My Menstruation is not a Sin!

Throughout the world, menstruation shares a common universal feature; women have historically been shamed because of it.

Although female sexual and reproductive health has started to become more important as a topic of study and discussion in the last few decades, many women to this day experience an overwhelming level of stigma around menstruation.

In many low-middle income countries, access to sanitary products such as pads and tampons is extremely restricted, forcing young girls and women to use inappropriate products, such as a piece of old cloth or banana leaves. A dire consequence of using unsanitary products is the development of genital and urinary tract infections that can, if unimpeded, cause severe complications.

While this is a truly worrying situation, it is not highlighted enough as a public health issue – primarily due to the stigma and shame surrounding menstruation.

The lack of proper sanitary products and/or facilities often forces girls and young women to miss school. This in turn affects women’s long-term economic development. This is not only seen in low-middle income countries; in the UK for example, girls and women often cannot afford the sanitary products they need – a problem known as ‘period poverty’.

In many countries across the globe, menstruation is considered dirty and repulsive. In some cultures, it’s even seen as a sign of ‘loss of virginity’ – insinuating moral and ethical depravity. In many countries, women and girls are ordered to leave their homes for the duration of their menses to prevent ‘desecration’ of their homes. In all these scenarios, girls and women find themselves ostracized, humiliated and expected to accept this without question or debate.

Even in parts of the world where the situation may not be so extreme, some degree of stigma remains around menstruation – large enough to prevent girls and women from seeking medical care because they feel too ’embarrassed’. Within the bounds of such societies, menstruators may not seek medical help and may not be able to recognize important health-related problems should they arise.

In the UK, almost 80% of adolescent girls have experienced a distressing symptom relating to their menstrual cycle but have not approached a medical professional for advice.

A large contributor to these misbeliefs is the lack of education and awareness on menstruation. This leads to an inundation of false conceptions and misrepresentations. Due to the restrictive social norms in many parts of the world, it is a topic rarely discussed within the family structure.

Not only does this mean an uneducated society when it comes to female sexual and reproductive health, but it also means that many young girls have no or very limited knowledge on what to expect and how to react when their menses start. Instead, they become more confused, isolated and unable to manage their menstruation in a safe, clean and dignified manner.

Many countries have addressed several of these demanding issues. In Kenya for example, free sanitary products are available and in neighbouring Ethiopia, menstrual hygiene clubs have been established in many schools.

How we are trying to help

The Swedish Organization for Global Health (SOGH) – in association with Uganda Development and Health Associates (UDHA) – has launched a project titled Ekibadha: Our Periods Matter, in recognition of this extremely important matter.

The UDHA Dignity Project

The project aims to understand and highlight the difficulties women and girls in rural Uganda are facing regarding their cycles. The project is in its first stages, but our goal is to develop a community-based initiative that involves the entire community which will be sustainable – economically and environmentally.

“Men should be more involved” said one of the women we interviewed last summer in one of the rural villages in Muyage District. We agree! Men need to be part of the conversation, this is not just a ‘women’s issue’.

To learn more about the project, please visit www.sogh.se/ekibadha-our-periods-matter/

How you can help

You can help us take this project forward. We are currently raising funds to support preliminary data collection, which is fundamental to shaping and guiding the project. Data will also give us the basics to apply for institutional funds. Click here and help us out, every penny is worth it! https://www.gofundme.com/MHproject-Uganda

Interview with a woman in Muyage District about menstrual health by SOGH and UDHA.

For any further information or to get personally involved please email us at MHproject@sogh.se. You can also help by spreading the word, sharing this article on social media.

#OurPeriodsMatter #BloodyIssues

The Impact of HIV on Adolescent Girls & Young Women

World AIDS Day celebrates its 30th anniversary this year with the theme of ‘Know Your Status’.

Great progress has been made since the first World AIDS Day in 1988 – 3 in 4 people living with HIV today know their status.

However, the work is not yet done – especially for women. Women account for more than half of the people living with HIV worldwide. In particular, adolescent girls (10-19 years) and young women (15-24 years) are significantly affected by HIV and have high prevalence rates.

In Eastern and Southern Africa, women make up 26% of new HIV infections despite making up only 10% of the population. Statistically, young women will acquire HIV five to seven years earlier than their male counterparts.

Why are women and girls at high risk of infection?

HIV disproportionately affects young women and girls because of their unequal social, cultural and economic status in society. These challenges include gender based violence, laws and policies that undermine women, and harmful cultural and traditional practices that reinforce stigma and the dynamic of male dominance.

