Menstrual Pain is a Public Health Matter

Menstrual health is a topic that is often neglected and ignored. In particular, the issue of menstrual pain can be overlooked because of the stigma that surrounds it. However, I recently read an article in Cosmopolitan magazine about period pain. It mentioned Professor John Guillebaud, of University College London, who described the severity in pain as being “almost as bad as a heart attack”.

Despite this, many doctors dismiss menstrual pain as irrelevant when a patient brings it up. As a practicing doctor, I have come across patients in casualty complaining of period pain. Shamefully, I admit that I have trivialized these women and their pain. Because of my own internalized sexism, I have choosen not to believe them or expected them to just ‘deal with it’ (it’s all part of womanhood, isn’t it?). I believe many other doctors, both male and female, have harboured similar thoughts. As a result, women to wait longer for medical attention and sometimes receive inadequate pain management.

Menstrual pain interferes with the daily life of one in five women.

The two main causes of debilitating pain are primary dysmenorrhoea and endometriosis. It is often difficult to differentiate between the two because they can present with similar symptoms. Endometriosis can be difficult to diagnose – in some instances the diagnosis process can take up to a decade. Doctors have struggled to find the specific medical causes for primary dysmenorrhoea. This may be related to the poor quality or low volume of sufficient scientific and medical research into menstrual pain.

I believe menstrual pain is ignored or completely disregarded by our society and culture. At times, males cannot relate because they cannot share the experience. As women, we are not taught not to discuss menstruation openly and to keep the great physical and emotional distress we may have to go through to ourselves.

In the workforce, menstrual pain is seen as a hindrance – yet another reason to deny women equality in the workplace. In schools, girls and young women are shamed for their pain and as a result, many choose to stay at home if the intensity increases.

There are changes that need to take place regarding menstrual pain:

  • Increased awareness around menstrual pain and its causes
  • More open discussions about menstrual health in the media, schools, offices and GP rooms to remove the stigma around menstruation
  • Consideration of menstrual leave
  • Increased scientific research
  • Access to adequate and safe pain management for women
  • Recognition of menstrual pain as a public health matter

Menstruation is a normal biological process and we should not shame people for it. We must not neglect menstrual pain or matters surrounding it. We need to open dialogue and provide more medical information on menstrual pain to help the many women who suffer silently.

What does COVID-19 mean for Young Women in the Kibera Slum?

COVID-19 has forced countries around the world to take unprecedented measures to combat the rapid spread of the virus. Although the pandemic affects all of us, it has hit people in urban poor settlements in developing countries especially hard. The global focus has rightfully been on containing the virus, but some sectors are being dangerously neglected. One of these is sexual and reproductive health and rights (SRHR), including safe abortion services. 

At Women Promotion Centre-Kenya (WPC-K), we work with vulnerable and marginalized communities (women, youth, LGBTQ groups) in the Kibera slum. It is the largest urban slum in Africa, characterized by high unemployment and crime rates, deplorable sanitation, poor housing conditions, and a lack of schools and healthcare facilities. The facilities that do exist are poorly structured private entities lacking qualified personnel or adequate equipment.

With the outbreak of COVID-19, the health situation has worsened in the Kibera slum.

This is especially true for girls and young women who need access to comprehensive SRHR – including safe medical abortion. Cases of rape and unprotected forced sexual encounters are on the rise due to movement restrictions. This has led to an increase in unplanned pregnancies and demand for abortion.

Girls and young women are facing hostility from already overstretched healthcare services. The majority of service-seekers are turned away without any form of support or service. After receiving numerous complaints from our beneficiaries, I decided to see what was happening for myself at one of the privately-owned healthcare facilities.

On arrival, I was received by a receptionist who seemed disgusted by my appearance. I was adhering to all sanitizing and social distancing guidance, so I ignored her and asked to see the clinical officer (we rarely have doctors in Kibera). After waiting 30 minutes to be seen, I inquired about family planning options I could use during the current situation. The clinical officer was not willing to help me. Instead, she advised me that contraceptives are ‘not good’ for girls and young women.

This might sound shocking, but it’s common for health workers to make judgements towards young women who are sexually active.

It is also common for them to discourage use of contraceptives by overstating negative side effects and creating excuses about availability. On this particular day, I tried to convince the clinical officer that I and other girls of my generation need contraception desperately. She told me to seek services elsewhere since this facility did not have supplies of contraceptives – even basic ones like condoms – due to restrictions on movement.

