Background
According to the UN Sustainable Development Goals (2015-2030), all nations should work towards ensuring healthy lives and well-being for all at all ages (SDG 3). There is need to ensure inclusive and equitable quality education and promote lifelong learning (SDG4), achieve gender equality and empower all women and girls (SDG 5); ensure availability and sustainable management of water and sanitation for all (SDG 6), and ensure decent Work & Economic Growth (SDG 8). In an effort to ensure dignity for women and girls, the United Nations in (2014), declared May 28th of every year a Menstrual Health and Hygiene Day that aims to create awareness and highlight the importance of menstrual health to different stakeholders.
The Government of Uganda in the National Development Plan III (2020/21 – 2024/25) committed to increase household income and improve the quality of life of Ugandans by harnessing both government and private sector strengths. The MHH strategic plan has been developed in line with broader objective 4 of the NDP III which aims to enhance the productivity and social wellbeing of the population. Under the Human Capital Development Programme implementation level, MHH strategic plan is anchored on objective 5 that aims to reduce vulnerability and gender inequality along the lifecycle.
The plan will also address human capital development programme result areas (iv), (xiii) and (xiv): increase average years of schooling, reduce teenage pregnancy rate and gender index respectively. Inspite of the glaring hope about MHH for women and girls, many of its pertinent issues remain underserved. In Low and Middle Income Countries (LMICs), families, communities, and schools have not been adequately provided with MHH guidance, information, sanitation facilities and materials for girls and women making it difficult for them to adapt to their body changes and the external environment[1].
The limited redress to MHH challenges is a historic issue. Some scholars indicate that many school environments in LMICs were constructed at a time when girls were not permitted or encouraged to attend school, and therefore, the design and construction of water and sanitation facilities, were oriented to the needs of students who were mainly boys[2]. Besides, majority of governments in LMICs had few women in leadership positions, and hence could not effectively advocate for Menstrual Health Management. This was exacerbated by the perception that it was a “taboo” to discuss menstrual issues in public as per the culture of a myriad of societies.[3]
The above barriers implied inadequate planning, response and resource allocation to address menstrual challenges and is still a challenge that has persisted overtime.
Studies have shown that there are many negative social and economic impacts of not attending to the menstrual needs of girls and women. Anecdotal evidence shows that 1 in 10 school-age African girls skip school during menstruation or drop out entirely because they lack access to necessary sanitary products. By contrast, MHH response has largely focused on sanitary materials as a “magic bullet” that will solve menstrual challenges for girls and women[4] yet MHH is beyond pads.
The United Nations Educational, Scientific and Cultural Organization report (UNESCO, 2014), estimates that one in ten girls in Sub-Saharan Africa loses about 4 to 5 days of school per month, and about 10- 20% of their school calendar time.[5]Surveys show 33%-61% increase in absence of adolescent school girls due to lack of menstrual hygiene provisions.[6] At individual level, inadequate Menstrual Health Management predisposes adolescent girls and women to Urogenital infections[7], psychosocial stress and reduced opportunities for accessing school and work.[8] All these consequences limit a woman’s ability to sustain herself and her family, and ultimately impacts negatively on a country’s economy[9].
Poor Menstrual Health and Hygiene and its Negative Impacts
Menstrual health and hygiene (MHH) encompasses both menstrual hygiene management (MHM) and the broader systemic factors that link menstruation with health, well-being, gender equality, education, equity, empowerment, and rights. If health and hygienic practices are not followed during menstruation can pose serious health risks, like reproductive and urinary tract infections which can result in future infertility and birth complications. Neglecting to wash hands after changing menstrual products can spread infections, such as hepatitis B and thrush
Poor menstrual hygiene can lead to many other issues like fungal or bacterial infections of the reproductive tract, irritation of the skin that may cause discomfort and can possibly result in dermatitis – a medical condition in which the skin swells, turns red, and at times becomes sore with blisters. If neglected, it leads to toxic shock syndrome and other vaginal diseases.[10] It generally leads to poor health, low productivity, poor education outcomes and abuse of socio-economic rights among others.
Figure 1: Poor Menstrual Health Hygiene & its negative impacts
Rationale
Generally in Uganda, there is increasing interest in MHH as a human right that requires fulfillment by government and other stakeholders for girls and women of menstruating age. The negative impacts of poor MHH are immense and range from socio-economic to environmental and political. Poor MHH impacts occur at different levels; ranging from individual to household, community/ societal, national and global.
In a study by Performance, Monitoring and Accountability Group (PMA 2017), only 35% of women in Uganda reported having everything they needed to manage their menstruation. By implication, majority of women; (65%) were unable to adequately meet their MHH needs[11]. Likewise, in a study conducted by SNV in 140 schools located in seven districts of Uganda, 70% of the adolescent girls acknowledged that menstruation affected their optimal education performance, while 77% of girls indicated missing averagely 2-3 school days per month[12].This translates into a loss of averagely 8 days of study per term and 24 school days per year.
Given the scenarios above, MHH issues need to be addressed from a national perspective. If not adequately attended to, may have negative implications on the country’s female productive population. Guided by these facts, the relevant government sectors such as Education, Health, Water and Gender as well as Civil Society Organizations (CSOs) in partnership with multi-lateral and United Nations agencies in Uganda, have provided policies and guidelines, and implemented direct interventions respectively to improve menstrual health and hygiene conditions for the women and girls of menstrual age.
Although the above initiatives and developments are appreciated, the drawback has been the absence of a strategic direction and implementation framework within which interventions on MHH can be coordinated, harmonized and synergies built. Poor Menstrual Health is a public health concern that needs robust programming and strategies to mitigate its negative socio-economic impacts to girls and women of menstrual age. It requires a multi-stakeholder approach and a national Strategic direction to maximize resources, and other capacities that can enhance programming and policy response. This hence justifies the development of this National MHH Strategic Plan.
