THE IMPACT OF PUBERTY AND FEMININE HYGIENE ON GIRLS’ PARTICIPATION IN EDUCATION A CASE OF KENYA AND MALAWI
Final Draft
UNICEF ESARO ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
ABBREVIATIONS AND ACRONYMS
BOG Board of Governors CBOs Community Based Organisations CFSI Child Friendly Schools Initiative DEO District Education Officer EFA Education for All FAWE Forum for African Women Educationalists FAWEK Forum for African Women Educationalists-Kenya FGDs Focus Group Discussions FGM Female Genital Mutilation GE Gender Policy on Education KESSP Kenya Education Sector Support Programme MDGs Millennium Development Goals MOE Ministry of Education MOH Ministry of Health NGOs Non-Governmental Organisations P&G Proctor and Gamble PTA Parents-Teachers Associations SMC School Management Committee SM&HMP Sexual Maturation and Hygienic Menstruation Practices ToT Trainers of Trainers TSS Toxic Shock Syndrome UNICEF United Nations Children Education Fund UPE Universal Primary Education
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CHAPTER ONE
BACKGROUND AND CONTEXT– KENYA AND MALAWI
“I normally hate it when “The pads take teacher comes to class and I am longer [than other forced to listen when in the real sanitary protection] to get wet or soaked.” sense I just prefer being alone and not in class.” “The skin on my thighs does not get irritated due to friction and wetness.”
“I do not knock off early due to stains.”
“My grades have Introduction improved.” This chapter locates the context within which the pilot project to investigate the impact of feminine hygiene on girls’ participation in schooling was implemented in the two countries –Kenya and Malawi –which served as case study countries in the Eastern and Southern African Region. The study aimed at interrogating the realities that many pubescent schoolgirls from impoverished communities in the African contexts encountered as they negotiated their educational1 careers. The accrued evidence is key in informing strategic interventions for responding appropriately to, not only the improvement of biophysical and educational needs within which girls navigate sexual maturity during the interface of basic schooling, but also sanitary and hygiene challenges they face during their menses. This chapter, therefore, highlights school- based and hygiene-related factors that have, over time, been perceived to have negative effects on the lives of pubescent girls, especially at the onset of menstruation. It also draws attention to the link between feminine hygiene issues and the educational participation and performance of girls relative to boys. The statement of the study problem as identified and defined by the two participating countries -Kenya and Malawi-
1 Education herein refers to the process of formal schooling within formal school settings
3 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi is presented towards the end of this section, alongside the specific study objectives and the related study questions that guided the project activities.
Overview –adolescence and puberty
While Adolescence is used to refer to the period of psychological and social transition between childhood and adulthood, the term puberty is conventionally used to refer to the bodily changes related to sexual maturation rather than the psychosocial and cultural aspects of adolescent development. Adolescence largely overlaps the period of puberty, however its boundaries are less precisely defined as it refers as much to the psychosocial and cultural characteristics of development during the teen years as to the physical changes associated with puberty.
Although there is a wide range of what is considered the normal age of puberty, boys and girls experience puberty differently. On average, girls begin the process of puberty at about 1-2 years earlier than boys, with average ages of 9 to 14years for girls and 10 to 17 years for boys. Girls usually attain adult height and reproductive maturity about 4 years after the first physical changes of puberty appear. In contrast, boys accelerate more slowly but continue to grow for about 6 years after the first visible pubertal changes (Gordon, Catharine, Laufer, 2005). This means that girls and boys of the same age and in the same school or class experience considerable difference in their maturation process.
Puberty, as a the biological and physical transformational stage between childhood and adulthood poses considerable challenges to young people, particularly the girls whose onset of menstruation requires that they enter into a cultural realm of secrecy, anxiety and uncertainty with regard to how they manage the regular occurrence of their period effectively. One of the major events in a woman's/girl’s life is when she experiences her first period and is reminded of her entrance to womanhood from that of being just a girl- child. This moment is importantly marked not only by societal expectation of change of behaviour but also by personal hygiene needs related to the management of menstruation. Anecdotal narratives from girls and women indicate that this new phase in a girl’s life is often characterised by practical worries that are unique to girls –in
4 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi particular the socio-economic and cultural situations. These include the worry about what to use to manage the period, how to acquire sufficient supplies that are effective in managing the period and more importantly, how to keep this function of managing the period hidden. This is done through secretive acquisition of protective material and even finding places to change and prevent potential ‘accidents’ of leakage and the possibility of ‘other people knowing’. More so, is the worry of finding some discreet disposal points where to deposit the used absorbent materials. The complex navigation of how to manage a period indicates that the onset of menstruation is not a simple matter but rather a combination of types and forms of special challenges, which the body of an adolescent menstruating girl presents. However, the way in which each culture thinks about and constructs menstruation is as important as the manner in which communities inform, educate and influence their adolescent girls to think and present the female body, develop self-image, and nurture self-esteem.
Because physical growth accelerates during the pubescent stage and tends to be generally more pronounced and noticeable among girls than boys, many pubescent girls get overly concerned about the manifestation of adult features earlier than their male peers. To some girls, this manifestation creates anxiety, particularly if it attracts attention towards themselves and their developing of features in ways that they themselves perceive to be sexually intrusive. For school going pubescent girls, the physical and biological changes often do compound their life in a manner that affects not only their self-esteem but also their construction of femininity, both at home, in the community and in the school where they spend most of their time. This is the stage when most girls experience an increased need to boost their image by observing hygiene practices and by being clean and tidy, well groomed and generally appealing. Kiminyo (1995:43) observes that at the stage of adolescence, girls (and boys) tend to be disturbed by their own sexual developments with some of them getting embarrassed by their body changes. Such embarrassment is exacerbated when people making remarks of the adolescents physical look (Kiminyo, 1995:43). Unfortunately, many of the girls from impoverished communities lack the means of developing and portraying the kind of ideal feminine image that is constructed by peers
5 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi and the wider community. Their families and schools may neither be aware of this need nor have the capability to provide the facilities such as adequate water supply, sanitary- wear and girl-friendly toilets, which are a prerequisite to the new challenges that the girls often face. Increasingly, the general view has been expressed in favour of providing the girls with puberty and feminine hygiene education as an empowerment tool. Apparently, this empowering education, which has potential to alter positively, the girls’ feminine identities, seems to be often lacking in schools and other education settings, including the family. It is in this context that the Kenya-Malawi Feminine Hygiene project was designed with the aim of generating evidence-based knowledge that would help inform intervention strategies for the enhancement of education for girls in poor African settings.
Puberty, feminine hygiene and girls’ education in Sub-Sahara African contexts
Sanitation, feminine hygiene and schooling Studies in Sub-Sahara African (SSA) countries show that the lack of adequate toilet facilities is a common feature in many schools where the child-toilet ratios is on average 1:100. In one school in Kenya, 190 girls shared only 2 available toilets, indicating a child-toilet ratio of 1:95. This ratio falls far short of the Government of Kenya recommendation of the ratio 1:15. Another common feature is insensitivity and lack of privacy for pubescent schoolgirls who have to share toilets with younger girls. Sometimes the girls’ toilets are uncomfortably close to those of the boys (Muchemi, 2007; Otieno, 2004). As is the case in many schools within the region, toilets in many of the schools observed in Kenya and Malawi lacked doors while others had gaping holes. Notably also, latrines for girls and boys in many schools were designed in a back-to- back fashion, making them semi-separate but close together. Cases of latrines that lacked proper means of locking from inside were commonplace in schools in poor communities. These kinds of conditions were cited as a major reason that kept girls at home and away from school during their menses, as they needed to change sanitary wear. The
6 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi implication is that in essence, when girls missed school they fell behind their male peers in learning. Observations show that missing school and lagging behind in school-related activities caused considerable anxiety and embarrassment to girls. This in turn affected their performance, which tended to push them out of school at a higher rate compared with boys. In addition, when menstruating, the girls also skipped school to avoid the embarrassment of having to share latrines with younger girls or boys at a time when they needed enhanced privacy in tune with a perceived feminine dignity.
In Kenya, for example, the coupling of sanitary facilities in schools, particularly functional toilets (with doors, roofs and a proximity to water source) with availability of sanitary pads, has been strongly linked to not only girl’s improved attendance to school but also, their improved participation in learning activities as well as their consequent enhanced performance relative to boys (Muchemi, 2007). According to teachers, poor conditions of the toilets and lack of privacy and hygiene facilities resulted in girls’ absenteeism from school. And even when in attendance, girls reportedly withdrew from school related activities –both within and outside the class. A UNICEF report (2004) confirms that on average, 1 in 10 schoolgirls did not attend school during menstruation. This translates to a considerable 10 percent of the schoolgirls who missed school several days in a month. It is estimated that girls living in sub-Saharan Africa could miss, on average, up to four days of school each month because they lack the basic necessity of sanitary protection as well as other resources needed to manage their periods. This in effect means that such girls could miss 10 to 20 percent of school days each month and consequently, each year (Hero, 2008; Protecting Futures2, 2008). During one of the informal discussions, the National Director of FAWE Kenya (Faith Macharia) observed that menstruating girls would stay home rather than be embarrassed, and cumulatively, they could lose a whole month of schooling each year. This trend undoubtedly mitigates against gender equity and equality that formal education is mandated to deliver. Consequently, achieving the gender targets
2 Protecting Futures is a comprehensive care program which aims at bringing puberty education to schools in southern Africa among other health related activities
7 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi articulated in United Nations Millennium Development Goals (MDGs) is problematised in the affected countries and their communities.
Poverty, feminine hygiene and schooling The above-mentioned issues notwithstanding, poverty has tended to compound the problems that girls in sub-Saharan African encounter at the onset of puberty. In Malawi, Zimbabwe, Ghana and Guinea for instance, studies have shown that during menstruation, girls who could not afford underwear on which to rest their sanitary protection materials tended to remain at home during their menstrual period (Camfed, 1994:7). Further, even those girls who had underwear but lacked the sanitary protection materials, such as pads and other improvisations, also kept away from school. This resulted in their lagging behind in learning, which consequently undermined their confidence in class making them less engaged and ultimately contributing to poor performance and early dropping out of the school system.
According to FAWE Kenya (2003), a family’s poverty level often determined which menstrual protective materials the girls used during menstruation. These ranged from the more conventional and sophisticated popular ‘Always’ pads to some old clothes or rugs –and even to nothing at all. Girls who were fortunate to access cloth, reportedly did not have enough of it, thus resulting in sharing of the menstrual cloth with other girls. Where water was scarce, the cloth would not be cleaned properly, thus, increasing the risk of genital infections. Further, even when the cloth was cleaned, it was not dried adequately in the sun because the girls wished to be discreet in managing their menses, and hence kept their menstrual cloth hidden and drying in the privacy of the house or even under the bed or mattress. Again, drying menstrual cloth in damp dark places increased the risk of genital infections from bacteria and fungi. This was bound to eventually create foul smell that would discourage girls from attending school even after the menstrual period was over. Because such infections are related to sexual organs, the girls are likely to keep the concerns to themselves thus increasing their physical and psychological problems that would keep them away from school.
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Notably, most families in SSA region live below the internationally defined poverty line of one USA Dollar per day. Logically then, most of the girls in the region belong to the poor families who may not afford to provide their pubescent daughters with intimate needs such as hygienic sanitary pads, cleaning materials, adequate underwear, among other things. Hence, it is not surprising that generally, schoolgirls in this region rank poorly in academic performance compared to their male peers in their respective schools and communities. Rights-based puberty and feminine hygiene education
Received the relevant education with regard to puberty and menstruation issues is a basic right to girls who need it. It is therefore an anomaly in the education sector that there exists an apparent lack of sensitivity with regard to the subject of menstruation, in particular. Notably, there taboos, myths and stereotypes associated to the menstrual period, which only a well-designed education system may help to address. Many of the related issues have resulted in girls and women in many of the African communities and educational institutions suffering physically and psychologically for lack of the much- needed puberty and feminine education as well as other necessary support during the onset of puberty and the eventual experience of the menses. This kind of situation has tended to hinder girls from living normal living normal lives that are free from the complexities that menstruation presents during this phase of their schooling. Absence of relevant and responsive education means that in essence, girls are denied their rights to relevant knowledge, skills and positive attitudes that would enable them to manage their menses appropriately and confidently as they observe personal hygiene in cost effective ways. It also means that by denying the girls this kind of education, the state governments as well as families and communities have failed in empowering girls to develop self-esteem, confidence and positive image of themselves as equal citizens and human beings who happen to be female and where menstruation is a natural phenomenon.
In order to address the pertinent issues regarding feminine hygiene and puberty education, UNICEF ESARO selected Kenya and Malawi to serve as case study countries for this project. Notably, Kenya and Malawi are home to pubescent schoolgirls
9 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi who, like their counterparts from poor families in other SSA and other developing countries, need to be empowered to deal with puberty and feminine challenges as well as cope with challenges of schooling.
To explore the impact of puberty and feminine hygiene issues as these affect girls’ education UNICEF ESARO, with financial support from Proctor and Gamble (P & G) facilitated the implementation of the study project using a three-part survey in selected sites in Malawi as well as in Kenya. The study was designed to interrogate issues of puberty and feminine hygiene that have continued to hamper girls’ education –both qualitatively and quantitatively. The research-based evidence generated from the two countries in the region –one in the Eastern Africa and the other in the Southern Africa- shall help in informing policy and practice regarding the dynamics of puberty and the interface of menstruation, and the role of feminine hygiene during the schooling process for girls. The evidence also provides the basis of the recommendations on how formal education could serve effectively in empowering girls to respond appropriately to the challenges presented by puberty and the accompanying feminine concerns. This is key to empowering the girls to participate fully in schooling and consequently benefiting from the schooling project on equal measure with boys despite their menstrual periods.
Statement of the problem
Unlike the education of the boy child in SSA countries, the relatively poor status of girls’ education has been attributed to various challenges that hinge on gender disparities in the ways that schools, families and communities engage with issues related to the well- being of the girl child. The lack of gender sensitivity and responsiveness in educational programmes has been linked to the poor outcomes of girls’ education, in terms of access, retention, performance and transitions to higher levels and to the world of work. This study focuses on girls’ education with regard to intimate issues of puberty and menstruation as well as feminine hygiene. These issues have been identified as having major impacts on the educational career of girls with regard to access (enrolment) and quality (participation) and performance vis-à-vis boys. The fact that education for most
10 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi girls retrogresses at the onset of puberty and takes a notable nosedive during the monthly period warranted this kind of research. While many studies have used gender as the analytic framework in addressing the poor status of education in the SSA countries, this study focuses only on the experience of girls –not boys- thus, taking on a phenomenological approach that addressed the girls’ reported experiences that affected their school lives. This focus was based on the realisation that it is the girls that were experiencing menstruation firsthand, firstly as learners in their schools who needed to keep up with their male peers and secondly as dependants on their parents, teachers, and friends for their feminine needs. In this context, the study undertook to investigate the level of knowledge of puberty, menstruation and feminine hygiene as before and after a multifaceted intervention that entailed education sessions as well as provision of feminine hygiene ‘Always’ pads. It is hoped that the findings of this study shall help to provide a responsive route-map towards improved educational programming that recognises the impact of puberty and menstruation in the schooling careers of girls.
Research objectives i) Establish the level of knowledge, skills and attitudes of the girls on issues of puberty and feminine hygiene. ii) Establish the impact of puberty, menstruation and feminine hygiene on school performance, absenteeism and participation amongst the girls. iii) Establish the role of parents, teachers and school management committees in supporting the girls through sexual maturation issues. iv) Determine if differences exist in attitudes and changes between the girls. v) Determine if the intervention of puberty education and the provision of the ‘Always’ sanitary pads could reduce absenteeism and close the gender gap by raising participation and performance amongst the girls. Research Questions i) Is there a significant difference between the Test and Control Group of girls in the way they rated their knowledge on puberty and menstruation before and after project intervention? ii) What is the reported impact of menstruation on the Test and Control groups of
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girls before and after project intervention? iii) What is the perceived impact of the education on puberty and feminine hygiene among the girls in the Test Group? iv) How has the combination of puberty education and supply of sanitary pads impacted on school attendance, participation and performance of the girls in Test and Control Groups of girls? v) Is there any significance difference in school attendance between the girls in Test and control groups?
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CHAPTER TWO
LITERATURE REVIEW
Taboos are perpetuated through folk tales that surround a young woman's period and traverse across cultural, racial, ethnic and historical boundaries.
Introduction
This chapter explores available literature and locates the study problem and project in the context of ideology, myths and taboos surrounding the event of menstruation and the menstruating woman/girl from socio-historical and cultural perspectives. The chapter foregrounds the mystification of the female body during menstruation and the construction of menstrual blood as a manifestation of impurity that warrants the exclusion of menstruating women from public life sanctions put in place to control her sexuality during that period. Hygiene issues surrounding menstruation yield insights into the genesis of menstrual products, the enhancement of privacy in their use and their disposal. The literature also captures the nature of consumerism that accompanies use of feminine hygiene products particularly the pad and the impact that this has on the construction of the feminine image. While the literature review reveals efforts made in researching and theorising issues around feminine hygiene, there is strong indication that the issue is under- researched and possibly under-documented within many of the countries in the study regions of Eastern and Southern Africa (ESAR), and in particular, Malawi which was one of the two study countries.
Ideology, the female body and feminine hygiene
Studies have continued to show that the constructed messages around menstruation hinge on the dominant culture, namely the underlying ideology. Hall (1986) defines ideology as:
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The mental frameworks - the languages, concepts, categories, imagery of thought, and the systems of representation - which different classes and social groups deploy in order to make sense of, define, figure out, and render intelligible the way society works (P. 28).
According to Becker (1984: 69), ‘ideology governs the way we perceive our world and ourselves; it controls what we see as natural or obvious.' Claims about what is natural (and thereby inevitable) serve ideology well because they are seen as the outcome of nature rather than culture. Ideology, then, has to do with the tools of a social system (language, imagery, institutions) that influence thought and serves to situate and stabilize beliefs among the masses, hence reinforcing and reinforces their subordinate place in the social system.
The constructionist theory acknowledges the role of Ideology in constructing and perpetuating myths around menstruation as well as supporting the consumerism embedded in the need to salvage the feminine image during the period of menses. Arguably, constructionism underscores the fact that events (such as the menstrual period) and objects (such as the menstrual materials) used in life do not, inherently, have meaning. Rather, through social agreement, meaning is created/constructed for them. In modern society, the medium for signification is language. Hence, it is what is said and interpreted through language –and practiced in society- that is gradually organized into symbolic products and meanings made. Hall (1982: 64) argues that the media are among the principle agents for making meaning, and that, making meaning with regard feminine hygiene is no exception. Hence, in this context, what the menstruation product stands for becomes more important than what the product is in essence. As the dominant view of menstruation equates it with being unclean, menarche is then constructed as a ‘hygienic, rather than a maturational, crisis’ for the girls and women (Whisnant & Zegans, 1975:809). Because of the positioning of menstruation as something to be kept secret and hence, reinforcing the view that at least, for part of every month, women and girls should be kept from public view, the menstrual protective materials serve as a practical strategy to facilitate the menstruating girl or woman to perform her duties without providing undue reasons for her exclusion .
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According to Frith (1995:185) therefore, menstrual related advertisement is ‘both a marketing tool and a cultural artefact’.
In order to perpetuate this particular feminine ideology –as is the case with other cultural ideologies- myths and taboos play a key role in shaping an idealised feminine image that is often not questioned.
Menstruation myths and taboos: role of tradition, culture and religion
Many communities world over have gone through centuries of myths and taboos that have created an ideology of the female body which has continued to organise the lives of women and girls in modern society. Religious teachings, cultural beliefs and traditional practices, have all played their role in the ideology of stigmatising the menstruating woman. For Western societies, the popular reference to menstruation as ‘the curse’ began with the biblical telling of it being inflicted on Eve because of her sin in tempting her husband to eat a supposedly forbidden fruit. The words of Leviticus (15:19- 33) in the Christian Bible speak directly to influence the fear of women's blood as the root of evil (Hoffman, 1995).
