I experienced my first menstrual flow in Primary 6. I was 12 years old. I did not tell anybody about it. Not even my mother! Frankly, I do not know why I did not tell her but somehow I managed the flow with toilet roll.
I recall sitting in class for the entire day without engaging in any activity. When I got home that day, I was relieved to see that the flow had stopped. The next time I saw another flow was in Junior High School (JHS) 1. After PE lessons, a classmate informed me that I had stained my PE shorts.
Fortunately, school was almost over, so I kept the shorts on until I got home. Upon reaching home, I showed my stained PE shorts to my aunt without saying a word. Obviously knowing what it was, she asked me to go take my bath and later boiled an egg for me to eat. There was absolutely no conversation whatsoever about how to use the pad or even how to take care of myself.
I manoeuvred through the early stages of my menstrual cycle on my own. Yes, I had been taught about adolescent life – girls develop breasts, have monthly menstrual flow, boys develop deep voices, broad chests, etc. – but that was woefully inadequate. It did not prepare me for the menstrual cramps, bloated abdomen, acne breakouts, running stomachs, the probability of staining myself, how to calculate my cycle, etc. I was completely clueless. It was not until my first year at Aburi Girls’, when Always Ghana visited the school, that did I learn how to use, properly dispose used sanitary towels, and maintain personal hygiene.
I met Belinda Osei Kontor through my Priest and in my conversation with her, she indicated that she also experienced her first menses in Junior High School (JHS 1). When she informed her mother, her mother’s first comment was “wo pre dodo”; to wit, you rush too much! Belinda said: “At that moment, I wondered if I asked my menses to come!” They never had any form of conversation about menstruation, so Belinda resorted to using cloths since she was shy to ask her mother for extra sanitary towels. Because of this experience, Belinda has set up an NGO called 1000 Sanitary Pads Project to educate young girls about menstruation, menstrual hygiene, and support them with sanitary towels.
I know that Belinda and I are not in alone in this. There are many young girls, who just like us, are managing their menstrual lives on their own.
Menstrual education
After naming ceremony, the next rite of passage is the puberty rite. These ceremonies symbolise the transition from childhood to adulthood. Under the supervision of the queen mother of the town, together with some female opinion leaders, young girls who have had their first menstruation are isolated for weeks as part of the puberty rites. During this time, they are educated about menstrual hygiene, sex, motherhood and childcare. This was our way of life; this was our culture.
Nowadays, young girls receive little to no information about menstruation from their parents. Menstrual education has been left in the hands of teachers, friends and the media. Most fathers have relegated the role of menstrual education to our mothers because we have not involved men in the conversation.
The family was watching TV one evening when an advert for one of the sanitary towel brands came on. My inquisitive younger brother asked my mum what that ‘thing’ was used for. She quickly told him to ask me, but I was too shy to answer the question or perhaps, I was not in the position to educate him so I simply ignored him – he was in Primary two at the time. He is now in medical school and knows everything there is to know about menstruation and pads, but could my mother not have taken opportunity of the question to give him the most basic knowledge he needed at the time? Was it because he was a boy and was not menstruating, or was it because he was too young to know about it? In my discussion with Belinda, I was impressed when she said she used to take money from her father to buy pads. I could not go to my father.
Menstrual education should be a collective effort – parents, teachers, clergy, traditional leaders, etc. – all need to come on board. It is not enough to provide pads for the young girls. Let us engage them.
Impact of menstruation on women and the introduction of menstrual leaves
This natural monthly flow has become a nightmare for most girls. Many studies have shown that most girls miss school because of difficulties in managing their menstrual hygiene and acquiring sanitary towels. Belinda reported that some girls miss school for up to five days per month during their menstrual cycle. This setback causes some girls to drop out of school entirely. During that time of the month, most girls are unable to play and interact with their peers, thereby lowering their confidence and personal effectiveness.
Some women experience a condition called dysmenorrhea. Dysmenorrhea, also known as period pain or menstrual cramps, is a pain experienced during menstruation. Menstrual pain is often accompanied by symptoms, such as nausea, vomiting, diarrhoea, headaches, dizziness, disorientation, fainting, exhaustion, etc. These symptoms can be severe, such that they interfere with the ability of some women to work effectively. As a result, some countries have introduced menstrual leaves into their labour laws.
In Indonesia, women are entitled to two days of menstrual leave per month though these are not additional leaves. According to Article 71 of South Korea’s Labour Standards Law, female employees are entitled to menstruation leave and are guaranteed additional pay if they choose not to take it. Spain introduces a different twist. In Spain, the law provides three to five days per month of paid menstrual leave but the cost of the paid menstrual leave is borne by the government and not the employer. This is to prevent discrimination in employing women. I was pleasantly surprised to learn that in Zambia, thanks to their menstrual leave policy, women are legally entitled to a day off each month known as ‘Mother’s Day’. If a female employee is denied this privilege, she has the right to sue her employer.
