Behaviour and Practices in the Louga Region, Senegal

MENSTRUAL HYGIENE MANAGEMENT: BEHAVIOUR

AND PRACTICES IN THE Study LOUGA REGION, SENEGAL ©2014: WSSCC and UN Women Design: ACW, London, United Kingdom Photos: Javier Acebal/WSSCC/UN Women For more information: www.unwomenwestandcentralafrica.com www.unwomen.org/en MENSTRUAL HYGIENE MANAGEMENT: BEHAVIOUR AND PRACTICES IN THE LOUGA REGION, SENEGAL

A report examining menstruation and its management from the perspective of women and girls in the Louga region of Senegal. These range from an inability to exercise their rights and access services due to the silence and stigma that surround menstruation, to poor menstrual hygiene practices and waste management.

TABLE OF CONTENTS

LIST OF ACRONYMS 2

FOREWORD 3

EXECUTIVE SUMMARY 4 Key Findings 5

BACKGROUND 7 Information about the study area 7 Education and vocational training data 7 Healthcare access data 8 Data related to access to Water Sanitation and Hygiene 9 A Joint Programme to address a complicated problem 11

OBJECTIVES 13

METHODOLOGY 14 T Data collection and analysis methods 14 ABLE OF CON T EN Sampling method 15 Limitations of the study 15

outcomes OF THE STUDY 17 Menstruation: a taboo subject 17 S Menstrual blood: a symbol of “uncleanliness” 18 Knowledge and feelings of girls experiencing their first period 20 Menstrual management 24 Menstrual waste management 30

IMPACT OF MENSTRUATION on THE LIVING CONDITIONS OF WOMEN AND GIRLS 33 Menstruation and adulthood 33 Menstruation and participation in daily activities 35 The impact of poor conditions in public buildings on women’s and girls’ participation 36

recommEndations 40

CONCLUSION 43

List of FIGURES 44

references 45

1 LIST OF ACRONYMS

ANSD Agence Nationale de la Statistique et de la Démographie (National Statistics and Demographics Agency) ESCR Economic, Social and Cultural Rights GHS Gender, Hygiene and Sanitation GSF Global Sanitation Fund MDG Millennium Development Goals MHM Menstrual Hygiene Management PEPAM Programme d’Eau Potable et d’Assainissement du Millénaire (Millennium Drinking Water and Sanitation Programme) SNEEG Stratégie Nationale pour l’Egalité et l’Equité de Genre (National Gender Equality Strategy) UNDP United Nations Development Programme Y MS LIS T OF ACRON UNESCO United Nations Organization for Education, Science and Culture UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund UN Women United Nations entity for gender equality and the empowerment of women WSSCC Water Supply and Sanitation Collaborative Council

2 FOREWORD

Hygiene and sanitation are development issues that have long been overlooked by governments. However, as a result of sustained advocacy efforts, they are at the very top of the global and national agenda today. Senegal has a fairly progressive national strategy that aims to improve gender parity in political representation, healthcare and education, access to drinking water and sanitation facilities and maternal and infant mortality among other priorities. These issues have a critical role to play in efforts to improve living conditions and support the country’s social and economic development. Development can only be achieved by meeting the needs and improving the well-being of the population as a whole: both men and women. Women make up half of Senegal’s population. Between the onset of puberty and menopause, women menstruate for around 3000 days. What impact does menstruation have on their personal and working lives? Do they have access to reliable information about menstrual hygiene? Can they rely on medical assistance if they need it? This report lifts the lid on an issue that remains hidden, unspoken and somewhat taboo in many African societies. This report examines menstruation and menstrual hygiene management. Perspectives range from women’s inability to exercise their rights and access services due to the silence and stigma that surround menstruation, to poor menstrual hygiene practices and waste management. Menstrual hygiene is complex, bringing together interrelated issues of personal hygiene and sanitation, water supply, health, education, the environment and FOREWOR D gender. The Government of Senegal, represented by the Ministry for Water and Sanitation and the Ministry for Women, fully support the aims and objectives of the “Gender, Hygiene and Sanitation” programme and the publication of this report, which we hope will inform future design, investment and decisions regarding hygiene and sanitation for women and girls in Senegal. We hope that it will inspire the region and the world as a whole.

Dr CHRISTOPHER WILLIAMS DR Josephine Odera Executive Director Regional Director and - Water Supply and Sanitation Representative of UN Women Collaborative Council - Regional Office for West and Central Africa 3 4 EXECUTIVE SUMMARY Senegal the Kébémerdepartment. came from theLougadepartment,28%from theLinguère department,and21%from Of atotalof616respondents (womenandgirlsaged13to65),approximately 51% chosen at random, and all respondents completed the survey on a voluntary basis. The study was conducted in mainly urbanand semi-urban areas. The sample was in theregion. important informationaboutbeliefs,knowledgeandpracticeslinkedtomenstruation informant interviewstogatherqualitativedata.Theoutcomesofthisstudyprovided and Sanitation”,alongwithaseriesoffocusgroup discussionsandindividual UN Women/WSSCC Gender, HygieneandSanitationprogramme, “Gender, Hygiene In June2014,asurveywasconductedintheLougaregion ofSenegalunderthejoint former MayorofLouga,Ms Aminata MbengueNdiaye. Senegal. Theprogramme waslaunchedinLougabytheMinisterforLivestockand Council launchedathree yearGender, HygieneandSanitationProgramme in On theninthofMarch, 2014,UNWomen andtheWater SupplyandSanitation EXECUTIVE SUMMAR Cameroon Niger Cameroon, Niger andSenegal. Africa withthree pilot countries: implemented inWest andCentral Hygiene andSanitationis The JointProgramme onGender, Y EXECUTIVE SUMMARY 5

ndeed, almost half of the half of almost Indeed, and a lack of knowledge about theabout of knowledge lack a and and facilities for proper menstrual hygiene menstrual and facilities for proper “hidden” practices and a lack of information are the main causes main causes of information are the a lack and practices “hidden” women and girls are from excluded in cultural, participating extremely limited information about why they menstruate and why they menstruate and extremely limited information about respondents indicated that they rarely attended school while menstruating. indicated that they rarely respondents lack of suitable spaces of suitable Due to a lack management, income-generating activities. Most women and girls social and educational, hygiene in the materials home. It is also more choose to change their menstrual convenient for women and girls to wash themselves and their materials at home, primarily due to a lack of suitable outside the spaces and facilities home. This, women and girls to limit their schooling and work activities for in turn, forces month. each to eight days anything between four Menstrual waste materials are regularly disposed of in latrines and toilets dueMenstrual waste materials are regularly options disposal alternative waste of lack a to in clogged, overflowing toilets and the waste is polluting consequences. This results waste does to dispose of menstrual The issue of how and where the environment. – in education or health curricula. not appear anywhere Menstruation is often viewed as a sign of both maturity and adulthood. Once viewed as “big girls” of potentially they have had their first period, girls are within their communities responsibilities marriageable age. They take on greater many girls and, despite a legal age limit of 18 for marriage under Senegalese law, the increases significantly marriage Early age. this reach they before married are without adequate birth spacing, pregnancy and repeated risk of child pregnancy the risk of complications such as fistula. and increases Most respondents reported drying menstrual cloths in secluded, private, dark cloths in secluded, drying menstrual reported Most respondents These locations. hygiene management. of infections related to poor menstrual friends act as their main source of information. However, these mothers and mothers and these However, information. of their main source as act friends body the as changes biological about knowledge necessary the lack often friends cycle, infection risks posed by poor practices, the menstrual puberty, reaches disposal options available to girls. and the absorption, drying and material these matters in detail with the eager to discuss were All respondents practitioners that healthcare enumerators and facilitators. They recommended officers clubs, hygiene promotion and policymakers, teachers, educational and trained in these issues and able to inform women and social workers are basic correct, access to able are girls that adolescent can ensure This girls. sessions, they have their first period. During the focus group information before of questions about sexual reproductive the participants also asked a wide range further endorsing the need for better information. health and early pregnancy, Girls have how to manage menstrual flows hygienically and safely. Mothers and how to manage menstrual flows – – – – – – – – – – The following is a snapshot of what the study found: The following is a snapshot This silence is exacerbated by taboos and myths that perpetuate practices that that practices perpetuate that myths and taboos by exacerbated is silence This personal from and how they manage their menstruation women and girls believe how about talk people Few materials. used of disposal and cleaning the to hygiene sanitation and hygiene managed with dignity and safety and can be menstruation of this women and As a result inadequate and inappropriate. are facilities for women and economic activities limit their cultural, educational, social girls often choose to missing school, work and play. while menstruating, There is a general culture of silence surrounding all aspects of menstruation. aspects of menstruation. all of silence surrounding culture is a general There Key Findings: Key 6 BACKGROUND Women makingthepledge during theMHMlabinLouga. BACKGROUND 7 6.78% 12.83% 1.99% 0.57% % private sector 44,546 21,948 10,887 11,711 Girls