Notably, societies have held beliefs about separating, classifying, and organizing to create social structures designed to withstand natural disasters, punish transgressions, and demarcate differences. In order to optimise the effects of orderliness and attained social control, sometimes it becomes necessary to exaggerate differences between groups of people that are based on fear and taboos. Gender and biology combine to provide the basis for essentialised/naturalised differentiation that romanticises the taboos. Often taboos are expressions of prohibitions and restrictions that are manifested in the:
Forbidden and excluded persons, acts, words, thoughts, and things that supposedly threaten a group's welfare and survival and are, therefore, used to that group's advantage’ (Voigt, 1984, p. 97).
Taboos are perpetuated through folk tales that surround a young woman's period and traverse cross cultural, racial, ethnic and historical boundaries. Hence, the
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‘curse’ is therefore a taboo that presents menstruating women as ‘filthy, sick, unbalanced, and ritually impure’ (Daly, 1978/1990, p. 248), thus, excluding them from the supposedly ‘clean’ members of society.
The mythical belief that menstrual blood is dirty and toxic can be traced to the writings of the early Greeks and Romans (Allen & Fortino, 1983; Delaney et al., 1988; Knight, 1991) as well as to many other cultures where such women were excluded. For example, in Persia, menstruating girls or women were thought to be possessed by a demon. In the Roman natural history books, myths abound about the potential of menstruating women turning wine sour, causing seeds to be sterile, withering grafts, causing garden plants to become parched and fruit to fall from a tree if she as much as sat under the plants (Mahoney, 1988). The woman was believed to be capable of destroying entire crops and wilting plants if she walked by them. Aspects of this are echoed in Hindu socio-cultural practices whereby woman abstained from worship and cooking and stayed away from her family, as her touch was considered impure during this period. In Jewish tradition, a woman was ritually impure during menstruation and anyone or anything she touched was considered impure as well. Over time, some Jewish communities considered other contaminant such as the menstruating woman’s breath, spittle, as well as her footprints, voice and nail clippings. According to Merskin (1999), Western Europe reveals a similar history of taboos and beliefs against menstruating women. In Pre-modern Europe, for example, a woman in her menses was seen as capable of causing ‘meat to go bad, wine to turn sour, and bread dough to fall’ (Thuren, 1994: 217-228). Mothers, aunts, storytellers, and community leaders passed down these myths unquestioningly from one generation to the next.
In traditional Islam, a menstruating woman was considered vulnerable and polluted; therefore she could not pray, fast, or have sexual intercourse. Menstrual blood was najis (polluted), haram (very dirty), just as is the case with all forms of blood, excrement, and reproductive fluids. In some Islamic traditions the jinn (evil spirit) were believed to be strongly attracted to menstrual blood. For these believers, anyone who sees or touches menstrual blood is ritually impure and vulnerable to malevolent spirits, and dire consequences bound to occur. To restore her socially acceptable state, the woman was required to use running water and do a thorough scrub of herself at the end of her
16 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi menstrual cycle or other reproductive blood flow. This physical purification allowed her to resume prayer, fasting and intercourse, and dispel the malevolent jinn. When she bathed, she also applied henna to her hands, feet and hair. Henna stained her skin and darkened hair making it visible for several weeks to show that she had a purified body, worthy in the eyes of God and her husband. The henna was also believed to serve as a repellent to malicious jinn.
A critique of the Quran suggests that Islam did not create these concepts or perceptions around reproductive blood; but rather Islam had adapted pre-existing Semitic traditions that had eventually created menstrual taboos based on ideas of pollution and vulnerability versus purity and strength.
Historically, menstruation has, and continues to be used as justification for preventing girls and women from fully participating in public life, justifying control over their activities in the public arena in general and over their sexuality in particular. The view that monthly bleeding is a biological defect or a divine curse renders itself appropriately to a social system in which men control women's behaviour in a patriarchal regime that often ‘subject women's bodies to more control than men's’ (Shilling, 1993: 38). According to Martin (1987/1989), this forces women to spend resources of money and time in managing and concealing menstruation and all other related aspects such as pregnancy, and menopause. Merskin (1999) observes that it is this context that has provided raw material for advertisements for feminine hygiene products that bear ideological undertones of targeting the pre-adolescent and adolescent girls for a future of consumerism that would hopefully provide escape route from the traditional negativity surrounding menstruation. Mesrskkin’s observations reflect what seems to be the case with the existing and potential market for feminine hygiene products among African communities where this dimension of research is apparently lacking.
Puberty education and the ideology of feminine hygiene
The role of education in addressing issues of puberty and not in the least the accompanying feminine concerns cannot be overemphasised. Arguably, because menstruation is a biological inevitability in human nature, preparing women and girls on
17 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi how to respond to menstruation issues without demeaning their dignity as menstruating beings is an educational imperative (Frederick undated). Over decades, women, including those in African settings and elsewhere, have been taught that having periods is shameful. Many of them have indirectly, if not directly, absorbed the messages that menstrual blood is dirty, unhygienic and unclean. Such messages have been perpetuated through advertisements for menstrual products or ‘feminine hygiene’ products in the mass media, which underscore the need for freshness. Even the term ‘feminine hygiene’ implies that help is needed with regard to cleanliness during the menses. With all these negative messages that target the event of menstruation, it is not surprising for women and girls to want to hide their menstrual blood and secretly/discretely throw it away. To do otherwise would go against the grain of what they have been taught as the essence of clean womanhood according to the creed of their communities, religion, or families –either in written or oral form.
Introducing consumerism of menstrual products
Records from Ancient Egypt entail laundry lists that indicate the existence of cloth pads, belts and tampon-like items as evidence of consumerism related to feminine hygiene particularly with regard to the monthly period. In addition to pad-like materials, like the tampon-like materials had been in existence since the ancient Egyptian times. Reportedly, the Egyptians invented the first disposable tampons made from softened papyrus while the ancient Greeks invented tampons made from lint wrapped around a small piece of wood as recorded in writings of the Greek physician, Hippocrates in the fifth century B.C. Interestingly the letters ‘O.B.’ in modern-day OB Tampons means ohne binde or ‘without a pad.’ Other materials used to make the first tampons included: wool, paper, vegetable fibres, sponges, grass, and later cotton. Elsewhere, women improvised from the materials at hand. In Rome, it was wool; in Japan, paper; in Indonesia, vegetable fibbers while in Equatorial Africa, rolls of grass came in handy (Sarah Kowalski, 1999). In World War 1, nurses used large cotton pads that were designed to absorb blood from wounds of soldiers and would keep changing these as and when the need arose.
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As recent as the 18th and 19th centuries, washing or changing underclothing during the period was considered unhealthy in many countries of Europe. Women feared blocking the flow or causing excessive bleeding. In the late 1900s Germany, doctors began proposing menstrual devices for women to wear so as to improve their health even when in the menses. According to Kowalski (1999) American patents for menstrual devices were evident around mid 19th century featuring belt with steel springs to hold a pad. Pieces of cloth, called ‘granny rags’, made from old bed-sheets, pillowcases or other surplus material were folded and pinned onto the underwear to serve the average German woman for many years before the advent of commercially made disposable pads. Rags were washed after each use, hung out to dry, and used over and over. When odour became noticeable, the rugs would be boiled for 5-10 minutes and were then ready to be re-used. Generally, disposal of menstrual cloth and other related material was done through incineration that dates back to the 1800s. In Germany, for example, women travellers either took their cloth pads home to wash or burned them in the fireplace. In the 1890's England, women had special portable burners specifically designed to burn menstrual pads.
From traditions to modernity and commercialisation of menstrual products
According to Inga Muscio (1998), women have been using alternatives such as the ‘sea sponges’ as menstrual products for several decades before the development of conventional types. Yet, knowledge about such natural materials is still largely lacking perhaps because of the intense commercialised menstrual products that portray an image of modernisation. Natural material is considered to be safer and cheaper alternatives for women. However, where there are no seas, other alternatives such as absorbent leaves have been used traditionally. Apparently, the concept of modernisation, which is also linked to western schooling, seems to mitigate against the return to traditional management of the menses. Perhaps this is part of the reason why there is a dearth of research and literature in this area, particularly in the Sub-Sahara African contexts.
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With regard to choices that girls make, some studies show that for most of the girls, mothers play a considerable role in influencing the initial use of menstrual protection materials (Thornburg, 1975; Kofi & Rierdan, 1995; Brumberg, 1997). This implies the possibility of a cross-generational interface between traditional and modern means of managing the period as noted not only in African settings but also elsewhere in the world including countries such as USA, Italy, UK, Spain and Bangladesh (Thuren, 1994; Fox, 1980; Gainotti, 1986; Konopka, 1985; Haq, 1984). Friends and school peers also have a considerable impact on the choices that girls make on sanitary protection, which may have compounded the conflict with traditional menstrual practices. Despite these understandings, there are suggestions that much of the fear associated with menses among young girls comes from lack of input from parents who are silent until the girl experiences her first period (Thornburg, 1975; 1985; Stoltzman, 1986; Gainotti, 1986; Kofi & Rierdan, 1995; Brumberg, 1997;). In this context, school and family emerge as important sites for the empowerment of pubescent girls in the management of their period regardless of whether the girls prefer modern or traditional protective materials and strategies.
Cultivating the modern feminine image around the menses
Over the past century the focus on menarche has gone from reproduction and traditional management to appearances of the feminine image and a re-defining of the identity of menstruating women and girls. This practical shift has enhanced consumerism and commercialisation of feminine hygiene products to levels that have sidelined girls from poor families and women of meagre means. In this scenario, it is the mothers and their daughters who find themselves stranded with the natural event of the menses because, according to Brumberg (1997):
Modern mothers typically stress the importance of outside appearances for their daughters: keeping clean, avoiding soiled clothes and purchasing the right 'equipment.' Hygiene, not sexuality, is the focus of most maternal discussions with girls (p. 30).
Brumberg’s observation positions mothers and mother figures at the centre of the girls’ responses to menstruation during which time their engagement with personal hygiene
20 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi and physical presentation are on the spotlight. In this context, analysis of modern advertisements for feminine hygiene products shows that, in part, some of the centuries-old myths and taboos associated with women's bodies based on ideologies of feminine hygiene and image have been used to enhance a consumerism that play into the hands of female anxieties around menstruation (Hall, 1973, 1982, 1986, 1989). According to Condit (1994), the presentation of menstruation as something to be feared as well as a hygienic crisis only helped to elicit guilt and diminished self-esteem that needed to be salvaged (See Lovering, 1995).
Effects of menstruation on girls’ education
In view of the aforementioned issues, it is noteworthy that, a study in Tehran, testing the level of knowledge of menstruation and menstrual hygiene among girls between 15-18 years found that even though 76% of the girls had adequate knowledge about dysmenorrhoea, only 32% practised menstrual hygiene such as taking a bath and using hygienic material like sterile pads (Bharadwaj and Patkar, 2004). Out of the girls’ sample, 15% stated that dysmenorrhoea had interfered with their daily life activities and caused them to be absent from school from between 1 to 7 days a month which amounts to a range of between 2% to 25% of lost school time each month.
A study that aimed at informing on rural hygiene in the context of environmental sanitation and drinking water project and which covered the plain land districts as well as the Chittagong Hill Tracts of Bangladesh revealed that, issues of feminine hygiene and menstruation elicited embarrassment among women and girls. The women needed to find secluded places in the riverbanks or lakeshores to wash the soiled cloth or rags and even to dry them (Bharadwaj and Patkar, 2004). Since, drying the menstrual cloth in the open sun would attract attention, reports that the women resulted to the use of damp cloth or rugs, which caused odour and infections was common. For women and girls to shed this kind of inhibition regarding their menses requires education on puberty and feminine hygiene that would elicit a sense of confidence about menstruation.
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In Kenya, the phenomenon of high toilet ratios that exceed the government recommendation have reportedly discouraged the girls who were on their menses from attending schools mainly because accessing the toilet was inconvenient for their needs (see Muchemi, 2007; Njoroge, 2004; Akoth, 2004; and Odhiambo, 2004) clearly reveal how the poorly state of sanitation in Kenyan that have made the toilet, in particular, to emerge as one of the most neglected facilities in the school infrastructure. Muchemi (2007) underscores the advantage that the boys had over their female counterparts in terms of responding to their toilet needs. In many instances, Muchemi’s findings confirmed the observations of other studies such as Mbatia (2003) whose survey of education access by girls in Arid and Semi-Arid (ASAL) regions of Kenya. Mbatia found out that sanitation was one of the major setbacks for girl-children that was manifested in may of them having to drop out of the formal education system due to lack pf basic facilities in schools such as toilets and sanitary facilities –this was in spite of the introduction of free primary education (FPE). Reportedly, in the ASAL the number of girls enrolled in upper primary progressively decreases towards upper classes and almost nil for the candidate class (Mbatia, 2003:53). The situation was not different in other districts as reported by Akoth (2004) and Odhiambo (2004) in their separate studies of districts in Western Kenya. In Kisumu, according to Akoth (2004), all head teachers reported lack of enough toilets and sanitation. The few latrines available were in desolate condition with no roofs, doors and the temporary walls had gaping holes.
Njoroge (2005) reports that 66.7% of teachers in Kiambu schools were of the view that provision of sanitary towels and construction of toilets could help retain more girls in schools. Further, the head teachers lamented that even though the government has provided teaching and learning materials, the schools still lacked essential facilities such as toilets, water and adequate sanitation. In the same timber, Kirimi’s (2005) school assessment survey on the provision of sanitary facilities under the FPE programme in Kenya showed that:
The expansion of physical infrastructure has been too slow to cope with the influx (of pupils). School sanitation and hygiene have received least attention in the allocations of free education monetary grants and other resources (Kirimi, 2005).
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Teachers in these schools attributed the periodic absenteeism of girls for several days each month to the inadequate toilets and lack of personal hygiene facilities. This situation inevitably contributed to the general poor female performance, class repetition and eventual female drop out at a relatively higher rate than that of the boys. Muchemi’s (2007) findings confirm earlier findings by Pichi (2005) whose study among girls in public primary schools in Nyatike division of Migori district in Kenya observed that the insecure and unfriendly school environment and lack of essential sanitary facilities made many girls to drop out of school at a higher rate that that of the boys
In an assessment report on sexual maturation in Kenyan, Ghana, Uganda, Zimbabwe, FAWE (2003) found out that menstrual materials used by girls during menstruation depended on the family’s socio-economic status that allowed girls to acquire absorbencies ranging from the ‘Always’ pad, old clothes to nothing at all. The absorptive capacity of the product determined how secure the girl felt and the level for mental concentration in class work. Reportedly, the girls who used ‘Always’ pads only worried about the period pains and crumps while those who used rags or cloth constantly worried about potential ‘accident’ of soiling their clothes. Hence, because of the physical and mental discomfort that accompanied the menstrual period, girls were essentially distracted from learning. It is therefore not unrealistic to imagine that many of the girls might have remained physically in class but would be mentally absent as they ‘listened’ to the pain or for an accident of soiling their clothes. To avoid these physical and mental discomforts, many of the girls reportedly opted to stay away from school during the duration of the menses, a practice to which teachers ignored because that was the only reasonably response they knew.
Water and sanitation in schools: addressing feminine hygiene
According to UNICEF (2008) the child-friendly schools, which provided privacy and hygiene facilities for girls through separate toilets for boys and girls as well as water and wash areas, tended to attract and retain students at a comparatively higher rate, especially the girls. This is because separate toilets not only provide privacy but also
23 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi encouraged girls who were menstruating to attend and remain in school where they could to attend to their feminine hygiene needs and manage their period discreetly. The provision of such facilities contributed greatly in addressing the constraints of the estimated one in four girls who did not complete primary school (compared with one in seven boys) by ensuring that the girls actually stayed on and completed schooling alongside the boys. In addition, this strategy also contributed in addressed the MDGs target on provision of drinking water and adequate sanitation which, when coupled with provision of feminine hygiene facilities was bound to greatly accelerate the attainment of MDG targets on universal primary education (UPE) and gender parity3. UNICEF has demonstrated, through its child friendly school initiative (CFSI), that girls’ attendance at school could be increased through improved sanitation. Unfortunately, surveys of school sanitation tend to ignore the pertinent issue of menstruation and feminine hygiene and its relevance to female education, particularly participation and performance in schoolwork.
The link between feminine hygiene, schooling, water and sanitation may be addressed holistically only when some of the stereotypes and myths against menstrual issues by sector specialists who are mostly men, are also addressed in a cross-sectoral manner.
The politics of costs in management of menses and free primary education
The issue of feminine hygiene has continued to undermine the efforts to provide quality free primary education in African settings. Because of this fact, the Government of Kenya through the MoE and in tune with the Sessional Paper Number 1 of 2005 provides Kenya Shillings 50,000 per school for water and sanitation improvement4. In support of UPE in Kenya, the Ministry of Health and that of water have developed an environment and hygiene policy as well as a school health program to address health issues in schools, including reproductive health. In the efforts to reduce the number of
3 The sidelining of appropriate and adequate sanitation facilities as well as absence of feminine hygiene provisions contributed to the various reasons why 60% of the 113 million children currently not enrolled are girls. 4 MoE in Kenya committed to institute affirmative action in support of the girl child; by providing funds to help meet water and sanitation needs in school; and mobilizing resources from development partners in support of FPE as part of the sector wide approach to education programming.
24 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi people without access to safe water, the Ministry of Water also has supported the water and sanitation issue to complement the activities of MoE in ensuring that Kenya’s children attend and complete school irrespective of their gender as outlined in the United Nations MDGs.
The awakening towards issues of feminine hygiene and the relevance that these bear on the MDGs has become a worldwide movement that is currently taking root in Africa. Frederick (undated) refers to a popularly growing ‘menstrual movement’ that focuses on four particular areas. Firstly, is the need to take the shame out of menstruation, whereby, women are encouraged to open up the lines of communication in order to educate each other (and the men) regarding management of the period for purposes of developing self-confidence and esteem. Secondly, is the issue of women's reproductive health that is linked to materials used to ensure feminine hygiene during the menses. Thirdly, is the link to the environment, which involves matters of disposal of women’s menstrual protective materials, and finally, is the focus on women's economic concerns that has direct link to the cost of managing the period throughout the menstruating life cycle. According to Frederick (undated), these issues are not the concern of girls and women alone but need to be addressed in the context of a nation’s development agenda.
In Canada, the Blood Sisters Project from the Simone De Beaver Institute at Concordia University in Montreal, Quebec, claim to have launched ‘an exciting launching pad girl base’ that motivates action to combat the silence surrounding the female bodies and the impacts of menstruation (Frederick, undated). This project comprises girl-directed activities aimed at popularising a web girl network, giving health workshops, organizing art exhibitions as well as distributing and advising on affordable alternative products to manage the period. The Canadian girls aim at:
Reconstructing politics of the female body and eliminating the shame surrounding menstruation
Disseminating information to women about the dangers to female health and the link to environment
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Offering alternatives to commercial tampons and pads
Offering pro-active steps for individuals to take in order to change the way the menstrual industry is commercialised
Considering the panic that is often experienced among users of factory developed feminine hygiene products in the developing worlds and Africa in particular, the Canadian girl’s project becomes relevant in any study that seeks to offer recommendations on cost-effective and culturally acceptable menstrual protective materials for the African girl/woman. Industries in the developed world have been accused of exploiting women’s menstruation by providing protective materials that contain viscose rayon; a product that has been proved to enhance the production of toxic shock syndrome (TSS) more than cotton (Armstrong & Scott, 1992). It has been noted that, unlike cotton, rayon has a tendency to shred, which means that when the tampon is removed, fibres may be left behind in the vagina. These fibres are known to be breeding grounds for the TSS-causing bacteria, as well as increasing a woman's exposure to dioxins. Other health agencies and doctors believe that the use of products such as tampons may be attributed to abdominal cramping, urinary tract infections and chronic and recurrent vaginitis (Armstrong & Scott, 1992). In SSA, expressions of apparent fears of the use of pads imported from Western countries are often captured from community and even official discussions5. Such fears are often based on preconceptions and myths regarding the pads having been laced with contraceptives or HIV with the aim of eventually wiping out the African population. These are pertinent issues that need addressing in a study of this nature that seeks to enhance schooling for girls by providing them with feminine hygiene products that would help improve school participation.
