WASH network compilation



WASH network compilation
Plan International
May 2015
Updates from the field .................................................................................................................................. 3
Indonesia: Engaging men in promoting menstrual hygiene management, Nagekeo District .................. 3
Sri Lanka: ................................................................................................................................................... 5
Creating a Dialogue for Upgrading and Providing Facilities for Menstrual Hygiene Management in
Schools .................................................................................................................................................. 5
Education and awareness is key to menstrual hygiene ........................................................................ 8
Uganda: ................................................................................................................................................... 10
UKNO:...................................................................................................................................................... 11
ANO: ........................................................................................................................................................ 14
Plan Netherlands:.................................................................................................................................... 15
Testimonials and case studies..................................................................................................................... 15
Indonesia:................................................................................................................................................ 15
Chandarayani, 11 years old ................................................................................................................. 15
Cambodia: ............................................................................................................................................... 15
Leak: My First Period........................................................................................................................... 15
Neath: My First Period ........................................................................................................................ 16
Horn: My First Period .......................................................................................................................... 17
Dary: My First Period .......................................................................................................................... 17
Trem: My First Period ......................................................................................................................... 19
Kheoun: My First Period ..................................................................................................................... 20
Luy: My First Period ............................................................................................................................ 20
San: My First Period ............................................................................................................................ 21
Malawi: ................................................................................................................................................... 22
Menstruation taboos and beliefs: A battle well fought by Plan Malawi in Chinyama Community .... 22
An onset of menarche in Mthuluwe Village: Teleza and Chisomo ..................................................... 25
Uganda: ................................................................................................................................................... 26
Eveline, 12 years old: .......................................................................................................................... 26
Agnes: Finally I knew what was happening every month” ................................................................. 26
Lovisa: “The girls feel better and are more confident” ...................................................................... 28
Peninah: “Everybody started laughing and pointing at the girl” ........................................................ 30
Rosemary: “I had sex to pay my debt”................................................................................................ 31
Samuel and Aleu: “Some boys laugh at me because I help girls.” ...................................................... 32
Moreen: “I used my grandmother’s old clothes” ............................................................................... 33
Plan Uganda Menstrual Hygiene Management Program–More than just menstrual hygiene
awareness ........................................................................................................................................... 34
Improving knowledge attitude and practice in Menstrua Hygiene among rural communities of
Tororo (Plan Netherlands) .................................................................................................................. 37
Menstrual Hygiene Management Project: Empowering women and men out of Poverty ................ 38
Ethiopia: .................................................................................................................................................. 39
Menstrual Hygiene Management in Setamo Primary School, Case of Dara district (Ethiopia) .......... 39
Blogs ............................................................................................................................................................ 40
USNO: Caitlin Gruer, Menstruation Matters: That's the Bottom Line .................................................... 40
Plan Netherlands: Sharon Roose ............................................................................................................ 41
UKNO: Cathy Stephen, Let’s all talk about ‘that time of the month’ on Menstrual Hygiene Day! ........ 42
Diana Sierra, Be Girl video blog: ............................................................................................................. 45
Online Resources ........................................................................................................................................ 45
ANO: ........................................................................................................................................................ 45
Plan Netherlands:.................................................................................................................................... 45
USNO: ...................................................................................................................................................... 45
UKNO:...................................................................................................................................................... 45
Updates from the field
Indonesia: Engaging men in promoting menstrual hygiene management, Nagekeo District
Ama Gafri (holding microphone and a sanitary napkin in the picture), WASH Supervisor of PLAN
NAGAKEO, INDONESIA, recalled feeling rather awkward initially when he had to facilitate a training on
Menstrual Hygiene Management, especially as most of the training participants were women. However,
he believes that MHM is crucial for girls and promoting proper management of menstruation among
adolescent girls at schools requires the support of all including boys and men. “I realized that my
knowledge as a resource person was still limited but I also worked closely with a lady doctor from the
local health office as my co-facilitator. My main role was to encourage active participation of all and
especially to convey the message to the male teachers that we – men – should support promotion of
MHM” Ama said. Without the presence of a male facilitator it was most likely that only female teachers
were assigned to attend the MHM training.
MHM promotion has been facilitated by Plan Indonesia at the Nagakeo Program Unit as the first
initiative as part of a WASH in Schools Project. At the 7 schools participating in the Project, male and
female teachers responsible for school health programs have been trained and subsequently trained
their students at their respective schools.
All the male teachers acknowledged that they all felt awkward initially having to discuss
menstruation, something that they all believe as purely girls and women’s personal affairs.
Through the training they have all learned of the importance of breaking the taboo of discussing
sexual organs, of the importance of ensuring proper facilities at schools for comfortable and hygienic
facilities to manage menstruation periods.
The training at the district and subsequently at school levels has resulted in improved
knowledge among students, both boys and girls, availability of sanitary napkin at schools accessible for
menstruating girls and improved toilets for girls with privacy for putting on or changing napkins and for
disposing of used napkins hygienically.
With these facilities, the girls as well as female teachers no longer have to return home during
menstruation days as before especially when they have to deal with the unexpected start of
menstruation periods.
The trainers have learned that both girls and boys have strong interests in knowing more of
menstruation but they usually feel shy to join the discussions. Trust building, often through friendly
conversations, is needed to overcome this constraint.
With the active participation of both female and male teachers, the seven participating schools
have managed to secure funds from the annual school operational budgets to procure sanitary napkins
for use by girls at schools.
The other results that signal the high potential for sustainability are listed below
 WinS and MHM have now been included in the Schools Work Plan and Annual Work
 The monitoring/assessment teams from the District Education Office have included
WinS and MHM as indicators to be monitored and reported during visits to schools
 The District Monitoring Team members who participated in the Project have initiated to
disseminate the practice in Nagakeo among schools in the areas beyond Plan-supported
 MHM and the three hygiene behavior, defecating only in toilets, always drinking safe
water and hand washing with soap, have become compulsory topics in this annual visits
by local Community Health Centres to schools in their respective working areas.
Events of Highlights for MH Day 2015:
To celebrate this year MHM day, an MHM awareness raising training will be conducted in 17
new schools on May 28th. The training will be replicating the same approach (and using similar tools)
introduced by WaterAid & WSSCC during the International WASH Conference in Brisbane last year. The
target participants of this training are school committees/PTAs and school principals.
By the end of this FY our BCC Specialist Herie Ferdian will produce a project highlight to
document lessons learned of this MHM project as a part of our Inclusive WASH component.
Sri Lanka:
Creating a Dialogue for Upgrading and Providing Facilities for Menstrual Hygiene
Management in Schools
Problem analysis:
Most of the schools in Plan working areas are lack of facilities for menstrual hygiene
management. Availability of sanitary pads, changing pads, washing and disposing, facilities for changing
and washing, disposal of used sanitary pads are challenging for girls. Appropriate technology for disposal
is not recommended and practiced by schools and these remain as an environmental problem as well.
Adult girls were advised by female teachers to bring used pads home for disposal. Girls in rural
schools practice this as their homes are close by and they do not attend private classes and after schools
without going home. They rapped used napkins well and put them in their bags until they go home. But
if the child come far from the school and stay after school and attend private classes and go home late
this becomes an issue. Menstrual management is an issue for school girls in urban setup where
travelling take considerable amount of time and girls attend in private classes. They may use one pad
during the whole day which can be smelly and over wet.
Problem analysis by children
Awareness and advocacy:
Menstrual hygiene management of adult girl children was taken as a special topic for discussions
during relevant stakeholder meetings at school, project, zonal and provincial levels. The appropriate and
specific system for menstrual hygiene management was developed in schools with the consultation of
teacher in charge of school health club, some female teachers and girl student’s of school health club.
Public Health Midwifes and teachers were involved in awareness creation about the menstrual hygiene
to adult girls and their parents and facilities for menstrual hygiene management within the schools were
visited by parents in Uva PU. School girls and boys, more importantly parents were made more aware
and sensitive about the menstruation and menstrual hygiene through Public Health Midwife or Medical
officer of Health. Transact walks within the school premises with adult girls, female teachers and
mothers before and after providing facilities for menstrual hygiene management.
Making parents, male and female teachers and principals sensitive about issue of girls during
their menstruation is expected before providing facilities. Then girls are made aware on how to use the
facility properly.
Transact walks with girls and parents to visit MHM facilities in schools
Consultations with girl children:
Separate consultation sessions were conducted with girl’s children’s groups at different stages
of the project cycle. System for menstrual hygiene management was designed with adult girl children.
Consultation sessions with disaggregated groups of children contributed to embed age-appropriate and
gender-sensitive features in to menstrual hygiene management infrastructure.
Certain modifications for the designs such as height of latrine, place of fan lights, mirrors, soap,
sanitary napkins, height and size of urinals, direction of doors, lockable doors to prevent stray dogs,
cows, cats and goats coming in, size of toilet cubicles were included after consultations with children.
Surrounding of latrines and hand/foot washing stations were made attractive by planting trees, grasses
and preparing flower beds and wall paintings with health messages.
Providing facilities:
Schools were provided with menstrual hygiene facilities for adult girls. Special disposal unit for
used sanitary napkins were attached to special latrine unit of the girls latrine (primary and secondary).
That special unit of the latrine has more space, light condition and ventilation. The unit was attached to
the girl’s toilet, to avoid other students to see it. Capacity of the dry pit was designed based on the
number of adult students. This initiative was very much appreciated by principals, teachers and
students. 7 Dry pits for sanitary napkin disposal were constructed in 21 schools as a pilot project.
Some schools have arranged system to sell sanitary pads through the health clubs/home
science/sick rooms/school canteens. Cost recovery mechanism was developed through money collection
from adult girl children and selling the sanitary napkins. Separate wash rooms with disposal and washing
facilities sometimes with bathing facilities were constructed. One school suggested producing sanitary
pads with low cost materials. Girl and boy students in primary and secondary sections, principals and
male and female teachers were consulted separately as groups during the project design period and
basic designs of water and sanitation infrastructure were shared with them.
Outside view of dry pit
Inside view of dry pit
Gender sensitive facilities in latrines :
Separate latrine areas and latrine blocks for girls and boys (toilets and urinals) were
constructed close to the class rooms and each toilet included hand washing basin, water tap for foot
washing and other necessary accessories such as the mirror, soap, soap holder, brush, water buckets,
cleaning materials detergents, sometimes toilet papers and towels. A wall was placed in front of latrine
doors to prevent viewing and they were positioned in opposite direction of the class rooms. Female and
male latrines blocks were located close to the latrines of female and male teachers accordingly. Boy’s
urinals in the same latrine block were separated for privacy.
Child friendly toilet
Safe disposal of Sanitary Napkins:
Dry pit method was practiced as a pilot without any issue from 3 years up to now. But degrading
of used sanitary napkins can be a slow process and sometime it may fill up to the top if capacity of the
pit is limited. One school planned to burn those partially degraded material once the pit is filled during
the school vacation. Some schools have added ashes and lime into the dry pit time to time. Proper and
safe disposal of remaining in dry pits and disposal methods for used sanitary napkins remain as a areas
for further development.
Education and awareness is key to menstrual hygiene
In Sri Lanka’s, Girl’s first menstruation is regarded as a key turning point of her life. Rituals
around girl’s menarche play a very significant role in the life of Sinhala and Tamil communities from very
ancient times. It’s celebrated by masses of Sinhala and Tamil communities and to a lesser degree by the
Muslim communities and many parents want to celebrate this with a party when their daughter steps in
to womanhood. The astrologer plays a major role in puberty rituals and after observing her horoscope
recommends various auspicious times to perform the rituals. Girls usually spend from 3-7 days in a
secure place, a room in their house, with access only to the female family members. They don’t get to
meet any men, family and non-family. According to the auspicious time referred by the astrologer, the
girl receives her first bath early in the morning, from the mother or a key female figure in the family. In
rural Sri Lanka, the old customs where the washer-woman conducts all rituals of the bathing ceremony
still continues. Thereafter the washer woman is paid in cash and other gifts. Then, the event is
celebrated with the family and friends joining for a big party. The girl receives many gifts and usually the
family gifts her with gold or precious jewelry. This is often seen as the biggest celebration in a girl’s life
before her marriage.
