Government urged to scale up efforts on Menstrual Health
Government has been urged to scale up efforts in menstrual health especially in rural areas. The call was made by Shamirah Nakalema, the Training coordinator, WoMena Uganda during a recent media cafe meant for dialogue to expound on the many intersectional issues related to menstrual health. The main goal of the event was to highlight the importance of menstrual health commodities in and of themselves and the relationship with Sexual and Reproductive Health (SRH) outcomes as well as to address core issues surrounding the provision of quality, affordable, and reusable menstrual product access, which is crucial for sustainable development, healthy futures as well as good governance. The pilot intervention was carried out over a period of fourteen (14) months, with a three-month product use period for Trained Trainers and a five-month trial period for primary beneficiaries (i.e. female students at Alere S.S. and Dzaipi S.S.). The intervention consisted of a pre-intervention exploratory visit, training of trainers, training of beneficiaries, distribution of a menstrual health kit containing a menstrual cup, and follow-up refreshers and M&E. In total, 12 local teachers, War Child Canada staff, and government officials were trained as trainers in menstrual health and 180 schoolgirls received training and a Bfree Cup Kit containing three different sized volume menstrual cups (10ml, 15ml & 25ml). WoMena Uganda carried out monitoring & evaluation (M&E) activities throughout the intervention with the training and technical support of PHAU and WGHI. The quantitative and qualitative M&E tools included menstrual health management (MHM) pre-training surveys, product uptake surveys, knowledge retention tests, baseline and endline questionnaires, interviews and focus group discussions (FGDs). Results from the baseline indicated that girls and women struggle to manage their menstruation effectively and with dignity. The qualitative data showed that most girls use disposable pads, although not always accessible, resulting in girls using clothes.
Additionally, The Bfree project was a fourteen (14) months pilot implemented in the refugee community schools in Adjumani. The menstrual cup is a newly developed antibacterial ‘Bfree Cup, a menstrual cup that does not require water for boiling and like other menstrual cups lasts for more than 10 years. This product is a sustainable solution to the menstrual hygiene challenges adolescent girls and women face in Uganda, especially in a refugee and rural settings contexts.
With support from WoMena Uganda and Public Health Ambassadors Uganda (PHAU) and funding from the UNFPA through Women’s Global Health Innovations (WGHI) based in Canada implemented a menstrual cup pilot intervention in Alere and Dzaipi Secondary Schools in Refugee Settlements, Adjumani District, Uganda, to assess the acceptability and overall impact of introducing the new antimicrobial Bfree menstrual cup.
It is against the results and findings of this Bfree pilot project that the Fund for Innovative Transformation (FIT), the Inter-council Network (ICN), and the Government of Canada has granted Women’s Global Health Innovations (WGHI) Canada in a consortium with PHAU and WoMena in Uganda to extend the interventions and positive results of the pilot project initially in the refugee settlements schools of Alere and Dzaipi Secondary Schools to now cover the entire district of Adjumanifor both girls in and out of school and women at large.
MENSTRUAL HEALTH OVERVIEW IN UGANDA
In Uganda approximately 86% of South Sudanese refugee arrivals are women and children (UNHCR, 2017a). Globally, girls and women often lack the ability to manage their menstruation with dignity due to lack of adequate and private facilities, safe, acceptable and accessible menstrual health products and knowledge, which can be further exacerbated during conflict and displacement. Menstrual health management is, however, often an overlooked component in acute and protracted emergency situations, as it is not considered life threatening. The menstrual cup is increasingly considered a possible solution for girls and women’s menstrual management in both low-income and humanitarian settings.
PROJECT RESULTS AND FINDINGS
The pilot intervention was carried out over a period of fourteen (14) months, with a three-month product use period for Trained Trainers and a five-month trial period for primary beneficiaries (i.e. female students at Alere S.S. and Dzaipi S.S.). The intervention consisted of a pre-intervention exploratory visit, training of trainers, training of beneficiaries, distribution of a menstrual health kit containing a menstrual cup, and follow-up refreshers and M&E. In total, 12 local teachers, War Child Canada staff, and government officials were trained as trainers in menstrual health and 180 schoolgirls received training and a Bfree Cup Kit containing three different sized volume menstrual cups (10ml, 15ml & 25ml). WoMena Uganda carried out monitoring & evaluation (M&E) activities throughout the intervention with the training and technical support of PHAU and WGHI. The quantitative and qualitative M&E tools included menstrual health management (MHM) pre-training surveys, product uptake surveys, knowledge retention tests, baseline and endline questionnaires, interviews and focus group discussions (FGDs).
Results from the baseline indicated that girls and women struggle to manage their menstruation effectively and with dignity. The qualitative data showed that most girls use disposable pads, although not always accessible, resulting in girls using clothes. Additionally, the girls reported they were often staining with their current products, causing embarrassment or shame at school.
Despite initial concerns about the menstrual cup, product uptake among intervention participants was high, with 91% of surveyed recipients using their menstrual cups consistently at endline (based on reported use during the last menstrual cycle). Users reported the menstrual cup being comfortable to use after getting over the initial fear. Adherence to safe care and user guidelines appeared high among participants, reporting they maintained correct handwashing and storage procedures – which was easier given the installation of hand washing facilities and storage tin provided as part of the Bfree Cup Kit. Access to clean water for rinsing the cup was the biggest barrier, although girls found ways around it by carrying a bottle of water with them to the school latrine/washrooms.
Recommendations for scale up include the incorporation of menstrual health clubs to further engage students and assess MHM challenges from a bottom-up, youth-led approach. Additionally, increased inclusion of school administrators and teachers at intervention schools is encouraged to strengthen supportive structures and school receptiveness to the intervention. An overall increased level of community sensitization and male involvement is encouraged to ensure sustainability and ongoing support once pupils exit the school setting. Finally, in future scale up there should be focus on gaining a more nuanced understanding of menstrual patterns and experiences with strengthened M&E framework.