In this context, the feminine hygiene project in African countries, particularly among schoolgirls who are the foundation of ‘future generation’ should be handled with considerable care, sensitivity, honesty and transparency. In order to overcome women's oppression and exploitation in an area such as the menarche that is relatively private
5 This information has been captured in personal communication with community members, NGO representatives and government officials in Nigeria and Kenya.
26 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi and personal but which, nonetheless attracts public stigma, there is need to create social awareness around the menarche and its impact on girls’ education.
As noted in the late 1980s, in the United Kingdom, it took only six weeks for all the major British sanitary protection companies –with the exception of tampon manufacturer- to abandon a process in their production of sanitary protective materials that was accused of causing ailment to women. According to Liz Armstrong and Adrienne Scott (1992), this effect has been attributed to three primary factors. Firstly, the grassroots organizations in the campaign advocated for promotion of the use of alternative products and a change in dominant feminine hygiene corporations that used hazardous synthetic materials. Secondly, many of the women in the campaigns provided information on how to produce homemade re-usable rags and even where to buy alternative items. Thirdly, the women suggested and directed the use of other products that many women may have known little or nothing about. One of these products was the ‘keeper’, which is in the form of a rubber cup that fits inside the vagina and holds up to one fluid ounce of menstrual blood. While the risk of TSS still remains with the ‘keeper’, it is greatly reduced compared to the risk posed by tampons. The ‘keeper’ was also cost effective in terms of time and financial resources because as it could be worn for up to ten hours without being changed, and could last up to ten years before it needed to be replaced.
On the one hand, however, Frederick (undated) observes that the biggest problem that most women seemed to have with using re-usable products entailed overcoming their shame and disgust about getting into contact with their menstrual blood. Accordingly, many women do not wish to touch their blood, and even more so, when using public facilities. Disposable products allow women to be quick in the management of the period and also remain discreet and avoid embarrassment. Inga Muscio (1998: 47), in her book Cunt: A Declaration of Independence, on the other hand, believes that, ‘Spending time with your blood is a constructive action’. While acknowledging that it may take some time to reach the level of comfort whereby most women would encounter their periods without a sense of panic or embarrassment, Inga Muscio (1998) offers another alternative. For those women who find it impossible to use anything but
27 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi disposable products when in public, they could opt for alternative products when at home, thus cutting consumption of disposable products by considerable proportions.
Summary From the literature review, it is evident that the issue of puberty and the related feminine hygiene has occupied the generations of women world over. Consequently, feminine hygiene facilities and menstrual protective materials have also influenced the private consumer dynamics for several centuries. Notably, until recently, these concerns had not been domesticated within the education sector planning and budgeting or adequately addressed within curriculum development. Many schools in African settings including those in Kenya and Malawi do not seem to consciously provide child friendly and girl-responsive sanitary facilities, resulting in many of the menstruating girls skipping school during their period or dropping out of the school system at puberty due to lack of hygiene-supporting and private sanitation facilities in their schools. Further, cursory studies have established that in sub-Saharan Africa, the few girls who persist in school after onset of menses tend to miss up to 20% of school time each month because of the difficulties they encounter in the management of their menstrual period. This undoubtedly contributes to the low participation of girls in school enrolments as well as performance and progression rates to upper classes compared with that of the boys. It is this concern that motivated the implementation of the Kenya-Malawi study on feminine hygiene with the aim of eliciting evidence-based knowledge of the girls’ realities as they engaged with puberty issues and challenges posed by menstruation and feminine hygiene needs, particularly during their schooling careers.
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CHAPTER THREE
RESEARCH DESIGN AND METHODOLOGY
Introduction
This chapter outlines the design of the study project and describes the procedures of generating data and analysing it in response to the research questions. The chapter also presents a general picture of the research locales, sites and sample. Sampling procedures are also presented herein.
Research design (Kenya and Malawi)– A three-tiered approach The research was designed to encompass sites located in the two countries, Kenya and Malawi in which samples of pubescent girls, their teachers and parents were identified for the study. The research was planned within a qualitative cum quantitative framework that accommodated complementary techniques of generating data.
Sampling in Kenya Two areas of Kenya were chosen for the survey. These include one of the Nairobi slum areas and Garissa rural settings. Nairobi is the capital city of Kenya and was included in the survey because parts of the city represent examples of severe social and economic deprivation. Garissa was chosen because of its location in the semi-arid areas of the country that are also categorised among rural regions that are economically poor. Apart from the region being one of the more economically disadvantaged in the country, enrolment in primary schools is also comparatively low, especially for girls. Moreover, some traditional/cultural practices are widely practiced, such as Female Genital Mutilation (FGM), commonly referred to as female circumcision, which tends to further compound the problem of girls’ education. In total, 1002 girls in 12 primary schools, with 9 schools in Garissa and 3 schools in Nairobi, were included in the survey. Of the 1002 girls, 877 had begun menstruation while the remaining 127 had not. Furthermore, 42 teachers and 22 members of the
29 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi school management committee that included parents of the participating schools were interviewed.
Sample of participating 12 schools and the respective girl samples in Kenya
District Primary school Number of % of total girls Garissa Young Muslim 156 15.6 Academy Kazugo 62 6.2 Tumaini 74 7.4 Umul-Kheir 82 8.2 Hyuga Girls 12 1.2 Yathrib 61 6.1 Boys Town 96 9.6 Sankuri 15 1.5 Nasiib 81 8.1
Kawangware 123 12.3 Nairobi (slum locations) Jamuhuri 111 11.1 Riruta HGM 129 12.9
Adult sample comprised parents, school management committee and teachers. Of these 22 were parents and members of the school management committee, 16 of whom were male while 6 were women. Of the 42 teachers surveyed, 32 teachers came from the 9 schools in Garissa and 10 teachers from the 3 schools in Nairobi. On average, each school had between 3 and 4 teachers interviewed. In the sample were 16 female teachers and 26 male teachers as follows:
Parents Total Teachers Total parents teachers Female Male Female Male 6 16 22 16 26 43
Clearly male parents and male teachers formed the majority of the adult sample in Garissa. This is possibly because, being a hardship area, fewer women teachers opted to work in Garissa unless they were there as spouses. Some of the men who worked there had left their families elsewhere. Furthermore, male teachers (more than the female colleagues) are often allocated upper primary classes, which were the target of
30 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi the study project. On average, each of the participating schools had between 3 and 4 teachers interviewed.
Sampling in Malawi
The Malawi sample comprised 65 girls all of whom were interviewed and their answers recorded on survey questionnaires and in note form. The girls’ sample is outlined below. Sample of participating 12 schools and the respective girl samples in Malawi MALAWI GIRL SAMPLE Primary SCHOOL Number of girls % of total Chagogo 34 52.3 Mnjolo 11 17.0 Mdzobwe 6 9.2 Nguluwe 14 21.5 TOTAL 65 100
Pubescent girls 42 64.6 Non-pubescent girls 23 35.4 TOTAL 65 100
Among the girls interviewed in Malawi, 17 of them came from Chagogo Full Primary School and had reached puberty and had experienced their first periods while 17 others from the same schools were yet to attain the age of puberty even though they were categorised as adolescents. All the eleven (11) girls from Mnjolo Full Primary had reached the age of puberty. There were 6 pubescent girls from Mdzobwe Full Primary School and 14 from Nguluwe Full Primary School all of whom had reached the age of puberty and had experienced menarche. In total, 64.6% of the girls interviewed in Malawi were in puberty. Information collected from non- pubescent girls was also useful in that it provided a general comparative guideline for average age of first period.
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IMPLEMENTING THE PROJECT
Data collection procedures and methods First Stage (baseline survey) The three-stage approach began with an initial survey that was followed by an intervention stage as the second-tier and a comparison stage as the third stage. This approach was crucial in facilitating a systematic procedure that helped to establish a strong ‘before and after intervention’ view of the girl participants’ attitudes towards school attendance, participation and performance.
The initial survey was carried out using questionnaires and focus group discussions with all the participating girls with the aim of establishing the level of their knowledge and understanding as well as their use of information related to puberty, sexual maturation, management of menstruation, coping with stress that was related to the menses as well as patterns of feminine hygiene practices. This stage also sought to gain an overall picture of the girls’ patterns of school attendance and class participation during their period days as well as their engagement in extra-curricula activities when on their period. Teachers, parents and members of the school management committees were also interviewed with the aim of determining the contextual responses and role of society in educating girls about sexual maturation and the management of menstrual periods.
Challenges in data collecting data for Stage One In Malawi, the enumerators helped the research subjects (girls and mothers) to complete the questionnaires, which had been designed in English. Generally, interviews with mothers were conducted in the local language, thus, requiring translations, back and forth between two languages. In Kenya, the main challenges involved the setting of interview times, especially with the parents and school management committees. This resulted in organising for the interviews to be conducted on Saturdays for these adult groups. For the teachers, the interviews were conducted in the later part of the evenings so as not to interfere with the school programmes. The timing for the FGDs
32 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi amongst the girls was simpler, especially in Nairobi where interviews were conducted during the lunch break, after the children had had their meals.
Second Stage (intervention) The second stage of the survey was the intervention stage. During this stage the initial study schools were divided into two so that one group of schools served as the Test Schools and the other as the Control Schools6.
The intervention stage was designed in response to the findings generated from the initial survey and aimed at intervening on the girls’ menstrual experiences by providing them with puberty education that is timely and sufficient supply of sanitary towels at designated, accepted, and girl-friendly delivery points. This intervention was two- pronged. The first step of the intervention was a seminar on puberty education and menstrual hygiene issues aimed at informing the Test Group of girls about the physical and emotional aspects of puberty. The second dimension of the intervention was to give the Test Group of girl sanitary towels to use during their periods and encouraging them to employ the knowledge they had gained regarding puberty, menstruation and feminine hygiene.
In order to provide on the ground support for the test group of girls, focal teachers from the participating schools had been identified and trained as Trainers of Trainers (ToT) on puberty education as well as on gender responsive pedagogy. The training aimed at building their capacity to educate the girls about sexual maturation and feminine hygiene issues during the puberty information session.
The intervention stage gained feedback from the participating Test Group of girls immediately after the puberty education session was concluded. The aim of the information gained following the intervention stage was to determine if the knowledge base of the Test Group girls had grown on the issues of puberty, menstruation and
6 These schools would take their positions in the second and third stages of the survey. For purposes of control, only girls who had taken part in the initial stage and had started menstruation participated in the second and third stages.
33 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi feminine hygiene. This stage also aimed to determine if there were changes in the attitudes of the Test Group girls towards menstruation and consequently on the attitudes of attendance and participation in school during their periods, based solely on the gain in knowledge from the puberty education sessions.
Kenya provides clear insights on the implementation of the second state of this project in which five schools participated. Out of these, three were from the Garissa initial survey and two were the initial Nairobi survey. Five Control Schools were then chosen with four coming from the initial survey in Garissa and one school from those that took part in the initial survey in Nairobi.
Since the interventions were based on the recommendations derived from the initial survey, there was a time lag between the two stages to allow the recommended interventions to be set up accordingly. In Kenya, this included identifying teachers from all the schools to be trained as Trainers of Trainers (ToTs) on puberty education, while in Malawi, medical nurses were trained for data collection. The training aimed at building the capacity of teachers and nurses to educate the girls about puberty, sexual maturation, including menstruation and feminine hygiene issues. The researchers then supplied each participating Test School with a sixteen-item questionnaire two months after the initial survey. The trained teachers and nurses were also responsible for giving the Test Group of girls a puberty education session on knowledge of puberty and menstruation as well as on hygienic practices during menstruation. They then administered the post-education questionnaires and assisted the girls to understand and interpret the questions as they responded accordingly. Following this activity, the girls entered the second intervention stage, whereby the Test Group that had taken part in the initial survey and subsequent puberty and feminine hygiene education were supplied with sanitary pad of the ‘Always’ brand for a period of three months. After the Test Group girls had experienced the use of ‘Always’ pad, they were required to respond to the second level of post intervention survey alongside the Control Group counterparts for comparison.
34 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Third Stage (comparison) The third stage of the survey entailed the comparison stage, which was conducted two months following the second intervention stage of using the ‘Always’ sanitary pads. This stage involved comparing the knowledge base of the Test Group girls who participated in the intervention with that of the Control Group girls. In particular, the knowledge base and attitudes of the girls towards menstruation, as well as the differences in school attendance, participation and performance, was compared between the two groups of girls. Furthermore, also compared were the changes that occurred amongst the Test Group girls at the initial survey and following the intervention. The Control group girls who participated during this comparison stage were taken from those girls who had participated in the initial stage. Likewise, in the case of the Test Group girls, only those girls that had participated in both the initial baseline survey and in the intervention stage of receiving puberty education and using sanitary pads took part in the comparison stage. It was important to use the same participants at all stages so as to fully capture the changes in attitudes, attendance and participation amongst the girls.
In the comparison stage, the girls from the Control Schools and Test Schools were subjected to the same survey interview and the results were compared to check any notably significant differences between the Test Group girls and the Control Group girls as far as knowledge of puberty matters, school attendance and changed perceptions, school participation and performance were concerned. Furthermore, changes that had occurred amongst the girls in the Test Group at the initial survey and the comparison stage were captured7.
Data analysis All the quantitative data from the three stages were cleaned, collated and validated before being processed using the SPSS 9.0 which is a statistical analysis software for Windows Operating System. Qualitative data from interviews and group discussions was organised thematically and used to complement the quantitative information. The
7 For both countries, the survey population for the Test Schools had dropped from the initial one at intervention stage because the girls were either sitting their national primary school class examination or were away from school preparing for the end of primary school examinations or preparing for their end of year examinations.
35 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi researchers further validated the data, interpreted its meanings and implications for the education of girls before sharing preliminary findings with UNICEF and P&G. This exercise was followed by the compilation of findings as presented in the next chapter within the context of this report.
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CHAPTER FOUR
STUDY FINDINGS AND DISCUSSIONS
Able to work at home well and able to play [CONVENIENCE]
Introduction The chapter entails a discussion of the finding regarding the impact of puberty and feminine hygiene education intervention combined with use of menstrual protective products of the ‘Always’ sanitary pad among pubescent schoolgirls from Kenya and Malawi. The findings presented and discussed are derived from comparisons of evidence regarding the girls’ pre- intervention/test and post-intervention experiences of negotiating schooling management of menstruation. The chapter also highlights the observations of teachers on the girls’ pre-test engagement with schooling and their engagement at the post-test period. These findings also take into account the girls’ out of school education on puberty and menstruation gained through peer learning and from parents/parent figures. Hence, this chapter focuses on:
- The perceived impact of puberty, menstruation and feminine hygiene on school performance, attendance/absenteeism and participation among girls
- The role played by parents, teachers and school management committees in supporting the girls through sexual maturation issues
- The link between attitudes towards, and knowledge about puberty and feminine hygiene vis-à-vis the changes in schooling experiences by groups of girls from different socio-cultural and economic backgrounds.
- The potential to improve school attendance, class participation and performance, reduce menstrual related absenteeism and enhance girls engagement with schooling in ways that help to narrow –and eradicate- the
37 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
gender gap in education through appropriate and practical interventions that are sensitive to girls’ maturation and menstrual issues. The following three sections, therefore, provide a framework for presentation and discussion of findings. 1. Girl’s knowledge about puberty and menstruation 2. Girls’ attitudes towards menstruation in relation to schooling activities 3. The girl’s level of school attendance, participation and performance.
KNOWLEDGE ON PUBERTY AND MENSTRUATION: AN OVERVIEW
Results from the initial survey show that many of the girls from Kenyan and Malawi lacked key sources of information on the subject of puberty, menstruation and related feminine hygiene. In some cases, girls in the FGDs said that their experiences of their first period was frightening as some of them thought they were suffering from a deadly illness. From confessions by the girls and the revelations from teachers and parents, it was clear that the culture of silence and mystery engulfed puberty issues of girls and more so, the experience of menstruating. Most of the girls claimed to have been left on their own to explore and learn how to deal with puberty issues and manage their menstruation. The community duty bearers (parents and teachers), reportedly, failed to provide pubescent girls the support they needed in order to embrace puberty without anxiety and to respond effectively to the physical and biological changes that accompanied this developmental stage.
Discussions with ‘Mother Group’ members revealed that it was mostly I can never tell the ‘mothers’ who talked to girls about puberty and menstruation and this my father about my periods did not happen until the girls reached 10 years of age. Apparently, the because some girls were afraid to involve the fathers in the issue of menstruation fathers take advantage of the because they perceived it to be intimately linked to their sexuality. situation and However, the majority of mothers reportedly talked to their daughters want to sleep (have sex) with when already in puberty and menstruating. The advice mothers gave to you . the girls ranged from cautionary statements such as ‘don’t mess with
38 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi boys’ (meaning do not have sex), to the more specific information about bodily changes and sexuality. The fathers were excluded in this kind of engagement because of shyness, fear of known or unknown consequences, or unexplained apprehensions. The exclusion of fathers from issues of their daughters’ menstruation seemed to be the dominant norm as articulated by the participating girls. The following are some of the explanations for such exclusions.
Kazugo: I feel very shy towards talking to my father BoysTown: I can tell my mother or my aunty but I feel shy to tell my father Hyuga: My mother can ask my father for money for sanitary towels for me Hyuga: I cannot tell my father I have started my periods because it may be that I will have to leave school [to get married?] Young Muslim: My father can know I have started my periods because I will ask for money for sanitary pads if he can afford Yathrib: It is not good for [males] to know that [you] have started [menstruation] Nasiib: I do not talk much to my father
According to members of the ‘Mother Group’ discussion, the girls would miss school during either their first period or during all periods. They attributed to this pattern of schooling to the lack of proper toilets and bathrooms that had basins and water for washing when need arose. The mothers also underscored the need to provide girls in school with feminine hygiene materials that included sanitary pads. This view resonated almost unanimously with that of the girls who qualified the need to have separate toilets that had lockable doors, basins, clean water and feminine hygiene supplies to enable them address effectively the feminine needs and cope with the concurrent demands of schooling during their menses.
On the one hand, teachers claimed to be too overwhelmed with a teaching workload to take on ‘other tasks’ such as those related to sexual maturation of the schoolgirls under their care and tutelage. In particular, male teachers claimed that they felt incapable or irrelevant to deal with girl’s feminine issues and believed that such issues were the responsibility of women. On the other hand, parents and mothers in particular, reportedly shunned this responsibility because they expected teachers to take it up. And like the male teachers, the fathers apparently left this task to the mothers. Instructively, while everybody seemed to ‘pass the buck’ to everyone else, the pubescent girl was left
39 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi to gather scanty and often-unreliable information on her own and basically guide herself along the path to womanhood that was fraught with not only psychological and emotional hitches but also physical, financial and educational challenges. However, as captured in the following excerpts, the teachers constructed education on puberty and menstruation to a female thing, which girls could learn from the science classes or girl- specific lectures.
Boys Town: Rarely discuss menstruation with pupils and is mainly tackled in science classes Umul-Kheir: The girls learn about puberty through the science subject, especially about the changes they go through, both emotional and physical Yathrib: It is tackled in the science subject, especially the changes involved in adolescence Hyuga: Discussed in the science class Sankuri: This being a school with only male teachers, it is not easy to approach the topic, but is mentioned in science class Nasiib: [Through] meeting with the girls once every week to discuss issues affecting them. Nasiib: Discussed in the science subject Young Muslim: Normally, the female teachers meet the girls every Friday. Kazugo: Initiative teaching for one week where girls and female teachers discuss issues affecting them in science lessons. Tumaini: Discussions are done during the science lessons
After the project introduced education on puberty and feminine hygiene issues and provided the girls with ‘Always’ sanitary pads, the girls reported an increased level of personal comfort, confidence and motivation to engage in the various activities expected of schoolchildren their age. The pre-intervention and post-intervention tests that were inbuilt in the project revealed the perception of Positive changes in school attendance and class participate were noted and school absenteeism was reportedly reduced drastically. Many of the teachers claimed that, their own training on puberty and feminine hygiene issues through this project helped to boost their confidence in responding to the challenges that confronted the girls. In addition, the teachers observed that puberty education for the girls had greatly encouraged them to become more engaged in class and school activities. The teachers also praised the combination of puberty education with the distributing of sanitary towels, which they said helped the girls to be in control of their lives while at school or outside.