Young women are also being denied access to safe medical abortion services. One young woman we work with, Adhiambo (not her real name), found herself in a life-threatening situation. Adhiambo was denied safe services at her local healthcare facility due to the social distancing directed by the governement. Since movement in and out of Nairobi has been restricted, she could not travel to another town. As a result, she attempted to procure abortion secretly with the help of her friend who was equally unqualified.   

In Kibera, due to the measures put in place to combat Coronavirus, many girls and young women are resorting to unsafe abortion practices. These include drinking a herbal concoction, inserting metal clothes hangers into their bodies, drinking Jik (washing detergent) and taking an overdose of prescribed medicines. This is all because they cannot access safe abortion services at a health facility, and will lead to unprecedented health issues in the near future. 

Although there is a need to focus on COVID-19, it is self-defeating for governments to ignore ongoing healthcare needs like SRHR.

It is the right of every girl and woman to have control over her body. This right can only be realized if she is enabled to access comprehensive SRHR, including safe abortion. Women Promotion Center is one of the leading feminist organizations in the Kibera slum. We are currently implementing a SAAF-funded project to tackle community-level, abortion-related stigma. During the current pandemic, we have stepped in to fill the SRHR gap, too. We are distributing essential contraceptives, such as pills and condoms, as well as re-usable sanitary towels and other COVID-19 related personal protective equipment (PPE).

Our staff and volunteers are using public forums to talk to community members about the major symptoms and prevention measures of COVID-19. Additionally, WPC is promoting safe self-managed abortion by strengthening the capacity of community volunteers. These volunteers can provide information and appropriate commodities (such as Misoprostol and Mifepristone) to those who need them.

Despite its overstretched resources, WPC continues to work with young women to strengthen their capacity to demand their rights to comprehensive SRHR services and information – including safe abortion. We are working to ensure that the Ministry of Health and other key stakeholders in the Kenyan health sector prioritize SRHR, especially in the slums like Kibera where they are so urgently needed.  

Women Promotion Centre is a Safe Abortion Action Fund grantee partner.

Why Women March to the Nairobi Summit on ICPD25

The Nairobi Summit kicks off this week. It will mark 25 years since the International Conference on Population and Development adopted the Programme of Action in Cairo. The summit comes at a critical time to discuss the way forward for sexual and reproductive health and rights. Girls’ Globe is on the ground to amplify the voices of grassroots activists and youth leaders. In this video, we hear why women march to the Nairobi Summit on ICPD25.

“I envision a country, or rather, a continent, where young girls and young women have power to decide on what to do with their bodies and have access to information so that they can make better and good decisions.”
– Ruth Mumbi, Social Justice Defender

The Girls’ Globe team, led by Felogene Anumo and Abigail Arunga, spoke to women marching in the lead up to the Nairobi Summit on ICPD25. A common thread in the responses to why they were marching was access to information and services for women and girls – especially those in marginalized communities. Realizing sexual and reproductive health and rights will lead to better decisions about their bodies. Women were marching for women to have full autonomy over their bodies and to put an end to maternal deaths.

“I am here marching today for ICPD to bring out the voice of the unheard. The young women in the slum areas. If the young people can get information at an early age, we are able to act better and make better decisions.”
– Maryanne Wanjiru from K Youth Media.

Kaz, Founder of Kaz Entertainment

“I am here to support women empower themselves, and find more empowering ways to live, and be and flourish! My dream is that women will have full autonomy of their bodies and decision-making.” – Kaz, Founder of Kaz Entertainment.

Follow along @girlsglobe on Instagram and Twitter this week for more grassroots voices, directly from the Nairobi Summit on ICPD25.

This reporting was supported by the Children’s Investment Fund Foundation.

Has Today’s Feminism Gone Too Far?

A common critique of today’s feminism is that it has ‘gone too far’. Some say that we’ve ‘created’ a gender ideology, that we hate men, that we cook up harassment stories, and that we’re easily offended, angry or radical. Others want to belittle feminism by calling it a fad.

‘Today’s feminism’ implies that, once upon a time, there was a more acceptable, amicable and effective feminist movement. When people criticise ‘today’s feminism’, they assume that ‘yesterday’s feminism’ was preferable. And I wonder, was it?

The first wave of feminism took place between the 19th and early 20th centuries. It focused on achieving women’s suffrage among other basic rights. These feminists were known as the Suffragettes. The right to vote, to property and to divorce may seem like obvious demands now, but they were met with ridicule at the time.

Suffragettes were depicted by media outlets as disgusting, boisterous and radical.