89,567 42,722 23,012 23,833 Total 2009 report research www.ansd.sn However, this figure this figure However, 3 4 9.32% 17.54% 1.71% 0.59% % private sector 2 43,896 20,864 11,632 11,400 Girls 89,040 44,396 22,093 22,551 Total 2008 t covers an area of 24,889 sq. km and has a population of 835,325 people. 835,325 of population a has and km sq. 24,889 of area an covers It

Louga, Sénégal : Représentations autour de la migration auprès d’une communauté d’origine, April 2008. Maggi/Sarr/Amadei, Audiovisuelles de la Migration Sénégalaise’ project, the ‘Mémoires from Plan Régional de Développement Intégré (Integrated Regional Development Plan) 2010-2015, Conseil Régional de Louga, 2010. Inspection d’Académie de Louga. Source: Data from the National Statistics and Demographics Agency, July 2014, available at: Agency, the National Statistics and Demographics Data from Région Louga Linguère Kébémer IDEN t is divided into three departments (Louga, Linguère and Kébémer), four communes, Kébémer), four communes, and departments (Louga, Linguère It is divided into three is home to 19 ethnic communes and 2,632 villages. The region districts, 48 rural 11 and, Wolof the from population are of the the vast majority although groups, groups. to a lesser extent, Halpulaar 2 3 4 1 At primary level, enrolment figures are rising steadily, with 89,567 primary-age with 89,567 primary-age rising steadily, are figures At primary level, enrolment girls. The private sector accounts for in school in 2009, 49% of whom were children 65.5% from Ratio (GER) rose Enrolment The Gross 6.78% of total student enrolment. of 2.5%. increase in 2007 to 70% in 2009, an average annual n terms of education, the Louga region has seen significant progress over recent recent over has seen significant progress In terms of education, the Louga region This progress and staff. enrolment in infrastructure, years, with major improvements undertaken as part of the Plan Décennal de l’Education has been driven by efforts Plan). Despite these Education and Training et la Formation (PDEF – Ten-year housed in temporary many education and training establishments are efforts, between work and a gap of alleged delays in construction accommodation, as a result demand and supply. Education and vocational training data training and vocational Education

The study was conducted in the Louga region, located in the north east of Senegal, in the north east of Senegal, located in the Louga region, The study was conducted of Louga is one of the 14 regions the capital, Dakar. km from 200 approximately Senegal. UND BACKGRO the study area about Information Drop-out rates are especially high in this region. Other than the Diourbel (31.9%), especially high in this region. rates are Drop-out Louga has the lowest completion rate in Matam (40.1%) and Kaolack (41.9%) regions, a year in primary school of pupils repeating the country (43% in 2009). The percentage marked among The fall was more with the 2008 figure. fell by 5.2% in 2009, compared boys (7.8%) than girls (1.09%). Table 1 : Pupils enrolled in primary schools in 2008 and 2009 in primary schools 1 : Pupils enrolled Table remains below the national GER, which stood at 91.1% in 2009. Significant progress below the national GER, which stood at 91.1% in 2009. Significant progress remains for cours d’initiation (CI – induction courses), has been made in terms of enrolment 96.5% standing at 98.5% (attendance of 100.6% for girls and with the overall figure 2007, in (42.5% unchanged relatively remains rate completion the However, boys). for objective for 2010 was 85%, it is unlikely rising to 43% in 2009). Given that the stated efforts for this indicator unless significant that Senegal will achieve the MDG target the situation. made to improve are 8 BACKGROUND for the15-24group. (LougaIntegratedRegionalDevelopmentPlan). age groups,women thanmeninboth standingat0.7%forthe15-49group and0.5% Among people (15 to 24 years), the rateis 0.3%. The infection rate is higher among AIDS prevalence rate in theregion stands at 0.5% for men and women aged 15 to 49. Senegal’s HIVand AIDS prevalence ratestandsataround 0.7%.The overallHIVand avoidance, however, with83.2% of women informed, compared with 73.4% of men. compared with97.8%ofmen).Thistrend isreversed when itcomes to prevention and in terms of information and knowledge about AIDS (96% of women informed, With regard toHIVand AIDS prevalence intheregion, there isaslightimbalance means thatthe2015target (MDG)maynotbemet. 55% ofbirthsinvolved medical assistance. Nevertheless, theslowpaceofthisincrease (mainly nurses and midwives). The nationalfigure stood at 52%.In2009,justover In 2005,around 50% of birthsinLougawere assisted by qualifiedmedical practitioners 100,000 livebirthsinprevious years. when themortalityratestoodat154per100,000livebirths,compared with377per 2005. However, there hasbeenadownward trend intheheadlinefigures since2005, The latestavailablematernalandchildhealthdataintheLougaregion are from 4,369 womenofreproductive age. per 402,586children under12;1nurseper10,658inhabitants;andmidwife inhabitants; 1gynaecologistper196,599womenofreproductive age;1paediatrician falls wellshortoftheacceptedWHOstandards, withonly1doctorper63,946 shortage ofdoctors,particularlyspecialists.Healthtreatment capacityintheregion In 2009,there were 424healthcare personnelacross allcategories.There wasasevere traditional medicine. to (modern)healthservices,andtherefore haslittlealternativebuttoturn In someremote rural areas ofLinguère, thepopulationappearstohavenoaccess dispersed nature ofhousingascompared toitslarge area. scores lowest.Thismaybeduetothearea’s lowpopulationdensity, aswellthe standards setbytheWorld HealthOrganization (WHO).TheLinguère department In terms of healthcare, the region remains well short of the health coverage Healthcare access data in catering,hairdressing andsewing. enrolled at thesecentres, 257 of whom are women. The centres offer three-year courses Féminin” (Women’s Technical Training Centre). Intotal,there are 260learners All three departmentswithintheregion havea“Centre d’EnseignementTechnique providing thistypeoftraining. There islimitedtechnicaltrainingprovision in theregion, withonlyafewfacilities helping tokeepgirlsinsecondaryeducation. especially among girls. A newsixth-form college has been builtinLouga and is The introduction of localschools has helpedtoslightlyreduce the drop-out rate, figures stood at 21.7% for middle school and 8.7% for secondary school in 2009. At secondarylevel,enrolmenttrends are largelysimilar, GER the although and failure ratesinsomeareas. factors have a negative impact on school attendance, and often explainhighdrop-out in schools, exodus, migratorylivestockfarmingandevenemigration. All ofthese temperatures (betweenMarch andJuneintheLinguère department),alackoflatrines These educationalproblems areof factorssuchasdistance,high a range causedby

