What are the issues?

Menstrual Health Management (MHM) 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 MHM and the recognition of menstruation as a sexual and reproductive health issue, we must also recognise that menstrual health is broader than the monthly vaginal bleeding episodes. Vaginal bleeding outside of menstruation
and related processes includes, for example, postpartum bleeding, bleeding after a miscarriage, endometriosis, fibroids, as well as different types of cancers that are associated with heavy bleeding. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are real; contraceptive choice, continuation or discontinuation are also 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 and other challenges, in particular for adolescent girls. People with 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.

It is becoming apparent that menstrual health products, especially commercial products, are often not affordable for women, girls and other people who menstruate. This has been highlighted for instance by evidence from Ethiopia, which indicates that 25 per cent of girls do not use any menstrual products; while in Uganda, research found that about half of girls reported using disposable pads and reusable materials – which include pieces of cloth, cloth pads and knickers, among others.

There is a strong need to critically examine and reflect on the demand side of menstrual products, including affordability, product range and choice, quality, safety, acceptability and context. Innovations such as the use of biodegradable and reusable products like the menstrual cup; effective supply chains to ensure that the products reach the end user, where they are needed the most; and sustainable waste management systems to reduce the burden on the environment are encouraged.

Through its members and networks, the Coalition is proud to have contributed to ongoing efforts in advocating for various product options, as well as the development of standards in Africa – at both regional and national levels. We therefore stand united in calling on policymakers, activists and human rights advocates to develop and implement policies, programmes and standards that promote safe, affordable options, as well as sustainable innovations and markets for appropriate menstrual products.

Girls, women and other people who menstruate, especially in rural areas and those who are marginalised, are often uninformed and unprepared for menarche (the beginning of menstruation) and other challenges throughout their menstrual cycle. Many of them 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 educator, health worker or social worker, their peers, a parent or even a 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 Comprehensive Sexuality Education (CSE), taught as part of the school curriculum and in communities through lifelong learning.

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 and dignity 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 in 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.

The disposal of menstrual and sanitary products is increasingly becoming a challenge and contributing to the negative effects on the environment. It is therefore critical to integrate efficient waste disposal mechanisms and programmes in menstrual health management and related policies and programmes. An example of this is the WASH pilot project in Uganda, which aimed to improve the management of menstrual product disposal in a sustainable way, in informal settlements in Kampala.

Each year, millions of girls, women and other people who menstruate face the risk of getting sick from diseases associated with poor water, sanitation and access to health education, especially in humanitarian situations. Menstrual health management 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 to maintain their health, hygiene and a sense of dignity, within humanitarian contexts.

Even though there are commendable efforts in research on menstrual health management, there is still a significant gap in research and monitoring and evaluation (M&E), especially in data collection and measurement, on the African continent. Many studies on menstrual health management have been conducted in recent years, but very few have made it into reputable international journals, and therefore have not been widely shared. MHM research has mostly been about schoolgirls and sanitation, which has resulted in a limited understanding of the broader MHM related issues – from menarche to menopause.

The Coalition aims to strengthen collaboration with and among key researchers and gather menstrual health management studies already conducted on the continent and elsewhere. These studies and the evidence will be collated, and where possible be refined for them to meet internationally acceptable research standards. This will facilitate their documentation and sharing through credible repositories, so that they can be effectively used for evidence-informed policy and programming, in development and humanitarian settings. Some of the available research documents and articles on MHM in Africa can be found in the research repository of this website.

This information, and any information produced by the Coalition, is available for Coalition members to translate into various languages for wider dissemination and use, for improved policy and programming in Africa. It is the Coalition’s priority to facilitate improved collaboration and menstrual health management research capacity and quality in Africa.

It is our intention and aim to ensure that the menstrual health narrative goes beyond focusing only on product distribution and school attendance. Menstrual Health Management should focus on and cater for the needs, rights and dignity of girls, women and other people who menstruate, in all contexts. We need to ensure that MHM messages are comprehensive and empowering, and demystify the socio-cultural stereotypes and taboos in order to ensure girls, women and other people who menstruate feel neither ashamed, endangered 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 and 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 marginalized groups, such as refugees, girls and women living with HIV, transgender people, people with disabilities, those living in informal settlements and sex workers. #LeaveNoOneBehind.