Keeping Girls Healthy in DRC

October 11 is the International Day of the Girl, one of CARE’s favorite days of the year. In some ways, we celebrate girls every day. After all, empowering girls and women is the focus of CARE’s mission, and we believe they are the key to overcoming global poverty.

This year, International Day of the Girl is focused on the empowerment of girls in crisis situations. According to UNICEF, approximately 535 million children worldwide were living in countries affected by conflict, natural disasters, epidemics, and other emergencies last year. The Democratic Republic of Congo (DRC) is one such country.

DRC is located in the Great Lakes region of Africa and home to breathtaking scenery and vibrant people. Although civil war here officially ended in 2003, conflict between government forces and various armed groups has persisted and remains ongoing in certain regions. DRC is rich in natural resources, but it remains mostly poor in terms of infrastructure and economic opportunity for its citizens. Women and girls, in particular, face enormous challenges just to survive and provide for themselves and their families.

The health system in DRC is weak and unable to fully meet the primary health needs of the population, including sexual, reproductive, and maternal health needs. Tens of thousands of Congolese women and girls die each year from pregnancy and childbirth – many are only teenagers.

Adolescents and young people in DRC often find it difficult or impossible to access health care. Information and services related to sex and reproductive health (SRH) are especially hard to find due to cultural norms and expectations (such as abstinence before marriage) that prohibit young people from seeking them out. If a young person does manage to reach a health clinic or provider, it is not uncommon for them to be denied care because of their age or even shamed for seeking it out.

“Why do you need condoms? You’re too young to be having sex! Go home!”

Of course, teenage girls and boys in DRC (and around the world) are having sex whether or not adults approve. And without knowledge of sexual health or access to contraceptives, girls are accidentally getting pregnant. Girls like Claudine.

Claudine is 19 years old and lives in Goma, the bustling capital of the North Kivu province of DRC. Not knowing how to protect herself, she became pregnant and gave birth to a child at age 17. She has returned to school and is studying social sciences at the Uzima Institute.

Fortunately, SRH information and services are becoming more available to Goma teenagers through Vijana Juu (translates to ‘Stand Up for Youth’), a project implemented by CARE DRC and funded by the UK Department for International Development. Adolescents and young people partnered with CARE staff to identify barriers to accessing and using contraception, brainstormed solutions, and worked with community leaders and health administrators to change the situation.

They recognized that their peers did not feel comfortable going to local health centers because they might run into judgmental adults, so certain clinics responded by setting up discreet side entrances available to youth only and created adolescent-specific referral cards to improve access to health services. Open meeting spaces designed by young people were established next to health centers where adolescents could come to talk with their peers about issues related to SRH in a relaxed environment that belongs to them, and teenagers could volunteer to be trained as peer leaders, providing information and referrals to their friends and neighbors.

CARE is helping to train health providers to recognize and challenge their own values and biases toward teenage sex that could discourage youth from seeking services. CARE is also supporting health facilities to provide a full range of contraceptive options and reproductive health services to adolescent girls and young women.

Over 6000 adolescents received sexual and reproductive health counseling and services through this program, and many began using contraception for the first time. About 30% of these new contraceptive users are girls, and 65% of them selected a highly effective, long-acting and reversible method (implant or IUD).

After her child was born, Claudine visited one of the Vijana Juu youth-friendly health clinics for an IUD so she could finish school without the risk of getting pregnant again. She has become a vocal advocate for safe sex in her community, and advises her friends to use contraception. When we asked why, she explained:

“Girls my age forget that sex can lead to harmful consequences like unwanted pregnancy, sexually transmitted diseases, abortions, and even death. Young people need to be informed. Adolescent girls and boys have a right to sexual health to make a better future and realize their dreams.”

Why is Menstruation Still Holding Girls Back?

In Uganda, adolescent girls and young women in inadequately-served and rural communities miss up to eight days of study each school term because they are on their periods. This is due to lack of washrooms, lack of sanitary pads and bullying by peers with in and out of school settings. Research conducted by various civil society organisations shows that on average girls miss up to 11% of the total learning days in a school calendar year.

This school absence rate is hard for adolescent girls and young women to make up for and partly accounts for many adolescent girls and young women dropping out of high school in rural and inadequately served communities.

At Peer To Peer Uganda (PEERU), we find that most of the adolescent girls and young girls we talk to during our school outreaches use pieces of cloth – called ‘kitenge‘ in Uganda – which they get from their mothers or they use their own old pieces. Others improvise with cloth nappies used by their younger siblings. Some girls even use dry leaves to try to soak up the blood in emergency situations.