BACKGROUND 9 M TA MA LABGAR JI BARKED JI DOD TIEL GE

LINGUERE OKH NG ARK TESSEKRE FORA QU NG YA TIARGNI ANE YA MBEULAKÉ GASS OF A AHRA KAMB OL D S TT OF MBOULA I TIAMENE DJ GA OL OU SA DJ -L According to PEPAM’s to PEPAM’s According 5 AINT S 6 BOULAL ALI DE L E L ER GANDE BA SY TIAMENE RBE BADIAN AM YA www.pepam.gouv.sn/ensemble/index.php?rubr=vue S ARR KEUR MOMAR S GUERMALAL ARAK OU A U KI I N’ UB E D KO RO MERINA TO PETE OU DA MOUSTY YENE GNE ON I RO N’DO G N’DIA LO NIOMRE ROU MARNAN KE KADIOR A DA AC URE UGA y KAL GUIDELE TT A RE TO N’ MB ALL SA ar LO GA KANENE NDIOB GUETH SS d M’BEDIENE FA SA OM F OUG L ARR S THIOL GOURANE y ommune N’ KEL GUEYE S NGUEUNE ar OUL KEBEMER GUE THIE area ONA LE BADEGNE OUOLOF

capital C capital bound

OUL N VRIGNE tment capital tment THEP DIOK DIA TRICT TRICT d otecte ANDE ouga region ouga Regional capital Regional r Depa DIS capital capital community Rural L DIS al community boun community Rural river Permanent Pr region Neighbouring KEBEMER LINGUERE LOUGA ND

KAB GUEYE

EA OC LANTIC

KEY AT Government of Senegal www.gouv.sn/Cartes Source: Programme Eau Assainissement du Millénaire (Pepam) Assainissement du Millénaire Eau Programme annual review for 2014, 83.32% of the population in the Louga region has has region Louga the in the population of 83.32% 2014, for annual review region, by disaggregated not are data Sanitation drinking water. to safe access 38.7%. stands at a mere access figure but the national sanitation (Sanitation Master d’Assainissement a Plan Directeur introduced The Louga region focused on access to safe drinking have largely efforts Plan) in 1979. However, and rainwater the detriment of urban sanitation. Inadequate waste water to water, of unsanitary waste management have led to the development drainage and solid in the region. hygiene problems living conditions and 6 5 Administrative map of the Louga region map of Administrative Water and sanitation access data show marked improvements in the Louga Louga in the marked improvements show data sanitation access and Water mechanism the State Coordinating to PEPAM, According years. recent in region MDGs, achieved its water-related has almost and sanitation, Senegal for water However, to safe drinking water. having access of the population with 89.5% to achieve its sanitation target. the country is unlikely Data related to access to Water Sanitation and Hygiene and Hygiene Sanitation Water to access to Data related t t t t a phe ondissemen égion ro onidissemen arr égée arr ot A s d'eau permanen e pr UG gion de Loug gion limit Légende Chef lieu de r Chef lieu de départemen Chef lieu d’ Ched lieu de commune Chef lieu de CR Ré Limite d’ Ré KEBEMER LINGUERE LO Air Limite de CR Cour 10 BACKGROUND living inrural areas withmostwomenengagedinnon-income-generatingactivities. water systems,etc.Genderinequalityseemstobeparticularlysevere forwomen access tobasicwaterandsanitationinfrastructure, transport,electricity, agricultural regions, andbetweenurbanrural areas. Thesedisparitiesare reflected inunequal disparities betweenmenandwomen.Inaddition,there are alsodisparitiesbetween Senegal’s GenderInequalityndexstoodat0.566in2011, reflecting gender According totheNationalEconomicandSocialDevelopmentStrategy2013-2017, development partnersandprogrammes. of genderissuesintoalldevelopmentsectorsandpresents areal opportunityto legal andeconomicenvironment. Thestrategyalsoseekstopromote theintegration gender equalityandequitybycreating afavourableinstitutional,social,cultural, a NationalGenderEqualityandEquityStrategy. Theaimofthisstrategyistopromote documents inanysector. Itisimportanttonote,however, thatSenegalhasadopted Menstrual hygienemanagementisnotmentionedinanynationalorregional policy alternative solutions. is notconnectedtothenetwork,andtherefore forced toadoptotherstrategiesand connections withoutextension).Thevastmajorityoftheregional capital’spopulation low usagerate,standingataround 25.8%(417connectionsoutofapossible1,200 water andrainwatereffectively. TheLougasanitationnetworkalsohasanextremely covers asmallpercentage ofdemand.Furthermore, itisincapableofdrainingwaste The region’s onlysanitationnetworkislocatedinthecommuneofLouga,and

BACKGROUND 11

10 , for example in in , for example 7 CEF study in Niger and Burkina Faso mentioned below The UNICEF study in Niger WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment Assessment An Bolivia: Cochabamba, Rural in Education Girls’ Empowers Schools in WASH 9 A handful of studies have also been conducted in Ghana, Nigeria Nigeria studies have also been conducted in Ghana, handful of A 8 Ibid. Menstrual Hygiene in Schools in 2 Countries of Francophone West Africa: Burkina Faso and Niger Case Studies in Africa: Burkina Faso and Niger Case Studies in Menstrual Hygiene in Schools in 2 Countries of Francophone West – 2013 UNICEF 2013, of Menstrual Hygiene Management in Schools, UNICEF 2012. The latter of these studies is part of a series that hygiene management in Bolivia, as well as in the Philippines, the challenges of menstrual will explore Rwanda and Sierra Leone. Faso and Niger Case Studies in Africa: Burkina Francophone West Menstrual Hygiene in Schools in 2 Countries of 2013, UNICEF 2013. Ibid. t is much harder to find studies or research on how this how this on or research to find studies harder It is much and Niger. Burkina Faso workplace and at home. ages inside and outside schools, at the women of all affects easier to find in East are management studies and interventions hygiene Menstrual have all been the Tanzania Kenya, Malawi, Rwanda and Ethiopia, Africa. Eritrea, to businesses have also been created number of small A this area. subject of studies in and Maka Pad in Uganda materials, such as sanitary protection low-cost manufacture SHE in Rwanda. is the only one of its kind to have been carried out in French-speaking Africa. Africa. kind to have been carried out in French-speaking is the only one of its beliefs, practices to initiate an investigation into the perceptions, This study attempts Africa, starting with Senegal. speaking and demands of women and girls in French hygiene the subject is taboo, menstrual the world where As in many countries around in either health or education establishments as important information is not regarded service users and than 50% of WASH women and girls account for more Yet in Senegal. hygiene and sanitation services. for managing water, also have de facto responsibility to articulate or meet the specific needs of It is indeed strange that these services fail access to information, periods and requires half of the population that has regular management waste washing facilities and menstrual soap and detergent, water, without anyone knowing to manage silently, forced and girls are options. Women in shame ill equipped to do so. This natural, biological function is shrouded and are Hygiene and Sanitation that the Gender, and silence. It is against this background between two United Nations agencies: as a joint initiative emerged programme Sanitation Collaborative Council (WSSCC). Supply and and the Water UN Women and overall aim is to accelerate the development of policies The programme’s and sanitation hygiene equality and the human right to water, practices that promote particular in focuses Africa. The programme and Central for women and girls in West to public policies, budgets and monitoring hygiene as an entry point on menstrual those from the specific needs of women and girls different systems that better reflect so that facilities are practice on the ground of men and boys. It aims to also improve of to the needs and maintained to respond designed, constructed appropriately more home. women and girls inside and outside the on based is and the Joint Programme, part of as been conducted study has This hygiene covering menstrual the analysis of data collected in the Louga region, management knowledge and practices. It is also the first in a series of studies that element, with a view to research will be conducted as part of the Joint Programme’s Africa. and Central knowledge on this subject in West strengthening and Sierra Leone. 7 8 9 10 There is very little qualitative or quantitative data available on menstrual hygiene hygiene data available on menstrual or quantitative very little qualitative is There have been level, there At regional in particular. Africa, and in Senegal in management in schools hygiene management studies on menstrual some recent A Joint Programme to address a complicated problem problem a complicated to address Programme A Joint 12 OBJECTIVES Addressing difficulties women and girlswithdisabilities face inmanagingtheir menstrualhygiene OBJECTIVES 13