Besides this background, another critical aspect that needs more attention is the education and
awareness among girls of this important shift in their lives -- into womanhood with her first
menstruation. As often the case is, there is less awareness and knowledge among girls of her first period
and in Sri Lanka this had even been more challenging as the age of girl’s first menstruation which was
earlier at their 12th or 13th birthday had advanced to in some cases at their 6th or 7th birthdays.
17 year old Dilki, has just completed Grade 10 government exams and is waiting for entrance to
high school to do her advance level studies to qualify for university entry. She is from Moneragala, an
area covered by Plan’s Uva Programme Unit. And her school is one in which Plan implements a total
sanitation programme, where menstrual hygiene is a key component.
“I’m sure girls of my age were not really aware of this whole physical and psychological change
following Girl’s first menstruation. We all knew it was a kind of change and we had to stay at home for
few days and that will be followed by a ceremony. But little we knew about the hygienic side of it. And
then we started to go back to school, that was not really easy. I studied in a school with girls and boys.
So we had to be extra careful, you know especially with the boys around. And many times, I remember
my friends had to leave school early when they have their monthly period. Sometimes they won’t turn
up for days”
“It was not a topic that we usually discuss with our mothers, and we seldom talked about it in
school with girls of our age. Especially, how we should maintain our personal hygiene during this time of
month, and what are the safe practices we should follow, and how we should not pollute our
environment as a result of the waste we need to dump. It was only in Grade 11 that we learnt more
about this in the school as that was part of the subjects we covered. But that was several years after we
really experienced it. We were glad when Plan Sri Lanka Uva programme approached our school and
discussed how they can help us to maintain a hygienic school environment.
It was very interesting. All of us as senior students got involved in the discussions. We took part
in the water and sanitation programme, through which we received a complete toilet system from Plan.
But as students we had a bigger role to sustain them. Separate toilets for girls and boys were also built.
Then we discussed about menstrual hygiene. It was one of the first times that we spoke it in open and
with our teachers. Our home science teacher was leading the discussions.
Then the teachers also spoke openly with our mothers too about the importance of menstrual
hygiene. What mothers can really do to help girls overcome some of the challenges they face during the
monthly menstruation etc.
As the discussions progressed, Plan introduced the idea of a safe and hygienic place in the
school to dispose napkins by way of a sealed dry Pit made out of bricks and cement work. Plan helped us
to construct the pit and also trainings for children how they should use it. It was very helpful” said Dilki
talking about how Plan introduced the discussions around menstrual hygiene in her school.
Dilki says the school health club plays an important role in terms of sustaining these systems and
creating awareness. Dilki as a member of the health club, has been a pillar of strength to the hygiene
education programme of her school. Few months ago, Dilki participated in a TV discussion that was aired
to mark this year’s world water day. Dilki and two other members of Plan supported children’s clubs
participated in the TV discussion over the national television that highlighted the importance of
children’s active participation in development work and especially in sanitation and hygiene promotion
We also spoke to the teacher in charge of the project in Dilki’s school, Mrs. Vijitha, who is the
home science teacher in the school. She gave me more insights into how girls and their families see the
importance of menstrual hygiene in the village where she lives.
‘Education and awareness of menstrual hygiene is a real need not only in our school and I think
everywhere. As a teacher, who work with adolescent girls in school and as an elder in the village, I have
seen although girls now a days use sanitary napkins during menstruation, they are not aware of the
hygienic requirements, such as the need to change the napkins regularly. They didn’t know the diseases
that one can get through such negligence and poor care.
As we discussed this project with Plan, we all agreed that these practices should start from
home. And we had a good discussion with mothers of the girls. They are almost 500 girls in our school
out a total of 785. So it’s fairly a big school. When we spoke to the parents we learnt that they need to
talk freely with their daughters about this condition. In school, I maintain a small stock of sanitary
napkins, and the girls come and ask me when they are in need. Few days after they replace them too. So
I could maintain my stock. They are now using the safe sanitary napkin disposal pit that is in built with
the girl’s latrines. That I must say is quite useful. I think this needs to be practiced in others schools as
well. This is a great service that Plan Sri Lanka has offered to ensure that Girls are in school and girls are
healthy. I always see that we should protect our girls and look after their well-being. They are the future
of the country. My thoughts at this upcoming Menstrual hygiene day is that, education and awareness
are key to bring about a healthy generation and especially when it comes to girls we need more care.
We need to establish support systems such as the disposal units and make girls use them for their own
A proper disposal system for sanitary napkins is helpful in many ways. Other than the obvious
convenience and hygiene for girls, it also helps schools maintain a hygienic school environment. In many
cases, girl’s latrines are blocked by used napkins since they didn’t have proper place and a disposing
system in place to use during school hours
Recent highlights of programs related to MHM:
1. Plan Uganda distributed about 2400 reusable menstrual kits to girls in 9 schools in Adjuman who
have been displaced by the on-going conflict in Southern Sudan.
2. Plan has distributed Menstrual Hygiene Readers for schools to about 315 schools in the districts
of Tororo, Kamuli, Alebtong and Lira
3. We have trained girls and boys on menstrual hygiene management in about 92 schools to equip
them with the right information
4. Supporting girls and boys with gender friendly and appropriately designed latrines to enable
them manage menstruation effectively and hygienically
5. Awareness creation through community theatre among parents to break the silence
surrounding MHM for continued support to the girls.
Brief summary of any events/activities planned for May 28th 2015:
1. Plan Uganda together with other CSOs will be presenting MHM charter to the speaker of
2. We will be holding an awareness session conducted by school girls and boys using poems,
music, debates and drama within the schools and communities. Parents will be invited to the
function and other leaders to participate
3. We are holding radio talk shows and spots in the three districts of Kamuli, Tororo and Lira to
highlight to the public issues pertaining to MHM and how they affect girls’ education. Selected
girls will be part of the talk shows to share their experience on the challenges and what needs to
be done to support them overcome them
Events or highlights for MH Day 2015:
1. The communications team in UKNO is working with ITV news network to highlight the campaign
against the ‘Tampon Tax’ (which treats tampons as a luxury good in the UK). This will link into case
studies on Plan’s work in Uganda on MHM.
2. Sharon Roose, Program Advisor Water, Sanitation and Hygiene, Plan Netherlands has prepared a
presentation on MHM for the AfricaSan conference.
3. Just A Tampon campaign: #JustATampon is a campaign to start a conversation about periods. Plan
UK is partnering with V Point News to break the taboo around menstruation and support women
around the world. The stigma and embarrassment attached to women’s periods contributes to
gender inequality worldwide.
Join the campaign
You can support women and girls by taking a selfie with a tampon, texting TAMPON to 70007 to
donate £3 to Plan UK and sharing it on Facebook and Twitter with the hashtag #JustATampon.
Because it’s just a tampon - there’s nothing to be embarrassed about, but just a tampon can change
women’s lives.
Your donation could help support our menstrual health work in the developing world and our
project dedicated to transforming girls lives. Just £3 can provide a girl in Uganda sanitary towels for
a year. Donations will help tackle discrimination faced by girls globally, not just around menstrual
hygiene but other issues they face including child marriage and female genital mutilation. Please
support women and girls by donating to Plan UK.
You can donate by texting TAMPON to 70007 to donate £3 or donating online here.
The issue
Around the world, millions of girls face discrimination just for being girls. One way this manifests
itself is through poor access to quality menstrual health and hygiene. It not only poses health issues,
but means girls can miss school when they have their period and face bullying. Only 12 percent of
girls and women have access to sanitary products around the world. And in Africa, one in ten girls
miss school when they have their period.
What we’re doing
Plan is working around the world to address stigmas and taboos around menstruation by talking
about menstrual hygiene in creative safe places and through school education.
We’re also improving girls and women’s access to sanitary products. In Rwanda right now, we’re
distributing sanitary and hygiene packs to girls and women fleeing political turmoil and fighting in
neighbouring Burundi. In Uganda we’re supporting girls and women to make recyclable sanitary
towels. In India, we’ve piloted a project where girls can get sanitary towels from an easily accessible
and discreet vending machine.
Take a look at some of our amazing stories here.
4. UKNO Website update: 28/05/2015 Let’s talk about that ‘time of the month’ on Menstrual Hygiene
Menstruation. It’s hardly the dinner table talking point. In fact, it’s something many people shy away
from or go rosy in the cheeks at the slightest mention. But here at Plan, we’re here to break that
taboo because menstruation matters. Menstruation has massive implications on the well-being of
women and adolescent girls all over the world. In fact, it has affects women and adolescent girls
around 3,500 days of their lifetime.
Since menstruation is experienced and managed by girls and women, it often has a quieter voice
and a low priority for development projects but we’re working to change that. Plan is focusing on
three areas to make that ‘time of the month’ more manageable for women and adolescent girls all
over the world. The areas are:
Overcoming stigmas and taboos surrounding menstruation
We’re addressing stigmas and taboos by talking about menstrual hygiene in creative safe spaces
(through radio or community radio) and increasing knowledge of boys, girls, men and women on the
reality of menstruation and how adolescent girls can be supported through school education.
Increasing access to and investment in safe and sanitary products and facilities
Only 12 percent of girls and women have access to sanitary products around the world. The rest rely
on materials such as old, dirty rags, newspaper, leaves, dirt, and other unhygienic materials that
often lead to infection and embarrassment due to leaks and odour. We are currently working on
menstrual management projects in Uganda, a country where:
28 percent of girls in Uganda do not go to school when they have their period, which
accounts for 20 percent of whole school year.
Girl adolescents stay at home because they don’t have access to hygienic and affordable
sanitary pads.
18 percent of the girls leave school before graduating, of which 46 percent do not go to
school because they don’t have proper water, sanitation and hygiene facilities.
There is need for private latrines for girls, water for washing, and access to locally appropriate
sanitary products for girls to reduce girls from dropping out of school. Selling affordable locally
made pads can also help sellers to earn an income in their communities.
Engaging men and boys
Educating adolescent boys on the challenges and struggles girls face could help decrease their
misconceptions, while at the same time helping them become more understanding and supportive
brothers, husbands, and fathers. In developing countries, fathers are often the breadwinners and
decision-makers in families. Educating them about menstrual hygiene is crucial because they
determine the budget for sanitary products.
A Profile of our work
Here’s a selection of some of our favourite stories that show the difficulties adolescent girls face
when they start menstruation and how we’ve helped them make that uncomfortable ‘time of the
month’ more manageable.
The goal shooter - Christine’s story
For a teenage girl, getting your period for the first time can be overwhelming. When you don't
understand what's happening to your body, it can be terrifying. In Uganda, many girls miss school
because of their period – and some drop out altogether. But not Christine. With Plan's support, she
learned how to manage her period and stay in school.
A photo story: My first period
Confined in doors for seven days, banned from using salt in food and missed school classes. Here,
nine girls from across world bravely open up about the stigmas and difficulties they faced when they
got their first period. We are working in communities across Asia and Africa to ensure young girls
are educated on how to manage their menstrual hygiene. Why? Because menstruation matters.
Finally I knew what was happening every month - Agnes’ story
When Agnes (16) was eleven years old she suddenly had blood on her dress. She was in the
classroom and everyone started laughing at her. She started to cry, because she had no idea what
was wrong with her. She even thought she was dying. Agnes didn’t confide in anyone about it,
because she felt incredibly ashamed.
