Low income society and menstrual hygiene

1. COMMUNITY EDUCATORS
TRAINING ON MENSTRUAL
HYGIENE MANAGEMENT

2. The Centre for the Study of Adolescence (CSA) is an independent, non-profit
and non-partisan organization that was established in 1988 by a group of
Kenyan professionals committed to the promotion of adolescent health.
Coverage: 3 regions Western, Nyanza and Nairobi, head Office in Nairobi with
satellite offices in Busia, Kisumu, Kajiado, Kiambu & Bungoma where CSA
implements its Adolescent Reproductive Health Programmes
“Supporting young people to make informed choices”
About CSA - Vidalyne

3. Vision: All of our programs, in their various forms, are working towards a single goal:
A society in which the sexual and reproductive health and rights of young people are
universally realized and enjoyed.
“Supporting young people to make informed choices”
CSA’s Vision & Mission
Mission: CSA seeks to promote and improve the health, well-being and sustained
development of young people through:
• innovative research
• evidence based programming,
• capacity building
• policy advocacy
in order to expand their choices, and improve access to safe and affordable SRH
services.

4. “Supporting young people to make informed choices”
Our Programmes
CSA’s activities are broadly grouped into the following areas:
• Reproductive health, gender and HIV/AIDS
• Social policy, advocacy and networking
• Capacity building – supporting service delivery through training
• Research and utilization

5. “Supporting young people to make informed choices”
Background Information
• CSA has been working in Bungoma County for over 10 year now implementing
different projects geared towards improving Sexual Reproductive Health and
Rights of adolescents and young people.
• The programmes continues to addressed issues of capacity building, skills
building and prevention of SRHR challenges that adolescent and young
people face in the process of growing up.
• The programmes intervene at various levels e.g schools, health facilities and
at community level.
• But all the interventions seems to have had a gap on menstrual health as one
of the components of SRHR which was not addressed.

6. “Supporting young people to make informed choices”
About the MHM Intervention
• The Project is a joint online session engagement on MHM between CSA and
SAIPEH and the beneficiaries and decision makers within Bungoma County.
• The project will be implement between September and October of 2020 to
support the plight of the girls during this COVID 19 pandemic.
• The project is aimed at improving knowledge on MHM, Improve supportive
environment on MHM and Improve access to MHM services amongst young
girls in Bungoma

7. “Supporting young people to make informed choices”
Why the intervention?
• Research shows that girls face stigma,discrimination,unfavouale MH
environment in schools, at home and in other social places.
• With COVID-19,the situation is getting out of hand as girls who could access
the limited supplies in schools cant afford them any more.
• Previous research identified that most schools lack enough toilets, some
toilets have no doors, hence no privacy and worst of all boys and girls share
toilets in some schools,
• There is also lack of water and changing rooms.
• These has pushed girls into risky coping mechanism like multiple boy friends
to get sanitary towels, leading to STIs and HIV and pregnancy

8. “Supporting young people to make informed choices”
Project Activities
The project activities include;
• Building the capacity of 20 educators in 10 communities
as MHM educators,
• Training 100 girls in 10 communities as MHM direct
beneficiaries.
• Train 50 boys as MHM champions
• Social Media sensitization on MHM
• Advocacy with county policy makers
• Sensitization of local stakeholders amongst them school
managers, BOM members and religious leaders on MHM.

9. “Supporting young people to make informed choices”
Intervention Outcomes
• Create a pool of young champions on MHM at community level
• MHM awareness creation amongst stakeholders and young people
• Improve government supply chain system on MH supplies
• Prioritize MHM at school level budgetary allocations to improve
environment
• Build case studies and support the girls to engage the county in advocacy.
• Tap into other opportunities that can drive the agenda of MHM forward
• Identify ways of address barriers to safe and dignified MHM for girls in
schools, as well as inclusive ways to end menstrual stigma and empower
girls with knowledge and skills to manage their menstruation.
• Push for the implementation of the MHM policy at county level

10. “Supporting young people to make informed choices”
Definitions - Mercy
What is:
• Menstruation?
• Menstrual cycle?
• Menstrual Hygiene Management?