the menstrual wheel and beads to make MHM bracelets the menstrual wheel and beads to make Some WSSCC materials used during the lab: the fold out book “as we grow up”, up”, grow “as we out book fold materials used during the lab: the Some WSSCC

Produce clear actionable recommendations for policy-makers. recommendations clear actionable Produce Collect information about cultural and social practices connected with menstrual with menstrual about cultural and social practices connected Collect information hygiene management; analysis in the Louga region; Conduct a situation among the population; of menstruation about perceptions Gather information hygiene; menstrual best practice in terms of effective Identify examples of – – – – – – – – – –

IVES T OBJEC behaviour hygiene management menstrual is to assess aim of the study The overall analyse their impact on the and practices and to living and girls conditions of women in the Louga region. the study sought to: specifically, More 14 METHODOLOGY India in2012byWSSCC The JointProgramme teamprepared aquestionnaire basedonaversiontestedin Quantitative data administrative departmentsoftheLougaregion (Kébémer, Linguère andLouga). (MHM) Lab,athree-day housetosurveywasconductedineachofthethree In addition to the focus group sessionsheld at the Menstrual HygieneMenstruation around menstrual hygienemanagement. i) toraiseawareness of theissues and ii) tounderstand public perceptions and demand lab erected in abusylocation at thecentre of the suburb. region. The data was collected in conjunction with a menstrual hygiene management prevailing menstrual hygienemanagementbehaviourandpractices,intheLouga andqualitativedatawereBoth quantitative collectedandanalysedtounderstand Data collection andanalysis methods METHODOLOG 13 12 11 menstruation and their impact on the livingconditions of women andgirls in the region. A literature review wasalsoconducted,focusingontheperceptions linkedto infrastructure andfacilities,bothinpublicspaces andinthehome. A seriesofobservationswere madeandphotographstakentoanalyse theexisting their knowledgeofmenstrual hygienemanagementandtheirpracticesinthisarea. and girlsfrom the Lougadepartment. Duringthesesessions, the participantsdiscussed Data wascollectedduringfocusgroupMHM Lab,comprisingwomen sessionsinthe Qualitative data information andknowledge. Lab, toprevent anyunduebiasorinfluencearisingfrom theirnewlyacquired Each participantparticipatedinanindividualinterviewbefore attendingtheMHM French andadministered inlocallanguagesfornon-literaterespondents. them totalkopenlyaboutasubjectthatremains taboo.Thesurveywaswrittenin the girlsandwomenquestionedfeelascomfortablepossible,toencourage languages other than French. Women-only researchers were chosen to ensure that ensuring that they were able to interact with thoserespondents who spoke in They camefrom different regions ofSenegal,andfrom different ethnicgroups, selected onthebasisoftheirsubjectexpertiseandprofessional qualifications. The researchers playedanimportantrole inthedatacollectionprocess, andwere menstrual hygienemanagement,thequestionnaire andtheuseoftabletPCs. researchers andcoordinators. provided menstrual hygienemanagementandMHMLaboperationstrainingtothe The questionnaire wasadministered viaanapplicationontabletPCs.WSSCCalso which provided thestatisticsusedinthisreport. application wasdeveloped.Theisconnectedtoanonlinedatabase, was thentranslatedintoFrench. Oncethequestionnaire hadbeenapproved, aweb visited bygirlsandwomen. three pillarsofmenstrualand MHM Labwassetupinatent management. Inthisinstance,the hygiene The MHM Laboratory is a dedicated facility where women and girls come to learn about and discuss the training programme. the data fully understand these three dimensions, and they are therefore covered in detail in the initial hygienically andsafely, andsafe reuse and disposalsolutions.Itis essential thatthepeoplecollecting WSSCC’s approach tothisissueisbased onthree pillars:breaking thesilence, managingmenstruation human rights. designed to show how failure toconsider menstrual hygiene managementconstitutesaninfringementof groups.population most vulnerable among the particularly sanitation, Thethree-pillar approach isalso WSSCC beganitsworkonMHM in India2011 withaviewtoreaffirming thehumanrighttowaterand 12 andadaptedtothesituationinSenegal.Thisquestionnaire 13 A totalof14researchers received trainingcovering 11 Y The aim was twofold –

METHODOLOGY 15 316 girls and women in the Louga department 316 girls and women department in the Linguère 173 girls and women in the Kébémer department. 127 girls and women Photo of tablet PC and application Photo of – – – – – – This is a qualitative, non-exhaustive study based on data collected from the MHM Lab This is a qualitative, non-exhaustive study based on data collected from and 65. Men and women and girls aged between 11 in Louga. The participants were As such, it focuses exclusively on the the study. deliberately excluded from boys were perspectives of women. This is a key limitation. education or into administrative, not involve any in-depth research study did This were field visits Instead, statistical data, interviews and infrastructure. healthcare used to gain a snapshot of existing facilities. in Kédougou, environment rural remote further study will be carried out in a more A will be more to gather data and information that, combined with this report, of the Senegalese population as a whole. representative Limitations of the study of Limitations The survey was conducted over a period of three days, and across the three departments the three and across days, over a period of three The survey was conducted in the Louga region: Sampling method Sampling A further 75 girls were questioned in the village of Dielerlou Syll. questioned in the village of Dielerlou further 75 girls were A aged between 13 and 65, the Louga department, and girls from In total, 359 women interviews. These were sessions and face-to-face focus group participated in the Louga. in the town of in the public square held in the dedicated MHM Lab, located fed into an online database, which also All of the information collected was collected were total of 556 responses A contains the statistics used in this report. using tablet PCs. views their during the MHM lab shared and facilitators The team of researchers that participants in a separate activity report and findings during interactions with also informed this study. 16 OUTCOMES OF THE STUDY Girl making abraceletGirl representing hermenstrual cycle OUTCOMES OF THE STUDY 17

In this report, we will see how we will see how In this report, 15 14 (Translation from French). This view is still widely held, particularly in the in the This view is still widely held, particularly French). from (Translation 16