40 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
The following sections entail presentations of cross-country and within-country comparison of findings in both Malawi and Kenya.
GROUP COMPARISONS OF KNOWLEDGE: PUBERTY AND MENSTRUATION
Sources of knowledge on puberty and menstruation When the girls were asked to indicate the people from whom they received information about puberty and menstruation, and one third of the Kenyan girls (33%) identified their mothers while 29% identified with their grandmothers. Hence, for nearly two thirds of the girls, close female family members were responsible for puberty and menstruation education. With regard to the person they felt most comfortable talking to about menstruation and puberty, 48% of the girls indicated their friends, peers, or girls who were mature enough (reached age of menarche). Grandmothers were the next most notable group with 21% of girls feeling comfortable talking with them. Notably, while mothers were indicated as the group that most frequently talked to girls about puberty and menstruation, it is instructive that only 12% of girls indicated that they felt most comfortable talking with their mothers. These finding demonstrate that with regard to puberty, most of the pubescent girls preferred talking with peers rather that adults, relatives other duty bearers such as teachers. This is crucial revelation that bears important lessons considering that this study engaged nurses and teachers to interview the girls on related issues. In Malawi, an independent observer noted that about one third of the girls said they received their first information on menstruation from their grandmothers as shown in figure 4.2.18 below. As in the Kenyan case, one in five of the Malawi girls named more than one confidante with family members appearing to the dominant source and teachers ranking second last with the nurses being ranked the lowest. Even with this kind of evidence, it is noteworthy that this project appointed nurses and teachers to conduct the education session, while nurses and teachers clearly rated the lowest on the girls responses as shown in figure 4.2.1 below9.
8 Table number inconsistent and not editable because the data base is missing (professional editor to do it) 9 Data bases linked to these charts are not available and hence, revision of chart labelling is not possible
41 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Despite the fact that nurses and teachers were the least preferred to educate the girls, most of the girls (nearly 60%) expressed their satisfaction of the education sessions, saying the sessions went either ‘extremely well’ or ‘very well’ as indicated in the Chart 20 below.
According to one third of the girls from Malawi, education on use of pads was most impressive perhaps because the pad was a new thing for many of them as captured in Chart 21. Some of the girls might have seen such pads for the first time during the project activities as observed among some of the girls from Garissa in Kenya.
42 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Findings from qualitative data in the Malawi study suggest that the puberty knowledge as well as the provision and use of the ‘Always’ pad, may have opened up capability horizons that the pubescent girls had not experienced since the onset of their menses. The girls explained that such knowledge and skills helped to ease the physical and mental discomfort they had suffered during their periods. In the group discussions, they appeared happy to provide examples of specific transformation in their lives generally and in particular during the periods, which were linked to physical comfort, convenience, enhanced confidence and general well-being even.
Notably before the project intervention, many of the girls from Malawi and the rural Garissa district of Kenya claimed that they had little or ‘I have never seen a no knowledge of the feminine hygiene pads, particularly the ‘Always’ sanitary product because they could not access any. Several of the girls towel and whenever I confessed that they had never seen a sanitary towel and looked hear schools forward to having the chance to see one, let alone having the are receiving them, am opportunity to use one. For many of the girls, access to the ‘Always’ always eager pad, coupled with the puberty and feminine hygiene education and wish to get a chance changed their lives from that of misery to one of expressed joy. Most to see them’ of the girls provided positive feedback about how the use of the pad had turned their lives around during the period of menses. Below are captions of some of the girls’ positive appraisals of their experiences revealing a range of improved
43 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi dimensions in their lives after the interventions with education and the feminine hygiene ‘Always’ pad.
Able to mix Able to mix Able to dispose I am always well with boys Able to Work at with friends [pads] well in a smart in class or at home well and [Confidence] pit latrine [Esteem] able to play home [Convenience] [Confidence] [Convenience]
Pads do not Pads do not Skin on my Doesn’t have to feel hot cause any Pads take thighs does not wash like cloth sores longer to get get irritated [menstrual] [Comfort] in the vaginal wet or soaked due to friction cloths. areas [Economy & and wetness [Comfort] [Health & convenience] [comfort & comfort] Health]
Puberty Issues
In Malawi, most of the Test Group girls (94.8%) agreed that their knowledge regarding puberty based on the puberty and feminine hygiene education had increased tremendously compared with the period before the education intervention. They said they eventually came to know more about changes in their bodies, the biological event of menstruation and how to deal with it. (See Table 4.1a below).
Table 4.1a: I know more about the changes in my body (Test Group - Malawi)
Agree Disagree Neither Agree Nor Disagree Total Count 239 8 5 252 (%) 94.8 3.2 2 100.0
44 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Knowledge of Puberty: Test Group and Control Group
In Kenya, findings showed significant differences in the ratings between the knowledge base of the girls in the Test Group who had undergone the puberty training vis-à-vis the girls in the Control Group who had not undertaken this education. This is captured in Table 4.1b, which shows that 53% of the girls in the Test Group reported that their knowledge of puberty was either excellent or very good compared to 45.3% of the girls who felt the same in the Control Group. The comparatively high proportion of girls in the control group who claimed to have increased knowledge lacks empirical interpretation in this study. However, there is possibility that some of the control group of girls may have learned from their test-group peers. This notwithstanding, it is notable that only 9.5% of the girls in the Test Group said that their knowledge of puberty was, fair or poor, compared with 44.7% of the Control Group girls.
4.1b: Rating Knowledge of Puberty –Test and Control Group Excellent Very Good Good Fair Poor Total Count 53 115 119 26 4 317 Test Group (%) 16.7 36.3 37.5 8.2 1.3 100.0 Control Count 69 88 35 118 37 347 Group (%) 19.9 25.4 10.1 34.0 10.7 100.0 Count 122 203 154 144 41 664 Total (%) 18.4 30.6 23.2 21.7 6.2 100.0 Source: ‘How Would You Rate Your Knowledge About Puberty’ of the Post-Puberty Education Questionnaire
The patterns noted above are replicated in the findings from rural Garissa where there was a significant difference in the proportion of Test Group girls (49.1%) who said that their knowledge of puberty was excellent or very good following education programme as compared to that of girls from the Control Group (26.9%). Conversely, 64.3% of the girls from Garissa who did not receive any intervention said that their knowledge of puberty was poor compared with a relatively small proportion of the Test Group girls at 8.7% (see Table 4.1c).
45 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Table 4.1c: Rating Knowledge of Puberty –Test and Control Group (Garissa) Excellent Very Good Good Fair Poor Total Count 26 59 73 13 2 173 Test Group Girls From Garissa (%) 15.0 34.1 42.2 7.5 1.2 100.0 Count 21 41 20 116 32 230 Control Group Girls From Garissa (%) 9.1 17.8 8.7 50.4 13.9 100.0 Total Girls In Test And Control Count 47 100 93 129 34 403 Schools From Garissa (%) 11.7 24.8 23.1 32.0 8.4 100.0 Source: ‘How Would You Rate Your Knowledge About Puberty’ of the Post-Puberty Education Questionnaire
Nairobi portrayed a curious scenario with 81.2% of the Control Group girls who did not receive any intervention claiming that their knowledge of puberty was either excellent or very good compared with 57.7% of the girls from the Test Group10. As Table 4.1d indicates, the proportion of the Test Group was much lower than of the Control Group that had not been exposed to puberty education. Further, in Nairobi, 10.4% of girls who received the puberty education session said that their knowledge of puberty was fair or poor compared to 6.0% of the girls in the Control Group.
Table 4.1d: Rating Knowledge of Puberty –Test and Control Group (Nairobi) Excellent Very Good Good Fair Poor Total Count 27 56 46 13 2 144 Test Group Girls From Nairobi (%) 18.8 38.9 31.9 9.0 1.4 100.0 Count 48 47 15 2 5 117 Control Group Girls From Nairobi (%) 41.0 40.2 12.8 1.7 4.3 100.0 Total Girls In Test and Control Count 75 103 61 15 7 261 Groups From Nairobi (%) 28.7 39.5 23.4 5.7 2.7 100.0 Source: ‘How Would You Rate Your Knowledge About Puberty’ of the Post-Puberty Education Questionnaire
Longitudinal comparison of Test Group Girls (post-test one and post-test two) While the first post-intervention test (after puberty education stage) revealed that only 23.8% of the Kenyan girls felt that their knowledge of puberty was either excellent or very good compared with 43.2% of those who had indicated that their knowledge of puberty was either fair or poor, the scenario changed overwhelmingly at the second post-intervention test. However, the combination of puberty education with the ‘Always’
10 While the Nairobi scenario lacked empirical explanation, it is most likely that the Control Group girls received the puberty education from the Test Group girls. Alternatively, their responses were prompted by a backlash feeling for having been excluded from the puberty education in the first place.
46 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
sanitary pad, resulted in a rise in the proportion of the Test Group girls (53%) who indicated that their knowledge of puberty was either excellent or very good, compared with 9.5% of the girls in the Test Group said that their knowledge of puberty was fair or poor at the comparison stage. Although it is not clear how the introduction of sanitary pads contributed to the presumed increase in knowledge, it may as well be that the girls perceived this increase based on practical experience of using the ‘Always’ pad (see Table 4.1d)
Table 4.1e: Rating Knowledge of Puberty –Initial survey and Comparison Stage Excellent Very Good Good Fair Poor Total Count 47 51 136 141 37 412 Test Group Girls at Initial survey (%) 11.4 12.4 33.0 34.2 9.0 100.0 Test Group Girls at Comparison Count 53 115 119 26 4 317 Stage (%) 16.7 36.3 37.5 8.2 1.3 100.0 Total Girls in the Test Group at the Count 100 166 255 167 41 729 Initial Survey and Comparison Stage (%) 13.7 22.8 35.0 22.9 5.6 100.0 Source: ‘How Would You Rate Your Knowledge About Puberty’ of the Baseline Survey and Post-Puberty Education Questionnaire
Menstruation Issues
Nearly all Malawi girls (99%) rated their knowledge on menstruation as either excellent or very good and claimed that the knowledge enabled them to understand the nature of menstruation and how to manage the challenges that it presented as captured in Table 4.2 (a). 4.2a: I know better what to do when I have my period (Test Group)
Agree Disagree Neither Agree Nor Disagree Total Count 250 1 1 252 (%) 99.0 0.5 0.5 100.0
On the Kenyan scene, an overall view on the girl’s knowledge of menstruation at the conclusion of the project activities shows that 49.5% of the Test Group girls said that their knowledge was either excellent or very good. Only 9.8% of the girls said that their knowledge was fair while 3.5% said it was poor. This is compared to 44.1% of the girls who did not receive sanitary towels and did not participate in puberty education session, who said that their knowledge of menstruation was either excellent or very good, while
47 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
31.4% felt only that it was fair and 11.8% of these girls from the Control Group said that their knowledge of menstruation was poor
Table 4.2b: Rating Knowledge of Menstruation –Test and Control Group Excellent Very Good Good Fair Poor Total Count 60 97 118 31 11 317 Test Group (%) 18.9 30.6 37.2 9.8 3.5 100.0 Count 71 82 44 109 41 347 Control Group (%) 20.5 23.6 12.7 31.4 11.8 100.0 Count 131 179 162 140 52 664 Total (%) 19.7 27.0 24.4 21.1 7.8 100.0 Source: ‘How Would You Rate Your Knowledge About Menstruation’ of the Post-Puberty Education Questionnaire
In Garissa, nearly half (44%) of the girls Test Group said that their knowledge of menstruation was either excellent or very good, compared to 28.7% of girls from the Control Group. Further, 17.9% of the girls from the Test Group said that their knowledge of menstruation was fair or poor, compared with more than half (59.6%) of the girls in the Control Group. (see Table 4.2c).
Table 4.2c: Rating Knowledge of Menstruation –Test and Control Group (Garissa) Excellent Very Good Good Fair Poor Total Count 24 52 66 21 10 173 Garissa Test Group (%) 13.9 30.1 38.2 12.1 5.8 100.0 Count 37 29 27 105 32 230 Garissa Control Group (%) 16.1 12.6 11.7 45.7 13.9 100.0 Total Girls In Test And Count 61 81 93 126 42 403 Control Schools From Garissa (%) 15.1 20.1 23.1 31.3 10.4 100.0 Source: ‘How Would You Rate Your Knowledge About Menstruation’ of the Post-Puberty Education Questionnaire
For the differences in the knowledge gained between the Test Group and Control Group of girls in Nairobi, fewer girls (56.3%) from the Test Group, who had undergone puberty education training, felt that their knowledge of menstruation was either excellent or very good, compared with a striking majority of the Control Group girls (74.4%) who felt the same. Again this is even a more prominent phenomenon where more of the control group girls claim to have increased their knowledge even when they had been exempted from the training. It is not far-fetched to speculate that perhaps, this Test Group may have passed on the knowledge they had received to their peers in the Control Group. Alternatively, the Control Group may have provided misleading information, as a backlash for having been excluded in education, which they might have perceived, was relevant to them11. The lower rankings of the education on
11 Studies of human beings may present curious social dynamics that raise further research questions.
48 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
menstruation did not reveal much difference between the two groups of girls (Test Group, 7.6% vis-à-vis 11.1% of the Control Group) as shown in Table 4.2d Table 4.2d: Rating Knowledge of Menstruation –Test and Control Group (Nairobi) Excellent Very Good Good Fair Poor Total Count 36 45 52 10 1 144 Nairobi Test Group (%) 25.0 31.3 36.1 6.9 0.7 100.0 Count 34 53 17 4 9 117 Nairobi Control Group (%) 29.1 45.3 14.5 3.4 7.7 100.0 Total Girls In Test And Control Count 70 98 69 14 10 261 Schools From Nairobi (%) 26.8 37.5 26.4 5.4 3.8 100.0 Source: ‘How Would You Rate Your Knowledge About Menstruation’ of the Post-Puberty Education Questionnaire
Longitudinal Comparison on knowledge of menstruation (post-test one and two) The girls in the Test Group at the conclusion of all the stages of the survey show a marked increase in the level of knowledge gained on menstruation as compared to their knowledge on menstruation at the initial survey. At the initial survey, only 31.6% of the girls from the Test Group felt that their knowledge of menstruation was either excellent or very good. However, at the comparison stage, this percentage rises significantly to 49.5% of the girls in the Test Group who now felt that their knowledge on menstruation was either excellent or very good. Furthermore, the percentage of those girls in the Test Group who felt that their knowledge of menstruation was either fair or poor dropped from 25.9% before the puberty education sessions to 13.3% following the puberty education sessions. (See Table 4.2d) Table 4.2d: Rating Knowledge Of Menstruation –Test Group Girls Only (Initial survey and Comparison stage) Excellent Very Good Good Fair Poor Total Count 56 74 175 85 22 412 Test Group Girls at Initial survey (%) 13.6 18.0 42.5 20.6 5.3 100.0 Test Group Girls at Comparison Count 60 97 118 31 11 317 Stage (%) 18.9 30.6 37.2 9.8 3.5 100.0 Total Girls in the Test Group at Count 116 171 293 116 33 729 the Initial Survey and (%) Comparison Stage 15.9 23.5 40.2 15.9 4.5 100.0 Source: ‘How Would You Rate Your Knowledge Menstruation’ of the Baseline Survey and Post-Puberty Education Questionnaire
The above findings regarding knowledge of menstruation issues As a result of notwithstanding, the girls from Kenya’s rural district of Garissa used circumcision, I always have the space that this project provided to articulate their agenda problems with my regarding their experiences menstruation having undergone female period. My stomach pains a lot and I normally feel very sick 49 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
circumcision (cliteridectomy and/infibulations). There was expressed concern that even though they had experienced positive changes in their lives during the menses, 75% of the girls reportedly continued to suffer relatively greater physical distress of period because of the narrow vaginal opening resulting from infibulations. Further, the physical effect of infibulations also resulted in prolonged periods, which were a major drawback on the girls’ daily activities, including the processes of schooling generally and class attendance and participation in particular. Logically, the circumcised girls were more likely to demonstrate increased absenteeism despite the feminine interventions. Such absenteeism is linked to poor performance in schoolwork and high potential for dropping out of school compared with other girls.
SCHOOL PARTICIPATION: IMPEDIMENTS TO LEARNING AND OTHER ACTIVITIES
Cross-country data confirmed that many of the girls had failed to participate fully in class during their periods. This is because they feared the possibility of being discovered due to either staining their clothes with menstrual blood or releasing unpleasant smell due to poor feminine hygiene that is worsened by the menstruation. According to girls’ testimonies during group discussions, many of them lacked the life skills to manage their periods while concurrently attending to the demands of schooling on an equal footing with their non-menstruating peers. I stay with my aunt Material and financial poverty and she is very poor and we don’t even Family poverty emerged as have Kerosene at home and we are many major factor that played havoc My mother is very in the house. So I poor and can never in the lives of menstruating cannot ask her for buy me sanitary sanitary towels when schoolgirls. The mothers towels, so mother there is no food and always gives me some and other female guardians were at also water… pieces of cloths to use the centre of negotiating poverty then I wash… My mother is very poor and menstrual needs of the and my father died. girls. In group discussions Sometimes we stay without food (…) I and interviews, many of the girls claimed that their cannot ask for sanitary towels… I always use pieces of blankets, which is uncomfortable, 50 and smell at times. ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi families were too poor to afford the commercially available feminine hygiene sanitary pads. Such pads were considered ‘too expensive’ and hence were not a priority in terms of competing for space in the family economy. As a result, the conditions of extreme poverty, some of the girls said that they had to improvise sanitary towels from items such as rags, weathered camel skin, blankets, sponge, toilet paper, soaked old newspapers and cotton wool that were undependable in terms of preventing leakage and/or foul odour. Further, girls described their female guardians, particularly mothers – as being the ones responsible for helping them to manage their periods despite being ‘very poor’.
Because of the use of the unreliable menstrual protective materials, the girls were often afraid of soiling their clothes or smelling badly while in class. Moreover, the improvised pads apparently restricted movement as girls worried that the pads would fall out leading to ridicule and embarrassment.
Confidence and Personal Freedoms In the Malawi pre-test, 74% of the girls listed cloth as being by far the most common material used in managing the period with pant liners being used by 11% of the girls. The use of cloth apparently affected the girls’ confidence and freedom because of the constant threat of leakage, roughness of the material that hampered movement and bad smell. However, the introduction of ‘Always’ pad seemed to have increased girls’ confidence and their personal freedoms as the engaged with class-work as well as the out of class activities. By the end of the intervention stage, many of the girls described the ‘Always’ pad as the popular material of choice. Nearly all the girls in the test group (over 97%) agreed that the use of the ‘Always’ pad during their menses boosted their confidence to engage in class work without worrying or being afraid about soiling their dress, emitting bad smell or being discovered that they had the period as noted in Table 4.3a, b, c, d and e. Notably, majority of the Test Group girls (96.0%) claimed that the foul smell that was associated with the period had disappeared with the use of the ‘Always’ pad, thus allowing greater concentration in class (see Table 4.4a and b).
51 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Table 4.3a: Feeling more confident about self Agree Disagree Total Count 249 3 252 (%) 98.8 1.2 100.0
Table 4.3b: Not afraid to stain their dresses Agree Disagree Total Count 245 7 252 (%) 97.2 2.8 100.0
Table 4.3c: Other people do not know when I have periods Agree Disagree Total Count 248 4 252 (%) 98.4 1.6 100.0
Table 4.3e: Do not smell badly Agree Disagree Total Count 242 10 252 (%) 96.0 4.0 100.0
Class concentration Nearly all the Test Group girls (99.6%) in Malawi indicated that their concentration levels had increased apparently because they did not experience the distracting thoughts and fears about possibility of the period leaking through the dress or being ‘discovered’ that they were having the period (see Table 4.5a).
