The HIV/AIDS epidemic and its deleterious effect on the human rights of women in Uganda is only one manifestation of the wider problem of neglecting women’s health. In 2015 the government of Uganda, in conjunction with several civil society organizations, signed the Menstrual Hygiene Management Charter, affirming their commitment to “promote the rights of girls and women during and after their menstrual cycle.” One year later, during his reelection campaign, President Yoweri Museveni pledged to provide free sanitary pads to Ugandan schools. By February 2017, First Lady and Minister of Education and Sports Janet Museveni revealed to parliament that the government did not have enough funding to cover the 4.4 million dollar promise made by her husband. Although Uganda has increased health spending in terms of raw numbers, the percentage of total government spending allocated for health has decreased overall. Reasons cited for this include: population increases without commensurate increases in health spending, reliance on foreign aid for health spending, and diversion of funds towards improving infrastructure and modernization. This example is one of many illustrating the disproportionately negative health outcomes women and adolescent girls face in Uganda. How adolescent girls in Uganda experience menstruation and the limits it places on them during their formative years can impact their future educational outcomes and health-seeking behavior.
The Netherlands Development Organization (SNV)/IRC International Water and Sanitation Centre conducted a study in 20 primary schools in five rural districts and found that about half the girls aged 12-17 missed between 1-3 days of primary school per month due to menstruation. Taken further, this translates into a total loss of 8-24 school days per year. At the most extreme end, this could mean missing 11% of the total school days. Reasons cited for school absenteeism during menstruation include: lack of sanitary products, lack of hygiene facilities in schools, physical pain from menstruation, and cultural attitudes that view menstruation as “unclean” promoting fear and shame. These issues are especially salient in rural areas where families cannot afford the estimated 5,000 Ugandan shillings it costs for a month’s supply of sanitary pads. This has led girls to use dirty rags, old T-shirts, cloth diapers from younger siblings, and even leaves in place of proper sanitary pads. One NGO worker has pointed out the practice of using sand: “Girls and women in Busoga, who can’t afford sanitary pads, have to pile up sand under a tree and sit on it. After a while the sand is supposed to absorb the blood before they can continue with their daily routine.” This unsanitary process exposes them to the risk of intrauterine infection.
The stigma surrounding menstruation and lack of access to sanitary products has compounding effects in other areas of women’s health, such as increased high-risk sexual behavior. While it is well-documented that adolescent girls turn to sex work in order to pay for living expenses, in Uganda, Kenya, South Sudan, and Tanzania, it has also been found that some engage in transactional sex specifically to afford commercial sanitary products.
Commercial sex work also exacerbates health inequalities by contributing to the spread and contraction of HIV, which augments the cycle of gender-based violence. The lack of sanitation infrastructure is also linked to gender-based violence. Many of the rural villages in Uganda lack basic sanitation infrastructure and WASH facilities. Often, women must venture away from their homes to use the toilet, bathe, or collect water. Menstruation puts women and adolescent girls in a more vulnerable position because of their increased need to access WASH facilities. This exposes them to the risk of harassment, physical assault, and even rape during menstruation when they need to leave their homes to use hygiene facilities more frequently. A project officer from the Ugandan NGO WoMena recalled a girl who told them that “she [got married] because she thought that she would receive pads.” While an adolescent girl may feel that marrying a man with higher wealth and status will allow her to afford menstrual products, this in fact increases her chance of contracting sexually transmitted diseases, such as HIV, as these men tend to be much older than the girl and have had several previous sexual partners.
To address these problems, Ugandan NGOs and international organizations alike are working to find solutions to the lack of sanitary products, and to sensitize the community to women’s health. Organizations like Afripads and Makapads produce affordable, reusable sanitary pads, as well as disposable ones made from paper waste. Straight Talk Foundation has bought over 53,000 packages from Afripads, and has implemented its own programs in partnership with UNFPA and the Swedish Embassy. They train teachers in the Karamoja district on how to help girls with their menstrual health, provide mentorship for adolescent girls, and train both boys and girls on how to make reusable sanitary pads. Involving boys helps break the taboo around menstruation and presents women’s menstrual health as a social issue and human right, rather than a burden that women and girls must face in isolation. Youth are getting involved in other ways too. EcoSmart Pads is a youth-led Ugandan startup that makes biodegradable disposable sanitary pads from sugarcane residue. They have received support from the UNFPA Up Accelerate Program, which provides a platform for youth-led startups to develop products related to sexual and reproductive health and bring them to market. Some Ugandan women have even experimented with menstrual cups. WoMena, mentioned earlier, partnered with the Netherlands organization ZOA to provide menstrual cups for over 100 women and girls, both Ugandan and South Sudanese, in a refugee camp in Uganda. They also provided trainings on how to insert and remove the cups, as well as how to track their menstrual cycle and manage menstrual pain.
It is clear that the Ugandan and international community have risen to the challenge to fill the void left by the government. They have worked hard to raise awareness of the risks and challenges associated with both the lack of hygiene infrastructure and the stigma surrounding menstrual health. Better education and more open dialogue can improve the psycho-social well-being of women and adolescent girls, as well as provide them with the tools and knowledge they need to advocate for their own positive health outcomes. Once women and girls frame their health as a universal human right, they can better confront and manage their health situations down the road. Whether it is safe sex, child bearing, illness, or HIV/AIDS, we must lay the groundwork for women’s agency in their own health decisions, and advocating for menstrual health is a great way to start.