I used my Grandmother's old clothes - Moreen and Peace’s story
Dealing with periods in the West may mean, a sore tummy, perhaps feeling a little more irritable.
And you need to remember to take pads or tampons with you when you go to school. But it is
nothing compared to girls in Uganda having their periods. Here is Moreen and Peace's story.
On Menstrual Hygiene Day, Plan has partnered with Iris International, who works to support the
education and empowerment of women and girls in East Africa through addressing the negelected
issue of menstrual hygiene management.
1. ANO have taken Afripads (reusable menstrual cloths from Uganda) onto the streets of Melbourne in
a lead up to the day. We asked people what they thought they were and filmed their responses
which will be collated into a short video which will be shown via the Plan Australia website and
shared with followers on facebook and twitter.
2. Further, we have sent Afripads (yes, we think they prompt interest!) to ~10 female media
personalities in the hope that one of them will be intrigued and consider the idea of providing a
short segment on morning television or similar on the 28th.
3. Sharon Roose and Tom Rankin are working on a “Frontiers” edition with IDS on MHM and CLTS
which was hoped to be ready but IDS do not have resources to print before 28th May (was originally
aimed at AfricaSan / MHM day).
Plan Netherlands:
Events or highlights for MH Day 2015:
1. Plan NL will do something on social media, but we tend to keep it relatively small as we are planning
a bigger MHM campaign around this project later this year or early next year (this will be combined
with documentary on national television, a fashion event in a big Dutch department store and
involves some "famous" Dutch ambassadors.
2. Apart from this Plan NL is working on an event (together with our Ministry of Foreign Affairs,
WSSCC, IRC, SNV and Simavi) around the VOLVO Ocean Race that will come to Den Haag around the
19th of June. We will most likely launch the event on MHM Day, but are not sure yet.
Testimonials and case studies
Chandarayani, 11 years old
I am a fifth grader in one of the elementary schools in Nagekeo. Menstruation is something very
strange to me as I have never experienced it before. The first time I got my first period was December
28, 2014 at home. The first person that knew it was my father. No symptoms I felt were on my body but
I got surprised to see blood spots on my underwear. Even though I was once told about menstruation, in
practice I did not know how to handle it. Lucky me, my mom was there. She knew it from my father. My
mom then told me how to put on sanitary pads properly. In my family there is no tradition nor rituals
applied when a girl has the first period. But there are things that my mother asks me not to do during
menstruation. I am not allowed to take a bath, rinse my hair and cook. During menstruation, I never take
sanitary pads with me to school or where I go because I only wear it at home. I usually change pads at
home, in bath room. During menstruation my school days run normally. Nothing bothers me. With
Plan’s support, I feel more comfortable because our toilet is now equipped with more facilities such as
clean water, boxes for sanitary pads and tissue. I thank Plan for all of this.
Leak: My First Period
Leak is 16 years old, and currently in grade 8. She is also a peer educator in Neang Teout
Commune, Dambe District, Tbaung Khmum Province. She said that her first period made her frightened
with some symptoms: belly cramp, headache, anxiety, irritation, chest pain, shiver, bad temper, and she
felt like eating sour foods. Her first period happened at home at night on 20 of May 2014.
Leak says:
I have heard of such period because I have joined child club at school since grade 4, and
attended village-based meeting(s) on menstruation with several organizations, its symptoms and
hygiene management. I understand that the period is not relevant or related to tradition and culture in
my community because there have been comprehensive outreach activities on reproductive and sexual
health, especially hygiene management during first period for community members.
During the first period, I boiled water and mixed with cool water to get a warm mixture so that I
could wash and clean my genital, washed clothes with detergent and dried them under the sun, took a
bath 3-4 times a day, and regularly changed sanitary pads 2-3 times per day. When going to toilet, I
always washed and cleaned my genital with clean water, and washed hands with soap.
The thing I used during the period was sanitary pads. Because my first period was in large
quantity, I had to change the pads 4-5 times a day. I didn’t tell my family members about the period
because of shyness. Instead, I told my friend at school who accidentally had her period too. So, I told her
about hygiene management. The period didn’t affect my study since I could attend class as normal.
Still, I sometimes felt stressed out when my friends came to play with and talk much. Despite
this, I could concentrate on my study because I have leant about it through meeting, learning and
outreach activities regarding menstruation, and reproductive and sexual health by Khmer Youth
Association and Sovanna Phum organization [Plan partners]. The Khmer Youth Association has
conducted outreach activities regarding youth reproductive and sexual health, especially girls. The
meeting sessions always dealt with girl’s menstruation and hygiene management at schools and
Neath: My First Period
Neath is 13 years old, and currently in grade 8. She is also a peer educator at So Korng
Commune, Kang Meas District, Kampong Cham Province.
She says:
I had my first period in my household toilet in October 2014. I felt a bit worried with some
symptoms: itchiness on my hands and legs. I have heard of such period from my joining outreach
activities of peer educator groups at school, posters which focused on menstruation, and reproductive
and sexual health at schools, and TV and radio commercials.
I understand that the period is not relevant or related to tradition and culture in my community
since there have been comprehensive outreach activities on reproductive and sexual health, especially
menstruation. During the period, I used simple water to wash and clean my genital, washed underwear
and any clothes stained with blood with detergent and dried them under the sun.
I took a bath 3-4 times a day, and changed sanitary pads 2-3 times per day. When going to toilet,
I always washed and cleaned my genital with clean water. Then, I washed hands with soap. I first told my
mother about the period. Then, it was my grandmother. The thing I used during the period was sanitary
pads. Because the period was in large quantity, I had to change the pads 4-5 times a day.
In some months, amenorrhea happened for 3 months. I told my mother and younger sister
about this. So, they sent me to health clinic for consultation and health check-up with doctor. The period
didn’t affect my study since I could attend class as normal, and play around happily with my classmate,
but sometimes I felt bored and stressed out once staying alone because of the school work and family
Now, I am no longer worried about reproductive and sexual health, especially management and
hygiene during girl’s menstruation because Khmer Youth Association has worked with my school
together with Sovanna Phum and Plan Cambodia to conduct school-based activities on promotion of
right to reproductive and sexual health among youth, especially girls, to prevent unwanted pregnancy
and STDs.
Horn: My First Period
Horn is 14 years old, currently residing in Roka Koy Commune, Kang Meas District, Kampong
Cham Province. She is also a peer educator in girl’s right promotion project for quality basic education
by Khmer Youth Association in grade 8.
She says:
Before, I didn’t know much about reproductive and sexual health, so I was shy and timid to talk
or express any ideas or take part in any programs which focused on menstruation. After joining the
project by Khmer Youth Association (KYS, I am well informed of reproductive and sexual health,
especially management and hygiene during menstruation. In 2014, I had my first period at home, and I
first told my mother about this.
Then, it was my elder sister. She, then, gave me sanitary pads and told me how to use them 3-4
times. Since then, I can use and change them frequently myself. During the period, I felt bored, belly
cramp, headache, and I always took a rest with these symptoms. In some months, my period was not
regular, which really worried me.
I, then, went to health clinic for consultation with doctor. I understand that the period is not
relevant to tradition and culture in my community since it is a natural process for girls and women, and
my parents don’t prevent me from going out. I can go anywhere, and it doesn’t affect my study. After
that, I joined the project by KYA. Since then, I am more well-informed of reproductive and sexual health,
especially hygiene management during menstruation such as washing and cleaning genital with clean
water, changing sanitary pads 3-4 times per day, drying clothes under the sun, taking enough rest and
eating nutrient foods.
When having any problems with reproductive and sexual health and amenorrhea, I always called
emergency number at school to consult experts or went to health facility or clinic for further
consultation. Besides, I can share and teach my friends at school and community members about
reproductive and sexual health.
Before, I dared not talk about reproductive and sexual health. Now, I have enough courage and
self-confidence to inform my friends of menstruation management during first period. Anyway, KYA and
Plan-Cambodia have been actively working on promoting youth reproductive and sexual health,
especially contributing to reduce girl’s drop-out rate at basic education levels.
Dary: My First Period
Dary is 15 years old, currently residing in Tbaung Khmum Province. She is also a peer educator in
girl’s right promotion project for quality basic education by KYA in grade 8.
She says:
Before, I knew nothing about reproductive and sexual health, especially problems during
menstruation since there were no outreach activities on reproductive and sexual health in community
and school. In early 2014, I had my first period, and I first told my elder sister about this. Then, she gave
me sanitary pads, and taught me how to use them. During the first period, I felt bored, complicated and
afraid of blood staining my pants or skirt.
I thought that I should change the pads only 1-2 times a day, and didn’t need to wash and clean
my genital. I understand that the period is not relevant to tradition and culture since it is a natural
process for girls and women. In addition, I dared not go anywhere because I felt afraid of blood staining
my pants or skirt so that somebody might look down on me.
Moreover, I thought that the period seriously affected my study because the blood might stain
tables, and my classmate might notice it. This might distract me during class, and I wished it would be
over soon. Besides, I went to toilet often to change the pads and wash my genital. This really bored me.
In mid 2014, I joined the project by KYA on girl’s right promotion for quality basic education with
emphasis on reproductive and sexual health, coordination skills, communication with others and group
After joining such activities, I have been better informed, especially of reproductive and sexual
health. I have practiced management and hygiene during menstruation such as washing genital with
clean water, wearing dry clothes, using sanitary pads properly, and I no longer feel afraid of blood
staining pants or skirt when going to school. Also, I know how to change the pads 3-4 times a day
depending on blood quantity.
Moreover, I can control my mood or stress by playing sports, doing exercises, seeing movies,
listening to music and chatting with friends. I have learnt these from KYA, which instructed me on
reproductive and sexual health in Life Skills session. Furthermore, I have shared what I learnt to my
friends, especially how to use sanitary pads and hygiene management during menstruation.
Finally, I really appreciate KYA and Plan-Cambodia for their outreach activities on youth
reproductive and sexual health at communities and schools to promote better understanding of STD
prevention, young pregnancy, unwanted pregnancy and reduction of girl’s drop-out rate.
Trem: My First Period
Trem is 14 years old. She has 5 siblings (4 sisters). She is the youngest child in a poor farmer
family after her brother and sisters have their own families, and her father has died for a long time.
Pheng Trem lives with her mother and elder sister in Tram Sasar Commune, Srey Snam District, Siem
Reap Province, but her elder sister has gone for business in Thailand to support the family. Nowadays,
she is in grade 8 A. She is also a peer educator in girl’s right promotion project for quality basic
education by KYA-Siem Reap.
She says:
Once I was carrying water from a well near the house in the field, I had my first period at 6:10
am. I was really afraid, embarrassed and shocked because I didn’t know that it was the blood of the first
period. I have heard of the period from my elder sister, mother, and female teachers. Still, I felt worried
and afraid because I didn’t know about its management and hygiene.
Pheng Trem mentioned that the tradition and culture in her family and community when girls
have their first period is that the elder will advise certain points: taking a bath with shampoo/soap
would cause amenorrhea (no period), and it is required to tie hands with thread and use white clothes
to stain first blood for making waist string to prevent diseases or any spell (witchcraft). During my first
period, I ran to inform my female teachers, my mother and elder sister.
Then, they took me to have a bath, and my elder sister gave me some pads for changing at
home. She also told me how to use them. Then, I washed my hands with soap. The period didn’t affect
my study because it came in the morning before the class started, and it happened only a half day. Later
on, the period somehow affected some of my subjects because I had to leave class to change the pads at
home. Luckily, my home is not really far from school. Those whose houses are far cannot come back to
class since they have to spend much time on this.
Anyway, Plan-Cambodia and its partners including Sovanna Phum and Khmer Youth Association
have provided school girls with sanitary pads so that they can change them during menstruation and
conducted capacity building training for students to promote their understanding of youth reproductive
and sexual health.