Men who supported them were publicly mocked. Anti-suffragists claimed that women’s ability to vote would grow radicalism, increase domestic terrorism, and generally turn the world on its head.

Anti-Suffragette Cartoon from 1908


A second wave of feminists emerged in the 1960s. These women fought for sexual and reproductive freedom, against strict beauty norms and for their right to work outside the home.

Second wave feminism suffered a tremendous backlash.

Society declared them ‘petty’ for discussing bras and body hair instead of ‘real problems’. Feminists at this time were heavily stereotyped as being humourless, hairy-legged, man-hating and unhappy women. Media outlets censored their fight by using the past tense when referring to feminism and falsely declaring that feminism was ‘dead’.

As a backlash to the backlash, a third wave of feminism sprouted in the 1990s – largely influenced by punk and underground trends. Third-wave feminists fought for social justice and focused on increasing the intersectionality and inclusivity missing from earlier forms of feminism. However, once again, they were demonised with the same arguments: man-hating, ugly, crazy, going too far.

I make these brief historical references to point out that no feminism has ever been fully celebrated. And in the current fourth-wave of feminism, which uses digital tools to strengthen the fight, anti-feminist voices are as loud as ever.

Anti-feminists have been critiquing ‘today’s feminism’ for decades.

Doing so allows them to acknowledge that widely-celebrated changes from the past were good, while simultaneously attempt to halt current and future progress.

Most people today will agree that to vote is a basic right and that women deserve economic independency and sexual agency. But not everyone understands yet that trans women are women, that sexism is an everyday problem and that the pay gap exists.

In 30 years time, we will look back and think of the #MeToo movement as a crucial point on the feminism timeline. It will be recognised as a necessary step on the way to equality – in the same way that no one now doubts that women’s suffrage was worth the fight.

One day in the future, 2019’s feminism will be normalised and seen as worth the fight. But for this to happen, we must never let them tell us that we’ve gone too far.

The App Empowering Young Women in Uganda

In Uganda, young women and girls face many sexual and reproductive health and rights (SRHR) challenges. For example, a high unmet need for contraception leads to dire consequences like unplanned pregnancies and sexually transmitted infections.

Challenges that limit provision of SRHR services to adolescents and young women include lack of privacy and confidentiality, knowledge gaps, cultural and social stigma, biased service providers, and inconvenience in accessing SRHR services despite their availability. Although there have been improvements in creating a youth-attractive environment for SRHR services and access to tools, more work is needed.

We are constantly reminded of the need to provide avenues where young people – including women and girls – can access sexual and reproductive health and rights services that are equitable, appropriate and effective.

At Reach A Hand Uganda, we help to address this need through our youth empowerment centres, and now, we have introduced the SAUTIplus app.

The SAUTIplus app is an innovative part of the SAUTIplus ecosystem,  helping to fill existing gaps in information. Uganda is experiencing a smartphone boom, with over half the population now owning one, and this number is increasing day by day.

Internet penetration in Uganda is at 41.6% – with 19 million Ugandans connected to the internet. In 2017, the Uganda Communications Commission recorded that the total number of mobile phone subscriptions was 23,529,979, up from 21,039,690 the previous quarter.

The SAUTIplus app was revamped two months ago to further engage Uganda’s high youth population and, at the time of writing, has 1,600 downloads on Google Play Store. The iOS version is in its final stages of going live.

On the app, information is available day or night. With a few taps of their phone, young women and girls can quickly find answers to their burning questions about sexual and reproductive health.

It’s the young people at Reach a Hand Uganda producing the content for the app and answering the questions – with support from the Programs and Communications departments. We understand the needs of the young women and girls and can craft our responses to reach the users in a relatable manner.

Users are able to see answers to questions other young people have asked and read tailor-made stories addressing issues faced by girls. Questions can be submitted on the website (hopefully soon to be added to the app) and the questions and answers can be viewed on either the app or website. The questions can be anonymous to maintain a safe and confidential space.

The app provides accurate information on SRHR, rather than simply promoting abstinence, which has proven an ineffective method of protecting young girls in Uganda.

The section named ‘Senga’ is a reference to a trusted relationship between a woman and her father’s sister (auntie). This relationship is commonly one where information regarding sexual and reproductive health and rights is passed on, but there can be a gap in appropriate or accurate information. This is where the SAUTIplus app comes in.

‘Senga’ provides an opportunity to view answers to questions you may have had yourself, smashing the common myths and misconceptions surrounding SRHR in Uganda. “My boyfriend says we don’t need contraception because he will pull out at the last minute. Is this a good idea?” is an example of one of the questions asked by a young girl on Senga.