Table 4.4a: Can concentrate more in class Agree Disagree Total Count 251 1 252 (%) 99.6 0.4 100.0
Generally, most of the girls from Malawi, like their counterparts from Kenya, said that because they felt more secure and in control of their own period, they did not fear having their next period.
Table 4.4b: Do not fear having next periods Agree Disagree Total Count 248 4 252
52 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
(%) 98.4 1.6 100.0
In Kenya, 83.3% of the Test Group girls said they were able to concentrate more in class during menstruation compared with only 45.5% of the girls in the Control Group after the second intervention stage. Furthermore, while only 13.6% of the girls in the Test Group girls said that they did not concentrate much better in class during their periods, almost three times as many (36.9%) of the girls in the Control Group girls claimed less concentration during their periods.
Table 4.4c: Concentrate More in Class During Menstruation –the Test and Control Groups Agree Disagree Neither Agree Nor Total Disagree Count 264 43 10 317 Test Group Percent (%) 83.3 13.6 3.2 100.0 Control Count 158 128 61 347 Group Percent (%) 45.5 36.9 17.6 100.0 Count 422 171 71 664 Total Percent (%) 63.6 25.8 10.7 100.0 Source: ‘I Feel That I Can Concentrate More In Class’ of the Post-Puberty Education Questionnaire
For the Test Group in Garissa, 81.5% of the girls perceived their concentration as having increased during their period compared with 14.5% of the same Group who disagreed with the effects of the project intervention. From the Control Group girls, 52.2% agreed that their concentration in class had increased after the intervention. Conversely, 25.7% of the girls in the Control Group in Garissa did not feel that they were able to concentrate more in class better compared to the 14.5% of girls in the Garissa Test Group.
Table 4.4d: Concentrate More in Class –Test and Control Group (Garissa) Agree Disagree Neither Agree Nor Disagree Total Count 141 25 7 173 Garissa Test Group Percent (%) 81.5 14.5 4.0 100.0 Count 120 59 51 230 Garissa Control Group Percent (%) 52.2 25.7 22.2 100.0 Count 261 84 58 403 Total Girls In Test And Control Percent Schools From Garissa (%) 64.8 20.8 14.4 100.0 Source: ‘I Feel That I Can Concentrate More In Class’ of the Post-Puberty Education Questionnaire
53 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
The pattern of girls’ concentration in Garissa reflected that of the girls in Nairobi. Whereas 85.4% of the Test Group girls in Nairobi felt that they concentrated better in class following the intervention programmes, only 32.5% of the girls in the Nairobi Control Group felt the same. Further, only 12.5% of the girls in the Nairobi Test Schools felt that they did not concentrate better in class during their periods after the intervention stage compared with 59% of the Control Group girls.
Table 4.4e: Concentrate More in Class - Test Group and Control Group: Nairobi Agree Disagree Neither Agree Nor Total Disagree Count 123 18 3 144 Nairobi Test Group Percent (%) 85.4 12.5 2.1 100.0 Count 38 69 10 117 Nairobi Control Group Percent (%) 32.5 59.0 8.5 100.0 Total Girls In Test And Count 161 87 13 261 Control Schools From Percent (%) Nairobi 61.7 33.3 5.0 100.0 Source: ‘I Feel That I Can Concentrate More in Class’ of the Post-Puberty Education Questionnaire
The above findings notwithstanding, an independent evaluator of the Malawi puberty and feminine hygiene project cautioned about drawing conclusive conclusions based on claims made on the usage of sanitary pads. The evaluation pointed out apparent inconsistency of data on use of menstrual cloth, which was not analysed vis-à-vis that of the use of the ‘Always’ pad. Observations from the data show that among the Malawi girls, the use of cloth had remained dominant over the use of the ‘Always’ pad in the three-month period, yet, when girls were asked to indicate the material they used during the last period, more of them indicated that it was the pad rather than not the cloth. According to the evaluation report, it is curious that only 10.5% of the girls had used sanitary pads in the past 3 months compared to nearly three quarters who used cloth. Yet, nearly two thirds (65.3%) of the girls still claimed to have used pads the last time they had a period. This explicit inconsistency suggests, quite importantly, that in Malawi, pads may have been distributed intermittently, thus allowing the cloth to remain the dominant material for use during the period, except perhaps, during the last month of the project. The Malawi evaluator, while commending the insights gained through this project, also questions the analytical value served considering that only 71.9% of the
54 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi girls actually conceded to having used the pads from the programme in the last three months12.
Standing up in class to participate without fear of being ‘discovered’
The confidence of standing up in class to answer question, which may be taken for, granted was a major worry for girls during their period. Always, there was that hidden fear that standing up would reveal either a bloodstain or a bump at the buttocks created by some menstrual cloth, blanket, camel skin or any other such improvisation of sanitary protection. The use of the ‘Always’ pad reportedly eradicated this fear for most of the Test Group girls who expressed tremendous confidence to stand up in class and answer questions without the undue fears of being ‘discovered’ and embarrassed by their peers. In Malawi, almost all the Test Group girls (99.2%) agreed that the ‘Always’ pad allowed them that level of confidence.
Table 4.5a: Able to stand up and answer questions in class Agree Disagree Total Count 250 2 252 (%) 99.2 0.8 100.0
Appraisals from the Kenyan Test Group girls indicated a similar pattern with almost three quarters of them (74.4%) saying that they could participate in class without fear of revealing their period status. Only 20.5% of the girls from the Test Group expressed the persistent fear of standing up in class during their period compared with 62.2% of the girls from the Control Group. Notably, 28.2% of the girls from the Control Group who obviously did not receive the sanitary pads from the project still claimed that ability to stand in class13.
12 In research terms, the fact that a considerable proportion of the girls confessed to having used cloth as the dominant menstrual material called for exploration on how to improve its use rather than dismiss it. 13 This group of girls may have had access to reliable sanitary pads from their parents: a fact that the study did not seek to establish
55 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Table 4.5b: Can Stand Up and Participate in Class without Fear During Periods –Test and Control Group Agree Disagree Neither Agree Nor Total Disagree Count 236 65 16 317 Test Group Percent (%) 74.4 20.5 5.0 100.0 Count 98 216 33 347 Control Group Percent (%) 28.2 62.2 9.5 100.0 Count 334 281 49 664. Total Percent (%) 50.3 42.3 7.4 100.0 Source: ‘I Feel That I Can Stand Up And Participate In The Class With No Fear’ of the Post-Puberty Education Questionnaire
Among the Garissa girls, the equation changed after the intervention stage to reflect a proportion of more than two thirds of the girls (68.2%) who were able to stand up in class without fear of their period being discovered. This compared with only 27% of the girls in Garissa who had received no intervention but said they felt confident enough to stand up and answer questions in class. Furthermore, whereas 26.6% of the girls from the Garissa Test Group still felt that they would not like to stand and participate in class during their periods, 60.9% of the girls in the Control Group in Garissa said they shared that fear.
Table 4.5c: Can Stand Up and Participate in Class without Fear During Periods –Test and Control Group: (Garissa) Agree Disagree Neither Agree Nor Total Disagree Count 118 46 9 173 Garissa Test Group Percent (%) 68.2 26.6 5.2 100.0 Count 62 140 28 230 Garissa Control Group Percent (%) 27.0 60.9 12.2 100.0 Count 180 186 37 403 Total Girls In Test And Percent Control Group From Garissa (%) 44.7 46.2 9.2 100.0 Source: ‘I Feel That I Can Stand Up And Participate In The Class With No Fear’ of the Post-Puberty Education Questionnaire
For the Test Group girls in Nairobi, 81.9% agreed that they were able to stand up and participate in the class with no fear compared to only 30.8% of the girls in the Control Group who expressed the same after the project intervention. Additionally, whereas the minority of girls in the Test Group (13.2%) said that they were uncomfortable about standing up and participating in class during their periods, the majority of girls from the
56 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Control Group (65%) said that they would not like to stand up and participate in class while on their period days.
Table 4.5d: Can Stand Up and Participate in Class without Fear During Periods -Test And Control Group (Nairobi) Agree Disagree Neither Agree Nor Disagree Total Count 118 19 7 144 Nairobi Test Group Percent (%) 81.9 13.2 4.9 100.0 Count 36 76 5 117 Nairobi Control Group Percent (%) 30.8 65.0 4.3 100.0 Total Girls in Test And Count 154. 95 12 261 Control Schools From Percent (%) Nairobi 59.0 36.4 4.6 100.0 Source: ‘I Feel That I Can Stand Up And Participate In The Class With No Fear’ of the Post-Puberty Education Questionnaire
Physical and emotional security Linked to confidence and personal freedoms was the experience of physical and emotional security and being in control of the period –rather than the period controlling the girls’ life particularly while in the school. More than half of the girls expressed an increased sense of security during periods after the educational intervention, which would possibly translate in confidence to participate actively in class. This compares positively with less than one quarter of the girls (22.5%) who at post-test still claimed to feel insecure during the menses (See Table 4.6a)
Table 4.6a: I feel insecure during my period (Malawi) Pre-test Post-test Strongly agree 56.2 22.5 Somewhat agree 13.4 9.8 Neither agree nor disagree 5.1 3.3 Somewhat disagree 6.5 10.2 Strongly disagree 18.8 54.1
In Kenya, the feeling of being unprotected from menstrual ‘accidents’ during periods was reportedly a major factor that affected schooling among pubescent girls. The experiences of most of the Malawian Test Group girls who claimed to have experienced greater physical and psychological comfort and security during their period in the intervention stage compared well with the relatively greater proportion of the Kenyan Test Group girls (66.6%) who claimed to have felt secure during their periods. This is
57 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
captured in data captured in Table 4.5b whereby less than one third (31.2%) of the girls claimed to have continued feeling insecure during their period. Table 4.6b: Feeling Insecure During Menstruation –Test and Control Group Agree Disagree Neither Agree Nor Disagree Total Count 99 211 7 317 Test Group (%) 31.2 66.6 2.2 100.0 Count 158 152 37 347 Control Group (%) 45.5 43.8 10.7 100.0 Count 257 363 44 664 Total (%) 38.7 54.7 6.6 100.0 Source: ‘I Feel Insecure During My Period’ of the Post-Puberty Education Questionnaire
Notably, there was little difference between the girls in the Test Group from Garissa and those in the Control Group from Garissa with regard to feeling insecure during their periods. The Test Group girls from Garissa (37.6%) said they felt insecure during their periods, compared with 36.1% of the girls in the Control Group from the same district. However, a much larger percentage of the Test Group girls (61.3%), said that they were comfortable during their period at as compared to 49.6% of the girls in Control Schools who felt secure during menstruation (Table 4.6b). Table 4.6c: Feeling Insecure During Period –Test and Control Group (Garissa) Agree Disagree Neither Agree Nor Disagree Total Count 65 106 2 173 Garissa Test Group (%) 37.6 61.3 1.2 100.0 Count 83 114 33 230 Garissa Control Group (%) 36.1 49.6 14.3 100.0 Total Girls In Test And Count 148 220 35.0 403 Control Schools From (%) Garissa 36.7 54.6 8.7 100.0 Source: ‘I Feel Insecure During My Period’ of the Post-Puberty Education Questionnaire
While only 23.6% of the girls in the Test Group from Nairobi agreed that they felt insecure during their period, a much higher proportion of the girls in the Control Group (64.1%) claimed the same. Moreover, while 72.9% of the Test Group girls from Nairobi felt that they were comfortable with themselves during menstruation, only a mere 32.5% of the girls in the Control Group felt the same during their period as demonstrated in Table 4.6c).
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Table 4.6d: Feeling Insecure During Period –Test and Control Group (Nairobi) Agree Disagree Neither Agree Nor Total Disagree Nairobi Test Group Count 34 105 5 144 (%) 23.6 72.9 3.5 100.0 Nairobi Control Group Count 75 38 4.0 117 (%) 64.1 32.5 3.4 100.0 Total Girls In Test And Control Schools From Nairobi Count 109 143 9 261 (%) 41.8 54.8 3.4 100.0 Source: ‘I Feel Insecure During My Period’ of the Post-Puberty Education Questionnaire
Longitudinal comparison of Test Group Girls on increased confidence (post- test one and post-test two) Longitudinally, over the course of the three-tier survey, it was noted that the proportion of the Test Group girls who expressed a feeling of increased confidence rose considerably. At the initial survey stage, 84.2% of the Test Group girls said they felt insecure during their periods and only 14.6% of these girls felt confident during menstruation. However, after learning about feminine hygiene issues and receiving sanitary pads, the percentage of girls from the Test Group girls who felt insecure during their period fell by more than one third, to stand at 31.2% while those who felt confident during menstruation rose by more than half to stand at 66.6% of the Test Group girls as shown in Table 4.6e below.
4.6e: Feeling Insecure During Menstruation –Test Group and the Comparison Stage (Initial survey) Agree Disagree Neither Agree Nor Total Disagree Count 347 60 5 412 Test Group Girls at Initial survey (%) 84.2 14.6 1.2 100.0 Test Group Girls at Comparison Count 99 211 7 317 Stage (%) 31.2 66.6 2.2 100.0 Total Girls in the Test Group at Count 446 271 12 729 the Initial Survey and Comparison Stage (%) 61.2 37.2 1.6 100.0 Source: ‘I Feel Insecure During My Period’ of the Baseline Survey and Post-Puberty Questionnaire
Participating in physical activities during the period Apart from class-work, girls, just like their male peers have the right to engage in outside of class activities, such as games, physical education, sports and others, even when they are menstruating. Notably, the after effect of the puberty and feminine
59 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi hygiene education, coupled with provision of the conventional feminine hygiene sanitary pad, seems to have motivated more girls to participate in physical activity. There was a nearly 20-percentage point drop among girls from the Malawi Test Group who had earlier said they had avoided physical activity and whose experiences had changed after the intervention on feminine hygiene and puberty education as captured in Table 4.7a below. Table 4.7a: During my period I avoid physical activity (Malawi) Pre-test Post-test Strongly agree 49 30.4 Somewhat agree 9.4 8.3 Neither agree nor disagree 3.8 3.9 Somewhat disagree 7.3 11.7 Strongly disagree 30.6 45.7 I am afraid of my next period 27.7 36.7 Did you miss school in the first three months because 21.5 35.5 of problems related to menstruation
At post-intervention stage, nearly all the Test Group girls in Malawi provided strong indication that they felt more confident and capable of participating actively in all activities within and outside of class as a result of the combination of puberty education sessions with provision of sanitary pads. They responded positively to activities such as games, playing with friends and doing physical education as shown in Table 4.7b, c, and d respectively.
Table 4.7b: Go for physical education (P.E) all the time Agree Disagree Total Count 249 3 252 (%) 98.8 1.2 100.0
Table 4.7c: Able to go for games all the time
Agree Disagree Total Count 251 1 252 (%) 99.6 0.4 100.0
Table 4.7d: Able to play with their friends comfortably Agree Disagree Total Count 251 1 252 (%) 99.6 0.4 100.0
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Girls from Kenya also reported increased confidence to engage in the physical activities with only about one quarter (25.6%) of the Test Group claiming that they had continued to avoid physical activity during their period after the intervention. This proportion of girls compares relatively well with the higher percentage of 66.3% of the girls from the Control Group who claimed that they continued to avoid physical activities. Furthermore, nearly three quarters (71%) of the girls from the Test Group disagreed that they would avoid physical activities and move about freely during their period following the intervention programmes. There was a marked difference between 71.0% the Test Group girls and the 26.2% of the girls from the Control Group who expressed the feeling of physical freedom during the period as shown in Table 4.7e. Table 4.7e: Avoiding Physical Activity during Menstruation –Test and Control Group Agree Disagree Neither Agree Nor Disagree Total Count 81 225 11 317 Test Group (%) 25.6 71.0 3.5 100.0 Control Count 230 91 26 347 Group (%) 66.3 26.2 7.5 100.0 Count 311 316 37 664 Total (%) 46.8 47.6 5.6 100.0 Source: ‘I Avoid Physical Activity During My Period’ of the Post-Puberty Questionnaire
In the rural district of Garissa, 31.2% of the girls in Test Group said they would avoid physical activity during menstruation compared with a higher proportion of 70.9% of the girls for the Control Group. Furthermore, while about two thirds (66.5%) of the girls in the Garissa Test Group said they would be active and move freely during their period, the Control Group girls had a mere 19.6% who shared such feelings. Table 4.7f: Avoiding Physical Activity During Period –Test and Control Group (Garissa) Agree Disagree Neither Agree Nor Total Disagree Count 54 115 4 173 Garissa Test Group (%) 31.2 66.5 2.3 100.0 Count 163 45 22 230 Garissa Control Group (%) 70.9 19.6 9.6 100.0 Total Girls In Test And Count 217 160 26 403 Control Schools From (%) Garissa 53.8 39.7 6.5 100.0 Source: ‘I Avoid Physical Activity During My Period’ of the Post-Puberty Questionnaire
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When comparing the results for the Test Group of girls in Nairobi and the Control Group who did not receive puberty education or sanitary towels, it is clear that the girls in the Test Group felt that they would be more outgoing during their periods than did those in the Control Group. Only 18.8% of the girls in the Nairobi Test Group claimed that they were likely to avoid physical activity during their period, compared with 57.3% of the girls in the Control Group for Nairobi. Moreover, 76.4% of the Test Group girls in Nairobi indicated that they were unlikely to avoid physical activity as compared to only 39.3% of the girls from the Nairobi Control Group. 4.7g: Avoiding Physical Activity During Period - Test and Control Group (Nairobi) Agree Disagree Neither Agree Nor Total Disagree Nairobi Test Group Count 27 110 7 144 (%) 18.8 76.4 4.9 100.0 Count 67 46 4 117 Nairobi Control Group (%) 57.3 39.3 3.4 100.0 Total Girls In Test And Count 94 156 11 261 Control Schools From Nairobi (%) 36.0 59.8 4.2 100.0 Source: ‘I Avoid Physical Activity During My Period’ of the Post-Puberty Education Questionnaire
Longitudinal comparison: Test Group Girls on physical activity In comparing the girls in the Test Group at the initial survey with the girls in the Test Group after all intervention programmes were put into place, it is noted that the girls felt much more outgoing at the comparison stage. During the initial survey, 77.2% of the Test Group girls felt that they would avoid physical activity during their period. The figure fell drastically to 25.6% at the comparison stage. Likewise, whereas at the initial survey only 21.1% of the girls felt that they would not avoid physical activity during their period, the figure rose to 71% of the Test Group girls who felt less withdrawn during their periods at the time of concluding the final survey. 4.7h: Avoiding Physical Activity During Menstruation –Test Group (Initial and Comparison Stage) Agree Disagree Neither Agree Nor Disagree Total Count 318 87 7 412 Test Group Girls at Initial survey (%) 77.2 21.1 1.7 100.0 Test Group Girls at Comparison Count 81 225 11 317 stage (%) 25.6 71.0 3.5 100.0 Total Girls in the Test Group at the Count 399 312 18 729 Initial Survey and Comparison
Stage (%) 54.7 42.8 2.5 100.0 Source: ‘I Avoid Physical Activity During My Period’ of the Baseline Survey and Post-Puberty Education
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MANAGING THE MENSTRUAL PERIOD AND BEING IN CONTROL
The concept of ‘managing the period’ could mean various things. However, in this study being able to ‘manage the period’ entails not just the access to menstrual protective materials but also having the skill to use the materials appropriately. In addition, in order to manage the period effectively, girls require the knowledge about when to change menstrual protection, how to observe feminine hygiene practices, dispose of the used materials accordingly and generally be in control of the menstrual event whenever it sets in.