Kheoun: My First Period
Kheoun is 16 years old, and has 4 siblings. She is the eldest child in a poor farmer family. Her
parents work as migration laborers in Thailand, leaving her and her siblings at home to take care of
themselves. She and her siblings all go to school. She lives in Siem Reap Province. Currently, she is in
grade 8 A, and also a peer educator in girl’s right promotion project for quality basic education by Khmer
Youth Association-Siem Reap in Koul Lower Secondary School in Koul Commune, Angkor Chum District,
Siem Reap Province. She is a friendly, polite and courageous person who coordinates peer education
session for her classmate. Besides, she has practiced hygiene management during menstruation, which
she has learnt from her teachers at school.
She says:
I was washing clothes near a well when I had first period, which made me feel really frightened
and embarrassed because it was strange for my puberty even though I have learnt about reproductive
and sexual health. I have learnt about the management and hygiene during first period from my
teachers and classmate. After joining the project by KYA at school, I gained more knowledge about
reproductive and sexual health, and I always practice this during my period, especially hygiene
management during menstruation such as taking a bath and washing genital with soap 1-2 times a day,
changing sanitary pads 3-4 times per day, eating nutrient foods like eggs, meat and green vegetable, and
doing exercises.
I told my mother about the first period, and she gave me some sanitary pads to change in a
room. Then, I washed my hands with soap. Later on, she told me that once a girl has her first period, she
had to tie her hands with red thread since it could bring her good luck and prevent diseases. She
mentioned that the period could also affect her study since it stained her clothes, which embarrassed
her and caused a belly cramp which distracted her during class.
In case of having no pads, I had to ask teachers to go back home. Anyway, Plan-Cambodia has
helped and worked with it partners such as Sovanna Phum and KYA to conduct outreach activities in
communities and school on physical changes of boys and girls, hygiene management during puberty,
and girl’s menstruation at school, and provided them with sanitary pads, first aid materials, rubbing oil,
wound medicine, prepared seminar and training for girl consultants and peer educators, distributed
manuals on reproductive health, and conducted community and school based outreach activities on
reproductive health.
Luy: My First Period
Luy is 16 years old. She has 2 siblings, and she is the eldest in a medium-income farmer family
living in Koul Commune, Angkor Chum District, Siem Reap Province. She is currently in grade 9A, and
also a peer educator in girl’s right promotion project for quality basic education by Khmer Youth
Association-Siem Reap in Koul Lower Secondary School in Koul Commune, Angkor Chum District, Siem
Reap Province. She is one of the peer educators who is the most clever and outstanding for coordinating
training session at school where she shares her knowledge on reproductive health taught by her
teachers with friends and self-practices.
She says:
I was cooking rice and foods under the house when I had my first period, and I felt normal for
this because I have heard of it, and reproductive and sexual health from my teachers and mother. I
understand that the period is not related to tradition and culture in my area or community. During the
first period, I told no one because I have known about hygiene management during menstruation such
as taking a bath and washing genital with soap 1-2 times a day, changing sanitary pads 3-4 times per
day in a room below the house, and washing hands with soaps.
The period could affect my study since it stained clothes, and embarrassed me. In case of having
on pads, I had to ask teachers to go back home. When having my own pads, it would not really affect my
study. Anyway, Plan-Cambodia has helped and worked with its partners such as Sovanna Phum and
Khmer Youth Association to conduct community and school-based outreach activities on physical
changes of boys and girls, hygiene management during puberty and girl’s menstruation at school, and
provided them with sanitary pads, first aid materials, balm, wound medicine, prepared seminar and
training for girl consultants and peer educators, distributed manuals on reproductive health, and
conducted community and school-based outreach activities on reproductive health.
San: My First Period
San is 16 years old. She has 2 siblings (one sister). She is the eldest in a poor farmer family. She
lives with her parents in Siem Reap Province. Currently, she is in grade 9 A, and she joined a follow-up
training with peer educator groups in girl’s right promotion project for quality basic education by KYASiem Reap in Thlork Lower Secondary School in Tram Sasar Commune, Srey Snom District, Siem Reap
She says:
I was sitting under the house when I had my first period, and I felt afraid and trembled even
though I have heard of it from my sister and mother. I understand that it is a tradition and culture for
the family and community that girls with first period have to rub their buttocks with 3 rungs, and jump
down so that the blood will come easily and finish soon.
Then, they will have nice skin and be more beautiful. I told my mother about my first period, and
she told me to take a bath and change the pads inside the house, then, washed hands with soap. I have
no problems with the following periods because I have joined a training on reproductive and sexual
health by KYA, which makes me more well-informed, especially of hygiene management during
menstruation such as taking a bath and washing genital with soap 1-2 times a day, changing sanitary
pads 3-4 times per day, eating nutrient foods like eggs, meat and green vegetable, and doing exercises.
The period didn’t affect my study because I carried my own pads to school. This was convenient
for me to change them without wasting class time. Anyway, Plan-Cambodia and its partner
organizations have worked on girl’s menstruation in community such as conducting school and
household-based outreach activities, and provided them with sanitary pads, and a phone contact in girl
consultant room for consultation on reproductive and sexual health together with some more materials.
Menstruation taboos and beliefs: A battle well fought by Plan Malawi in Chinyama Community
Menstruation is a natural body function for the reproductive health of women. It is part of the
reproductive cycle in women. Menstruation is a sign of good health However, there are different taboos
and cultural beliefs associated with menstruation in Malawian communities including Chinyama
community of T/A Mabuka in Mulanje district. The beliefs expose females not only to health risks but
also to emotional and economical problems which hinder them from living to their full potential both in
their families and society. Being an adolescent girl in Chinyama community comes with its own
Effie, narrating what is taught at the initiation
ceremonies in Chinyama
At the onset of a girl’s menarche in Chinyama community, parents are supposed to arrange for
an initiation ceremony in which the girls are integrated into adulthood; again it serves as a preparation
for marriages as they are now believed to be grown-ups. Apart from being told on how to handle
menstruation, lots of cultural beliefs and taboos are also presented to the girls during the ceremony by
the initiators who are locally known as “Nankungwi” meaning Counsellor. According to Effie Maneya, a
committee member of Satemwa School Mother Care group, culturally girls are expected to undergo a
‘kusasa fumbi” {removing dust} ceremony soon after the initiation ceremony. Kusasa fumbi is a cultural
ceremony in which girls are expected to have sex with men so that they are groomed into adulthood.
Long ago, sexual partners were arranged for girls in the kusasa fumbi cultural practice, however, in
modern days, girls are told that for them to be regarded as adults they have to engage in sex.
In preparation for womanhood, the community teaches the young girls to make their labia long
enough as it is believed that this will make them satisfy their husbands sexually when they get married.
The Nankungwi ‘Counsellor’ then checks if the labia are long enough when the girl undergoes initiation a
few months from the onset of menarche. According to Effie, this has been fuelling up early marriages
among young girls as they are always eager to practice what they have learnt. Girls are also told to wear
strings of beads in their waist as it is believed to entertain sexual partners.
At home, girls are not allowed to add salt when menstruating up until they have sex which is
believed to be a cleansing process. Menstruating girls are not allowed to use the same bathroom with
their fathers. Instead, they are told to bath at the river which becomes a challenge to many school girls.
With this, most of the girls shun classes and the Mother Care Groups used to encourage them to do so.
In Chinyama community, girls who menstruate are not allowed to sleep in the same house with
their fathers. A separate house is constructed for these girls. According to Effie, this is done to show
respect to the father and that the father should not see the menstrual rugs that the girl uses as the rugs
are regarded as filthy. Most girls take this as a chance to practice what they were taught at initiation
ceremonies since they now sleep in a separate house.
Mrs. Petros, a teacher at Ntata primary school concurred with Effie that girls used to stay at
home for about a week when menstruating. “They missed at least 1 month of school days out of the 3
months they have for every school term” said Mrs. Petros. Girls had no knowledge of the menstrual
cycle and it was difficult for the girls to anticipate their next period. This saw a good number of girls
staining themselves and they turned to be a laughing stock for both young girls and the boys at school.
Both Effie and Mrs. Petros are thankful to Plan Malawi for the project that is being
implemented. Plan Malawi, is implementing a WASH project in Mulanje district which has a component
of Menstrual Hygiene Management (MHM); as such MHM was rolled out in Chinyama community in July
2014. The project has trained 91 key leaders which have helped to sensitize the community to change
their attitude towards menstruation. According to one of the Group Village Head, the trainings were an
eye opener for them and they are now aware of the sanitary needs of the schoolgirls, a thing they had
overlooked for a longtime, the local leaders now appreciate on how menstruation is connected to
education. As communities, they pledged to work hand in hand to create a conducive learning
environment for both boys and girls. The traditional leaders also promised to look into the demerits of
initiation ceremonies so that the girls are not exposed to harmful cultural practices.
Plan Malawi conducted mobilization campaigns and reached out to more than 1100 community
members. Communities are now able to support menstruating girls. Community members were told to
change their bathroom designs so as to accommodate these girls.
Plan Malawi also distributed reusable sanitary pads to 1000 girls from this community. “Am
very happy that I participated in this training. It has given me power and a reason to be proud of
feminine. Am now positive of being a girl unlike in the past where I used to feel bad each time I have my
monthly period. I can now openly discuss about menstruation and the sanitary facilities I need. I feel
confident and empowered” commented Mirriam a learner at Ntata Primary School.
Boys also participated in MHM training as they were on the forefront to ridicule girls on
menstruation issues. The boys are no longer laughing at their sister learners and they are now
advocating for a positive change on menstrual issues.
An onset of menarche in Mthuluwe Village: Teleza and Chisomo
Teleza Amos who is 15 years old of Mthuluwe village, T/A Nkanda in Mulanje district and in class
5 started menstruating when she was 13 years and it came as a surprise to her. Teleza never knew
menses until she had her menarche. Her elder sister, who saw Teleza’s stained dress, told her granny.
After hearing that, the granny came to the house with a traditional medicine called “Livala” which was
given to Teleza to drink so that she shouldn’t menstruate for a long time. Teleza was given rugs that she
was to use as menstrual pads. Teleza didn’t feel comfortable with the rugs as they easily fell when
playing. These rugs pulled her from social circles. She no longer plays with her mates when
menstruating. Teleza is not allowed to add salt to any food while menstruating as her society believes
that those who eat the food will be stricken by a strange disease.
Teleza’s family doesn’t allow her to use the same bathroom with them when menstruating. Thus
she just opts for her granny’s bathroom. Teleza is not allowed to use the same bathing soap with others.
She is given her own soap if the household has an extra or is forced to bath without soap when there is
no extra.
Chisomo, who is 15 years, is another girl from the same community. She had her menarche
when she was 14 years. She learnt of menstruation from life skills one of the subjects in the new primary
school curriculum. Despite this being the case, she had no knowledge of how to handle it or what
exactly happens for someone to menstruate. She told her granny, who accused her of having sex as a
cause of menstruation. In Chisomo’s community, older women take the girl’s menarche as a chance of
knowing the girl’s secrets. Instead of proper guidance, “these women forced us to reveal what we have
done for us to bleed”, explained Chisomo.
Chisomo is not allowed to use the same bathroom and soap with other members of the
household. Chisomo counts herself lucky as she has a granny close by and shares a bathroom with her
granny. The community also doesn’t allow her to be close to men as they believe that menses do stink.
Chisomo believes that the menses really stink but it’s because of the rugs that are used.
In Teleza and Chisomo’s community, menstruation is a symbol of adulthood and an alert of
womanhood. Most girls are not allowed to sleep in the same house with their fathers soon after
experiencing menarche and instead a small house is built for them where they sleep in or they share
houses with their grannies. This behavior fuels up early marriages among girls. This is so because there is
too much freedom among these girls and they feel that they are adults consequently they easily fall into
early marriages.