11. “Supporting young people to make informed choices”
Menstruation
Menstruation is a woman's monthly bleeding. When you
menstruate, your body sheds the lining of the uterus
(womb). Menstrual blood flows from the uterus through
the small opening in the cervix and passes out of the
body through the vagina. Most menstrual periods last
from 3 to 5 days. A girl can start her period anytime
between the ages of 8 and 15. Most of the time, the first
period starts about 2 years after breasts first start to
develop

12. “Supporting young people to make informed choices”
Menstrual cycle
• The menstrual cycle is the monthly series of changes in a woman’s body
• Several hormones are responsible during the entire cycle (progesterone,
follicle stimulating hormone (FSH) and oestrogen)
• Each month, one of the ovaries releases an egg – a process called ovulation.
• At the same time, hormonal changes prepare the uterus for pregnancy.
• If ovulation takes place which is around the 12th and16th day, if the egg is not
fertilized, the lining of the uterus sheds through the vagina. This is a
menstrual period.
• The menstrual cycle, is not the same for every girl/ woman. Menstrual flow
might occur every 21 to 35 days but most women have the 28 day cycle and
last 3 to 5 days. However, menstrual cycles tend to shorten and become more
regular as you age.
• Your menstrual cycle might be regular or somewhat irregular, and your period
might be light or heavy, painful or pain-free, long or short, and still be
considered normal

13. “Supporting young people to make informed choices”
Menstrual cycle
The menstrual blood is about 2 tablespoon (40ml) and is a
mixture of blood, cervical mucus, vaginal secretions and
endometrial tissue

14. “Supporting young people to make informed choices”
Menstrual Hygiene Management
MHM is defined as use of clean menstrual material to
absorb or collect blood that can be changed in privacy as
often as necessary for the duration of menstruation, using
soap and water for washing the body as required and
having facilities to dispose of used menstrual
management materials

17. “Supporting young people to make informed choices”
Challenges and Risks that Girls Face
1. What are some of the Problems faced by menstruating
schoolgirls?
2. What are some of the risks they are likely to
encounter?
3. What myths have you heard about menstruation in
your community?
Kindly share your thoughts!

18. “Supporting young people to make informed choices”
Problems faced by Menstruating Schoolgirls
• Expense of commercial sanitary pads;
• Lack of water for bathing and washing of menstrual materials;
• Dirty latrines – the hygiene hazards and unpleasantness;
• Lack of hygienic anal cleansing materials;
• Unsuitable places to dry menstrual materials;
• Lack of access to pain relief (analgesic) drugs;
• Inadequate waste disposal facilities;
• Lack of privacy for changing menstrual materials;
• ‘Leakage’ from poor-quality protection materials;
• Lack of resources for washing such as soap and basins;
• Limited education on facts of menstruation; embarrassment and low self- esteem
• Limited access to counselling and guidance;
• Fear caused by cultural myths; and unsupportive attitudes of some men

19. “Supporting young people to make informed choices”
The Risks
• Absenteeism
where girls stay at home rather than attending school, sometimes occurs when
schoolgirls are menstruating. There is debate about the reasons for menstrual- related
absenteeism.
There are three main arguments:
a) Schoolgirls do not have adequate sanitary protection materials (i.e. pads). They
are embarrassed about the potential ‘leaking’ of blood if less protective materials
are used.
b) Dysmenorrhea (or period pain caused by the contraction of muscles in the uterus)
causes school girls to feel unwell. If there is nowhere to rest in school or if
analgesic drugs are not readily available, girls prefer to remain alone at home.
c) Inadequate water supply and sanitation facilities deter school girls if they cannot
wash or change in privacy.

20. “Supporting young people to make informed choices”
The Risks
• Cultural and religious restrictions
Some cultures do not allow girls and women to perform particular tasks and
responsibilities during their periods which leads to isolation and discrimination of the
girls. This include religious norms where a women cannot go to the pulpit because she
is viewed as unclean.
• Reproductive health risks
The lack of this provisions can make girls engage in risky behaviours e.g early sex,
forced sex, transactional sex, intergenerational sex which can lead to early pregnancy,
STI infections including HIV/AIDS, urogenital infections, unsafe abortion. All these can
also affect their relationships with parents, relatives and also their self esteem.

21. “Supporting young people to make informed choices”
Myth around menstruation
Restrictions on menstruating girls/ women Associated beliefs
Confinement to a room or a separate menstruation
hut to avoid interaction with men
A menstruating woman is ‘unclean’
Prohibited from cooking, fetching water, sweeping or
doing any housework
Objects, especially food and drink, that are touched
become contaminated and cause the user/consumer
to be cursed
Not allowed to cross roads or walk around freely Crossing a road will increase a woman’s menstrual
flow
Forbidden from walking through gardens where
certain food is growing (e.g. pumpkins or groundnuts)
The produce will rot or yield a poor harvest
Forbidden from entering a kraal (cattle pen)
containing pregnant cows
The cows will miscarry
Prohibited from using open wells The well may dry up or become filled with blood
Women must hide menstrual cloths and protection
products
Those who see such cloths, especially if blood-stained,
will be cursed. Women whose protection materials
are sniffed by dogs become infertile.