The SAUTIplus app is providing a platform for women and girls to take charge of their sexual health. The knowledge the app provides is giving power to young women.

With power comes increased agency and the ability to negotiate within relationships – for example, with regards to contraceptive use to prevent pregnancy. No topic is taboo on the app. This includes menstruation and menstrual hygiene, a key SRHR challenge Reach a Hand have identified among young women in the country.

The for-the-youth attitude of the SAUTIplus app means it is an engaging platform for young people to access reliable information. Multimedia content, including photos, videos and blogs, provide a plethora of youth-friendly, easily digestible resources on SRHR.

The app is in continuous development, striving to meet the changing needs of young women in Uganda. It aims to create a positive relationship between young people and SRHR information, showing that information is a tool of power and not something to be dismissed. 

Could an App Help Diagnose & Treat Endometriosis?

Endometriosis is an often painful chronic gynaecological disorder in which tissue that normally lines the inside of a woman’s uterus grows outside of the uterus. The patient has to live with certain symptoms, like painful periods and ovulation, pain during or after sexual intercourse, heavy bleeding, chronic pelvic pain, fatigue, and infertility over time.

These symptoms can impact on general physical, mental, and social wellbeing. If left untreated, endometriosis can lead to further health complications, painful intercourse and infertility. According to the World Endometriosis Society and the World Endometriosis Research Foundation:

Endometriosis affects an estimated 1 in 10 women during their reproductive years,  which is approximately 176 million women in the world.”

Despite this, there has been little commitment to investing in basic research and there is currently no known cure for endometriosis.

Not only is there no known cure, diagnosis isn’t simple. This is because endometriosis symptoms are often dismissed as ‘just bad periods’. Symptoms can also be similar to those of other diseases.

At Sweden National Finals Creative Business Cup on May 8 2019, Sweden’s top 8 startups within the creative industries pitched their ideas to a ‘jury’ of investors. One of these ideas might just be able to validate under-recognised illnesses such as Endometriosis.

Endometrix

Endometrix is an app that aims to make endometriosis easier to understand. It can provide self-care advice on how to treat symptoms through adequate, accessible and individualised healthcare through the use of technology.

Behind Endometrix is a cool team from Stockholm with backgrounds in bio-entrepreneurship, media & communication and healthcare. Witnessing the inadequate gynaecological care and a lack of everything from validation to awareness, choices and treatment, they created an innovative tailor-made solution for a slow-moving, conservative industry.

Meet the Endometrix team.

Do not undermine the power of women turning to one another to share their knowledge and emotions with each other. Endometrix was born with this connective mindset. Our vision is that every woman receives adequate care by sharing their experiences and progress with one another.” – Moa Felicia Linder, Co-Founder

I was told, the only time you look at what someone else has is to see if they have enough. I looked, and found that there wasn’t enough; there has been unequal treatment, unequal pay and unequal care for women. Through Endometrix, I want to change at least one of those things.” – Sushrut Shastri, Co-Founder

I had an incredible six years helping people working as a registered nurse, but there came a point where I wanted to be able to help people on a larger scale. Ultimately, to provide people with easier access to adequate care. I hope to achieve just that through Endometrix.” – Mitchell Isakka, Co-Founder

At the core of their solution lies the personal experiences of endometriosis of different girls and women. “We sent out the survey to which a lot of people responded and that was the basis for training a machine learning algorithm,” says cofounder Sushrut Shastri. The app uses machine learning, an automated system that uses data to answer questions. By using data from over 700 individuals, Endometrix identifies patterns and teaches themodel to learn how each user manages these symptoms.


Its 80% accuracy reduces the time it takes to reach diagnosis. It has potential to expand to other gynecological conditions, such as Polycystic Ovary Syndrome (PCOS), Adenomyosis and all sorts of infections.

Machine learning in healthcare is not something new. It has been playing an integral role in for at least 5-10 years. In the case of Endometriosis, the Endometrix app gives users access to information from the experiences of others who are overcoming similar challenges. It also helps to curate a wellness plan (diet, fitness, medication and meditation) and bust myths around endometriosis. “The future of machine learning used in healthcare is to help doctors to work together with doctors”, says cofounder Sushrut Shastri.

Using the full potential of artificial intelligence, and machine learning in particular, often requires addressing certain issues. However, health is fundamentally different from other areas since it concerns the understanding of diseases and treatments.

Machine learning technology can help tremendously with under-recognised disorders like endometriosis and provide doctors with the evidence they need to help girls and women.