Here some other reasons why gender inequality leaves women vulnerable to HIV:

  1. Lack of access to healthcare services – women encounter barriers to health services on individual, interpersonal, community and societal levels.
  2. Lack of access to education – studies show that educated girls and women are more likely to make safer decisions regarding sexual and reproductive health and have lower risk of partner violence.
  3. Poverty – an existing and overarching factor that increases the impact of HIV.
  4. Gender-based violence & intimate partner violence – these types of violence prevent young women from protecting themselves from HIV.
  5. ‘Blesser/Sugar Daddy’ culture and transactional sex – sex with older men for monetary or material benefits, exposes young women and girls to low condom use, unsafe sexual practices and increased rates of STIs.
  6. Child marriage – girls who marry as children are likely to be abused by their husbands and forced into sexual practices.
  7. Biological factors – adolescent girls are susceptible to higher rates of genital inflammation, which may increase the risk of HIV infection through vaginal intercourse.

Importance of HIV testing

HIV testing in young women and girls is essential. Many receive access to treatment and care services after testing. Some important determinants of testing are:

  • Going through antenatal care
  • Being married
  • Having primary and secondary education

We need to aim for more young women and girls to being tested so that they know their status, and can access adequate care and treatment services. HIV testing is necessary for expanding on treatment and ensuring that people with HIV have healthy, productive lives.

Addressing the Impact

To address the impact of HIV on young women and girls we need to have approaches and interventions that incorporate the diverse perspectives of women and girls. This is needed on all platforms from campaigning and policy-making to program design. As the World Health Organization recommends, a woman-centred approach that includes women as participants is required, so that our needs, rights and preferences are considered.

Better strategies are needed across all health system to improve accessibility, acceptability, affordability, uptake, equitable coverage, quality, effectiveness and efficiency of services, particularly for adolescent girls worldwide.

To Prevent Abuse, Young People Must Know their Rights

Content note – this post refers to sexual violence and suicide.

Recently, a Twitter user named @twadi_doll shared her story fearlessly and curtly online – giving many people a reality check and leaving them feeling shaken.

Twadi narrated in her thread that at 13 years – orphaned and young – she found herself living with a pastor and his wife.

A respected…no, scratch that…a revered member of society, the man of God raped Twadi her on a regular basis. On other occasions, he would call his friends and they took turns exploiting her body. As if that wasn’t enough, the pastor would ask her constantly to seek forgiveness from God, for making him commit a sin.  

Since she had nowhere to go and was being blackmailed by the pastor for receiving food and shelter from him for 3 years, Twadi couldn’t escape the reach of the preacher’s hand. Even when she spoke out in church, she was called a liar and a demon who had been sent to tempt and disorganise the pastor in his job of shepherding the Lord’s people.

As a result of the continued sexual abuse, Twadi became pregnant and 6 months later, her teachers learnt of her story and offered her immediate support. They opened a case against the pastor, who in shame committed suicide. An abortion was arranged for Twadi and painful as it was, she took the option because she had long decided that either the baby dies or she commits suicide herself.

Twadi’s story calls upon us all to play our part in improving SRHR information and service access to young people.

This lack of access spirals into multiple other challenges, and sadly, it is the young person who suffers. Their untapped potential is heavily undermined.

For starters, we should always be able to come out and condemn what is wrong, no matter the position or reputation of the person in question. The pastor’s wife, years later after her husband’s death, wrote Twadi a letter saying she knew about the abuse the whole time, but found it better than her man going out to cheat. In Twadi’s own words, “she used me as a glue to hold her marriage together.” The pastor’s wife betrayed and failed Twadi, and her suffering falls as equally on her shoulders as it does on the pastor’s.

We need to pay special attention to young people’s voices on their reproductive health concerns with as open a mind as possible.

Sometimes we can’t understand young people by assuming we know who they are and what they want, especially if we aren’t young people ourselves. The pastor’s congregation was way off course in this case, defending the pastor simply because of his position and ignoring the truth Twadi was telling.

If even one of them had taken time to hear her out, it could have changed her fortune. We should seek virtual spaces where young people are free to talk about their challenges with no fear of judgement, and where they are sure they will be believed and helped.

It is critical that we provide young people with information on their rights so that they can know when to say no, how to say it and how to defend themselves against manipulation and abuse.

The more we starve young people of such information, the more we make them vulnerable to attacks and abuse and the multiple challenges that ripple from those.

Finally, we need to work with stakeholders who can put policies in place to ease the combatting of these challenges. In Uganda, for example, we have been advocating for an operational School Health Policy where we can provide sexual and reproductive health and rights information to young people that fits the context we live in.

Such a document is key, because then we can arm young people with knowledge, and we will have the backing of the law. It is something that policy makers and governments should consider, lest we see more young people come out with stories similar to Twadi’s.

This selfless story should be an eye opener.

Many young people are undergoing such horrific challenges, and the veils of religion and culture, which otherwise should be guiding us to a sane and loving society, are being used as defences and barriers against SRHR access. Such incidents are indeed present in our society and the best we can do is speak out against them, bring the perpetrators to justice and provide young people with information and services so that they can make informed decisions and protect themselves.