22. “Supporting young people to make informed choices”
In summary
CHALLENGES:
• Cultural challenges
• Stigma
• Lack of supplies
• Lack of supportive environment e.g water, changing
rooms
RISKS:
• School absenteeism and school drop outs
• Pregnancy and abortions
• STIs and HIV
• Reduced self esteem
• Urogenital infections

23. “Supporting young people to make informed choices”
Important things to note about Menstruation:
• It is a natural process and a vital sign of the healthy reproductive
cycle of women and girls.
• It is not a sickness, but women and girls may suffer from
abdominal pains, nausea, tiredness, headache, back ache or
discomfort.
• Women and girls may also have feelings of sadness or irritation
due to hormonal changes.
• These experiences vary from person to person and over time.

25. “Supporting young people to make informed choices”
Practical considerations for MHM - Carolyne
There are four ways in which stakeholder can enable schoolgirls to
overcome some of the problems mentioned previously:
1. promoting low-cost sanitary pads;
2. designing female-friendly sanitation facilities;
3. increasing access to pain-relief medication; and by
4. providing education and counselling.
These will be considered in turn, with particular emphasis on low-
cost sanitary pads.

26. “Supporting young people to make informed choices”
Menstrual hygiene
Menstruation blood itself is clean. But once the blood leaves the
body, bacteria can grow in it, causing it to smell.
This is why good hygiene is especially important when you´re
having your period.
Are there some of the materials that can be used to
manage menstrual flow?

27. “Supporting young people to make informed choices”
Sanitary pads
How to use sanitary pads
• Pads stick to the inside of your underwear and soak up the blood
that comes out through the vagina.
• Some pads are thinner for days when your period is light, and
some are thicker for when you are bleeding more.
• Check your pad every couple of hours during the day to see if it
needs changing.
• If you are concerned about any smell, changing pads often and
keeping up good hygiene will help control this.
• wash your hands before and after you use the products and to
especially wash your genital with soap and water every day
when you have your period.

28. “Supporting young people to make informed choices”
Vaginal cap
How to fold and insert Menstrual cups are an environmentally-
friendly, comfortable, convenient, and cost-
effective solution that are rapidly becoming
the most preferred choice by women all over
the planet.
With the rising popularity of the menstrual
cup, there are more and more brands,
varieties, and
• Step 1: Fold
• Step 2: Hold
• Step 3: Insert
• Step 4: Seal and Rotate
• Step 5: Removal
• Step 6: empty
• Step 7: wash and reinsert
This can be done least 2 times a day (twice in a 24 hour
period) and can be worn overnight without concern of
leaking.

29. “Supporting young people to make informed choices”
Homemade reusable sanitary pads

30. “Supporting young people to make informed choices”
How to put on the reusable
pads and washing
Important things to note about
Menstrual Hygiene:
• Girls should have access to accurate
and realistic information
• Girls should have access to products
like sanitary pads and inner wears
• Girls should have access to clean and
safe toilets where they can change
their pads.
• Girls should have access to water
and soap
• Girls should have access to disposal
facilities for used sanitary pads

31. “Supporting young people to make informed choices”
Conclusion
Given the multiple challenges adolescent girls and women face, it is evident that
promoting menstrual hygiene management (MHM) is not only a sanitation
matter; it is also an important step towards safeguarding the dignity, bodily
integrity and overall life opportunities of girls and women.
Menstrual health requires a multi-component approach: combining access to
WASH facilities, a choice of products with comprehensive SRHR interventions
that are targeted both at people who menstruate and the people in their
environment.

32. “Supporting young people to make informed choices”
Next steps - Vidalyne
Post test questions
Pairing the 100 girls against the 20 educators
Two weeks of engagement with the girls both the online and physical
Celebration in each sub county (distribution of pads and masks, documentation
of success stories, experiences and achievements)
Preparation and presentation of a memorandum to the County officials
(decision makers)

33. THE CENTRE FOR THE STUDY OF ADOLESCENCE
Mbaazi Avenue, Off Kingara Road, Lavington
P.O. Box 19329 - 00202 Nairobi, Kenya
T: +254 (0)202 398 724
F: +254 202 398 723
W: www.csakenya.org
E: csa@csakenya.org