Both Chisomo and Teleza live in a community that was heavily affected by floods in January
2015. Different institutions including Plan Malawi responded with different support to the affected
families. Apart from household items that were given to the victims, plan Malawi distributed school
kits/packs to learners from 8 affected primary schools. Knowing that when disaster strikes girls are
highly affected and their needs are overlooked, Plan Malawi distributed reusable sanitary pads to
adolescent girls including Chisomo and Teleza. According to these girls, menstruation life has been easy
amidst the disaster as they had their own soap and they no longer use rugs that easily fall. Each pack
consisted of 5 reusable pads, underwear, a tablet of soap, exercise books, writing pens, pencils and
rulers so that menstruation disturbances are minimized.
Eveline, 12 years old:
“I haven’t had my period yet, but I do know what it is. At school there was a lady from Plan who
told us about it in class. I now know that there is blood coming from the vagina and that it’s normal for
girls from a certain age. When I’m older and I start having my period, I will tell my mother and talk about
Agnes: Finally I knew what was happening every month”
When Agnes (16) was eleven years old she suddenly discovered blood on her dress. She was in
the classroom and everyone started laughing at her. She started to cry, because she had no idea what
was wrong with her. She even thought she was dying. Agnes didn’t confide in anyone about it, because
she felt really ashamed.
“When this happened at school I went home straightaway. I didn’t know what was happening
to me and what I could do to stop the bleeding. The children from my class came round to my house to
make fun of me there, too. They said: “Come and have a look at Agnes, she’s got blood on her dress.
And she smells.” At home she didn’t tell her stepmother (her mother died when she was very young,
ed.). “I was afraid she wouldn’t believe me. That she would think I was lying. I also made sure my father
didn’t notice. I quickly washed my dress and knickers, because the girl next door had told me that my
father would go blind if he saw blood on my clothes.”
When Agnes had had her period a few times, she plucked up the courage to tell her
grandmother. “My grandmother said that all girls suddenly bleed sometimes and that it is normal. I was
reassured a little bit, but I still didn’t know what to do about it. Grandma told me that I should put dried
banana leaves in my knickers. That helped to stop the bleeding a little bit. Once, grandma gave me
money to buy sanitary towels. I was so glad that it protected against leaking, but unfortunately my
family can’t afford to buy them every month. They are really expensive: 3000 shillings (about 1 euro,
ed.) for a pack.”
For years, Agnes stayed home from school during her period. “I hated missing all those lessons. I
am one of the brightest pupils in my class and I want to do my best so I can become a lawyer. But the
banana leaves I used for protection only worked very briefly. At home I couldn’t help to fetch water or
help with the cooking. And I couldn’t play with my friends or play football with my brothers; something I
really like to do. I could only lie in bed. I would tell my stepmother that I was sick, although she probably
knew what was really happening to me. After all, she had a period every month too.”
In 2013, Plan started a Health Club at Agnes’s school. They trained one of the teachers to
become a Health Teacher and the children learned all about hygiene and the changes in the bodies of
boys and girls, which included having periods. “Finally I knew what was really happening to me when I
bled a few days every month. And – a very important point – all the boys in the class learned that it’s
normal for girls to have periods. Since these health lessons, they no longer laugh at girls who have
problems with leaking. The girls feel less insecure.”
Part of Plan’s project also involved building separate girls’ toilets and a special area where girls
can wash when they have their period. The trained Health Teachers also sell washable sanitary towels
that have been subsidised by Plan. “Our teacher told us about the Afripad. It’s a pack of four sanitary
towels that you can attach to your underwear. You can use these during your period and you can wash
them, dry them and use them again. A pack lasts a whole year!”
At home, Agnes finally had the courage to talk to her stepmother about periods. “She too didn’t
have any idea what happens to women every month. No one had ever told her. I was able to explain to
my stepmother exactly what happens to a woman’s body when she has her period. I also told her about
the Afripad. My stepmother asked how much it cost and talked about it with my father. Fortunately, my
father then bought a pack for all the women in our family. In my class, I’m now the only one who can
talk about it a little with my father,” says Agnes proudly. “After all, he’s the one who buys sanitary
towels for me.”
With five daughters in the house, William – Agnes’s father – has made a significant investment.
“Normally girls in Uganda don’t discuss such matters with their father,” he says. “Agnes didn’t dare to
ask me to buy sanitary pads every month. And I don’t think about such things, of course. But when my
wife told me that Agnes’s teacher told her about Afripads, it seemed like a good idea to me to buy some.
It was a lot of money, but I don’t regret it. I see plenty of advantages. Agnes was afraid to go to school at
first. Now she knows that she will stay clean, so she can go to classes when she has her period. And I
think that’s really important, because it’s better for her future.”
William has gone even further with the purchase of the washable sanitary pads. “My brothers
live in another village, where the Afripad is not yet for sale. I bought a pack for their daughters too. I
hope the project is introduced in more villages. Girls who can’t use these pads suffer when they have
their periods and fall behind at school.”
William also hopes that more fathers will talk to their daughters. “Some fathers believe it has
nothing to do with them. But I want my daughters to trust me and be open about everything. I even talk
to them about sex and getting pregnant. I learned that from my eldest daughter. She’s a social worker
and has taught me how to talk about these things with my daughters. I see a lot of her in Agnes; she also
wants to help people all the time. At least she can go to school without taking days off each month now.
I pray that Agnes does just as well as my eldest daughter.
Agnes is incredibly happy with the Afripad. “I can go to school as normal every day and help
fetch water and cook at home. I can also play to my heart’s content. My favourite is playing football at
school or with my brothers at home. I’m really good at it, especially at scoring goals. I’m so glad that
thanks to the sanitary towels I can even play football when I have my period. It’s a shame that not every
girl in the class has the Afripad. Some girls don’t get money from their parents to buy sanitary towels. Or
the family is too poor. And that’s a real pity. If a girl leaks during class I take her to the Health Teacher.
She can give her an emergency pad. We make these pads from cotton every Friday at the Health Club.
Once she has the emergency pad I take her to the washroom and fetch her some water. At least I’m glad
that the children no longer laugh at girls when this happens.”
Lovisa: “The girls feel better and are more confident”
Many children in Uganda have little or no knowledge of their own bodies. They don’t know how
to keep themselves clean or what changes the bodies of girls and boys go through. There are many
taboos about things such as periods, for instance. This is why Plan started Health Clubs in a number of
schools and trained teachers to become Health Teachers who give lessons on this subject.
“Plan trained me to become a Health Teacher in 2013,” teacher Lovisa explains. “I learned all
about the bodies of boys and girls and also about hygiene. To be honest, I didn’t really know about all
these things myself. Plan built separate toilets for girls with special washrooms and together we set up a
Health Club.” Now, a year later, the children’s knowledge has increased a lot. In class, Lovisa talks about
the importance of washing your hands with soap to prevent disease, about sexuality and pregnancy,
about wet dreams that boys have, and the very important subject of periods.”
“Before these lessons, many girls didn’t know what was happening to them every month. When
they had their first period they thought they were dying. After all, they were bleeding! The girls didn’t
talk about it to their parents. They felt far too ashamed for that. And the boys in the class laughed at the
girls who had problems with leaking. This meant that girls felt even more ashamed and they would stay
away from school for five days every month.”
The absence of girls from schools due to their periods was a huge problem. They would miss a
lot of lessons every month, and some girls got so far behind that they felt that they had to leave school
altogether. In addition to embarrassment, a lot of girls had trouble following lessons without decent
protection against the bleeding. “Normal sanitary pads are really expensive for most families at 3,000
shillings (around 1 euro, ed.) for a pack of ten pads. A girl might manage one, maybe two months with
those. And their parents would not buy them for them. That is why girls used dried banana leaves, old
rags or newspapers. But they would start leaking very quickly.”
To improve this situation, Plan worked together with Afripads to put together a pack of
washable sanitary towels. Plan subsidises the largest part, so the girls can get four washable pads for
5,500 shillings. These last a year. So it’s a cheaper solution than buying normal sanitary pads. This is why
more and more girls finally get the right protection from their parents. “I sell the Afripad to pupils at
school and also to their mothers and older sisters. And because some people have trouble paying the
amount in one go, they’re also allowed to pay in instalments.
Lovisa has seen a huge change since she started selling the washable sanitary pads at school.
“The number of absences have decreased considerably. The girls feel better in themselves and more
secure. They can go to school during their period, so they don’t get behind in class. Together with
lessons about periods, the Afripad has had a very positive influence on the girls!”
It’s a pity that not all pupils get money from their parents or carers. Or they daren’t ask. “Some
of the children are being brought up by their grandparents, and they daren’t even mention anything to
do with periods. And unfortunately there are also families that can’t afford it. For these children, Lovisa
and a group of pupils make emergency pads. “In addition to the lessons for the children in the class, I
have also set up a Health Club together with Plan. We get together with a group of pupils twice a week,
outside school hours. There we talk more about subjects such as periods. Boys attend too. They learn
how they can help a girl when her period begins during class and she leaks, for instance. They also think
about how they can get other boys not to make fun of girls who have their periods. And finally, we make
a new stock of emergency pads every Friday. We do this by sewing together pieces of fabric, with plastic
on the bottom and a cotton filling. They don’t work as well as the Afripad, but this means that girls who
can’t afford it can at least come to school during the exams. Or they are given one if they have problems
with leaking while they’re at school.”
Betty (13) is one of the pupils receiving the Afripad for the first time today. “I got my first period
two years ago,” says the girl shyly. “I told my older sister and luckily she knew that it was normal, even
though she didn’t know exactly what it was. In class my Health Teacher taught me what was actually
going on. Betty’s grandma couldn’t afford normal sanitary pads, so she used old rags. Until today,
because today Betty is given her first Afripad.
On a bench below the tree, Lovisa kindly explains to Betty how to use the washable sanitary
pads. “Look, these are for during the day. When a pad is full you can put it in this bag and use a new
one. Then when you get home you can wash the sanitary pad, hang it up to dry and use it again the next
day. You use this sanitary pad with wings at night. Then it’s Betty’s turn to fix the pad to the try-out
knickers. With a little giggling she fixes the sanitary pad correctly to the underwear. Lovisa’s ‘lesson’ is
over. “I’m really pleased with it,” Betty beams. “Now I can go to school when I have my period.
Hopefully my grandma will see how well they work and I’ll be allowed to buy them again next year.”
Peninah: “Everybody started laughing and pointing at the girl”
It’s not one of the easiest things for a 14-year old girl to talk about. Nonetheless, it’s not difficult
at all for Peninah (14) to talk about her periods, because the Health Club at school taught her that it’s
very normal for a girl to have to cope with her period once a month. There’s nothing strange about it.
“I was twelve years old when I had my first period,” says Peninah. “I didn’t know what was
happening to me. Was there something wrong with me? I didn’t dare talk about it to my aunt, with
whom I live. I was convinced there was something weird going on with me.” It kept happening every
month. Sometimes Peninah was afraid she was dying. Luckily it would go away again after a few days. “I
had to protect myself against the bleeding. I didn’t want anyone to see it, so I would put old rags and
toilet paper in my underwear. But that didn’t help for very long. The blood often leaked through and my
dress would be covered in it. What if my friends saw it? They would probably laugh at me. I felt really
Peninah still didn’t know what was happening to her when she found out that other girls in her
class have this problem too. “Once the dress of one of the girls in my class was covered in blood.
