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Menstruation  is  an  integral  and  normal  part  of  human  life,  indeed  of  human  existence.  Menstrual hygiene  is  fundamental  to  the  dignity  and  wellbeing  of  women  and  girls  and  an  important  part  of  the basic  hygiene,  sanitation  and  reproductive  health  services  to  which  every  woman  and  girl  has  a  right. Globally,  approximately  52%  of  the  female  population  (26%  of  the  total  population)  is  of  reproductive age. Most of these women and girls will menstruate each month for between two and seven days. 

Menstruation is a natural part of the reproductive cycle, however, in most parts of the world, it remains taboo and is rarely talked about. As a result, the practical challenges of menstrual hygiene are made even more difficult by various socio-cultural factors.

According to Data from the 2015 National Population Census the proportion of females to males as per the national population remains high with about 18,124,684 people being women. 24.5% of these were women adolescents between 10-19 years (4,440,547). 

According to the research study in 2014 by SNV entitled “Mapping the Menstrual Hygiene Market in Uganda”, At least 84% of these women are from  rural areas and majority poor and assumed to be unable to (sufficiently) access and/or afford sanitary materials including sanitary towel. According to a study done by UNICEF in 2013, 1 in 10 school girls in Africa miss school or drop out completely due to lack of access to menstrual materials and other sanitary products. 

This critical unavailability of sanitary products is a major barrier to education for girls of school-going age. The inability to effectively manage menstruation contributes to absences of up to 4-5 school days each month, equating to as much as 20% of the academic year intentionally skipped, simply due to menstruation. Eventually many of these girls drop out of school entirely, increasing their risk to the likelihood of early initiation to sex with associated risks of HIV, early pregnancy, teenage pregnancy with its associated maternal health complications, and further limiting their future career and economic opportunities.

Other young women mainly from poor backgrounds suffer from virginal and urinary infections as a result of using unhygienic sanitary materials since they are unable to afford or access proper menstrual products. Many women and girls from such poor backgrounds rely on crude, improvised materials like scraps of old clothing, pieces of foam mattress, toilet paper, leaves, and banana fibers to manage their menstruation – all of which are unhygienic, ineffective, and uncomfortable. Such circumstances have continued to deprived young girls and women of their potential to exercise their right to health, education and dignity.

Most schools lack sanitary facilities that have access to washing facilities including clean water points and soap, changing rooms, disposal facilities to Because of  this  inconvenience,  many  girls  opt  to  stay  at  home  during  menses  and  this  has  implications  on  their general academic performance and achievement levels in the different grades/classes.(Crofts 2012).

However, menstruation is also still seen as taboo in many African societies. Cultural practices and taboos around menstruation impact negatively on the lives of women and girls, and reinforce gender inequities and exclusion.

But menstrual hygiene cannot be left to women and girls to discuss in secrecy and isolation. It must be acknowledged as a subject for public discussion. Education regarding menstrual health should be promoted. Furthermore, it’s noted in the same research study by SNV, at least 20% of the teachers interviewed said that there were still restrictive cultural beliefs surrounding menstruation. 28% of girls reported that people around them expect them to restrict their movement during menstruation.

In the Central Region of Uganda, menstruation is referred as “Ensonga” or “the issue”’; but this does not reduce the cultural practices and social myths which make it difficult for both men and women to talk about menstruation. 

It’s against this background that Public Health Ambassadors Uganda (PHAU) in partnership with Uganda Youth and Adolescents Health Forum and with support from Virginia Gildersleeve International Fund (VGIF) and Wakiso District Education Department is running a Menstrual Hygiene and Health Management Project dubbed “Ensonga Campaign”  aimed at breaking the silence, stigma and building awareness among boys girls, parents, teachers and communities about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.

The “Ensonga Campaign” is  contributing to improved Menstrual Hygiene and Health Management (MHHM) among school going adolescent girls through sensitization and creating awareness on how to manage menstruation hygienically and with dignity, highlighting the role of boy, men and parents in ensuring girls enjoy menstruation with dignity by reducing the stigma and discrimination that surrounds menstruation and   improving access to Water, Sanitation and Hygiene (WASH) facilities within primary and secondary schools in Wakiso District.

