, water and sanitation, trade and industry, environment, gender equality, empowerment programmes.
Partnering with global, regional and national organizations to support the development of a blueprint comprehensive framework – including SMART goals, tangible outcomes, indicators and a shared Theory of Change- to guide national multi-sectoral MHM programmes. Increasing efforts to engage with communities, religious and cultural leaders as well as men and boys with the aim of addressing social and cultural norms upholding positive practices and transforming discriminatory and unhealthy practices for improved menstrual health.
Calling on decision-makers at all levels to coordinate efforts to promote integrated and comprehensive Menstrual Health Management at legislative and policy level with adequate financial resources to ensure sustainability and accountability.
Finally, we commit to every two years have a symposium on MHM to update each other on the progress made, frameworks, research, sharing key successes, challenges and lessons learnt.
Meet the Secretariat
Under the leadership and support of the UNFPA-ESARO Regional Director and the Adolescents & Youth Regional Programme Specialist, the African Coalition for Menstrual Health Management Secretariat is now in place to lead and provide overall support and coordination to the Coalition.
Puleng Letsie: Regional Coordinator
Maja Hansen: Regional Programme
Specialist – Adolescent and Youth
Why menstrual health management?
Providing girls, women and people who menstruate with the necessary information, resources, skills, social support, water, sanitation, waste disposal and health facilities required to manage their menstrual needs and other types of vaginal bleeding through the life course from menarche to menopause is important for their well-being, mobility, educational and economic empowerment and dignity. Yet many girls, women and other people who menstruate in Africa, especially those who live in poor areas and those that have been displaced or affected by political, economic and social emergencies, have little to no access to age-appropriate information on menstrual health, skills, health and hygiene facilities (including disposal and waste management) and products that are accessible, effective, comfortable, convenient, affordable and safe to use and change. This hinders the ability of girls, women and other people who menstruate to understand and manage menstruation and to seek help and support when they experience menstrual health problems, thereby negatively impacting their self-esteem, sense of agency and ability participate in daily activities, including school, social activities and work.
Today many countries in Africa are moving towards more holistic responses to menstrual health management (MHM) with strengthened efforts to ensure that the focus on menstrual health management is expanded from product availability as a stand-alone solution, to integrated, cross-sectoral policy and programmatic responses involving gender, education (including Comprehensive Sexuality Education for in- and out-of-school youth), water and sanitation (WASH), waste disposal and health system strengthening with a competent workforce, both in development contexts and humanitarian responses. It is also increasingly recognized as an issue for research and learning, monitoring and evaluation. However, despite progress in some countries in Africa, many of these efforts remain undocumented, limited in geographical coverage, lacking a strong evidence-base, and are largely donor or charity dependent. More needs to be done to strengthen high-level policy commitment, coordination, knowledge sharing, and evidence-based programming.
In addition, there is a need to develop effective and innovative approaches to supply management and distribution, build commitment to strengthen education efforts, improve water and sanitation infrastructure in school and other spaces, and to ensure that multi-sectoral plans are costed and supported with adequate financial resources to sustain efforts, develop monitoring and evaluation, and bring programmes to scale across the African continent.
The flow of blood and tissue lining the uterus through the vagina. The flow happens for 5 days on average (range 2-7), every 28 days (range 21-35 days).
The onset of menstruation, which signals the start of a woman’s fertile age, when the female body is biologically able to become pregnant.
UNESCO refers to puberty as a “time of rapid physical, psychological and cognitive changes, when gender norms and identities are being shaped. For girls, menarche is one clear physical
indication, among several.
The cessation of menstruation, which signals the end of the fertile age. Average age at menopause is 50 (varying between 49 and 52).
MHM in the 2030 agenda
In order to advance the MHM agenda, the African Coalition for Menstrual Health Management is strategically positioned to facilitate and enhance coordination among its members, so that they contribute towards the achievement of the SDGs in their respective countries as well as collectively across Africa.
Menstrual health management (MHM) is critical to the attainment of at least eight of the Sustainable Development Goals (SDGs). Therefore, the work of the ACMHM from 2019-2024 will be guided by the SDGs, as an overarching strategic framework:
Vaginal bleeding outside menstruation is usually discussed at most levels of society, and it includes, postpartum bleeding, bleeding after a miscarriage, endometriosis, fibroids, and different types of cancers associated with heavy bleeding. Menstruators need information on what constitutes normal and abnormal vaginal bleeding and when to seek medical attention. Both menstruators and health-care workers need better access to health information, with health-care workers requiring the necessary training to address the needs of menstruators and help lift the veil of secrecy surrounding MHM. When women, girls and people who menstruate are unable to access appropriate information, healthy and safe sanitary supplies, they resort to using alternative methods, which are in most cases not only ineffective, inconvenient and uncomfortable but are extremely unhygienic and can lead to serious health issues.