Everybody started laughing and pointing at her. I didn’t want that to happen to me so I decided to stay
at home when I had my period. I no longer went to school, so I missed a lot of lessons. When I was at
home I stayed inside. I didn’t dare play outside or dance, which I really enjoy doing. The rags were really
uncomfortable in my underwear, so I couldn’t help out at home. Normally I fetch water or wash my little
nieces. Luckily my aunt – with whom I live - understood and let me to stay in bed. Even though we didn’t
talk about it, she obviously knew exactly what I was going through. After all, she had the same problem
every month, I know that now.”
In 2013, Plan trained one of the teachers at Peninah’s school to give lessons in health, hygiene
and menstruation. “In the lessons we talk about the changes in the bodies of boys and girls. The
teachers told us about the fact that girls start getting their periods at a certain age. And that this is
perfectly normal. I suddenly realised what was happening to me. It’s really annoying, but I’m not going
to die from it. I also heard about sanitary towels for the first time, and that it’s important to keep clean
when you have your period.”
Plan built separate toilets for girls at school, with a separate area where they can wash. In
addition, the Health Teacher began selling Plan-subsidised Afripads: sanitary towels that can be washed
and reused. Peninah was really keen to have those! At home she told her aunt all about it. So, a year
after Peninah had her first period, she finally talked about this with her aunt.
“In our culture, it’s not the custom to talk about menstruation,” explains Winnie, who has
brought up Peninah from a very young age. “My mother never talked to me about it. I found it very
difficult. At the start her teacher would come along to talk about it together. She insisted that it is very
important. She told me that girls don’t know what’s happening and that they can get very worried.”
Together, they also talked about the Afripad. “I was immediately interested. We’ve no money to buy
‘ordinary’ pads every month. They cost 3,000 shillings (about 1 euro, ed.) per pack. The Afripad costs
5,500 shillings and lasts a whole year. I bought a pack for Peninah and also one for myself. The Health
Teacher explained exactly how to use them. I’m very happy with it, and I see a big difference in Peninah
too. She used to feel insecure during her period. She would stay home from school and just lie in bed.
She couldn’t move freely because of the old rags that she was using and she was afraid the blood would
leak through. She was ashamed. Now that she uses the reusable sanitary pads, she basically does
everything she usually does on normal days. And Peninah has taught me that I can talk about periods. If
she has the courage to do this, so can I! Thanks to Peninah, I’m no longer afraid to talk to my daughters
about it when they’re older. Hopefully they’ll be better prepared and they’ll know that it’s normal.”
Ever since the start of the Health Club, Peninah has realised that it’s important to know about
hygiene and periods. “In addition to the classes at school I always go to the meetings outside school
hours. I’m now the Health Club leader for the pupils. It’s good to learn about your body. I talk about it
with the girls next door. Some of them hear the oddest stories from their parents. That a cassava plant
will die if you stand next to it when you have your period, for instance. Or that you should not cook for
your father during your period because he would die. I tell them that none of that is true.” Peninah is
clear about the future. “I want to become a teacher first, and then a Senior Health Teacher!”
Rosemary: “I had sex to pay my debt”
If only she’d known more about her own body. And had help from a Health Teacher, like the one
who has been working at her old school for the past few months. Then life would have turned out
entirely different for Rosemary. Now she finds herself in an incredibly difficult situation: she has left
school and is six months pregnant with the child of a stranger.
“School was always a challenge for me,” says Rosemary sadly. “My family doesn’t have much
money, so buying textbooks or a uniform was difficult. Still, I managed to follow a few lessons with other
people’s help. Until I got my period.” Rosemary used old rags to prevent leaking. “But that didn’t work
very well and I got blood on my dress. I was ashamed and when I had my period I stayed home from
school. I didn’t feel so good.”
One day a stranger approached Rosemary. “He told me that I could buy sanitary pads and that
they would protect me against the bleeding. He was happy to give me money. I bought the pads and
was very pleased. Until the man visited our house a few days later. He said he wanted the money back,
but I couldn’t pay. I went with the man and to pay the debt I had sex with him.”
Rosemary didn’t know you could get pregnant from having sex. “Nobody had ever told me this.
My old classmates have told me that they now have a special teacher at school who tells them about
things like this. This lady also gives homemade emergency pads to the kids who need them. They make
those at the Health Club. I wish I had known all that.”
Rosemary saw no other solution than to leave school. She regrets this, just like her mother. “I
wish my daughter could finish school. It’s important. Then she would have a better chance in life than I
had. That is now impossible.” Rosemary’s mother hopes that her daughter can go back to school after
the birth, but it won’t be easy. “My daughter feels too ashamed.”
Samuel and Aleu: “Some boys laugh at me because I help girls.”
It’s quiet in the classroom. Everybody’s paying close attention to what the teacher is writing on
the blackboard. Today, the English lesson is about sentence analysis. Suddenly, there’s a commotion. A
couple of boys start laughing loudly and pointing at a girl. Soon, more of the children in the class start
giggling. The girl cowers in shame. Her period has just started and her green uniform has a red stain on
it. She quickly runs out of the class, followed by her friend.
Not long ago, this is exactly what used to happen in Samuel and Aleu’s class. “And I must admit
that I used to join in the laughter when this happened to a girl,” Aleu (15) admits honestly. “But at the
time I didn’t know what was going on. Now I know better. At the Health Club I learned that it is perfectly
normal for a girl to start her periods at a certain age. It’s very upsetting for her because it also causes
her pain in her abdomen.”
Many children in Uganda – both boys and girls – have little knowledge about their own bodies.
Girls don’t know what’s happening to them when they get their period. The first time it happens many
think they are ill or even dying. They don’t know how to protect themselves either. ‘Accidents’ in the
classroom and then being laughed at are a regular occurrence. And the children who are laughing have
no idea what is going on either. They just think it’s weird.”
To increase the knowledge children have about such things, Plan set up a health education
programme in Uganda. In addition, outside school hours, children get together in so-called Health Clubs
to learn more about the subject and to talk about their experiences. “I think it’s great that we’re
learning about our bodies,” says Samuel (14). “So we know what will change as we get older, and we
learn to stay clean and healthy. I’m keen to learn more about it, so I go to the Health Club outside school
hours. We learn that it’s important to wash our hands with soap so we don’t become ill. We also have to
brush our teeth and wear sandals when we go to the toilet. And we talk about periods at the club. It’s
normal, nothing to ridicule someone about. That’s something I also tell the other boys in the class. And I
also tell the children in the neighbourhood. I tell the girls next door that they don’t have to be afraid
when they get their period. That it’s not abnormal but just a part of life. My sisters are still too young,
but I’ll help them when they’re older.” Not all the boys in the class are as interested as Samuel. “Some
boys laugh at me because I help girls. Well, I just tell them that I’ll keep doing it anyway. It’s good for me
and good for the girls.”
Aleu also ignores the comments from his classmates. “It’s good to know more about health.
When I’m older I want to use this knowledge to become a Health Worker, but I can already help other
children. In the Health Club we learn what to do when a girl has a problem with blood leaking through. I
first take her to the Health Teacher. There she is given an emergency pad. Then I take her to the
washroom and go to fetch one of her friends from class. Meanwhile I fetch water from the pump and I
give it to the girl’s friend so the girl can wash herself. Aleu, too, doesn’t just limit his helpfulness to
school time. “My 13-year old sister doesn’t have her periods yet, but she does have a lot of questions.
She wants to know why there is blood and where it comes from. I told her all about this. At home we
don’t talk about such things with my parents, so my sister is glad I can teach her about it.
Moreen: “I used my grandmother’s old clothes”
In the Netherlands, most girls know what’s happening to them when they have their first period.
They may even be a little proud. They are now ‘a woman’ and finally no longer different from the other
girls in their class. It’s a bit nerve-wracking, of course. But most mothers are quite happy to explain how
they can use sanitary pads or tampons to protect against leakage. It’s no fun, really. A sore tummy.
Perhaps a little more irritable. And they need to remember to take pads or tampons with them to
school. But it’s a very different story for girls in Uganda...
“It happened last year,” says Moreen (14). “I suddenly had blood in my underwear. It even got
on my dress. I didn’t know what was happening to me. Could I be ill? Where did that blood come from?
After some thought, I decided to tell my mother. She didn’t know exactly what it was either, but it
happens to every girl, she said. So that made me a little less afraid.” Moreen’s mother told her that she
had to wash and put rags in her knickers. “I used my grandma’s old clothes, tore them into strips and put
them in my underwear. I soon found out that this only stopped the blood a little bit. It quickly leaked
through onto my dress. I still don’t really know why I bleed every now and then.”
Peace (15) knows a little bit about why she bleeds every month. “At school a teacher told us that
it’s normal for girls. It’s called menstruation. I think the blood comes from the vagina.” Peace was
fourteen when it happened for the first time. “Luckily I wasn’t afraid, because someone at school had
told me about it. I knew that girls get this. I really don’t like it when it happens. My abdomen hurts a lot
and I have to wash myself all the time. I put rags in my underwear, but that doesn’t really help much.
When I’m bleeding I don’t go to school. I’m afraid it will get onto my uniform, and that the whole class
will laugh.”
Jacinta is a teacher at Moreen’s and Peace’s school. “Girls from our school who have their
periods often stay at home. They feel ashamed. They’re afraid they will leak in the classroom. They have
no proper protection from bleeding. Sometimes I’ll call a girl forward in class to write something on the
blackboard. She will say nothing and stay seated. Then I already know what’s happened. I’ll give her a
big scarf to tie around her dress and send her home to wash. That’s the only thing we can do, because
we have no washroom at school. It’s better that she stays at home until her period is over.”
Peace has heard of sanitary towels. “I know what they are, but I don’t have them myself. My
parents have no money to buy them. I saw a poster for Afripad at the market. It’s a sanitary towel that
you can wash, dry and reuse. It lasts a year, that’s what the poster said. I would love to have it, because
then I could fetch water for our family on the days that I have my period. And I could run, which is
something I really enjoy. But I don’t know where to buy an Afripad. Teacher Jacinta has also heard about
the Afripad. “It would be good for the children – and for myself – because thanks to the pads they can
attend school as normal. They wouldn’t miss so many lessons. Unfortunately, there’s no Afripad dealer
in our area.” Moreen didn’t know what sanitary towels were, but once it was explained to her she was
really keen. “When I have my period, I can’t dig in the garden at home. That’s my job at home, but I
can’t do it. I think that if I had sanitary pads I could manage it. And I could also go to school and play.”
Plan Uganda Menstrual Hygiene Management Program–More than just menstrual hygiene
Margaret sits calmly in the shade, with a few friends from her community. Some are fellow
Afripads dealers, some are consumers who have recently purchased the pads and some are just curious
bystanders interested to hear what Plan staff have come to discuss. The village is sparsely dotted with
mud huts seemingly pushed up through the dry, red earth that surrounds them. It must be close to 40
Margaret (right) and the other Afripad dealers in Abwoc community
degrees C in the sun, over 100 in the old scale, and dust is whipped into our faces by the odd gust of
wind. Thank goodness for this mango tree!
Abwoc community is one of eight villages in Otteno Parish, in the North Ugandan district of
Alebtom which is one of the three districts where Plan Uganda are implementing a menstrual hygiene
management (MHM) awareness project in partnership with Afripads, a social enterprise fabricating
reusable sanitary pads in Uganda.
Margaret became an Afripads dealer late in August 2014 after her interest was captured during
a village MHM awareness session and she gained the recommendations of her community. She owns a
small kiosk in town and has a quiet confidence which sets her apart from some of the others in the
group. There are four other dealers in the Otteno Parish who have divided the village between
themselves to share the potential market.
The dealers are trained by Afripads staff, with support from Plan Uganda, on MHM issues, good
sanitary practices and basic business/marketing skills. They’re tasked not just with selling pads, but
educating community members on good MHM practice as they do it, as a marketing tool with a hidden
agenda; improved knowledge. This is coupled with school and community awareness campaigns that
utilise community and school drama groups to improve awareness on the facts around menstruation
(not commonly understood and plagued by myths) and to illustrate its severe impacts on women and
girls in the community. The dramas draw large crowds, are engaging and funny while providing
important MHM information.