The campaign has empowered Adolescent girls with MHM information including use of reusable sanitary pads through formation of Sanitation health clubs and installation of sustainable WASH facilities. The project slogan is #MenstruationMatters

  
The pictures above show PHAU and UYAHF peer educators conducting a school outreach on Menstrual Hygiene at  Nansana Church of Uganda Primary School in Wakiso District.

On 4th August 2016, the “Ensonga Campaign” was launched in two selected schools in Wakiso District.  PHAU with partners from UYAHF conducted school outreaches at Nansana Church of Uganda Primary School and Wakiso Secondary School. The entire school was taken through the introductory session about menstruation and puberty before being grouped into Focused Group Discussions (FGDs). The focused group discussions provide a conducive environment for girls to speak and share freely about their views, experiences, opinions and challenges on menstruation; this is followed by Question and Answers session. 

If I skip my periods this month or have them for 3 days then I have them for 5 days next month, am I normal?” asked during FGD

  
In the pictures above, Girls at Nansana Church of Uganda Primary School demonstrate to fellow pupils on how to dress up a reusable sanitary pad at  one of #Ensonga’s School Out reaches on Menstrual Hygiene.

Sometimes when I am about to have my periods, I grow pimples then the next cycle I do not have them, I instead have stomach pain, is it normal?” asked during FGD

   
In the pictures above, PHAU and UYAHF Peer educators conducting another school outreach session on menstrual hygiene and management at Wakiso Secondary School. 

The students were also sensitized on how to manage cramps, monitoring their cycles using the calendar and the different methods of menstruation management such as the disposable and reusable sanitary pads, towels, tampons, the menstrual cup, cotton and gauze for both boys and girls. 

I missed classes for four days when I came back to school I found out that I had missed two topics and I don’t have any one to take me through” Flora –Student, Wakiso Secondary School

Through Pad Demonstration sessions, students received practical sessions on the correct and consistent use of sanitary pads. The boys were encouraged to support girls before, during and after menstruation. The boys were also counseled to stop mocking, insulting, abusing, isolating and laughing at girls during periods, but to support and comfort them through these tough times. The boys were also called on to support #Ensonga Campaign by lobbying parents and school authorities to create and ensure a supportive environment for girls during menstruation.

  
In the pictures above, Boys at Wakiso secondary school demonstrate to fellow students on how to dress up a sanitary towel during the boys focused group discussion. 

We had never heard anything openly like this about menstruation, but from today we will also tell our fellow girls who are not in the health club about how to be in school during their menstrual period.” Scovia - Student, Nansana C/U Primary School  

Sanitation health clubs were formed in the respective schools comprising of representatives from the different classes. The clubs members will act as change agents towards adoption of good menstrual hygiene and sanitation practices and advocate for a favorable environment for girls during menstruation . The Senior Women or Senior Men are the patrons for the established school clubs hence they will provide support, guidance and mentorship to the members, while PHAU and UYAHF will continue to provide technical guidance to the clubs

  
Sanitation Health Club members from Nansana Church of Uganda Primary School and Wakiso Secondary School pause for a group picture with PHAU and UYAHF team.

Menstruation education should not be left to teachers only. It’s an initiative of mothers to educate their daughters about menstruation hence we need to involve and educate mothers too” - Jackie, Deputy Head Teacher - Nansana C/U Primary School.

A total of 386 students were sensitized on accurate information on Menstrual Hygiene Management with emphasis on reusable pads.

To manage menstruation hygienically, it is essential that women and girls have access to correct and accurate information on menstruation issues as well as access to sanitary wear and proper disposal facilities.

They need somewhere private to change sanitary cloths or pads; clean water for washing their hands and used clothes; and facilities for safely disposing off used materials or a place to dry them if reusable. There is also a need for both men and women, teachers, parents and communities to have greater awareness and information on menstrual hygiene management.  

PHAU and UYAHF will continue to conduct routine follow up activities in respective schools to install talking compounds with Menstrual Hygiene Messages to provide an enabling environment for students to discuss more on issues related to menstruation.  

To follow the project activities, check out our Facebook, Twitter, YouTube using the following Hashtags #Ensonga #MenstruationMatters

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