“menstruation is seen as an act of punishment. The language that people use to talk The language that people use to talk “menstruation is seen as an act of punishment. ’adolescente et ses menstruations. Vécu et représentations à travers le temps et les cultures. Enquête auprès de quinze à travers le temps et les cultures. ’adolescente et ses menstruations. Vécu et représentations ’éducation traditionnelle en Afrique et ses valeurs fondamentales, Dr A. S. Mungala, 1982. Afrique et ses valeurs fondamentales, Dr ’éducation traditionnelle en

L Annaïg Mainguet, Faculty of Medicine, University of Nantes, 2006. adolescentes. Thesis, Doctorate in Medicine, L L Annaïg Mainguet, Faculty of Medicine, University of Nantes, 2006. adolescentes. Thesis, Doctorate in Medicine, Menstrual hygiene management materials Menstrual hygiene management fear is used to warn girls against unwanted pregnancy and/or sexual violence. pregnancy fear is used to warn girls against unwanted a better understanding of the issues, we need to go back to the origins of gain To seek to explain why have traditional myths that cultures Numerous menstruation. seen as a form “In many of these myths, menstruation is girls and women menstruate. people, for example, believe that women bleed of punishment against women. The Bambara taboo a is menstruation why explains aspect “punishment” This sinned. have they because subject.” 16 14 quinzede auprès Enquête cultures. les et temps le travers à représentations et Vécu menstruations. ses et ’adolescente 15 Menstruation remains a taboo subject in many societies and is associated with a taboo subject in many societies and is associated with remains Menstruation and uncleanliness. adulthood maturity, fertility, concepts such as femininity, These views are widely held in the Louga region of Senegal. Menstruation is is of Senegal. Menstruation widely held in the Louga region These views are tales popular language, including through ways, different of variety in a represented form an important part of education, and stories, music and the arts. These elements on a range of different Africa relies education in Africa. Traditional particularly in of passage. techniques, such as stories, fear and rites Although menstruation is now considered an everyday subject in the developed the developed an everyday subject in is now considered Although menstruation edition of the by stigma. The 1694 a taboo topic surrounded world, it has long been Latin “mensis”, the (from Académie Française defines “menstrues” dictionary of the each month”. that women experience as follows: “purgations meaning “month”) women each is defined as: “an illness that afflicts meanwhile, “purgations”, The word be avoided in the plural form. Blood-letting should only ever expressed month, for this reason during these purgations.“ THE STUDY THE a taboo subject Menstruation: OUTCOMES OF OF OUTCOMES (Translation from French). from negative.” (Translation about menstruation is almost entirely area covered by this study. One of the participants attending the MHM Lab admitted One of the participants attending the MHM Lab admitted by this study. covered area that 18 OUTCOMES OF THE STUDY Moors, Serer, Bambara,Soninkeandmixed-raceMoors. followed byFula(12.2%)andHalpulaar (7.4%).Theremaining respondentswere groups:smaller ethnic dividedbetween coveredThe interviews peoplebelongingtodifferent ethnicgroups livingintheregion. Wolof is thedominantgroup (66.2%), Respondents’ age Figure 1 between 14and19,confirmingthatearlymarriageispractisedintheregion. More than69%oftherespondentsstated thattheywere notmarried.Around 8%ofthosewhowere marriedwere aged cases menopausalwomen.Themajorityofthesurveyrespondents were agedbetween14and30. and focusgroupThe surveys involved pre-pubescent sessions girls, adolescentyoungmothers,mothersandinsome Box 1–Participantprofiles Ethnic groups Figure 3 ALL DEPA NUMBER ALL DEPA 7.4% 12.3% 140 210 280 70 0 RTME up t RTME o 13 NT NT S 14 -1 S 9 20 -30 66.3% AG E 31 -40 foteu” (meaning“Iamwashing”,referring tothewashingofsanitarymaterials). period, girlsusetheWolof terms“sétouma”(meaning“Iamunclean”)or“damay commonly spokenlanguageintheregion, andinSenegalasawhole.Duringtheir The Wolof peopleare themajorityethnicgroup inLouga,andWolof isthemost Menstrual blood:asymbolof “uncleanliness” 41 -50 ot la bam Jola SoninK SeReR SeReR mooR halu Ful Wo numbeR ob heRS 51 a lo aRa + a pa F S a aR Marital status Figure 2 ALL DEPA 69.4% RTME NT S 30.6% no ye S OUTCOMES OF THE STUDY 19

, Edouard Vincke, 1991. Vincke, , Edouard chRiStianS muSlimS 98% S 17 NT RTME ALL DEPA Figure 4 Figure Religion 17 Liquides sexuels féminins et rapports sociaux en Afrique Centrale As Louga is located in a semi-urban area, certain traditional rituals are not as not as rituals are certain traditional in a semi-urban area, As Louga is located questioned, the majority of the women However, commonplace as elsewhere. evil spells indicating that off pads to ward stated that they washed their sanitary with superstition such as black magic. blood is still widely associated menstrual material belief that an evil eye can cast a spell on used menstrual The widespread is widely held. causing infertility, thereby remaining the while Muslims, were they that stated respondents the majority of The Christian. minority were (98%) stated that they performed purification The majority of the Muslim respondents and five times a day while menstruating, rituals. Muslim women stop praying ritual the They also perform ended. has their period prayer ritual once this resume period. bath of purification at the end of their rites of passage when they have their girls must undergo In certain cultures, first period. No such rites were observed or reported in Louga. observed or reported first period. No such rites were Uncleanliness is a recurring theme across many ethnic groups, and is a source of of and is a source ethnic groups, many theme across is a recurring Uncleanliness to is hazardous that menstruation people believe The Jola various superstitions. their period. women during from themselves that men should distance men, and keep menstrual expected to are blood, and women not see menstrual Men must women are customary laws, times. Under some men at all from blood away society while menstruating. from explicitly excluded accepted generally a was “there region, the in conducted studies other to According distance during their period. Africa that women should keep their in Central rule They were banned from the marital bed, from preparing food, from engaging in engaging in food, from preparing the marital bed, from from banned They were a range of potentially and from and brewing, as forging work such productive menstrual Furthermore, such as hunting, fishing and war. activities hazardous a poison. It was viewed with black magic and was viewed as blood was associated during women close to, be even and with, contact to have dangerous as extremely their periods.“ 20 OUTCOMES OF THE STUDY in thethree departments Availability of information before thefirst period Figure 5 ALL DEPA 69% RTME NT S 31% menstruation atschool. currently ineducation,only5.6%statedthattheyhadreceived informationabout with more than40%ofthoseaged50andabove. Among thoserespondents Around 30%ofrespondents aged 14-19 answered “no”to thisquestion,compared prior totheirfirstperiod. departments, themajorityofrespondents (55.3%)hadreceived noinformation to informationbetweendepartments.InLinguère, themostrural ofthethree said thattheyhadreceived noinformation.There isamarkeddifference inaccess 69% oftherespondents saidtheyhadalready received information,while31% “Had youalready heard aboutmenstruation whenyouhadyourfirstperiod?”, exposed to some information about menstruation. By thetimetheyhadtheirfirstperiod,alarge numberofrespondents hadbeen discuss withmen. such asatschool(seeBox2).Moreover, itisasubjectthatgirlsandwomencannot shame. Itisadifficult subjecttoaddress bothinthehomeandexternalsettings As ataboosubject,menstruation isalwaysassociatedwithfeelingsoffearand Understanding ofmenstruationandknowledgethesubject Knowledge andfeelings of girlsexperiencing theirfirst period no ye S in theLinguère department Availability of information before thefirst period Figure 6 LINGU 44.7% ÈRE VILLAG E 55.3% In response to the question, no ye S OUTCOMES OF THE STUDY 21