The dealers purchase the pads for 4,500 UGX and sell them for 5,500 UGX (<$2.00 USD), keeping
1,000 UGX profit per kit sold. However, similar to the experience of dealers in other villages, some
members of the community in Abwoc have difficulty in finding the 5,500 UGX to pay for the pads. Being
an entrepreneur, Margaret has given people the option of ‘bartering’ (trading goods) for purchase of
pads. She receives goods such as beans, maize, chickens and even piglets in exchange for a pack of
Afripads. She then on-sells these items through her kiosk or keeps them for her own consumption or
investment. Margaret’s business mind has allowed her to turn these modest profits into something
more. After selling 210 packs of pads in the last 3 months, Margaret decided to purchase a pig for
50,000UGX which has since reared eight piglets each worth the same. And she’s already had offers to
buy them all!
Abwoc community are engaged with an informative drama on menstrual hygiene management in March 2015
Community drama to raise awareness on MHM in Abwoc
- March 2015
But this project is about more than just the economic empowerment of Afripads dealers. Its key
focus is on improving MHM of women and girls and their accessibility to the necessary suitable
materials. A recent Plan Uganda survey in Tororo District showed that 28 % of girls don’t come to class
during their periods and 13% personally know a girl who has dropped out as a direct result of
menstruation. For girls, that’s missing around 20% of class due to menstruation. Women are cursed by
stigma surrounding menstruation which restricts their freedom, reduces their opportunities and
jeopardises their health.
During a recent door-to-door sales drive, Margaret recently sold a set of Afripads to Mr Anthony
Thomas who bought a packet for his wife. When he was approached by Margaret, she explained about
menstruation, the burden it carries for women and explained the use and cost of Afripads. Thomas was
taken immediately, particularly with respect to cost effectiveness compared to disposable pads. Due to
the cost of disposables, he said his wife often used rags to manage her periods. When this was the case,
he was well aware when she was menstruating due to her discomfort and lack of mobility. Now that she
is using the Afripads, he doesn’t’ even realise when she has her period as she continues to move around
the village with confidence.
Mr Thomas has since bought 2 extra packs of Afripads to assist his wife to manage her periods
better and allow her to change the pads as frequently as she wants. He says that with improved
understanding of MHM and the discussion that the purchase of Afripads from the dealer prompted, his
wife now feels comfortable expressing her concerns and around menstruation and they can manage it
better together within the family.
Mr Thomas (right), Afripads dealer Daniel (center) and
Plan Australia WASH PM Tom Rankin (left)
Mr Thomas is a carpenter with regular income of 10,000UGX per day. His trustworthy nature
and friendship with Margaret allowed her to offer the pads on credit to him which he has repaid over
time. This is not usual practice as Margaret knows historically, running her business, that it is too risky
to sell items on credit. Mr Thomas was too shy to come to the kiosk to purchase the pads, so the doorto-door sales gave him the opportunity to purchase the pads discretely.
Hannah is a neighbour of Margaret’s who couldn’t resist the urge to try out the pads after
Margaret explained the product to her. She saved some money that she makes as a chef at the local
school and feels much more free to move around during menstruation than she did before using
Afripads. She can continue working during her period and comes home to change her pads during the
day, before returning to school to continue working. She purchased a packet of AFripads in August 2014
and feels strongly that she will prioritise their replacement when they wear out. She has also shared her
experience with friends which has resulted in some of them also purchasing Afripads.
Daniel is a farmer who became an Afripads dealer when he saw the opportunity to supplement
his cropping income. He tends to his crops during the morning and makes time for door-to-door sales in
the early evenings. With the profits he has made selling Afripads, he has purchased some beehives,
another business venture he hopes will improve his family’s income. He and fellow Afripads dealer,
Moses, both feel comfortable approaching women to sell pads and believe that provided you build a
rapport with the female customers before broaching the topic of menstruation, they are comfortable
and interested to engage and learn about good MHM and the AFRIpads product even if it’s from a male
sales representative.
Dorcus Opio is a female dealer who usually sells tomatoes in the village market place. She says
there are advantages to selling pads because they don’t perish like tomatoes. She has sold 80 pads in
the last 3 months and purchased three goats with her profits. Her income has also assisted her in paying
her daughters school fees which she is proud of because she thinks education is very important.
It was quickly evident from discussions with the Afripads dealers in Abwoc that the community
have gained a general acceptance of menstruation, better understanding of MHM and an interest in
improving their practice through purchase of Afripads. The project team have plans to improve the
effectiveness of the approach with a new, improved Afripad product that eliminates the need for Plan’s
current subsidy (thus ensuring sustainability of the product in the market place) and identification of
other low cost options to improve access to all. The initial investigations into alternate low cost options
will include discussions with village tailors to fabricate pads, teaching girls and women to make their
own pads and identifying small scale fabricators/tailors already fabricating pads who are rumoured to be
dotted around Uganda.
Improving knowledge attitude and practice in Menstrua Hygiene among rural communities of
Tororo (Plan Netherlands)
Menstrual hygiene Management (MHM) is one of the neglected health and hygiene issues
surrounding the rights of the girls and women. It is considered taboo, with discussions surrounding
menstruation largely taking place in secret. Girls often find out from their fellow adolescents who may
mislead them or provide inaccurate information. Some girls are told to sleep with men so as to reduce
menstrual pain while others are told that once they have their first child the pain will not return. This
has contributed to high rates of teenage pregnancies and dropping out of school. The Ministry of Health
and the Water Department have not included menstrual hygiene as part of their hygiene and sanitation
promotion leaving the Village health team member with limited knowledge on the subject.
It is with this backdrop that Plan Uganda designed and initiated the Menstrual Hygiene
Management project in an effort to address issues of knowledge, attitude and practice while increasing
access to hygienic pads and empowering women and men with opportunities for income generation.
Village health members, pupils and teachers were trained on MHM and in turn the VHTs formed drama
clubs to create awareness in several different villages in the sub-counties of the importance of
menstrual hygiene.
Pauline, a 45 year old woman from Atiri Parish in Tororo district, is one of the VHTs trained on
MHM to further support her community by improving knowledge, attitude and practices surrounding
menstrual hygiene. She is also a member of the drama group creating awareness about hygiene,
sanitation, HIV, and other health issues. She shares with us her experience as a VHT, mother and
“The training on MHM improved my knowledge, I did not have all the information that we were trained
on. This has enhanced my knowledge and I can now use it to help different people from the
communities. Using drama as a way of delivering awareness is very important given that talking about
menstruation is a taboo in our culture. It is easier to relay information through drama than if you would
just mobilize and talk about it. Women and men have come to appreciate the drama and one woman
from the crowd lamented “it is like this people came to my home first and saw what happens before
playing the skit, this has opened our eyes, we did not know that what we use has health effect”’
Plan will follow up on the beneficiaries of the drama awareness to further document how the
MHM program impacted their lives and that of their community members. Pauline’s story demonstrates
that the MHM program does not just provide the tools girls need to maintain proper menstrual hygiene
but it is empowering women to feel they have some ownership over their community by providing
women with the knowledge and skills they need to educate others.
Menstrual Hygiene Management Project: Empowering women and men out of Poverty (Plan
Unable to afford proper menstrual products, many schoolgirls have no choice but to rely on
crude, improvised materials to absorb their menstrual flow. Girls’ options range from using rags and
scraps of old clothes, to wads of toilet paper or newspaper – materials which are neither effective nor
comfortable. Faced with frequent, embarrassing leaks and a susceptibility to recurrent infections, this
situation reduces most girls’ experiences of menstruation to a monthly dose of discomfort and shame.
The absence of clean water for washing, private changing rooms and sanitary materials in schools has
aggravated the problem. The reality of taboos and socio – cultural restrictions surrounding menstrual
practices prevents adolescent girls from accessing vital and accurate information and facts on menstrual
hygiene. It’s imperative for women and girls to have access to the necessary knowledge, facilities and
cultural environment that will allow them to manage menstruation hygienically and with their dignity
Plan Uganda’s Menstrual Hygiene Management (MHM) project works with a private Sanitary
Company making reusable pads to improve access to affordable hygienic sanitary pads for women and
girls. The project strategy included recruiting 15 women and 3 men from existing village saving and loan
associations to market the product among the women and girls. Plan subsidized the product to reach
the community at half price, making each pad cost $2. The dealers were trained both in Menstrual
Hygiene Management and in the use of AFRIpads reusable pads. The AFRIpads dealers get the product
from an AFRIpads staff and then sell it to the women, girls and men who buy for either their daughters
or wives. From each kit the dealers earn a profit of UGX 1,000, thus serving as a mechanism for the
empowerment and income generation for women and men in the community.
Zebia is a 42 year old a mother of seven from Akadot parish in Tororo district who has been
selling AFRIpads kits since the initiation of the project in February 2013. She received her first capital of
UGX 40,000 to begin the business from a Village Savings and Loan Association (VSLA) group of which she
is a member. Since this initial loan, Zebia has now grown her capital base by over UGX 300,000. Zebia
has sold approximately 300 AFRIpads Reusable Kits since then, earning her a profit of UGX 300,000. She
no longer borrows money from the saving groups as she has made enough money to buy more products
to sell. The most significant change that has happened in her life is that she earned back her respect in
the community, ‘I now teach people about MHM and I am now called teacher or madam. I got surgery
some years back where my uterus was removed due to cancer and was stopped from engaging in any
hard work; this made me loose respect from my fellow women as in my culture a woman who is not
productive is not respected. People feel like you are there to eat food and not produce anything. But
since I engaged in business I have gained back my respect and my husband is happy too and supports my
movement due to the great change he has seen in my live. I now do contribute something to my family; I
buy some school necessities for my children when I visit them at school and my daughter who used to
come home due to inadequate sanitary pads has stopped as she has what to use throughout. I am
grateful to Plan for introducing such a good idea, women are gaining back their confidence in society and
the embarrassment due to soiling of one’s dress with menstrual blood is fading. Girls who have accessed
the pads are happy and cannot attend school fully without fear that they will soil their dresses.
Unless men know about what girls and women go through each month, they will not provide the
appropriate support required. Zebia’s story illustrates that embedding the training of AFRIpads sales
agents in the MHM program is an effective method of promoting income generation and empowering
members of the community while simultaneously increasing knowledge about good menstrual hygiene
and breaking the silence surrounding menstruation. This community benefit will facilitate community
involvement in the MHM program thereby contributing to its success.
Menstrual Hygiene Management in Setamo Primary School, Case of Dara district (Ethiopia)
Student Tihunie Wondimu, aged 14, living in Setamo Kebele of Dara district is attending primary
education in Setamo Primary School and is grade 8. She utters, “My school mates and I were using toilet
with boys in a mud walled toilet and have no access to clean and safe sanitary rooms, or to a clean and
private space in which to change menstrual cloths or pads and to wash”. “Besides the health problems,
students in this school were suffering from absence of water supply, sanitation and hygiene facilities in
the compound and due to poor hygiene during menstruation, menstruating girls temporarily or
sometimes permanently leave out of school, having a negative impact on their right to education,”
Teacher and girls club Representative, Emebet Haile and Deputy Head of School, Tamene Tagese
speaks. In 2012, the school principal and teachers of Setamo Primary School requested the district
offices of Water, Education and Health to get safe and adequate water supply, sanitation and hygiene
facilities to school, the school teachers & students came to know that, because of the fund available
from plan international Ethiopia WASH & FNS project, their school was selected by the district sector
offices together with other localities and planned to address their problems after two years. Tihunie
explained the previous and current situation in the following way, thanks to Plan International Ethiopia,
“we, 267 girls, have access to menstruation time use, and are using the water & toilet, for personal
hygiene and consequently school attendance rate has been increased due to the presence of clean
water, sanitation and hygiene facilities in the school compound which helps us to use the toilet during
menstruation and we wish long life for this project.”