Menstruation is one of the leading causes why girls in developing countries miss school. Lack of products, correct information, and infrastructure from a WASH (Water, Sanitation and Hygiene) standpoint lead to low attendance and high dropout rates.
The way menstruation is understood and practised is affected significantly by negative social norms and beliefs.
Women and girls continue to experience stigma and discrimination due to the lack of normalisation of menstrual health, while negative cultural practices such as child marriage continue to be linked to menarche. Community involvement, particularly that of boys and men, traditional and religious leaders, is key to changing perceptions, practices and policy. Menstruation needs to be managed with dignity, without ever having to feel ashamed, or being mocked for a natural process. Menstrual Health Management is crucial to achieving gender equality.
Women and girls need facilities that are safe, clean, and culturally acceptable where they can safely (and discretely) dispose of their menstrual products. They also require adequate water to safely clean their menstrual products.
Women and girls need facilities that are safe, clean, and culturally acceptable where they can safely (and discretely) dispose of their menstrual products. They also require adequate water to safely clean their menstrual products.
Without proper facilities there are few options for privacy and safety for women, girls and people who menstruate, especially those living in poverty. They have limited access to menstrual health products, which are primarily disposable and cost-prohibitive, posing problems for access, sustainability, and hygienic waste management. Menstruation has become an economic burden, undermining empowerment and promotion of the social, economic and political inclusion of all.
Sanitary products and supplies are not only often taxed as luxury items by governments, but high import fees often make them far too expensive for the majority of women in Africa. Menstruation should not be a financial burden for women, and products need to be made available.
The complex and interrelated menstrual health challenges require a comprehensive, collaborative, and intergenerational approach that engages all partners – governments, civil society, private sector, communities, boys and girls. These partnerships must address all key MHM issues including social and cultural norms, access to water and sanitation, Products, Education, Standards, Rights, Marginalised populations, Humanitarian settings, as well as Research and M&E – hence the establishment of the African Coalition for MHM to establish and nurture these partnerships. These will provide and share solutions grounded in unique local contexts for transformative and rights-based MHM responses.
MHM and Sexual and Reproductive Health Rights
Menstrual Health Management involves ensuring the reproductive health and rights of all women, girls and people who menstruate – from menarche to menopause. The timing of these milestones is critical for a woman’s health trajectory over her lifespan; hence girls, women and other people who menstruate need to be supported and empowered with education, services and relevant menstrual health products to embrace and deal with menstruation.
With the increased focus on menstrual health management and recognition of menstruation as a sexual and reproductive health issue, we must also recognize that menstrual health is broader than the monthly vaginal bleeding episodes. Vaginal bleeding outside menstruation includes, for example, postpartum bleeding, bleeding after a miscarriage, endometriosis, fibroids, and different types of cancers that are associated with heavy bleeding. PMS and PMDD are real; contraceptive choice, continuation or discontinuation are linked to menstrual experiences.
Stigma and limited knowledge about menstruation and menstrual health management prevent women, girls and other people who menstruate from seeking or receiving timely medical or other treatment related to either abnormal bleeding, pain, increasing anxiety or psychosocial stress in particular for adolescent girls, and other challenges. People within no or limited economic stability may sometimes resort to other means of acquiring menstrual health products, such as transactional sex, as evidence from East and Southern Africa suggests. This exposes them to new risks, including HIV, sexually transmitted infections, gender-based violence, and unintended pregnancies.
MHM and Products/ standards/value chain
It is becoming apparent that menstrual health products, especially commercial products are often not affordable to women, girls and other people who menstruate. This has been highlighted for instance, by evidence from Ethiopia which indicates that 25% of girls do not use any menstrual products; while in Uganda research found that about half the girls reported using disposable pads and reusable materials – which include pieces of cloth, cloth pads and knickers, among others.