PS: Twadi has moved on and is strong now. However, is that what we want, for all young people to become strong like her and move on? Or is it better to stamp abuse out once and for all? Something must change in our communities, right here and right now.

Building the Foundation for a Skilled GirlForce

With nearly 1 billion girls on the planet and 600 million adolescent girls entering the workforce in the next 10 years, enabling girls to be active participants in the global economy is vital – for those girls, their families, and their countries.

Supporting girls in becoming economic agents is important not only because girls should be treated equally and fairly, but also because girls’ participation in the world of work is of structural importance for the global economy.

The theme for this year’s International Day of the Girl, With Her: A Skilled GirlForce, speaks to the importance of a global conversation on this issue.

So how do we prepare girls to be contributing members of the global economy, prepared to join the worldwide workforce? One much discussed answer is by completing primary and secondary education. With 131 million girls currently out of school, we still have a long way to go to accomplish this goal. But there’s another important foundation that can help empower girls financially and economically.

WomenStrong International believes the key to a skilled ‘GirlForce’ is by building girls’ ‘protective assets’, a term coined by the Population Council to describe the most important skills, resources, and knowledge girls need to protect themselves and thrive.

Girls’ ‘protective assets’ include having a trusted adult to turn to in times of crisis, knowing how to access contraception, being skilled at communicating with elders, and understanding how to manage money.

When girls have these essential skills and awareness, they are able to advocate for themselves, express their opinions and desires, seek support and help, and have the self-esteem and confidence needed not only to dream big, but also to follow those dreams. These basic skills are a foundation on which girls can then learn any technical skills they may need to enter the workforce and make the best decisions for their own financial futures.

Without vital life skills, girls may be subject to discrimination or exploitation in the workplace, or may not be allowed to work at all.

For example, if a girl’s father tells her she cannot sell popsicles after school to earn money for school supplies, she can use her conflict management and communication skills to have a respectful discussion with him. Another girl may begin work as a waitress but is sexually harassed by her boss – she knows his behavior is inappropriate because of her understanding of human rights, so she can report this behavior to the appropriate person at the restaurant or managing company. 

An effective approach to teaching these life skills is in safe spaces for girls, such as Girls’ Clubs. WomenStrong consortium members in Ghana, Kenya, India, and Haiti run Girls’ Clubs for more than 9,000 girls. Clubs teach girls about financial literacy, sexual and reproductive health, gender-based violence, communication and relationship-building skills, goal-setting, self-esteem, and much more.

Girls attend a Club sponsored by WomenStrong in Kenya (Credit: WomenStrong)

In early 2019, WomenStrong will release Strong Girls Make Strong Women: A Practical Handbook for Creating and Leading a Girls’ Club. The handbook compiles best practices from our Clubs and other experts, including a 16-chapter curriculum covering the most important topics girls need to know.

Crucially, the sisterhood formed among Club members serves as a valuable protective asset for the girls, because they have a community with whom they can share their successes and challenges, peers to turn to when they need support or are in crisis, and a community of friends who will encourage them to pursue their goals. This social aspect of the Girls’ Club is every bit as important as the skills learned. 

Equipping girls through Girls’ Clubs with soft skills and a social network enhances their economic wellbeing and helps girls avoid or deal effectively with situations that might otherwise derail them from their goals and dreams.

But what do life skills have to do with helping girls transition into the world of work?

Take Nancy, who lives in the peri-urban community of Krobo, outside of Kumasi, Ghana. Nancy became pregnant in the first year of junior high, at age 15. Faced with uncertainty about her pregnancy and her financial future, Nancy dropped out of school. Fortunately, Nancy was a member of a Women’s Health to Wealth (WHW) Girls’ Club, supported by WomenStrong.

Club members and the Club facilitator noticed she was absent from school for several weeks and reached out to her. Learning of her pregnancy, WHW helped Nancy return to school to finish her basic education. Her social safety net, the Girls’ Club, helped her get back on track.

Credit: WomenStrong

Equipped with the skills from the Girls’ Club and from her basic education, Nancy then went on, with WHW’s support, to study jewelry-making and now runs a successful bead-making business that supports her three-year-old child and employs two other teen mothers. Nancy’s life skills education and Girls’ Club membership enabled her to become a thriving member of her local economy, benefiting herself, her family, and other young women in Krobo.

As we, the global community, look ahead to how 600 million adolescent girls can be best prepared to join the world of work, we must remember to build girls’ foundation of life skills.

Empowered with the knowledge of how to manage a budget, advocate for oneself, and respectfully manage conflict and debate (just a few life skills girls need to know), girls are then free to pursue their careers of choice and to be thriving members of the global economy, benefiting themselves and creating ripples of benefits that can improve the lives of those around them.