Despite the implementation of these policies, the number of requests for menstrual leaves has declined with time. Most women are uncomfortable requesting for the leave because they will have to disclose that they are menstruating. They are also afraid of being judged by their male colleagues and the probability of being overlooked for promotions.
Although we do not have such a policy in the Ghana Labour Law, we can explore a well-regulated flexible work arrangement, such as working from home, providing resting rooms at the work place, and allowing regular breaks to support female employees during that time of the month. The only issue might be people taking undue advantage of this.
Cost, types of sanitary towels, and other alternatives
Aside from the fact that there is little to no education about menstruation, pads are very expensive. Some parents cannot afford sanitary pads for their daughters due to financial constraints. Sanitary towels are classified as finished goods under the ECOWAS Common External Tariffs and are subject to a 20 percent import duty and a 13 percent import VAT charge. This has significantly increased the cost of pads.
There are many types of sanitary towels. For the purposes of this article, we will classify them under reusable and disposable pads.
Reusable sanitary pads are not common in Ghana. As the name implies, girls do not have to throw them away after use. One type of reusable sanitary wears are menstrual cups. Menstrual cups are flexible funnel shaped cups made of silicon or latex rubber. The cup is inserted to collect the blood. When the cup is full, it is removed, the blood is poured out and the cup is washed to be reused. The cup can be worn for up to 12 hours depending on one’s flow. Most women are put off by the thought of using it but those who are regular users find it ideal. Another type of reusable pad is the cloth pads. They look just like disposable pads and are considered eco-friendly due to the materials used to make them. It can be washed, air dried and reused. Although they are quite expensive when buying them for the first time, the ability to use it for a long time makes it cost effective. Reusable pads can last 2-5 years, depending on the brand or material used and how well they are cared for. The cheapest one I found on the market costs GH¢45 for two (2) reusable pads.
As the name implies, disposable pads are disposed (thrown away) after use. In Ghana, disposable pads are the most commonly used sanitary towels. There are many brands in the market such that it is difficult to know which one is ideal to use. Some of the pads cause irritation and rashes when worn for long. Generally, these pads are not considered eco-friendly. Most disposable pads contain plastic and other non-biodegradable (cannot easily decompose) materials that are harmful to the environment. Because they are disposable, they are expensive to maintain. The cheapest I have seen in the market is GH¢17 for one pack of pad.
What are the alternatives? Well, the alternatives are scary! I was astounded to learn that some girls use rags and old newspapers, during their menses. These options are unsafe.
Health implications for not practising good menstrual hygiene
It has been reported that poor menstrual hygiene can pose serious health risks, such as reproductive and urinary tract infections, which can result in future infertility and birth complications. According to Dr. Yeboah Grayer, a Doctor at the Agyenkwah Hospital at Kintampo, blood is a very good medium for bacterial growth; thus there is a significant probability of bacteria growth if the pad is used for an extended period of time without being changed or if the cloths are not thoroughly washed and allowed to air dry. He stated that during menstruation and childbirth, women are exposed to and susceptible to bacterial illnesses. The cervix dilates during these periods, allowing organisms to enter the cervix. These organisms can cause infections, such as inflammation of the fallopian tubes, inflammation of the ovaries, inflammation of the lining of the uterus, pelvic inflammatory diseases, etc., which can lead to infertility.
In order to prevent infections, Dr. Yeboah advised women to practise good personal hygiene, take their bath, wash themselves properly and develop the habit of changing their pads frequently. For those who cannot afford disposable pads, he encouraged them to use clean cloth pads. All reusable pads should be changed periodically, washed with warm water and detergents, and allowed to air dry.
How we can support
Individuals, organisations and NGOs have made efforts to make sanitary towels available to young girls in deprived communities. Staff of Bank of Africa, as part of their yearly voluntary donation to the vulnerable, have decided to donate sanitary towels to girls in deprived areas in Accra, Kumasi, Tamale and Takoradi; and educate them on menstrual hygiene. Belinda Osei Kontor, through her 1000 Sanitary Pads Project, is supporting many girls in the Bono East Region. The Sylvia Lawson Foundation, Tracy Owusu-Addo’s SincerelyBRAVE project, and Robert Annan Dugan’s EDUFIRST Foundation are all also playing their part.
Every year on May 28, the world celebrates World Menstrual Hygiene Day. The aim of the celebration is to raise awareness about challenges concerning access to menstrual products, menstrual education as well as eliminate all forms of stigma associated with menstruation. The theme for this year’s Menstrual Hygiene Day is ‘We are Committed’. What can we do to show our commitment? Let us run personal campaigns dubbed ‘Adopt a girl-child’. Challenge yourself and buy pad for a girl child every month. Engage them and provide answers to all questions they might have. Let us help demystify all negative myths about menstruation.
Menstruation is not by choice, else I can bet that all women will opt out. Let us help make this natural experience a smooth process for our women.
The writer is the Communications Officer, Bank of Africa (BoA), Ghana
