menstrual hygiene2

Menstrual Hygiene: a Culture of Silence

Menstrual hygiene is a concern for women globally. In Sudan, the lack of knowledge and awareness surrounding  menstruation, especially in rural and conflict areas, along with social, cultural, and religious restrictions, makes it difficult for women and girls to take proper care of their hygiene during their monthly cycle. This can result in many challenges at home, school, and the workplace. Menstrual hygiene is important for the well-being of women and girls. In order to ensure menstrual hygiene for women and girls, it is important for women and girls to be able to manage their periods safely without shame or stigma, but with dignity and confidence. 

According to a UNESCO report surveying several countries in sub-Saharan Africa, one out of every 10 girls misses school during menstruation. A Ugandan study found that nearly two-thirds of schoolgirls in rural areas miss school at least once a month due to menstruation. Similarly, in Ethiopia, more than half of the adolescent school girls remain absent during menstruation. 

In Sudan, the situation is similar to some extent. Women and girls from low socioeconomic backgrounds, especially those in rural and conflict areas, suffer from unhygienic menstrual practices. The lack of sanitary products as well as accessibility to safe and hygienic places to manage their periods leads girls to miss school and to feel unsafe and self-conscious. 

“I share a little torn towel with my 11-year-old daughter during our menstruation because buying actual sanitary pads from the shops is very expensive and not available. Family hygiene kits are crucial for us.  In the past I used to feel bad each time I had my monthly period, I didn’t feel comfortable using unhygienic rugs they are not comfortable, nor are they effective, and they can lead to very serious health concerns,  with free disposable sanitary pads provided, I can safely manage my health, I can now openly talk about menstruation and the sanitary pads. I feel confident and empowered.”

Leila Mustafa, who lives in a camp in East Darfur and received family hygiene kits from UNICEF.

Poor menstrual hygiene management practices can be attributed to three main factors: lack of knowledge, lack of access, and lack of acceptance.

Lack of knowledge:

Despite the scarcity of data, different studies indicate that less than 40% of adolescent girls are unaware of menstruation until they encounter their first period. This leads to girls being too ashamed and afraid to seek medical advice. The lack of knowledge surrounding menstruation leads to misconceptions, taboos, and negative societal attitudes and perceptions.

Lack of access:

Many girls and women cannot afford sanitary products, so they resort to rags, cloths, papers, layering underwear, and other highly unhygienic methods to manage their menstruation. Several countries, such as Kenya and Rwanda, have removed taxes from menstrual products. Counties such as Zimbabwe have used local resources to sustainably manufacture sanitary products for women.

According to UNICEF, globally, 2.3 billion people live without basic sanitation services. In developing countries, only 27% of people have adequate hand washing facilities at home. Not being able to use these facilities makes it harder for women and young girls to manage their periods in a safe and dignified manner. 

Lack of acceptance: 

In various cultural settings, the topic of menstruation has been surrounded by silence. While anthropological literature documents that various cultures have historically embraced menarche as the passage to adulthood, menstrual blood itself along with  its management has been stigmatized and perceived as a taboo.  Menstruation and menstrual practices are often obscured by taboos and socio-cultural barriers rendering adolescent girls oblivious of medical facts and hygienic practices which can lead to negative health implications.

We asked women and girls about their reactions when they first encountered their periods, most of them expressed how stressed and scared they were. The lack of knowledge about menstrual hygiene and the stigmatization of menstruation forced many girls to suffer in silence. Some didn’t even tell their mothers. The girls shared with us how they suffered from infections and lack of confidence:

“I did not understand what I was going through. At first, I thought that I was injured somewhere and was searching for the source of bleeding. I was not comfortable with asking my mother or any other person to buy me sanitary pads, so I used other materials to manage my period, without knowing the negative effects of using unhygienic products.”

“I was shocked and frightened. I thought that I did something bad and my body is punishing me. I ran to my mother but she shut me at first because I was talking in front of my brother. I felt ashamed, shy, and bad about myself.”

“I searched for various ways to provide the products used during the menstrual cycle secretly without anyone’s help. During that period, I was not able to use medical cotton properly, which caused me a state of tension during my menstruation.”

Period Poverty:

Period poverty is a global issue affecting women and girls who do not have either access to safe and hygienic sanitary products or knowledge on menstruation often due to financial issues. Period poverty does not only refer to those who have no access to sanitary products, it also refers to women and girls who have limited access to sanitary products which leads to prolonged use of the products which can cause infections.