We need to look at the demand side including affordability, product range and choice, safety and acceptability. Innovations such as the use of bio-degradable and re-usable products like the menstrual cup, effective supply chains to ensure that the products reach the end users where they are needed the most, and sustainable waste management systems to reduce the burden on the environment are encouraged
The Coalition therefore calls on Policymakers, activists and human rights advocates to issue policies and standards that promote safe, affordable options and sustainable innovations and markets for appropriate menstrual products.
MHM and Education
Girls, women and other people who menstruate, especially in rural areas and those that are marginalized, are often uninformed and unprepared for menarche and other challenges throughout their menstrual cycle; and many receive limited and inaccurate information. They often experience high levels of shame and embarrassment due to limited knowledge, social and cultural norms, and inadequate means of managing their menstruation.
To be cared for and supported during their menstrual periods, girls, women and other people who menstruate need information and education. They need to be able to consult a competent and caring health or social worker, parent or even community leader when they have menstrual health and other related challenges.
Interventions targeting schoolgirls and communities with education and menstrual health management materials can improve their health and social well-being. This can be attained through competency-based education of health workers, as well as teachers Comprehensive Sexuality Education (CSE) taught as part of the school curriculum and in communities through lifelong learning.
MHM and WASH
Today, there are around 2.4 billion people who do not use improved sanitation and 663 million who do not have access to improved water sources. Approximately one-third of schools around the world lack adequate sanitary facilities, disproportionately affecting the hygiene of girls, women and other people who menstruate.
Reports from some African countries like Malawi, indicate that girls who report that school toilets lack privacy are more than twice as likely to be absent during their menstrual periods than girls at schools where more privacy is available.
While most programmes focus on schools, Water, Sanitation and Hygiene (WASH) outside of school settings can successfully be implemented in communities, like the WASH pilot project in Uganda which aimed to improve management of menstrual products disposal in a sustainable way in the Kampala informal settlements.
MHM in humanitarian settings
Each year, millions of girls, women and other people who menstruate in humanitarian situations face the risk of getting sick from diseases associated with poor water, sanitation and access to health education. Menstrual health in an emergency is often low on the list of urgent priorities for governments and aid organisations. Nonetheless, menstruation does happen, and it is critical for emergency preparedness to include menstrual health management, while also taking into consideration the specific needs, preferences, and norms of the target population.
Equally important is the type of emergency, so that the necessary and appropriate tools and products are provided for those who menstruate, within that emergency or humanitarian setting – context in this regard is key!
Agencies such as UNFPA distribute ‘dignity kits’ containing menstrual pads, soap, underwear, and other necessities to help women, girls and other people who menstruate maintain their health, hygiene and a sense of dignity within humanitarian contexts.
MHM Research and M&E
Research on menstrual health management in Africa continues to lag behind, especially in data collection and measurement. While many studies on menstrual health management have been conducted in recent years, very few have made it into reputable international journals. Menstrual health management research has mostly been about schoolgirls and sanitation, which has resulted in a limited understanding of the broader issues from menarche to menopause.
The Coalition aims to strengthen collaboration among with key researchers and gather menstrual health management studies already conducted on the continent and elsewhere, collate them and where possible refine them to meet internationally acceptable research standards, and share them so that programmes are informed by evidence. More of these can be found on the research repository on the website.
This information, and any information produced by the Coalition is available for Coalition members to also translate into various languages for wider dissemination in order to inform programming for menstrual health management in Africa.
It is the Coalition’s priority to facilitate improved collaboration and menstrual health management research capacity and quality in Africa.
MHM and Marginalised Groups
It is our belief that the menstrual health narrative is refocused and repackaged to ensure that it goes beyond just focusing on product distribution and school attendance. Menstrual Health Management should focus and caters for the needs, rights and dignity of girls, women and other people who menstruate, in all contexts. We need to ensure that menstrual health management messages are comprehensive, empowering, and demystify the socio-cultural stereotypes and taboos in order to make girls, women and other people who menstruate not to feel either shamed or limited by their periods.
The Coalition has prioritised integrating menstrual health management in development and humanitarian settings, while making a conscious and deliberate effort to engage men, boys, religious and traditional leaders on menstrual health management issues. This will ensure that no one is left behind in MHM responses, especially the youth and marginalised groups such as refugees, girls and women living with HIV, transgender people, people with disabilities, those living in informal settlements and sex workers.
We aim to ensure that no one is left behind as we engage in menstrual health management issues.
#Towards attaining human rights and Sustainable Development