Nearly all the Test Group girls in Malawi said that they felt better able to manage their periods after puberty education and receiving sanitary pads. The same feeling was expressed in Kenya whereby most of the Test Group girls (89.9%) expressed increased confidence about managing their period than the Control Group girls (49.3%). Conversely, a higher percentage of girls from the Control Group (49.3%) did not feel that they were able to manage their period better as compared to 6.9% of the girls from the Test Group, clearly because they had been exempted from the relevant education and the provision of the sanitary pads. Table 4.8a presents the girls responses on management of the menses. Table 4.8a: Better Able to Manage Period – Overall Test and Control Group Agree Disagree Neither Agree Nor Disagree Total Count 285 22 10 317 Test Group (%) 89.9 6.9 3.2 100.0 Count 159 171 17 347 Control Group (%) 45.8 49.3 4.9 100.0 Count 444 193 27 664 Total (%) 66.9 29.1 4.1 100.0 Source: ‘I Can Better Manage My Period Now’ of the Post-Puberty Education Questionnaire
In the separate Kenyan district of Garissa, the pattern did not change much as noted in the 87.3% of the Garissa girls who expressed increased ability to better manage their period following puberty education and sanitary pads intervention. In comparison, 51.3% of the girls from the Control Group in Garissa, felt better able to manage their period during the final survey.
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Table 4.8b: Better Able to Manage Period – Test and Control Group (Garissa) Agree Disagree Neither Agree Nor Total Disagree Count 151 14 8 173 Garissa Test (%) 87.3 8.1 4.6 100.0 Count 118 102 10 230 Garissa Control (%) 51.3 44.3 4.3 100.0 Total Girls In Test And Count 269 116 18 403 Control Schools From (%) Garissa 66.7 28.8 4.5 100.0 Source: ‘I Can Better Manage My Period Now’ of the Post-Puberty Education Questionnaire
Nairobi presented results that were slightly different as far as the Test Group and the Control Group of girls were concerned. A large majority (93.1%) of the Test Group girls agreed that they could better manage their period following the intervention programmes compared with only 5.6% who disagreed. In the Control Group, however, 35% of the girls said they felt better able to manage their period despite not having received any intervention. Among the same group, 59% indicated lack of confidence in managing their menstrual period.
Table 4.8c: Better Able to Manage Period – Test and Control Group (Nairobi) Agree Disagree Neither Agree Nor Total Disagree Count 134 8 2. 144 Nairobi Test (%) 93.1 5.6 1.4 100.0 Count 41 69 7 117 Nairobi Control (%) 35.0 59.0 6.0 100.0 Total Girls In Test And Control Count 175 77 9 261 Schools From Nairobi (%) 67.0 29.5 3.4 100.0 Source: ‘I Can Better Manage My Period Now’ of the Post-Puberty Education Questionnaire
School and Class Attendance/missing School There was a notably decline in the number of Test Group girls who missed school during the last month intervention stage because of problems related to menstruation. In Malawi, as shown in Chart 8, between the pre-test and post-test, less than one quarter of the Malawi girls indicated they had missed school because of problems related to menstruation. However, in the last month of the intervention stage, nearly all the Test Group girls in Malawi claimed to have attended school regularly (see Table 4.9a).
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Table 4.9a: Do not miss classes or school Agree Disagree Total Count 242 10 252 (%) 96.0 4.0 100.0
The number of days that the Malawi girls missed school due to menstruation-related hitches declined markedly after the intervention was introduced14. However, while the decline in absenteeism is positive, the project evaluator observed the difficulties involved in attempting to draw conclusions on the reasons for the changes considering that the data gathered on the menstruation/absenteeism dynamic was incomprehensive. For example, the claims that the girls made regarding attendance and absenteeism were not verified empirically but were impressionistic and perceptual. This notwithstanding, the general trend indicated that during the post-test, the days of missing school for the Test Group girls in Malawi had decreased except on the column of ‘one day’ whereby more girls had missed school compared to the period of the pre- test. Qualitatively, this curious occurrence in Malawi regarding Day 1 did not yield explanatory data. .
In Kenya, a comparison of the attendance patterns of the girls during days when they had their periods showed that among the Test Group, 77.9% of the girls did not miss
14 Notably, the choice of zero days for Malawi girls was not included in this data.
65 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
school at all during their periods compared to 25.1% of girls from the Control Group. Likewise, while 8.5% of the girls from the Test Group missed 1-3 days of school since the interventions, this figure was much higher at 22.5% for the girls in the Control Group. While 7.3% of girls from the Test Group had missed 4-6 days of school, three times as many (22.8%) of girls from Control Group had missed school for the same period. Additionally, while 6.3% of the Test Group girls had missed a week or more of school since the intervention programmes due to problems related to menstruation, the percentage of girls from the Control Group was much higher at 29.7%. Table 4.9b: Missed School Days over Last Two Months Due to Problems Related To Menstruation – Overall test and Control Group 0 Days 1-3 Days 4-6 7 Or More Total Days Days Count 247 27 23 20 317 Test Group Percent (%) 77.9 8.5 7.3 6.3 100.0 Count 87 78 79 103 347 Control Group Percent (%) 25.1 22.5 22.8 29.7 100.0 Count 334 105 102 123 664 Total Percent (%) 50.3 15.8 15.4 18.5 100.0 Source: ‘How Many Days Of School Did You Miss In The Past 2 Months Due To Problems Related To Menstruation’ of the Post-Puberty Education Questionnaire
In Garissa, the girls in the Test Group were less likely to miss school due to period- related problems over the two months since the puberty education session and receiving the sanitary towels. While 67.6% of the girls in the Test Group from Garissa did not miss any school day since the introduction of the project intervention, 13.9% of the girls from Garissa’s Control Group did not miss school during that period. Furthermore, 10.4% of the girls from the Test Group missed 1-3 days of school as compared to 19.6% of the girls from the Control Group and 12.1% of the girls from the Test Group missed 4-6 days of school as compared to 27% of girls from the Control Group. While 9.8% of the girls from the Test Group in Garissa missed 7 or more days of school over two months due to menstrual-related problems, this figure was relatively high at 39.6% of girls from the Control Group in Garissa (see Table 4.9c)
Table 4.9c: Missed School Days over Last Two Months due to Problems Related To Menstruation –Test
66 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Group and Control Group (Garissa) 0 Days 1-3 Days 4-6 7 and More Total Days Days Count 117 18 21 17 173 Garissa Test Group Percent (%) 67.6 10.4 12.1 9.8 100.0 Garissa Control Count 32 45 62 91 230 Group Percent (%) 13.9 19.6 27.0 39.6 100.0 Total Girls In Test and Count 149 63 83 108 403 Control Groups From Percent (%) Garissa 37.0% 15.6% 20.6% 26.8% 100.0% Source: ‘How Many Days Of School Did You Miss In The Past 2 Months Due To Problems Related To Menstruation’ of the Post-Puberty Education Questionnaire
The pattern of missing school remained similar among the girls in Nairobi, whereby, 90.3% of the Test Group had not missed any day of school following the intervention period compared with 47% of girls in the Control Group. Notably, only 6.3% of the girls who had received puberty education and training coupled with sanitary pads missed 1-3 days of school over the two-months intervention period compared with 28.2% of girls in the Control Group. Further, while 1.4% of the girls in the Test Group had missed 4-6 days of school since the intervention programmes were put into place, the figure was higher for the girls from the Nairobi Control Group at 14.5%. Moreover, while 2.1% of the girls from the Test Group had missed a week or more of classes, this figure was 10.3% of the girls in the Control Group from Nairobi. These patterns are illustrated in Table 4.9d.
Table 4.9d Missed School Days over Last Two Months due to Problems Related To Menstruation –Test Group and Control Group (Nairobi) 0 Days 1-3 Days 4-6 7 Or More Total Days Days Count 130 9 2 3 144 Nairobi Test Group Percent (%) 90.3 6.3 1.4 2.1 100.0 Count 55 33 17 12 117 Nairobi Control Group Percent (%) 47.0 28.2 14.5 10.3 100.0 Total Girls In Test and Count 185 42 19 15 261 Control Groups From Percent Nairobi (%) 70.9 16.1 7.3 5.7 100.0 Source: ‘How Many Days Of School Did You Miss In The Past 2 Months Due To Problems Related To Menstruation’ of the Post-Puberty Education Questionnaire
Overall in Garissa, slightly over two thirds (67.6%) of the Test Group girls did not miss any school compared to 90.3% of the girls from Nairobi. This situation emerged despite
67 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi the fact that all the girls received the same intervention programmes. Likewise, while 10.4% of the girls from Garissa missed 1-3 days of school, a relatively small proportion of the Nairobi girls (6.3%) missed school for the same period. Additionally, while 12.1% of the girls in Garissa missed 4-6 days of school, the proportion was much lower for the girls in Nairobi at 1.4%. And even when 9.8% of the girls from Garissa were absent from school for 7 or more days over a two-month intervention period, a mere 2.1% of the girls from Nairobi missed school. This scenario which is captured in Table 4.9e raises questions whose answers might lie outside the puberty and feminine hygiene project and possibly be found in gendered cultures of the Garissa communities.
Table 4.9e: Days of School Missed in the Last Two Months of Intervention –Overall Test Group 0 Days 1-3 Days 4-6 Days 7 and More Days Total Count 117 18 21 17 173 Garissa Percent (%) 67.6 10.4 12.1 9.8 100.0 Count 130 9 2 3 144 Nairobi Percent (%) 90.3 6.3 1.4 2.1 100.0 Count 247 27 23 20 317 Total Percent (%) 77.9 8.5 7.3 6.3 100.0 Source: ‘How Many Days Of School Did You Miss In The Past 2 Months Due To Problems Related To Menstruation’ of the Post-Puberty Education Questionnaire
In Kenya, it was clear that missing school during the periods was strongly related to what region the girl came from and by extension, the socio-cultural dynamics involved. Girls from Nairobi were clearly less likely to miss school during their periods as compared to their counterparts in Garissa. Nonetheless, It was clear from the first step of the survey that more of the Kenyan girls as well as those from Malawi, tended to miss school during their period days because of lack of reliable sanitary pads and the lack of knowledge about feminine hygiene issues and generally how to manage the period. However, the findings have shown that the level of absenteeism falls dramatically amongst the girls from both Kenya and Malawi after they had received sanitary pads and education and training on how to manage their menstruation. . Among the 42 girls interviewed in Malawi, 14 (33%) of them stated that their period impacted negatively on school attendance. Many girls (62%) reported that they were not able change their menstrual cloth, cotton wool or pads at school because of various reasons, including lack of privacy and hygiene facilities. Clearly for these girls, the
68 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi school toilets were unfriendly to their needs and hence inappropriate. Most of them said that they went home to change their sanitary wear, while others went to change at community toilets, or in the bush. This means that the girls lost most valuable school time as they sought for the ‘changing places’ that would be appropriate for their needs. Consequently, then, they were likely to lag behind in schoolwork and hence the potential of them eventually performing relatively poorly cannot be ignored.
Again, out of the 42 girls interviewed in Malawi, 29 (69%) recommended the construction of bathrooms, which would make schools more suitable for girls during their periods. Eight (8) of these girls (19%) indicated that the provision of feminine hygiene materials such as cotton wool or pads was a necessity. These recommendations make sense in the context of the finding that more than half of the girls from Malawi (59.5%) reported having soiled their clothes at school.
When girls were asked how helpful teachers were when girls soiled their clothes, five girls did not answer the question, of the remaining 37, 60% said that teachers gave them cloth to cover the soiled clothes, 22% said the teachers sent them home, 7% said teachers were not helpful, and 5% said teachers told them to get cloth from friends.
GIRLS’ APPRAISAL OF PUBERTY EDUCATION AND FEMININE HYGIENE INTERVENTION
Most of the girls rated the puberty education and feminine hygiene project as worthwhile claiming that they learned new things about their bodies, which they did not know before the project had been implemented. They said that the new knowledge in conjunction with the provision of feminine hygiene pads helped increase their confidence and ability to manage menstruation and related hygiene matters. In Kenya for instance, 79.2% of the Test Group of girls strongly agreed that they had gained better understanding of puberty issues. Nearly half of them (45.7%) said they were less afraid of their next
69 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi period because they had gained knowledge about what happened to their bodies during puberty.
In Malawi, the girls’ responses regarding the impact of the education and training they received on puberty and feminine hygiene issues were notably positive as presented in the set of tables below. More than 80% of the girls agreed either moderately or strongly that the programme offered new knowledge about their biological changes at puberty. And slightly less than half of the girls (43.5%) were of the view that the education session they received had taken just about the right time to generate the effects, which they described, as positive. Even though girls were not asked to suggest how the programme could be enhanced, the feedback they gave provides insights about the perceived impact.
Table 4.10a: Learned something new from the programme % Strongly agree 68 Somewhat agree 16.9 Neither agree nor disagree 5.6 Somewhat disagree 5.6 Strongly disagree 3.8
Table 4.10b: Programme helped better understand body changes % during puberty
Strongly agree 78.8 Somewhat agree 18.4 Neither agree nor disagree 1.6 Somewhat disagree .9 Strongly disagree .3
Table 4.10c: Programme helped understand body functions % during period Strongly agree 74.1 Somewhat agree 22.2
70 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
Findings from Kenya resonated the Malawi findings, giving unequivocal indication about the girls’ positive perception regarding the value derived from the feminine hygiene and puberty intervention programme. Even across the Kenyan regions of Garissa and Nairobi, both Test Groups of girls agreed strongly that the programme helped them to be more confident about themselves during the menses. Notably, 96% of the girls from Garissa compared well with 96.5% of the girls from Nairobi regarding the value of the project. Further, only 4.0% and 1.4% respectively of the girls from Garissa and Nairobi felt that they did not gain much from the programme.
4.10d: Programme Helped Girls to be More Confident –Garissa and Nairobi Agree Disagree Neither Agree Nor Disagree Total Count 166 7 0 173 Garissa Test Group Percent (%) 96.0 4.0 0.0 100.0 Count 139 2 3 144 Nairobi Test Group Percent (%) 96.5 1.4 2.1 100.0 Total Girls In Test Count 305 9 3 317 Group Percent (%) 96.2 2.8 0.9 100.0 Source: ‘I Feel That The Programme Helped Me To Be More Confident’ of the Post-Puberty Education Questionnaire
CONTROLLING FOR EDUCATION AND SANITARY PADS
Controlling between the first and second post-test was not effectively done as the questions requiring the girls’ responses were not maintained in the tests. Only items in the initial survey and the second post-tests seemed to have been retained for purposes of measuring the impact of the pre-project stage and the two intervention stages. Hence, the answer to the question of whether education alone –in the absence of the ‘Always’ pad –yielded any significant results may be deduced from only three (3) items which were presented to the girls in a consistent manner (wording and apparently, the entailed meaning) during the first and second post-test. Even then, this comparison of post-test 1 and 2 is not viable for the Malawi girls whose data is inaccessible. (See the following items cited) 1. I feel the programme helped me to be more confident (post test 1 & 2) 2. I can better manage my period now (post test 1 & 2)
71 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi
The other closest item that solicited for the girls’ responses was on whether the girls were afraid of their next period. However, this item fails to yield a viable comparison for post-test 1 and 2 because conceptually the item is phrased differently in the two tests as shown below15. 1. Post-test 1 –after puberty education. I am less afraid of my next period because I know what is happening to my body 2. Post test 2 –after combining puberty education and sanitary pad. I am afraid of my next period
Results of post–test 1 and 2 on: I feel the programme helped me to be more confident
Clearly, the extremes of ‘strongly agree’ and ‘strongly disagree’, which had appeared in the first post-test, are not available in post-test 2. However, it is clear that the combination of education and sanitary pads made the girls more confident than education on its own. Their verbalised reasons through interviews and group discussions are captured elsewhere in the earlier sections of this report
Table 4.11a: Programme Helped Girls to be More Confident – Test Groups Garissa and Nairobi
Post test 1 Strongly Agree Neither Disagree Strongly Total (Education only) Agree agree/ disagree % Disagree Garissa 50.25 23.86 6.09 6.60 13.20 100 Schools Nairobi 51.57 35.86 3.77 5.03 4.40 100 Average 50.84 28.93 5.90 5.90 9.27 100
Table 4.11b: Programme Helped Girls to be More Confident – Test Groups Garissa and Nairobi Post test 1 Agree Neither Disagree Strongly Total (Education + Pads) Strongly Agree Nor disagree % agree Disagree Garissa ---- 96.0 0.0 4.0 ---- 100.0 Schools Nairobi ---- 96.5 2.1 1.4 ---- 100.0 Average ---- 96.2 0.9 2.8 100.0
15 Essentially the two items are requiring conceptually different processes of appraising their the girls experience of fear with regard to the project interventions. Being less afraid and actually being afraid measure two different states of being and hence are not comparable as measures of impacts in post-test 1 and post-test 2.
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In Tables 4.11a and b, we note that in post-test 2, nearly all the Kenyan girls (over 96%) agreed that the combined intervention programme had made them more confident about themselves compared with just about three quarters in post-test 1 who strongly agreed or agreed on the same.
Results of post–test 1 and 2 on: I can better manage my period now
While data from Post-test 1 indicated that 78.9% of the Kenyan girls agreed puberty education enabled them to better manage their period, in Post-test 2, this proportion of girls rose by more than 10 percentage points to 89.9 of the girls who agreed that the combination of education and provision of the ‘Always’ sanitary pad.
Table 4.12a: Better Able to Manage Period – Overall Test and Control Group Agree Disagree Neither Agree Nor Disagree Total
Test Group (%) 89.9 6.9 3.2 100.0
Control Group (%) 45.8 49.3 4.9 100.0
Total (%) 66.9 29.1 4.1 100.0
Better able to manage period
120 100
80 Test Group (%) 60 Control Group (%) 40 Total (%) 20 0 Agree Disagree Neither Agree Nor Total Disagree
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CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
General conclusions In both countries, it was confirmed that knowledge about puberty and menstruation served as the foundation of appropriate understanding of sexual health and feminine hygiene issues. Hence, the education on puberty and feminine hygiene helped to empower the girls in the two countries who claimed to better understand and respond to what was happening to their bodies as they navigated the journey through puberty towards adulthood.
The fact that menstruation may temporarily or permanently disrupt school attendance, participation and performance among the menstruating girls means that, girls who miss school because of menstruation are actually not learning equally with the peers who attend school regularly. Consequently, the girls’ absence impacts negatively on their performance and general feeling of confidence and self esteem.
The study findings from both Kenya and Malawi have shown that menstruation and its accompanying physical, social, and psychological effects on the girls was bound to results in major impediment on the girls’ education. The strong evidence which portrayed the multi-faceted intervention of puberty education coupled with provision of feminine hygiene pads provides a viable basis for advocating and supporting the improvement of girls’ schooling through programmes that address the challenges they face due to menstruation and puberty related concerns.
Through their responses, the majority of girls from both Kenya and Malawi confirmed that the project was a success in enabling them to manage their lives while menstruating and negotiating the demands of schooling and other activities within and outside the school. This change in the girls’ lives would inevitably help in improving
75 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi their school attendance, participation and performance. However, in the absence of reliable data on the patterns of class performance, attendance and participation, it would be presumptuous to make concrete and reliable conclusions that transcend the reported impressions and perceptions by both the girls and their teachers.
In Kenya, statistical tests on correlations using the Pearson Chi-Square indicate that there the perceived relationship between the intervention of education programme and the reported increased levels of confidence or the girls ability to participate actively in class was not significant. However, the same test showed significant relationship between the girls’ reported ability to manage the period (a possible consequence of the intervention programme) and their reported ability to concentrate in class and participate actively. This implies that regardless of how girls interact, perceive or interpret the value of the intervention programmes, which address their pubescent issues, it is the enhancement of their capabilities to be in control of their periods that is likely to make a positive impact on their schooling in terms of attendance, participation and possibly performance.
Specific conclusions First, the findings suggest strongly that education on puberty issues and improved skills on feminine hygiene result in marked increase in the girls’ knowledge with regard to managing their menses and improving their attitude towards dealing with menstruation while at the same time engaging with other activities including schooling. The fact that in one instance a comparatively larger proportion of girls Control Group girls from Nairobi claimed to have increased knowledge even without being exposed to the project intervention suggests ‘leakage’ of the project intervention because possible weaknesses in the control aspect of the project design. Nonetheless, in terms of human rights, it was necessary for the project to have made a provision at the end of the study to expose the control group of girls to similar treatment and experience (education and sanitary pads) as their Test Group counterparts. All the girls need at least the puberty and feminine hygiene education.