Period poverty has a great role in poor menstrual hygiene which leads to reproductive and urinary tract infections. Additionally, period poverty stops women from reaching their full potential by missing out on opportunities important for their growth. It also forces girls to miss days of school which impacts their school performance. 

“Meeting the hygiene needs of all adolescent girls is a fundamental issue of human rights, dignity, and public health.”

Sanjay Wijesekera, former UNICEF Chief of Water, Sanitation, and Hygiene

Menstrual Hygiene in Humanitarian Situations

As of 2017, more than 26 million menstruating girls and women have been displaced as a result of conflict and disasters while many more have been affected without being displaced. Menstrual hygiene is almost always overlooked and not effectively addressed in post-conflict and disaster settings. Conflicts and disasters can leave women and girls without access to clean and proper sanitation facilities, privacy needed to proceed with their menstruation management methods, and access to safe sanitation products and material to manage their menstruation. This could be due to the lack of availability of these products or the lack of funds to purchase them. As a result, women and girls are forced to use improvised methods to manage their periods, including torn pieces of clothing, filthy rags, and other unhygienic methods.

Such alternative methods are often ineffective, uncomfortable, and unhygienic. They can lead to dangerous infections and other health complications which can cause women and girls to feel isolated during their period. In the aftermath of an earthquake in Nepal, women and girls were left with no option but to depend on the use of locally available resources as adsorbents during menstruation. Menstrual hygiene products and kits were not addressed as essential humanitarian needs by humanitarian agencies. 

Tackling menstrual hygiene management during emergencies needs a multi-faceted approach and interventions ranging from providing proper and private sanitation facilities, protection, reproductive health education to community support.

Health complications:

Menstruating women and girls have developed their approach to cope with menstruation based on their knowledge, available resources and economic and sociocultural statuses. As a result of these limitations, women often manage menstruation with practices and methods that are unhygienic. Such methods can lead to serious health complications. Certain practices are more likely to increase the risk of reproductive tract infections which can increase susceptibility to cervical cancer. Using unclean rags, especially if they are inserted into the vagina, can facilitate the growth of unwanted bacteria in the cervix and the uterine cavity which could lead to infection. Prolonged use of the same pad will also increase the risk of infection and skin irritation that can result in dermatitis. Douching (forcing liquid into the vagina) upsets the normal balance of yeast in the vagina and makes infection more likely.  Also, unsafe disposal of used sanitary materials has the risk of infecting others, especially with diseases such as Hepatitis B. The lack of hand-washing after changing sanitary materials can also facilitate the spread of infections. 

Why it isn’t addressed often

Despite its importance, menstrual hygiene management doesn’t receive enough attention in developing countries. Since the global health priorities in Sexual and Reproductive Health was aimed at reducing maternal morbidity and mortality and the HIV epidemic, the main focus in developing countries was towards adolescent girls because of their increased vulnerability to unwanted pregnancy and infection with HIV and other sexually transmitted infections.

Many in the education sector perceived menstruation as less important than the shortage of resources for textbooks, classrooms, and other essentials, and believed that the onset and management of menses was a private matter, to be taken care of within the family. The low number of women in leadership and decision making positions hindered the efforts to effectively advocate forcefully about a topic as taboo as menstruation and the importance of Menstrual Hygiene Management (MHM).

What can we do?

Menarche remains one of the biggest taboos. A study conducted by the International Women’s Health Coalition found that there are about 5,000 euphemisms used to refer to menstruation in 10 different languages which can indicate the general attitude the follow the word. Breaking such taboos and publicly addressing the needs of menstruating females is the first step we can take to educate and try to eliminate period poverty. The current initiatives in Sudan to provide pads and menstrual products in the areas that were affected by floods as part of the humanitarian response can be highlighted as an excellent step to address and bring light to the hidden emergency menstruating females go through. 

  • To work more on raising awareness and knowledge among local communities to end the menarche stigma through public advocacy.
  • To advocate for policy changes to make menstrual products more accessible through evidence-based advocacy to decision-makers.
  • To work on the implementations of proper sanitary facilities in marginalized communities.
  • To raise awareness on the importance of the inclusion of menstrual hygiene health and management in education and health programs to build knowledge for girls and boys, and work on engaging parents and community leaders.
  • To further research and collect data on menstrual hygiene effects on women’s health and rights.


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