l level e leve level Ry at Ry 38.3%

ice level ov tion Ree level S NT , Deg 26.5% Sity RTME 9.9% Ranic School, n Ranic School, inteRmeDi heR conDaRy School level tRaDitional School, SiXth FoRm level tRaDitional School, pRima no FoRmal eDuca univeR Se Ko Ko FRanco-aRab School, pRima ot ALL DEPA Figure 8 Figure attainment Educational 9.1% 6.7% 18 e level y level 62,4% at ice level ov tion Ree level E , Deg Sity ÈRE VILLAG Ranic School, n Ranic School, inteRmeDi tRaDitional School, SiXth FoRm level no FoRmal eDuca tRaDitional School, pRimaR univeR Ko Ko 10.8% 18.3% in the region, which stands at 30%. which in the region, in total). 20% forms of education (approximately popular and vocational courses remain Both Koranic schools those among higher is This figure education. formal no received had they that stated respondents the of 9.1% Similarly, department. in the Linguère 18.3% Louga, reaching further from living respondents In total, 26.5% of respondents left school at primary level, 38.3% completed secondary education, and 6.7% reached and 6.7% reached 38.3% completed secondary education, left school at primary level, In total, 26.5% of respondents no formal education. attended a Koranic school or received had followed a vocational course, college level. The remainder profiles Box 2 – Participant Education ratio among girls enrolment gross statistics on the national reflects of the respondents attainment level The educational Figure 7 Figure attainment Educational LINGU 18 Data from the Senegal National Statistics and Demographics Agency, July 2014, www.ansd.sn Agency, the Senegal National Statistics and Demographics 18 Data from Those respondents who had knowledge about the menstrual cycle had obtained this who had knowledge about the menstrual respondents Those (often their mother). Only one participant a friend or a close relative knowledge from information about the subject at Koranic school, and stated that she had received a few others at traditional school (around 12). This may explain the strong demand may explain the strong 12). This (around at traditional school a few others for information, tools and training on the subject. also show that girls tend to go to the same person for advice The Louga results stating that they have when they have their first period, with all of the respondents the main forms of of Some friend or elder sister. their mother, advice from received are: advice and comments that they receive if a man touches you, need to watch out for boys”, “Be careful, a big girl now”, “You “You’re etc. you could fall pregnant”, to the of information in response or friend was the main source close relative A did you get you had your first period, who/where following questions: “Before and “After you had your first period, who/ from?” information about menstruation or friend The close relative from?” did you get information about menstruation where the first period, and 85.6% 87.2% before this information in 90% of cases: provided after the first period. 22 OUTCOMES OF THE STUDY Sources of information before thefirst period Figure 9 ALL DEPA gRou gRoup ot oR oRganiS community gRou e. WRit Social School (FRomateacheR FRienD cl 33.1% g. apRoSp oSe Rel heR ten inFoRm p, RTME , ReligiouSoRcult ageoRiniti Wo at RKeR, oRthRoug at ive ec NT ion (e.g tuS) S at p ion, at ion gRoup) . Wo , uRa men’ h l S 54.1% to absorbtheblood.Thephenomenonisgenerallyassigned aname: turn theirattentiontowashing,withaparticularfocuson cleaning thematerialused has herfirstperiodhelptousetherightmaterialsabsorb theblood.Theythen The focusgroup datademonstratedthat,ingeneral,the peopleinformedwhenagirl as muchIcan”reported afocusgroup participant.(Translation from French). “I don’tto behavenormallyandhideit people toknowthatI’monmyperiod.Itry wantother are menstruating. about menstruation and reported that they usually try to hide the fact that they The majority of the girls and women questioned were embarrassed to talk Girls’ feelingsandinformationobtainedafterthefirstperiod “women’s business”andmenneverrefer toit. world. According tooneoftheMHMLabparticipants,menstruation isviewedas It is also atopic that receives verylittlecoverageinthemediaorwider healthcare professionals aftertheirfirstperiod(0.9%). information from schoolbefore theirfirstperiod(5.2%),andevenfewerfrom It istherefore particularlyconcerningthatsofewoftherespondents hadreceived disappear onceIbecomeamother.” (Translation from French). “I alwayshavestomachpainsbefore myperiod.Mymothersaysthatthesepainswill syndrome anddysmenorrhoea. OnegirlquestionedattheMHMLabstatedthat their wards aboutthephysiologicalchanges,emotionalaspects,premenstrual information onmaterialsandcopingstrategies.Theyare unablehowevertocounsel of information.Mothersandfriendshelpgirlsmanagetheirperiodswithbasic It isimportanttonotethatmothersandfriendsare notnecessarilyreliable sources – – – – – – “diouliwouma “sétouma” (I’munclean) “da mayfoteu ” (I’mwashing) ” (I’mnotpraying). 13.3% ALL DEPA Sources of information after thefirst period Figure 10 RTME 9.6% NT S 72.3% cl o heal noboD FRienD theR oSe Rela thcaRe pRoFeSSiona y tive l