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Second, the impact of the project intervention activities on the girls who have reached menarche is indisputable considering that reports from the girls and from the teachers indicated increased confidence, improved school attendance, increased class participation, improved participation in physical activities and increased motivation to learn. Further, there was expressed feeling of improved sense of security and decreased fear of encountering the period among the majority of the Test Group girls encountered during various forms of undue anxieties.
Third, the combination of puberty education and supply of sanitary pads was identified as a major factor that was linked to the perceived increase in school attendance, participation and performance of the girls in class activities where they majority of the Test Groups girls were able to stand up and answer questions without fear of ‘accidents’ from their period. The Test Group of girls also reportedly increased their physical activities such as doing PE, games, playing among others while on their period. This kind of evidence, supports the view that given the right education and practical means of responding to their period, girls are capable of taking up equal chances with the boys both in the school and outside.
Fourth, cultural and religious beliefs and practices that are hinged on female sexuality, have emerged as key in inhibiting girls’ ability and/or willingness to attend school and participate in the learning activities freely. These cultural factors are considerably strong as noted among the girls from Garissa, whose interaction with the project resulted in comparatively lower positive results compared with those from the girls in Nairobi or Malawi. In such cases therefore, education on puberty and feminine hygiene alone may not yield the required impacts unless it is combined with education that possibly addresses cultural issues on girls’ sexuality and puberty. This kind of educational and practical approach which should not only focus on the girls alone but also on the community, is likely to prepare future generations of girls who are positive about the naturalness of puberty and its accompaniments of womanhood and which are consistent with the career of schooling.
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Fifth, even though the project did not incorporate the issue of period pain as a major factor that interfered with girls’ engagement with schooling, it nonetheless emerged as a dominant agenda in the girls’ discussion, which could not be ignored or wished away in the reporting of findings. Because approximately three quarters of the girls reportedly experienced severe period pains, it is logical to suppose that some of them may have opted to stay away from school to nurse the pain if they could not afford doses of painkillers. Hence, focusing on education and provision of feminine hygiene pads per se while ignoring the impact of period pain on the girls’ schooling may not help in acquiring the required results of ensuring that girls who are menstruating attend school regularly, participate effectively and perform comparably well among their peers.
Sixth, it is clear that the community members, especially ‘Mother Group’ members and grandmothers, including female peers formed a critical mass of informants and confidantes of the pubescent girls with regard to menstruation. Hence, involving and empowering this group of community and family duty bearers as well as female peers with pertinent knowledge and skills could enhance greatly the much-needed support of the girls during the onset of puberty and the ensuing challenge posed by menstruation.
Finally, the findings of this project should be treated as exploratory with the emergent insights forming the foundation for pursuing more comprehensive data on the actual impacts of education and feminine hygiene products on the schooling of girls. This would enhance the existing documentation of perceived educational impacts particularly on key educational gender equity targets articulated in the EFA goals and MDGs.
Recommendations
The following recommendations are derived from the conclusions of the study project and supported by the study findings from Kenya and Malawi.
There is need for girls to receive explicit, correct and relevant information on matters of puberty and menstruation through formal and non-formal channels that should include schooling. Such information should aim at
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enhancing girls’ confidence in themselves during menstruation, their self- esteem, physical and emotional comfort. Feminine hygiene and the provision of sanitary towels should be encouraged as part of good practices in schools with government and development partners being involved to support the practice through relevant policies. Response to period pain requires due attention aimed enhancing the impacts of puberty education and provision of sanitary towels where applicable and ensuring that menstrual pains do not keep girls away from school or other pertinent activities. The provision of sanitary pads should be done with consideration that girls would inevitably need proper underwear to secure the pad in place and that for some families may not afford to buy girls any/adequate underwear. Adequate water and sanitation facilities that are designed with privacy in mind and which are girl-friendly should be part of the school infrastructure to support the puberty and feminine hygiene education As the relevant arm of any state government, the Ministry that deals with Education, often the Ministry of Education, needs to be brought on board in all interventions that seek to impact on the educational outcomes of children and young people; not in the least interventions on puberty and feminine matters. Teachers, both male and female, should be capacitated on feminine hygiene issues and puberty education so as to empower them in supporting pubescent girls when needed. Schools should be encourage to organize regular guidance talks by trained personnel for girls on matters of menstruation, puberty and feminine hygiene whereby girls can have the chance to ask questions that they may find difficult to ask heir mothers or teachers Education that challenges oppressive cultures that hurt the girls should be designed and implemented in sensitive ways at community levels.
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Addendum recommendations from Evaluation Report There was clear indication that despite the usefulness of the findings, the data upon which these were generated was of a relatively superficial nature and so this affects the confidence with which conclusions are made on the overall impacts of this programme. There are however a number of positive conclusions which may be drawn as well as a series of difficulties which should be underlined, in order to guide further research on this matter. o It is without doubt that participants grew in confidence over the course of the programme. Self-assessed knowledge levels of puberty and menstruation improved markedly while attitudes to puberty and menstruation demonstrated greater self-confidence. These are certainly positive outcomes. o Important data is also gathered in terms of the practice of girls during their period. Cloth is the dominant material used by girls during menstruation and so sanitary pads represent a break with convention. While data gathered on the use of pads is disappointingly inconclusive this does demonstrate that promoting the use of appropriate pads in the interest of improved feminine hygiene must take place in a context where cloth is the established norm. Perhaps an emphasis needs to be placed in future on maximizing the hygienic use of cloth. Good hygiene behaviour with cloth is already evidence from the schools baseline as participants stated that they bathed and washed clothes frequently during their period. o Some basic data is also collected on school absenteeism during menstruation. It underlines that this is a real and serious issue with a significant number of girls liable to miss at least one day’s schooling each month, even with access to the ‘Always’ pad. The data collected at the baseline also raises a number of interesting issues that unfortunately were not followed upon during the pre-test and post-test. These include why girls miss school and what could be done to ensure their continued attendance. While the data is by no means conclusive it does raise issues for further research and consideration. o The community baseline data also has some significance. While it is far too small a sample to have a statistical impact, it does raise issues of cultural beliefs and
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how they may impact menstruation based school absenteeism. It also explores the kind and level of information on menstruation, which parents and community members give to young girls. Combined with data on which girls like to receive information from, more detailed data could identify ideal candidates for community-based trainers. o However there are significant gaps in the data, which inhibit the drawing of firm conclusions. Greater confidence and self-assessed knowledge levels do not equate to actual knowledge on puberty and menstruation and do not necessarily reflect improved female hygiene practices. By not collecting adequate data in these areas means that the research design did not achieve some of its most fundamental objectives. This is unfortunate and flags the need for greater care in future. o Another particular difficulty is the poor quality of the data collected at the post- test stage on the use of materials during menstruation. The data is inconsistent and lacks the necessary depth to properly analyse the impact of training and encouraging participants on the use of sanitary pads. For example no data was collected on participants’ actual experiences using the pads. It may be possible to conclude that most participants still use materials such as cloth and cotton wool although they have experimented with the towels they were given. But such a hesitant and general statement is not sufficient in a project where the promotion of appropriate sanitary pads was part of the overall objective. o Data on school absenteeism is not rich enough despite promising aspects in the baseline survey. While it is apparent that the self-assessed knowledge of participants has no particular relationship with absenteeism, this data reveals little else, as the menstruation/absenteeism dynamic was not probed in the depth required. o It is apparent that there is a need for capacity building in the design of research studies and also in data collection procedures because, while there are positive elements in the overall research design, ultimately the surveys lacked depth and consistency. Furthermore the data collectors did not enjoy adequate experience, a weakness that would undermine even the use of strong methodologies.
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o In summary the data collected is not as thorough as might be hoped for evaluating the programme. The participants were certainly positive about the experience and are eager to develop their knowledge further. This much is a testament to the benefits of the programme. However the overall strengths, weaknesses and impacts of the programme were not adequately captured by the data and this limits the extent of conclusions. However,
1. There is strong evidence that the programme has enhanced the confidence of participants on issues of puberty and menstruation. It therefore shows potential to be scaled up and integrated within broader hygiene education initiatives, either through water/sanitation interventions or through the Life Skills curriculum. It is recommended that any such programme be reconsidered in light of the below recommendations and re-piloted accordingly. 2. Greater analysis of the menstruation and school absenteeism dynamic is required. Feminine hygiene certainly plays a role but not enough is known about this or how it relates to other determining factors. Such knowledge would positively influence the design of future programmes and strategies. Before any definitive conclusions can be made about the promotion of sanitary pads, comprehensive data must be collected. In particular, issues of facilities, existing practices, and privacy, the presence of male students and the advice of authority figures should be considered. 3. In future, emphasis must be placed on objectively measuring changes in the participants’ levels of knowledge. Attention should also be paid to how any changes in knowledge have impacted upon the life of the girl in terms of hygiene levels, school attendance, and so forth. In the evaluation of future programmes it is strongly recommended that objective measures of knowledge be designed and implemented. 4. Greater focus must be placed on the actual experiences of using pads as very little is known about why participants did or did not use the pads. Such information would be crucial to informing future strategies. It is recommended that further data be collected to fill in these substantial gaps in knowledge. 5. There is an urgent need for capacity building amongst the partners in research design. There are particular weaknesses in linking research design to the overall
82 ______Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi objectives of the programme to ensure that the data being sought will provide the answers and information required. It is recommended that all partners receive specific training in the development and implementation of research projects before any future project. 6. Data collection is also an area in need of capacity building. Data collectors not only require training but extensive support throughout the data collection process to ensure that they are capable of fulfilling their duties. It is recommended that data collectors not only receive comprehensive training but that in future, a project supervisor is appointed specifically to support data collectors throughout the process. 7. Project management capacity must also be inbuilt, both within UNICEF and implementing partners. Strong monitoring and evaluation procedures throughout the implementation of research projects must be implemented so that challenges are identified and resolved during the process rather than noted at the conclusion. 8. Future programmes and data collection must place the participation of girls at the centre. They must not be passive recipients but rather active agents in the design, implementation and evaluation of programmes, which are intended to benefit them. It is recommended that all proposed programme and research designs be first evaluated for how participatory they are. 9. It is recommended that greater participation also be sought from the community. Members of the community clearly have an influential role in teaching and advising girls on menstruation. Obtaining greater knowledge on this can inform the development of future programmes and strategies that can engage community members as trainers. In particular, understanding is required of knowledge levels within communities and the roles of cultural beliefs and practices in shaping the experience of girls during their period. 10. It is strongly recommended that the experiences of teachers, particularly male, in conducting information sessions and handling issues surrounding menstruation be considered. Teachers play an important role in the treatment of girls during their period and so how this relationship can be used to support the girl child must be explored.
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APPENDICES Appendix 1 Pupils Questionnaire For The Baseline Survey
Pupils’ Questionnaire
Questions to be asked:
Step 1-Pre-attending the puberty education programme
School ______Class ______
1. Age in years +months______
2. Have You Had Your Period? (Tick the correct answer) Yes No
3. Who gave you first information about menstruation? (Tick all that apply) Teacher at school Doctor/gynaecologist Nurse School clubs Friend Mother Sister Aunt Grandmother Articles in newspapers/magazines Other
4. How would you rate your knowledge about puberty? (Tick the correct answer) Poor Fair Good Very Good Excellent
5. How would you rate your knowledge about menstruation? (Tick the correct answer) Poor Fair Good Very Good Excellent
6. How much do agree/disagree with the following statements? (Choose the appropriate number that agrees with your answer) 1. Strongly 2. Somewhat 3. Neither Agree Nor 4. 5. Agree Agree Disagree Somewhat Strongly Disagree Disagree
I feel insecure during my period Period days are like any other day – I do not feel any difference
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I prefer staying at home and not go out during my period During my period I feel less self-confident than during other days During my period I avoid physical activity I am afraid of my next period I wish I would know more about my period
7. How many days of school did you miss in the past three (3) months because of problems related to menstruation?......
8. What do you use during menstruation? (Tick all that apply) Cotton wool Cloth Toilet paper/tissue Sanitary pads Tampons Pantiliner
9. Which of the following issues, if any did you experience during your last period? (Tick all that apply)
Skin irritation / rashes to the body Pain Felt insecure Panty soiling Outside garment soiling Sticky/sweaty feelings Wet feeling Unpleasant intimate odour Headache Cramps/stomach pains Boating/tenderness/swelling Back pains Irritability/moodiness Depression Did not have any issues during the period Other……………………………………………………………………………………
Appendix 3: Pupils Questionnaire For The Findings Survey
Pupils’ Questionnaire
Questions to be asked: Step 2-Having Attended The Puberty Education Program:
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1. How much did you like the puberty information session overall? (Tick the correct answer) Extremely Well Very Well Somewhat Slightly Not at all
2. Which part of the puberty information did you like best? …………………………………………………………………………………………………… 3. Which part of the puberty information session did you like least? …………………………………………………………………………………………………… 4. How much do you agree/disagree with the following statements? (Choose the appropriate number that agrees with your answer) 1. Strongly 2. Somewhat 3. Neither 4. Somewhat 5. Strongly Agree Agree Agree Nor Disagree Disagree Disagree The program helped me better understand what is happening during puberty The program helped me better understand what is happening during my period I learned something new from the program I already knew everything that was said during the program I am less afraid of my next period because I know what is happening in my body
5.How much do you agree/disagree with the following statements? (Choose the appropriate number that agrees with your answer) 1. Strongly 2. Somewhat 3. Neither 4. Somewhat 5. Strongly Agree Agree Agree Nor Disagree Disagree Disagree I feel that the program helped me to be more confident Period days are like any other-I do not feel any difference I can better manage my period now I feel I don’t need to stay at home and not go out during my period During my period should not avoid physical activity I am not afraid of my next period I wish I would have had this lecture before
6.How do you rate the duration of the program? (Tick the correct answer) Too Long Slightly long Just right Slightly short Too Short
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Appendix 4: Pupils Questionnaire For The Final Survey
Pupils’ Questionnaire
School ______
Age ______Class ______
Step 3 – 2 Months after having participated in the puberty education program
1. How would you rate your knowledge about puberty? (Tick the correct answer) Poor Fair Good Very Good Excellent
2.How would you rate your knowledge about menstruation? (Tick the correct answer) Poor Fair Good Very Good Excellent
3.How much do agree/disagree with the following statements? (Choose the appropriate number that agrees with your answer) 1. Strongly 2. Somewhat 3. Neither Agree 4. Somewhat 5. Agree Agree Nor Disagree Disagree Strongly Disagree
I feel insecure during my period Period days are like any other day – I do not feel any difference I prefer staying at home and not go out during my period During my period I feel less self-confident than during other days During my period I avoid physical activity I am afraid of my next period I wish I would know more about my period
4.How much do agree/disagree with the following statements? (Choose the appropriate number that agrees with your answer) 1. Strongly 2. Somewhat 3. Neither Agree 4. Somewhat 5. Agree Agree Nor Disagree Disagree Strongly Disagree
I feel that the program helped me to be more confident I feel that I can concentrate more in class I can better manage my period now I feel that I can stand up and participate in the class with no fear
5.How many days of school did you miss in the past 3 months because of problems related to menstruation …………………………………………………………………………………………………… …
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6.Did you use the Feminine protection pads you received during the puberty education programme? (Tick the correct answer) Yes No
If not, please explain …………………………………………………………………………………………
7.How many pads did you use in total? ……………………………………………………………………….
8.Did you use all pads for yourself or did you share with anybody? (Tick the correct answer)
Used All For Myself Shared With Others
9.What type of feminine protection did you use before receiving the sample? (Tick all that apply) Cotton wool Cloth Toilet paper/tissue Sanitary pads Tampons Pantiliner
10. If Used ‘Always’ for the last period, how did you find the product absorption and protection? ………………………………………………………………………………………………… ………………..
Did you have any issue in disposing the product? Where did you dispose it? ……………. ……………………………………………………………………………………….
11. Which of the following issues, if any did you experience during your last period? (Tick all that apply)
Skin irritation / rashes to the body Pain Felt insecure Panty soiling Outside garment soiling Sticky/sweaty feelings Wet feeling Unpleasant intimate odour
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Headache Cramps/stomach pains Boating/tenderness/swelling Back pains Irritability/moodiness Depression Did not have any issues during the period Other Appendix 5: Extracts from the FGDs- Girls in Garissa
Before you started your menstruation, what did you know about it? Boys Town: [A] teacher mentioned it in the science class and my mother once talked about it to my sister and I overheard Umul-Kheir: [A] teacher mentioned in class Yathrib: Science Lesson Sankuri: My teacher and also from mother Nasiib: Science lesson in Class 6 and [my] sister Young Muslim: Mother, elder sisters and aunties, then in science lesson Kazugo: Science teacher During your first period what happened to you? Boys Town: Was very shy and got scared to tell my mother about it Boys Town: [I] cried Umul-Kheir: [I] soiled [my] dress in class and a fellow pupil went running to teacher saying that there is someone in class with Rift Valley Fever [because of the blood oozing out from all orifices] Yathrib: [I] was shy] Yathrib: [I] cried because I thought I was sick Sankuri: Asked for permission to go home because I soiled my dress Nasiib: Just sat in class the whole day and told my friends who told my teacher who helped me Young Muslim: Went with a friend to the head teacher to ask for sanitary towels Young Muslim: Told my elder sister who I knew had started her periods Kazugo: Was very shy and never wanted anyone to know about it, but eventually my mother [asked me about it] because she saw me using rags
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Tumaini: Was at home that day and I opted not to go to school, then my mother asked me why I was not preparing for school and I feigned sickness During menstruation, my concentration in class is low. Is this true? Sankuri: Yes. There are no toilets for girls in school and you to hold from 7.00a.m. until 10.00 a.m. when you get to rush to [the dormitories] Sankuri: [I am] scared of soiling my dress for fear of [being] laughed at by [the] boys Nasiib: Yes. Fear of the piece of cloth or rag falling off and soiling my dress Young Muslim: Yes. [Because of] attention from boys and fear that they will notice I’m wearing something down there Yathrib: Yes. Because of boy’s attention and also wondering if my dress is soiled Yathrib: Yes. I feel sick [during menstruation] Boys Town: Yes. My concentration is normally low because of abdominal pains and discomfort, [making] me loose focus in class Boys Town: [I] do not have proper hygienic materials to guarantee that I do not stain [my dress]. [I] only have cloth or rags or mattress cuttings Hyuga: I feel very shy in class in case everyone will notice that I have my periods and the boys will laugh if they see [stains] on my dress I did not want my parents, especially my father, to know that I had started menstruating. Is this true and why? Kazugo: I feel very shy towards talking to my father Boys Town: Only a mother or aunty should be told that I have started [menstruation] Boys Town: I can tell my mother or my aunty but I feel shy to tell my father Hyuga: My mother can ask my father for money for sanitary towels for me Hyuga: I cannot tell my father I have started my periods because it may be that I will have to leave school [to get married] Young Muslim: My father can know I have started my periods because I will ask for money for sanitary pads if he can afford Yathrib: It is not good for [males] to know that [you] have started [menstruation] Nasiib: I do not talk much to my father How do you help a friend who has soiled her dress during class and needs an extra pad?