Not only are these girls dealing with a lack of materials, they are also stigmatised by cultural attitudes that regard menstruating women and girls as being unhygienic or dirty. Many girls grow up dreading their periods because of the social stigma associated with menstruation, as well as the lack of services and facilities to help them.

“I used to use cloths that I would cut from my old T-shirts to keep the blood from staining my dresses, but they were not enough and blood would still stain my clothes,” said Joan, a 14-year-old student at St. Noa Kiyinda Primary School in Mityana. “Boys used to laugh at me and I eventually simply stayed home whenever my periods started.”

After a visit by Peer To Peer Uganda (PEERU), and a sensitization and awareness campaign called Know your Body at her school, Joan said:

“Now I don’t get ashamed or embarrassed when I get my periods,” she says. “I even attend classes during my periods and nobody notices. Even boys at school no longer laugh at me like they used to do.”

Milly, who is from Nakasongola – a district in Central Uganda – had to repeat a class for another year at Zengebe Primary School after she missed her final exams because of her period.

“When I started menstruating, I went through many difficult days,” she says. “I could not get myself any materials to use to stop myself from soiling my clothes. It was better for me to stay at home rather than go through that shame at school.”

There are many private companies selling disposable sanitary pads in Uganda, but they are only sold in supermarkets in towns and don’t reach rural areas. A number of social enterprises have emerged to address the issue, like Afripads, making re-useable menstrual kits, and Makapads, making disposal pads out of paper waste. The cost of their products is generally lower than the imported disposable pads, but they are still relatively expensive and their outreach to rural areas is very limited, since local manufacturers often lack financial support to increase production to satisfy the demand.

To fill the gap, Peer To Peer Uganda (PEERU), with support from Community Health Alliance Uganda and the International HIV/AIDS Alliance is implementing the Know Your Body Campaign under the READY Teens Project, to teach adolescent girls, young girls and their parents on menstrual hygiene, management and body change.

We also involve the wider community to address cultural taboos around and myths that hinder discussions on menstruation. Now, schools in Mityana, Luwero and Nakasongola – both secondary and primary – are engaged through the campaign which is to run till 2019 as we further engage adolescent peers through school health clubs, focused group discussions and puppetry activations. 

There is still a great need to address the issues adolescent girls and young women face holistically, and this includes advocating for the provision of affordable solutions for every girl in every school as a basic right.

Ugandan female parliamentarians under the leadership of the Speaker of Parliament Rebecca Kadaga are leading a campaign asking the government to provide adequate washrooms and to drop taxes on sanitary pads. The Ugandan Constitution includes a pledge to “provide the facilities and opportunities necessary to enhance the welfare of women to enable them realise their full potential and advancement”. Sanitary towels and bathrooms seem a small price to pay for helping adolescent girls and young women to access a complete education.

Bwire Moses is Founder and Team Leader at Peer To Peer Uganda (PEERU). Follow them on Facebook & Twitter.

Read more blog posts about reusable sanitary products on Girls’ Globe. 

A Journey to Challenge Child Marriage in India

A rhythmic clap grows louder as the girls step into the room. They have travelled 1.500 kilometres across India to reach this destination – Selwada, a village a couple of hours outside of the city of Udaipur. As they enter the meeting venue, they are greeted by rows of smiling peers, applauding to welcome them. This is a session for the girls to share experiences on the issues that confront them – one being child marriage.

Since 2015 The Hunger Project India has worked to build support structures for young girls across the country to address the issue of early child marriage. According to UNICEF, almost half of all girls in India are married before the age of 18, despite the practice being outlawed. Two of the most affected states are Bihar in the east and Rajasthan in the west.

THP India’s vision was for girls from the two states to meet and exchange knowledge and experiences. In partnership with Sweden’s The Girl Child Platform, the idea was finally realised this summer. On July 12th, 25 adolescent girls (aged 14–19) from Bihar boarded a train to take them across India.

Fatma, 17, squares her shoulders a little as she stands up in front of the group. It is a humid day in Selwada and the ceiling fans are spinning frantically, but apart from that, it’s silent – the girls give each other their full attention. As a regular attendee at the meetings at home, Fatma has grown comfortable with speaking in front of others. This is not the first time she tells her story, one of a wedding ceremony she cannot even remember – that is how young she was when she was married. Yet, her voice still breaks a little, as she describes the struggle of refusing to leave her home to move in with a man she had never met.

As early as ten or twelve years old, girls can be expected to leave their homes for their in-laws’. A sense of alienation is shared by the girls of Bihar and Rajasthan. Many of them testify to a feeling of not belonging, of being outsiders both in their families and in their new homes.