OUTCOMES OF THE STUDY 23 Certain groups of women and girls using fabric rather than sanitary pads because Certain groups sanitary pads cause infertility. when Girls counting (appliance used to make couscous) the holes in a couscoussier in the month that they will days to limit the number of they get their first period be on their period. Women and girls having to use separate toilets while menstruating, because separate toilets while menstruating, girls having to use and Women blood brings bad luck. menstrual – – – – – – Beliefs, myths and social and religious norms in the region Beliefs, myths and appear menstruation norms surrounding social and religious The beliefs, myths and family n general, it is the older women in the with the onset of a girl’s first period. I and act during menstruation. the girls about how to behave who instruct Beliefs and myths talked sessions at the MHM Lab, several participants During the focus group that women and girls must refrain culture about the widely held belief in Wolof weaving during menstruation. from disposal, washed their sanitary pads before The vast majority of the respondents to cast an evil spell leading to infertility or so that their blood could not be used be carefully blood must during childbirth. In this belief system, menstrual difficulties view. managed and must not be exposed to public of women Social norms leading to the exclusion generally girls are women and As a result, unclean. blood is considered Menstrual that – a practice certain domestic activities during menstruation excluded from also those who believe women are as soon as a girl has her first period. There emerges blood menstrual as the periods cheese during their butter or girls cannot make and The same applies to mayonnaise, which does not allow the milk to ferment properly. by a women or girl who is menstruating. cannot be prepared apparently several other forms of exclusion sessions, the participants revealed During the group based on myths and taboos. These included: These expressions reveal the practices, beliefs and restrictions that apply that this during restrictions practices, beliefs and the reveal These expressions with impurity. associated periods are period, whereby that or education stated information they were received girls who had not Most of the The first noted. were kinds of responses Two first period arrived. when their scared and told nobody on her period the fact that she was girl tried to hide was that the about second was that at least during the first two days. The it, straight the girl went help. to ask for her mother in this region) (normally to a close relative information had received and girls questioned stated that they None of the women changes or about the hormonal menstruation, behind processes about the biological at the MHM Coordinators during adolescence. in both girls and boys that occur cycle. Several girls lack of knowledge about the menstrual Lab observed a general occurs. about the age at which the first period information more requested Religious norms to Muslim women. Most of the relate norms encountered The main religious activities during various religious from women and girls interviewed refrain mosque. Koran or entering a touching the fasting, such as prayer, menstruation, girls are and which women locations, from so-called “sacred” certain avoid Others out of fear. or during menstruation before generally barred 24 OUTCOMES OF THE STUDY rather thanfabric. embarrassed about thissubjectandpreferred tosaythattheyused sanitary pads The researchers observedthattheadolescent girls questionedwere generally not alwaysknowwhatmaterialorfabrictheyused. disposable liners, dark-coloured orblackfabric,newfabric.Some participants did Other practices also exist. Some girls indicated that theyused multiple pairsofpants, cotton purchased from ashop(8.3%),orhome-madesanitarypads(4%). used Other typesofmaterial cotton). of financialhardship, generally favouringtheless expensive option(fabricor sanitary stated thattheyalternatebetweenfabricandsanitarypads, particularly duringtimes Women and girls adapt theirpractices according to these factors. Several respondents materials seems to depend on two factors: household budget and market prices. hygiene management. The amount of money that women and girls spend on these respondentsSome 69.8%ofthe used sanitarypadsformenstrualthey statedthat Principal menstrualmanagementmaterials Menstrual management 19 material suchasash,sandorsawdusttoabsorbtheirmenstrual blood. None of the girls or women questioned in theregion stated that theyused harmful girls tendtoviewfabricas“old-fashioned”andlessreliable thansanitarypads. ALL DEPA Material used Figure 11 See Researchers’ Report,available from theJoint Programme teamonrequest. 8.3% RTME NT S 19 Sanitarypadsare seenasreliable and“modern”,adolescent 69.8% includepiecesoffabricorrecycled clothing(13.2%), S pie home neW F o SuRgical c ani the ce oFF ta R -maDe Sani abRic oRF Ry p abRic, c aDS oR ot to n boughtFRomaSho abRic p ta lo ta Ry th, olDSKiRt mponS boughtFRomaSho p aDS boughtFoRthiSpuRpoSe aDS , olDlinen p p/ maRKet OUTCOMES OF THE STUDY 25 a) cal aRe g ailable in my lo aDS p y av ay Ry aSil ta g. e y Sani y when purchasing (2.3%). when purchasing e Da 20 ay -uSe t St 4 timeS a D t uS t embaRRaSSeD When puRchaSin R lea Se oF DiSpoSal Se oF Re ailability (e. 3 timeS a tWice a Da at once a D i Don’ the av ea ea i am no o comFoR SaFety coSt 54.7% 34.7% S S NT NT 34.2% RTME RTME 17% 6.2% Only a handful of girls stated that they were embarrassed when buying sanitary pads in shops. Only a handful of girls stated that they were by men. run available are are these products It is important to note that most of the shops where 25.4% 6.5% ALL DEPA ALL DEPA Hygiene during menstruation with hygiene practices overall, adequate menstrual The survey data revealed material. shortcomings in terms of drying sanitary a) Sanitary material replacement frequency basis, changed on a regular indicate that blood absorption materials are The results depending on their material several times each day, with girls and women replacing three least at material their changed respondents of 54.7% Overall, levels. flow blood 25.4% changed it at least twice a day and 17% changed it at least four times a day, their blood absorption also show that women tend to replace The results times a day. their material basis after giving birth, with 80.1% replacing material on a regular between two and four times a day. 20 Figure 12 Figure Material selection criteria Reasons behind the choice of MHM material the choice of Reasons behind comfort and are sanitary pads why women choose common reasons The two most stated that they chose of respondents departments, 34.7% the three Across safety. most third Cost was the safety. and 34.2% for for comfort reasons, sanitary pads high number of driven by the on safety is partly (12.1%). Focus common criterion pads brands) in the region. counterfeit brands (including as follows: availability (6.5%), ease of disposal (6.2%), were The other criteria lack of embarrassment (3%) and a ease of reuse Figure 13 Figure the region in frequency Sanitary material replacement 12.1% 26 OUTCOMES OF THE STUDY Bathing frequency duringmenstruation Figure 14 ALL DEPA RTME NT 99.1% S Source of water Figure 16 they usedtowashtheirsanitarymaterial. 96% ofrespondentsthey hadaccesstoasource statedthat ofdrinkingwater, which Effective practiceswere observedintermsofthewashingprivateparts.More than c) Washing ofprivatepartsandsanitarymaterial hands withsoapafterhandlingmenstrual blood. respondentsperiod. Mostofthe during their washed their they alsoindicatedthat The overwhelmingmajorityofrespondents (99.1%)statedthattheyshowered daily b) Personalhygiene 21 Dataaggregated under“Other”. located, 1.7%atworkand0.4% atschool. Among the respondents, only 1.1% changed their material wherever they were premises withoutreturning home. a timeattheiremployer’s at workwere thoseemployed asdomesticworkers,whooftenspendseveraldaysat bathroom athome.Theonly womenwhoindicatedthattheywashedtheirmaterial material. More than93%ofrespondents statedthat theywashedtheirmaterialinthe results below. Thiswasnormallydoneinthesameplacewhere theychangedtheir The respondents generallywashedtheirsanitarymaterialat home,asshowninthe ALL DEPA 2 to eveR 3timeSaWeeK y Da y RTME 96.4% NT S changing sanitarymaterial Frequency of handwashingwithsoapafter Figure 15 ALL DEPA RTME NT 90.5% o boRehol eXiSting Well DRinKing S theR 21 e Wa teR FRomthet RaRely Sometime oFten, butnot eveR ap y time S eveR y time OUTCOMES OF THE STUDY 27 m e K R oR he hom W at at WheReveR i a ot Toilets at the CEM Adama Diallo school at the CEM Adama Toilets S 93,9%93.9% NT RTME ALL DEPA Figure 18 Figure washing sanitary material Location for m e K oR hom W School theR at WheReveR i a at at o S NT 93,7%93.7% RTME ALL DEPA Figure 17 Figure changing sanitary material location for Preferred 28 OUTCOMES OF THE STUDY Location for dryingsanitarymaterial Figure 19 in direct sunlighttoavoidtheriskofinfection. Respondents displayedpoorawareness oftheimportancedryingmaterials such astoilets,bedrooms, intiledrooms orunderpillows(52.1%ofrespondents). The datashowthat,oncewashed,thematerialismainlydriedinadampdarklocation Shortcomings were identifiedwithregard tothedryingofsanitarymaterial. d) Dryingofsanitarymaterial 43.8% ALL DEPA RTME NT S 52.1% Panoramic view of theMasse Massaer Niane1school o outSiDe inDiR unDeR theRooFtileS in at in aD aS o theR theR cl oW aRK, pRi el, unDeRthema ot va heS aReDRieD ec te place(e. t Sunlight ) tt g. behinDaDooR , intheSameplace ReSS, ,