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Yathrib: I would look for a pad from a teacher in the staffroom Umul-Kheir: I would look for a pad or a piece of cloth as the girl cleans herself in the latrine, then she can ask for permission to go home Umul-Kheir: [The girl] can use the long piece of cloth they put on to cover the stain and then ask for permission to go home Kazugo: The girl can go to the teacher to get a pad then can ask to go home Young Muslim: Can ask for a pad from any female teacher in the staffroom Boys Town: If the dress is soiled, the girl can cover the stain with a long piece of cloth Tumaini: The girl can clean herself then ask a teacher for permission to go home Recently, two girls shared their story with a teacher/counselor. One girl who has undergone circumcision said that her period lasts between 2-3 days and she is comfortable during her menses. However, the other girl reported that after her circumcision, her periods last longer and are more painful. When the teacher asked her why, she said it is because of circumcision. Which girl do you agree with? There was general consensus that if a girl is not circumcised, there is ample space to allow blood to pass through, unlike when circumcised, the blood flow is very light and most of it clots inside, hence a lot of pain and long-lasting periods. Majority of the girls from the schools said that they had undergone circumcision. If you were the head teacher of your school, which, from the following list, would you give priority to first? The answers in all schools were unanimously agreed upon as follows: 1) Stocking sanitary towels in the school to stop absenteeism from school every month 2) Allow girls to answer questions while seated to avoid embarrassment in case of soiling one’s dress 3) Ensure plenty of water to allow girls to clean themselves when they soil their dresses instead of going home 4) Ensure that the girls toilets are far from the boys to allow for privacy 5) Ensure that there are disposal bins and incinerators for disposing used sanitary towels
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6) Ensure that there are remedial classes for the girls who miss class because of menstruation Appendix 6: Extracts from the FGDs- Teachers in Garissa
How do you prepare girls for puberty before its onset? Boys Town: Rarely discuss menstruation with pupils and is mainly tackled in science classes Umul-Kheir: The girls learn about puberty through the science subject, especially about the changes they go through, both emotional and physical Yathrib: It is tackled in the science subject, especially the changes involved in adolescence Hyuga: Discussed in the science class Sankuri: This being a school with only male teachers, it is not easy to approach the topic, but is mentioned in science class Nasiib: [Through] meeting with the girls once every week to discuss issues affecting them. Nasiib: Discussed in the science subject Young Muslim: Normally, the female teachers meet the girls every Friday. Kazugo: Initiative teaching for one week where girls and female teachers discuss issues affecting them in science lessons. Tumaini: Discussions are done during the science lessons Having interacted with girl pupils in your class for some time, are you able to identify girls who are having their periods in class just by observation and if so, how do you tell? Boys Town: Yes, it is possible to tell when a student is in her [period] days and assist where possible by giving both emotional and psychological support. It is also evident that when most girls reach upper-primary classes, they perform poorly as compared to when they are in their lower classes. Umul-Kheir: Yes. There is a time of the month that a [girl] pupil will always come to ask for permission to go home. [Also because of the girls] having mood swings and
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not going for [Physical Education] giving excuses that they are sick and opting to remain in class Yathrib: Yes. [The girls] start having excuses to go home because of sickness once every month. Sankuri: Yes, as the girls will be frequently absent and do not want to participate in class Nasiib: Yes. [The girls] feign sickness and loose interest in class work and absent themselves from class Young Muslim: Yes. Girls [will not be] active in school and there is minimal movement as the girl prefers to stay in one position. Hyuga: Yes. The girls make excuses to go home due to illness once every month’ Tumaini: Yes. A girl looks withdrawn and also lacks empowerment and [her performance] declines Kazugo: Yes. The girls [feel free] to come and ask for sanitary towels in the staffroom, though at times when the pain is unbearable, they ask for permission to go home Do both male and female teachers give the same level of support to girls during their periods? If no, please highlight the different areas of support. Sankuri: Being a male dominated school, including the PTA/SMC members, girls do not associate so much with their teachers and the only support they give to the girls is to encourage them to work very hard in their academics Nasiib: Male teachers feel that it is a female role Yathrib: There has not been that level of assistance as the pupil-teacher relationship is not substantial Hyuga: The girls appear to be very shy and do not open up to the teachers Umul-Kheir: Female teachers feel that some of the male teachers hardly take care of their women at home, so can not [be expected to then] support the girls Umul-Kheir: Male teachers believe it is the role of female teachers to support the girls Kazugo: Male teachers do not involve themselves in female issues. They feel it is a female role to guide the girls during their menses.
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Kazugo: Girls are very shy towards their male teachers and are even shy to receive sanitary towels brought by well-wishers from male teachers Tumaini: Both male and female teachers assist the girls by encouraging them on the importance of academics and also meeting with the girls occasionally to advise them Young Muslim: Both male and female teachers assist the girls in different capacities. For example, the Head Teacher, who is male, is in charge of issuing sanitary towels, received from well-wishers, to the girls and when there are none available, he buys the girls some. Female teachers will occasionally meet with the girls to empower them and encourage them to work hard in school Boys Town: Female teachers support the girls more than male teachers and some will even buy sanitary towels for the girls and give them additional information on sexual maturation. Pupil-teacher interaction, however, is low From your own experience, is there any significant difference in participation in class for girls during their periods? How do you help such girls? Umul-Kheir: There is a difference. Girls prefer answering questions while seated and their level of performance declines. We then encourage the girls by taking them to the latrines to help them clean themselves if they have soiled themselves, or giving them permission to go home Sankuri: Participation in class is minimal [during girl’s menstruation]. Girls in the school normally rush [to the dormitories] every time there is a break to visit the toilets, because there are hardly any girls’ toilets in the school. We encourage the girls by separating them from boys Boys Town: There is a big difference in class concentration and [the girls] tend to stay aloof. However, pupil-teacher interaction is so poor, so rarely do anything Tumaini: The level of performance declines and the girls retain their answers though when pushed to answer are correct but have no confidence in themselves. Try to motivate the girls and ensure that they compete with the boys Hyuga: The girls in the school lack empowerment during their periods. However, we try the best we can to motivate them and ensure they compete with the boys at all times
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Yathrib: A girl will resist standing up while answering questions. We normally understand and encourage her to answer the question while seated Nasiib: The girls are very withdrawn and shy. Try to encourage the girls to open up, but most are from very poor backgrounds and lack confidence to come to the teachers except when they soil their dresses Young Muslim: The girls become a bit more withdrawn during their periods. However, the girls are open enough to come to the Head Teacher, who they refer to as ‘Cucu’ (meaning grandmother), because he is very free with them. Also, the girls have support from role models who occasionally come to talk with them about empowerment and working hard in school Kazugo: The girls do not participate in activities when they have their periods. However, we try to help the girls when she soils her dress and guide her on how to wash the stained garment and allow her to go home if need be How do you ensure that the parents of the girls provide sanitary towels for their daughters? Boys Town: The school has majority of the pupils coming from very poor backgrounds and most parents are ignorant and don’t care much about their daughters, so it is difficult to approach a parent and advise him or her on what to do for their daughters Umul-Kheir: Most of the parents have no viable economic means to even provide for food, so how do you ensure that such a parent buys the girl sanitary towels? It is not possible. Yathrib: Parents are poor and some don’t attend the meetings we call for. Sankuri: Most of the girls do not have very close relationships with their parents at home and is difficult to discuss issues affecting the girls Hyuga: Most of the parents are very poor and cannot afford sanitary towels for the girls Nasiib: Most parents live from hand to mouth, so it is difficult to talk to the parents about sanitary towels. They really struggle to make ends meet and even ask for permission every Wednesday for the pupils to accompany them to the market to help sell their wares
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Young Muslim: Every time we have a parents meeting, we sensitize them on the importance of taking care of their girls and providing them with sanitary towels Kazugo: Parents sensitisation is done during meetings and the response has been fair Tumaini: Poverty is a dominating factor and it is hard to talk to the parents about sanitary towels If you were the head teacher of your school, what items in the following list would you give priority to? Most of the schools answered in the following manner: 1) Sanitary towels should be stocked in the school 2) Girls should be allowed to answer questions in class while seated 3) Ensure that there is water in the schools which should be close to the latrines 4) Ensure that there are disposal bins and incinerators for disposing used sanitary towels 5) Ensure that there are recap classes for the girls when they miss class because of menstruation
Appendix 7: Extracts from the FGDs- SMC/PTA in Garissa
How many of you have daughters in Class 6, 7 or 8? Of the 2 women and 13 men interviewed from all the 9 the schools, both women and 7 men had girls in upper-primary. Considering the fact that your daughters have reached puberty, would you know whether they have started their periods and if so, how did you know? Male respondents argued that the culture only involves women in issues concerning their daughter’s upbringing and men only get involved insofar as education, marriage and moral upbringing Some men felt strongly that it is taboo for a man to discuss issues about their daughter’s maturation and menstruation Only 3 men said that their daughters feel free to ask for money to buy sanitary towels and thus they know that their daughters have started menstruation
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The women argued that sometimes when a girl starts her menstruation, she will not confide in anyone. However, they quickly get to know because they will notice that she will not say her prayers or read the Holy Koran and will keep off religious activities and thus they garner that she is menstruating Are there days when your daughter does not attend school because she is unwell during menstruation? What kind of preparations did you as a parent give your daughter before she began menstruation? The parents said that it is difficult to know if a child has missed school as a result of menstruation as some girls are not free with their mothers or the mothers will not discuss menstruation issues with their husbands or also because their culture does not allow a man to discuss such issues with their daughters It was noted that the girl are also closer to their female teachers than their mothers and as a result mothers hardly prepare their daughters for menstruation. A few girls depend on their elder sisters to teach them how to make a sanitary pad and how to wash it. How does your culture and environment prepare young girls for their menstruation? Which cultural issues do affect girl’s participation in education? Most mothers understand what menstruation is, but they hardly discuss it with their daughters because they do not know what approach to use Some cultural issues that affect girl’s participation in education include: Perceived superiority of the boy-child over the girl-child Marring off a girl after she has started menstruation as she is now considered a grown woman Infibulations caused by circumcision causing a lot of pain during menstruation Have you been called in by a teacher in the school to discuss issues or any problem affecting your daughter during menstruation? The respondents said no and it was evident that cordial relationships did not exist between parents and teachers How best can parents support their daughters during menstruation? The respondents said that parents, especially fathers, are very shy to talk to their
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daughters about menstruation, but the responsibility should be carried out by the mother and female teachers to give them relevant information to assist them during puberty If the head teacher of the school asked you to approve a budget to: implement the provision of sanitary towels in the school, the provision of more water and the addition of more female teachers in the school to assist training the girls in feminine hygiene issues, as well as the provision of disposal bins and incinerators for disposing used sanitary towels, would you approve the budget? The respondents agreed that they would approve the budget, but it would not be a priority as they lack the finances to do so. However, with the assistance of well- wishers, they would not hesitate to put in the projects. Appendix 8: Extracts from the FGDs- Girls in Nairobi
Before you started your menstruation, what did you know about it? Kawangware Primary: [It is] blood coming out from the vagina Jamuhuri Primary: It is [a stage of] adolescence Riruta HGM: It is a natural thing that happens to every woman and if you don’t receive it, then you are incomplete because you cannot have children During your first period what happened to you? Kawangware Primary: I was so shy and could not even face my mother to tell her [I had begun my periods]. Kawangware Primary: I thought I was urinating blood and told our house-girl who congratulated me and told me to stay away from boys because I could get pregnant any time Jamuhuri Primary: I was at home and told my mother about it and she gave me pads Riruta HGM: I had to stay out of school for that day because I had a lot of pain in my stomach During menstruation, my concentration in class is low. Is this true? All the girls said that they feel very shy because the periods can catch one unawares and one can they end up soiling the dress.
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Likewise, some girls said that they use tissue paper, which absorbs blood fast, and leaks soiling their clothing, making one loose confidence. Most of the girls also replied that they have low concentration in class because of discomfort from menstrual pains and also feeling that everyone is watching them and knowing that they are menstruating. I prefer to be absent from school during my periods. Do you agree and if so, why? Majority of the respondents would skip and afternoon class session or a whole day if they did not have sanitary pads or if the abdominal pains and back aches were very bad. I did not want my parents, especially my father, to know that I had started menstruating. Is this true and why? Kawangware Primary: Yes, because fathers sometimes can be very hard on you and could be having bad motives like sexual advances Jamuhuri Primary: [I would be] very shy and wouldn’t want to be embarrassed by telling my father that I have started my periods Riruta HGM: I do not mind my father knowing about it of which I am sure he does because whenever I ask for money to buy sanitary towels, he gives me without hesitating, because he understands Riruta HGM: It is uncouth to tell a father about my menstruation. It is only my mother who should know How do you help a friend who has soiled her dress during class and needs an extra pad? Kawangware Primary: I can accompany her to the toilet and help her clean the soiled dress and wait for it to dry Kawangware Primary: Can ask a female teacher for money for pads Jamuhuri Primary: Some [female] teachers can dig into their pockets to buy sanitary towels Jamuhuri Primary: Can use a cardigan to tie [around] the waist Riruta HGM: Some specific teachers are king enough to but sanitary towels for the girls
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Riruta HGM: [Can help the friend by] cleaning the soiled dress and using tissue to hold the flow of blood If you were the head teacher of your school, which, from the following list, would you give priority to first? A great majority of the girls responded as follows: 1) Stocking sanitary towels in the school to stop absenteeism from school every month 2) Ensure plenty of water to allow girls to clean themselves when they soil their dresses instead of going home 3) Ensure that the girls toilets are far from the boys to allow for privacy, especially because when the boys toilets are being cleaned, the boys are allowed to enter the girls toilets 4) Ensure that there are disposal bins and incinerators for disposing used sanitary towels *Most of the girls did not see the point of allowing girls to answer questions while seated, as this would make the boys suspect that there was something amiss and then of course they would be teased and feel inferior and discriminated upon. The girls felt strongly that menstruation is not a disease and if they could be provided with sanitary pads, then they would be as good as normal *The girls also did not see the point of repeating classes if they were stocked with sanitary towels and painkillers as they would then be attending classes all the time Appendix 9: Extracts from the FGDs- Teachers in Nairobi
How do you prepare girls for puberty before its onset? Kawangware: Through peer education when the pupils are grouped together, trained and learn from each other Jamuhuri: [The girls are] taught through science lessons and role-modelling Riruta HGM: Through guiding and counselling sessions where girls are taken aside in the field and talked to on issues affecting them
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Having interacted with girl pupils in your class for some time, are you able to identify girls who are having their periods in class just by observation and if so, how do you tell? All the teachers responded that it is possible to tell by observing their behaviour in class such as frequenting the toilet and being shy to answer questions in class and [looking] very uncomfortable Do both male and female teachers give the same level of support to girls during their periods? If no, please highlight the different areas of support. It was unanimously agreed that the male teachers do not do much at all and that it was a role for the female teachers From your own experience, is there any significant difference in participation in class for girls during their periods? How do you help such girls? It was agreed that there was a significant difference in class participation with girls being very shy in class with limited participation and movement in class, hesitating to stand up and having little to no interaction. It was also noted that most teachers try to understand, but some male teachers felt that they may not be very conscious of why the girl was behaving in such a manner and may punish the girl for indiscipline. How do you deal with issues of self-esteem and empowerment for girls who have been affected during puberty? How do you assist girls who soil their dresses during class sessions? Kawangware: During science lessons, we prepare the pupils through talking about the menstruation process openly and encourage them to understand that it is a normal process Jamuhuri: We assist the girls by purchasing pads for them once in a while and asking them to tie their pullovers [around] their waist if they have soiled their dress or giving them permission to go home Riruta HGM: During life skill week, a number of pupils are selected for training, and they then talk to their peers as they learn from each other How do you ensure that the parents of the girls provide sanitary towels for their daughters?
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The teachers explained that during parents meetings, they encourage parents to provide sanitary towels for their daughters and also to train the girls on how to take care of themselves. However, majority of the parents are very poor and live in the slum areas and cannot afford sanitary towels. The teachers added that it was quite necessary for sanitary towels to be provided in the schools, as it sometimes inconvenienced them greatly to buy sanitary towels for the girls in cases where they had only enough money for her bus fare home and she then has to then borrow money from her colleagues to get home If you were the head teacher of your school, what items in the following list would you give priority to? Most of the schools answered in the following manner: 1) Sanitary towels should be stocked in the school 2) Ensure that there is water in the schools 3) Ensure that there are disposal bins and incinerators for disposing used sanitary towels. The teachers strongly felt that incinerators would be preferable to disposal bins, which are misused and not emptied on time causing dogs to come in at night and litter them around the school compound. 4) Ensure that there are soaps and painkillers to make the girls stay in school and avoid asking for permission to go home by feigning sickness such as malaria 5) The teachers felt that it would be impossible to have recap lessons as they were already greatly overloaded and there would be no chance, in any case, as after the set lessons, there are other programmes such as games and clubs *The teachers did not feel that it would be conducive to allow girls to answer questions while seated, as this would encourage favouritism and the boys would be inquisitive as to why they are being discriminated upon. The teachers felt it would be more productive if girls are trained on proper use of sanitary towels to avoid leaks and soiled garments *The teachers further felt that girls and boys and girls are equal and should be treated the same in so far as where toilets are concerned with no separate toilets for boys and girls. They added that in the home environment, the girls and boys would not have separate toilets
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Appendix 10: Extracts from the FGDs- SMC/PTA in Nairobi
How many of you have daughters in Class 6, 7 or 8? Of the 4 women and 3 men interviewed from the 3 the schools, all but one had daughters in upper-primary. Considering the fact that your daughters have reached puberty, would you know whether they have started their periods and if so, how did you know? Male respondents said that the topic was sensitive and only taken care of by mothers, however the girls would occasionally ask for money to buy sanitary towels or cotton wool or write a shopping list including sanitary towels or cotton wool A parent said that his daughter missed school and when he inquired her mother as to why this was the case, the mother told him that she was having the ‘moon days’ for the very fist time The women said that it is possible to tell if the girls had started menstruation as there would be physical changes in the girl’s body. The female respondents added that some girls would shy away from the topic when asked Are there days when your daughter does not attend school because she is unwell during menstruation? What kind of preparations did you as a parent give your daughter before she began menstruation? A parent said that the very first time his daughter started her periods and she missed school because of pains in her lower abdomen, he learnt about it and gave her mother money to buy some painkillers and cotton wool Male respondents in general said that their daughters had not missed school due to menstruation and added that it was the mother’s role to prepare a girl for menstruation Female respondents said that daughters could be difficult to communicate with and that furthermore, they tended to learn things at an early age in school from their teachers and through watching television. The mothers added that they were also very busy with their jobs and hardly spent any time with their children
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How does your culture and environment prepare young girls for their menstruation? Which cultural issues do affect girl’s participation in education? The respondents said that the girls learn about the different changes in their bodies through books, magazines and television The respondents did not feel that there were any particular cultural issues that affected a girl’s participation in school, but said that the girls matured very fast and were exposed to sex at a tender age, with high drop-out rates amongst girls due to early pregnancy Have you been called in by a teacher in the school to discuss issues or any problem affecting your daughter during menstruation? All respondents said that they had not been summoned to discuss issues affecting the girls during menstruation, but that during parents meetings, they are encouraged to take care of their girls and provide them with sanitary materials and encourage them to perform well in class How best can parents support their daughters during menstruation? The respondents said that it was the mother’s role to guide their daughters on issues pertaining to growth and development, but if need arose, both parents should step in to encourage the girls If the head teacher of the school asked you to approve a budget to: implement the provision of sanitary towels in the school, the provision of more water and the addition of more female teachers in the school to assist training the girls in feminine hygiene issues, as well as the provision of disposal bins and incinerators for disposing used sanitary towels, would you approve the budget? The respondents said that there were other stalled projects that would take priority, but that they would happily take support given by well-wishers and would want the girls to have, in the following order Sanitary towels Sufficient water to allow the girls to wash any stained garment and return to class
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Ensure disposal bins and incinerators for disposing the used sanitary towels Provide first-aid kits and painkillers for the girls to give those who ask for permission to go home because they are feeling unwell The respondents felt that ensuring that the girls and boys toilets are far apart to allow for privacy would be a long term strategy Appendix 11: List of Survey Schools in Kenya
1. Young Muslim Primary School 2. Kazugo Primary School 3. Tumaini Primary School 4. Umul-Kheir Primary School 5. Hyuga Girls Primary School 6. Yathrib Primary School 7. Boys Town Primary School 8. Sankuri Primary Boarding 9. Nasiib Primary School 10. Kawangware Primary School 11. Jamuhuri Primary School 12. Riruta HGM Primary School
Test Schools: Test schools in Garissa 1. Boys Town Primary school 2. Sankuri Primary Boarding 3. Yathrib Primary School Test schools in Nairobi 1. Riruta HGM Primary School 2. Jamuhuri Primary School
Control Schools: Control schools in Garissa
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1. Umul-Kheir Primary School, 2. Tumaini Primary School 3. Hyuga Girls Primary School 4. Kazugo Primary School Control schools in Nairobi 1. Kawangware Primary School
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