USNO: Caitlin Gruer, Menstruation Matters: That's the Bottom Line
For two billion women and girls worldwide, menstruation is a monthly reality. Yet in many cultures, it is
surrounded by stigma, shame and silence.
In low income countries, women and girls face serious challenges when it comes to managing their
periods. They lack access to affordable hygienic menstrual products and are forced to use improvised
materials, such as rags, that are uncomfortable and can lead to leaks and infections.
Many girls do not have access to clean, private, safe latrines. There is no clean water within or near
toilets or bathrooms, which means there is nowhere to clean up and discreetly dispose of used
menstrual products.
To make matters worse, women and girls often face harsh social taboos about menstruation which
excludes them from certain activities, such as cooking or praying.
Understandably, this situation can have a detrimental impact on the lives of women and girls. Many
women miss work because of cramps or the inability to manage their periods in the work environment.
This can lead to losing out on an income.
In some cases, girls skip school during their periods, while others drop out altogether as there are no
facilities available for them to cope. This can have a detrimental impact on girls later down the line, as
girls with fewer years of education earn less and are more likely to be married as a child.
The bottom line? Menstruation matters.
From providing hygiene kits to girls affected by disasters to constructing child-friendly toilets in schools,
child rights organisation Plan International is working hard to break the taboos surrounding
menstruation across Asia and Africa.
In Uganda, Plan has partnered with local social enterprise AFRIpads, to help Ugandan girls and women
better manage their menstruation.
AFRIpads trains Ugandan women to manufacture reusable sanitary pads, then Plan purchases the pads
and sells them to local vendors at a subsidised rate. This allows vendors to sell pads to girls and women
in the surrounding areas for an affordable price and still make a profit. The project is improving access to
sanitary pads, while providing vendors with a reliable source of income.
AFRIpads is a local social enterprise organisation and Plan partner that makes and supplies affordable
and reusable sanitary pads. Photo credit: Plan International/Nyani Quarmyne
The AFRIpads partnership has been so successful, Plan is now developing other partnerships with social
entrepreneurs, such as Be-Girl.
In contrast to AFRIpads, which is a standard reusable pad, Be-Girl combines the convenience and leakproof performance of a disposable pad with the affordability of a reusable one. Essentially, it is a
washable waterproof pair of knickers that has a pocket that can be filled with any available safe
absorbent material.
Through its Because I am a Girl campaign, Plan and Be-Girl are seeking to improve the quality of primary
school education in Ethiopia, as well as train girls and teachers on the topic of menstruation.
Through innovative projects such as these, Plan is committed to breaking the stigma around
menstruation. It remains a topic that is grossly underfunded and often left off the global agenda despite
its importance for many aspects of women and girls' lives.
That's why this Menstrual Hygiene Day, it's time to talk. Period.
To find out more about the myths surrounding girls' menstruation, visit www.planinternational.org/menstrualmyths
Plan Netherlands: Sharon Roose
Finally: the AFRIpads factory!
“Big girls don’t cry... But I really did have tears in my eyes when I finally arrived at the factory
where young Ugandan women make the sanitary pads that the ladies within the Plan communities are
going to be selling and using as part of our project.
The young women in the AFRIpads factory (a room the size of a classroom) are sewing reusable
sanitary pads and thanks to the joint venture between AFRIpads and Plan these will be sold at cost price
to women from village savings and loan groups in Tororo. The women from these groups can then sell
the sanitary pads in their villages and the surrounding area, making a profit of around 1,000 shilling
(around € 0,30). As part of the Plan project this will be combined with raising awareness about hygiene
and breaking down the taboo surrounding menstruation.
The whole day in ecstasy
It is fantastic to see the young women in the AFRIpads factory so enthusiastic about the small
company they're working for. In total there are around 50 young women, and five boys, all from the
villages around Masaka, where the factory is based. And Paul and Sophia, the owners of AFRIpads, have
so much passion for their business and their workers that it was difficult not to spend all day in a kind of
ecstasy. And I was allowed to be part of it, hurrah!
Dream job
Here in the factory I thought I had finally found my dream job... I was going to become a
seamstress for AFRIpads! While the “professional seamstresses” were laughing and giggling loudly, I was
being allowed to sew my own sanitary pad. I operated the sewing machine with my feet and instantly
broke the needle. From that moment things just went downhill... My own sanitary pad looked like a
wilted piece of cloth that might be able to hold a single drop of blood, this because I had sewn straight
through the pad and not along the edges the way the young women in the factory were able to do so
When the lady from quality control gave it the thumbs-down, in full view of everyone, my
downfall was complete. And I don't think that the six-month sewing course will do anything to change
my standards.
So I'll just have to stick to my job as WASH adviser, but let me be clear: I have no complaints
Sharon Roose
WASH Advisor, Plan Netherlands
UKNO: Cathy Stephen, Let’s all talk about ‘that time of the month’ on Menstrual Hygiene Day!
How many nicknames do you know for a women’s time of the month? Here are a few that
come to mind:
Aunt Flo, On the Rag, I’m at a Red Light, Surfing the Crimson Tide, Checked into Red Roof Inn,
I’m having the painters in tomorrow, Riding the cotton pony, Curse of Dracula, Leak Week, My Dot, On
the blob, Miss Scarlett has returned to Tara, Smoking a lady cigar and Monthly Oil Change
Few people want to talk directly about the topic of menstruation. It’s labelled as a topic for
schools to deal with or for women (quietly, behind closed doors please) to talk about. Just try asking a
man in your office or home about it today and they’ll find it uncomfortable and awkward at the very
least; if they haven’t already run away at the topic!
Women and adolescent girls around the world spend about 3,500 days of their life
menstruating, but it remains a taboo topic in their lives. Since it is experienced and managed by girls
and women, it often has a quieter voice and a lower priority for development projects, even though its
effects can be profound.
Some of the stories collected for Plan’s menstrual project in Uganda included:
“…When you are in your period, you are not supposed to walk near a ground nut garden or pumpkin
plant or even touch a Jackfruit tree. If you do, the plant will die…” [A respondent during a focus group
discussion explained in Ogengo village, Uganda]
“Ladies in their menstrual periods look beautiful because they tend to become soft and browner than
their usual colour.” [A boy responds during a group discussion with boys at Ngelecom Osukuru subcounty, Uganda]
These is not unusual in many countries where Plan works: there are myths, misconceptions and
taboos around even talking about menstruation, let alone starting to consider practical ways to support
girls through the logistics of managing the monthly flow of blood without embarrassment or stigma.
As international charities, we have become increasingly confident at talking publicly about the
smelly business of faeces and shit. We have devised approaches and tools devoted to supporting
communities to become open defecation free and influenced governments to develop campaigns on the
importance of washing hands to reduce the spread of disease.
But on the issue of menstrual hygiene management, we’re tongue-tied. We’re silent in the area
of policy and influencing with governments, we’re quiet in funding projects that address menstruation
directly and often we’re reticent when it comes to tackling this issue in communities we work with. It’s
just not a priority.
But this year Plan is starting to join the conversation about menstruation because it really
matters to the health, education and dignity of adolescent girls and it must start to matter to their
families and to organisations supporting the development of communities.
Plan is highlighting 3 important themes on this year’s Menstrual Hygiene Day on 28th May and will
have awareness activities in UK, US, Australia, Indonesia, Uganda and other Plan operational countries.
We will be focusing on 3 key areas:
1. Overcoming stigma and taboos surrounding menstruation
By talking about menstrual hygiene in creative safe spaces (through radio or community radio) and
increasing knowledge of boys, girls, men and women on the reality of menstruation and how, especially
school-aged children can be supported.
This needs to be advocated to be included in schools alongside sexual reproductive health
2. Increasing access to and investment in safe and sanitary products and facilities
Only 12 percent of girls and women have access to sanitary products around the world. The rest rely
on materials such as old, dirty rags, newspaper, leaves, dirt, and other unhygienic materials that often
lead to infection and embarrassment due to leaks and odour.
In Uganda, where Plan is working specifically on menstrual management:
28% of girls in Uganda do not go to school when they have their period (20% of whole school
They stay at home because they don’t have access to hygienic and affordable sanitary pads
18% of the girls in Uganda leave school before graduating. In Lira district this percentage is
almost 36%
Of those girls almost 46% do not go to school because there are no proper WASH facilities
There is need for private latrines for girls, water for washing, and access to locally appropriate
sanitary products for girls to reduce absenteeism from school. Selling affordable locally made pads can
also help sellers to earn an income in their communities.
3. Engaging men and boys
 Educating adolescent boys on the challenges and struggles girls face could help decrease their
misconceptions, while at the same time helping them become more understanding and supportive
brothers, husbands, and fathers.
 In developing countries, fathers are often the breadwinners and decision-makers in families.
Educating them about menstrual hygiene is crucial because they determine the budget for sanitary
We’re supporting the Menstrual Hygiene Day campaign by raising the issue of the importance of
Menstrual Hygiene and working with Irise International to encourage people to talk about it on social
media and to take a pledge and break the silence around menstruation.
Plan is implementing menstrual-specific programming in seven countries throughout Africa and
Asia. There is a long way to go so today, go on girls, talk about your monthly oil change (and don’t
forget to include the boys!).
Diana Sierra, Be Girl video blog:
Diana Serra, co-founder and CEO of Be Girl describes her inspiration and motivation for starting
the company. Be Girl provides girls with appropriate and beautiful menstrual hygiene products. By
engaging girls in the product design process Be Girl is empowering girls through design.
Online Resources
A vox pop featuring Youth Ambassador Kayley and filmed by Natalie. Watch here:
A blog post put together by Mark Evenhuis on behalf of the Policy and Advocacy team. (the
Disney film is worth the 10 minutes, trust me): http://www.plan.org.au/OurWork/Blog/20150527-Eight-fun-facts-about-periods.aspx
ANO have taken Afripads (reusable menstrual cloths from Uganda) onto the streets of
Melbourne in a lead up to the day. We asked people what they thought they were and filmed
their responses https://www.youtube.com/watch?v=qvif66lRT1w
“The Goal Shooter: Christine’s Story” highlights the importance of ensuring women and girls
have access to effective, low-cost menstrual hygiene products https://www.plan.org.au/OurWork/Blog/20140407-The-goal-shooter-Christines-story.aspx
Plan Netherlands:
 VIVA (Dutch magazine) visiting the MHM project in Uganda:
 Campaign video for Day of the Girl Child 2014:
 Plan Netherlands ambassador Giovanca sings a song she has specifically written for the MHM
project https://www.youtube.com/watch?v=h5C7IKIGwwY&index=4&list=PLt8LrHgp9f2jbmtI9J
10 Ways Periods are Stigmatized Around the World
What is Menstrual Hygiene Day?
VIDEO BLOG: Why Menstruation Matters
Breaking Down the Stigma: Distributing Menstrual Pads in Uganda
Periods Are No Longer a Pain
Innovative Sanitary Solutions for Girls
MHDay landing page 2015 http://www.planusa.org/contentmgr/showdetails.php/id/3122399
 Irise has produced a short video “Periods Change Lives” https://youtu.be/aJkwJfCZf1Y. Irise
really want this video to be shared widely and freely by any members of the Plan family.
 #JustATampon campaign: http://www.plan-uk.org/because-i-am-a-girl/just-a-tampon/
 UKNO website update for MH Day 2015: http://www.plan-uk.org/news/news-and-features/letstalk-about-that-time-of-the-month/

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