Once the session is over, however, high spirits prevail. When the girls pour out of the venue, it is arm-in-arm with newfound friends. The comfort and strength of not being alone cannot be underestimated. By listening to one another, they can recognize the larger forces at play – as well as the means and tools to withstand them.

In so many ways, their traveling is a learning process. Veda Bharadwaja, programme officer for THP India, explains the importance of letting the girls internalise their journey in their own way: “They are the leaders of tomorrow. But they are active citizens today. You can’t look at girls as a group that needs to be rescued, you have to empower them to take their own stand. And they already have, many before they even came here”, she says.

These girls have broken the isolation of the walls of their households and expanded their horizons. Just as they were brave enough to board a train to change the tracks of their lives, we, as a global community, have to keep stretching out of our own confined bubbles. Creating common platforms to discuss the issues of girls’ rights allows us to address patriarchy as the global structure it is. We can learn tremendously by recognising the courage and perseverance of young girls across the world. For it is in the homes of these girls that development happens. Every day, as they negotiate for their freedom, they are pushing the agenda for their own human rights.

We have the power to support girls that are working towards the end of child marriage. We can amplify their voices by recognising that girls are experts on girls. And we should listen to them.

Explore the life changing journey from Bihar to Rajasthan under the hashtag #girlschangetracks and spread the message.

Sugar Daddies are Definitely NOT Sweet

The situation is all too common…a young girl is looking to fill a void left by an absent or abusive father, and an older man seizes the opportunity to offer comfort and gifts – at a price. The term ‘Sugar Daddy’ is an awfully sweet-sounding way to refer to men who leverage their power and wealth to bait young girls into a sexual trap.

In Lesotho (southern Africa), sugar daddies are called ‘blessers’. As girls’ bodies start to change in early adolescence, older men take notice. The girls, often orphans with no emotional support, crave the attention and feel that it is cool to have an older man show interest in them. A mother from Lesotho explains, “we find that for some girls who have grown up without a father, these sugar daddies provide something like a ‘fatherly love’, but really they are exploiting them.”

Blessers initiate relationships by buying girls presents ranging from small trinkets to new clothing to cell phones. At first the gifts are given with sweet words and compliments and the girls are thrilled to have new, luxury items. But before long, blessers are asking for favours in return and they only have one thing in mind.

All relationships between girls and blessers are sexual in nature. Many girls become pregnant, which typically terminates the relationship because blessers will not take responsibility for impregnating the girls. The blesser returns to his wife and children, while the girl is left with the shame of telling her elders that she had a relationship with a man the age of her father.

Perhaps even more devastating than pregnancy, many girls contract HIV as a result of their blesser relationships. These men typically know their status yet they convince girls that having sex with a condom is a bad idea (some men go so far as to say that condoms cause kidney disease in men – a claim with no truth whatsoever). The girls have no defence and no retribution; their shame keeps them from asking for help.

Shocking as it is, some girls intentionally seek out blessers, entering into relationships with a list of goods they hope to secure. These girls know that this behaviour is dangerous, yet the appeal of accessing nice items is too strong to resist. Most girls do not yet recognize that the gifts are not worth the cost of what they are required to give up. It often takes hindsight for the girls to recognize that they do not really want to be in a relationship with a blesser. Many wish they could return to childhood and forget the adult world they abruptly entered.

Ending a relationship between a blesser and a girl is at least as unsavoury as the relationship itself. Most girls have no say whatsoever, and may even be further victimized for trying to end things. One girl shared, “my friend is trying to end her involvement with a sugar daddy and now he wants to kill her. She has changed her phone number too – he is stalking her.”

Some parents of adolescent girls try to warn their daughters of the risks associated with sugar daddies; others encourage it. Regardless, the girls are often more interested in what their peers are up to rather than listening to their parents. For parents with daughters who board at school, the concern is even worse. One mother explains:

“My daughter normally uses public [transportation] to go home. One day, I called her to check in and I heard men’s voices in the background. I started to panic. It was the case that they were just men near the bus, but of course I was so worried that maybe a man had offered her a ride in his car.”

The prevalence of sugar daddy relationships is difficult to determine since both the girls and the blessers go to great efforts to keep their relationships a secret – girls because of the shame, blessers because of the risk to their marriages and family relationships. What we do know for certain is that these relationships are too common. In any high school, it would not be difficult to find several girls who sneak off to meet their blessers after school.

Sugar daddies, as the adults in the relationships, need to take responsibility for protecting rather than preying on young girls. These relationships are dangerous and harmful, often leading to a lifetime of trauma. The good news is that this problem is relatively straightforward to address – men need to stop engaging in sexual relationships with young girls!