OUTCOMES OF THE STUDY 29

Disabled woman travelling in a cart, travelling Disabled woman with her wheelchair on the back nterviewee with a visual impairment. (Translation from French). from Interviewee with a visual impairment. (Translation “I live in Madina Salam, an out-of-town neighbourhood with no water or fixed an out-of-town neighbourhood “I live in Madina Salam, shelter with a straw door. we have to use a temporary toilets. When we need the toilet, no septic tank, just a bed of sand. my period, I avoid using During this toilet There’s in the behind. I go to visit my relatives blood want to leave any traces of because I don’t change. I tend not to wash and so I can days, couple of every neighbourhood Santhiaba ” uncomfortable. and embarrassed beg. I feel I don’t period. my much while I’m on do “My sisters manage their periods with privacy. But not me. When I’m on my period, But not me. When I’m “My sisters manage their periods with privacy. the house, often around I creep it (men and women). the whole household knows about and have an indoor toilet, don’t We or losing my sanitary towel altogether. blood leaking access to is difficult toilet The family. my other members of with toilet a share to I have with motor disability, germs.” Woman and is often wet, exposing me to dirt and French). from Louga department. (Translation Menstrual Hygiene Management among vulnerable groups among vulnerable Hygiene Management Menstrual have with motor disabilities that individuals interviews revealed The in-depth door frames make with narrow facilities. Public toilets accessing sanitation difficulty the access routes these facilities and users to use crutch for wheelchair or it impossible where is further aggravated dirty floors. This situation involve wet or to toilets often toilets with men. women have to share during of toilet people causes particular access for disabled hardship Difficulty confirmed that The nine disabled women interviewed they were menstruation. all members and that as a result with privacy, menstruation unable to manage their These problems are aggravated further when the family does not have its own toilet. the family does not have its own toilet. aggravated further when are These problems have neither out-of-town neighbourhoods Some disabled women living in poor, They can sometimes go for two days a fixed toilet nor access to water at home. may be a temporary shelter which serves as without washing. In some cases, there to avoid these shelters while menstruating a toilet. These women tend not to use leaving traces of blood behind. of their family knew when they were menstruating. Some of them stated that they them of Some menstruating. knew when they were their family of the they lacked that and hands, with their own their material wash unable to were the clothes to reach unable they were pads. Furthermore, to buy sanitary resources line to hang up their washing, often hiding their washed fabric and clothing after the bed as a result. sanitary pads under 30 OUTCOMES OF THE STUDY 14,3% 14.3% Menstrual wastedisposal Figure 20 covering managementinthehome,publicplaces,atworkandschool. The various menstrual wastemanagementoptions were discussed at theMHM Lab, management ingeneralproving especiallyproblematic. and disposalare mattersofparticularconcerninthisarea, withhouseholdwaste was haphazardly disposed with nosystemsinplace.Waste collection,management affectedthat region the not justmenstrualas awholesothat all waste wastebut All interviewees and participantsstatedthatwastemanagementwas a wider issue disposed ofitinseptictanksorelsewhere, 2.5%burnedit,and12.2%buriedit. threwthey dustbin, 14.3%saidthat in the or latrine. toilet in the it A5.3% further While 65.8%ofthewomenquestionedstatedthattheydisposed of theirusedmaterial Menstrual wastemanagement business duringtheirperiod.Theotherspreferred tostayathome. Of theninedisabledwomeninterviewed,onlyfourcontinuedtoattendtheirdaily mattresses tomanagetheirmenstruation. than onepackofsanitarypadspercycle.Somementionedtheusefoamfrom respondents statedthattheyhadmeagre income,andwere unabletoafford more live withtheirclosefamilyhavetoseekhelpfrom theircarer. All ofthedisabled a day. Someofthemaskedtheirmotherordaughtertohelpthem.Thosewhodo The disabledwomenquestionedstatedthattheychangedtheirmaterialatleasttwice during theirperiods. assistance, andthosewhodonotlivewiththeirmothersfacegenuinehardship Disabled peoplecannotlivefullyindependentlivesinSenegal.Theyrequire a non-visuallyimpaired persontocheckforher. clothing wasstainedwithblood.Shefounditdeeplyembarrassingtohaveask was unabletotellwhetherhersanitarymaterialcleanordirty, orwhetherher to changeduringtheirperiod.Oneofthevisuallyimpaired womenquestioned outside amosqueorfindanotherplaceintowntobeg.Theyare unabletogohome interviewed were beggars.Eachmorning,theygotothemarket,installthemselves hairdressers andhadameagre source ofincome,allthevisuallyimpaired women periods start.Unlikethewomenwithmotordisabilities,someofwhomwere trained Women withvisualimpairmentssometimesfinditdifficult toknowwhentheir ALL DEPA 12,2% 12.2% RTME NT S 65,8% 65.8% o i buRnit i buR i thR i thR theR oW oW y it itintheto itintheDuStbi ilet oRla n tRine

OUTCOMES OF THE STUDY 31 Pupils’ toilets at the Masse Massaer Niane 1 school Massaer Pupils’ toilets at the Masse 32 IMPACT OF MENSTRUATION On THE LIVING CONDITIONS OF WOMEN AND GIRLS Participant of theactivitiesinLouga IMPACT OF MENSTRUATION On THE LIVING CONDITIONS OF WOMEN AND GIRLS 33

23 22 TION

One of the women who who One of the women

t is important to mention the legal position surrounding age and marriage. It is important the to mention legal position surrounding of Human Rights states that Article 16, point 1 of the Universal Declaration any limitation due to race, nationality “Men and women of full age, without entitled They are have the right to marry and to found a family. or religion, to equal rights during marriage and at its dissolution.” Point 2 as to marriage, and full consent into only with the free states that “Marriage shall be entered on Consent to Marriage, Minimum of the intending spouses.” The Convention Article 1 this principle. Age for Marriage and Registration of Marriages reaffirms free into without the full and be legally entered marriage shall that “No states by them in person after consent of both parties, such consent to be expressed of the authority to solemnize the competent due publicity and in the presence In Senegal, the law has recently by law.” as prescribed marriage and of witnesses, 16 to 18. been changed, raising the age of consent to marriage for girls from Mapping Early Marriage in West Africa: a Scan of Trends, Interventions, What Works, Best Practices and the Way Best Practices and the Way Interventions, What Works, Africa: a Scan of Trends, Mapping Early Marriage in West September 2013. Forward, Judith-Ann Walker, de quinze Enquête auprès à travers le temps et les cultures. et des menstruations. Vécu et représentations L’adolescente Annaïg Mainguet, Faculty of Medicine, University of Nantes, 2006. adolescentes. Thesis, Doctorate in Medicine, n this study, conducted in the Louga region in northern Senegal, 7.3% of the girls in northern Senegal, 7.3% of the girls conducted in the Louga region In this study, married. stated that they were aged 14-19 questioned the – before able to understand girls are information, to the right access Through that onset of their – that first period the phenomenon is a natural, biological process this study. in the respondents among observed concern the fear or not cause should to adulthood. adolescence it should not be viewed as the transition from Furthermore, With the onset of ‘menarche’ or the first period, a girl is considered an adult and an adult and considered or the first period, a girl is the onset of ‘menarche’ With in several ethnic groups Early marriage is practised in suitable for marriage. married. were of women aged 15-19 in Senegal 25% Senegal. In 2010, around Menstruation and adulthood Menstruation and UA MENS TR OF T IMPAC

GIRLS AND OF WOMEN ITIONSD CON LIVING THE ON “in our society, once a girl has had her first period she once a girl has had her first period she attended the MHM Lab stated that “in our society, French). from to marry”. (Translation is ready girls girls (French that “adolescent in France revealed study conducted recent A on the path to adulthood, milestone a major as not see menstruation questioned) do (…) Rather than a sign global process. but rather a commonplace event in a more as seems (in their view) to be a sign of good health.“ menstruation of femininity, 22 23 34 IMPACT OF MENSTRUATION on THE LIVING CONDITIONS OF WOMEN AND GIRLS 28 27 26 25 24 permanent incontinence,shameandsocialdiscrimination. with untreated obstetricfistulasinsub-Saharan Africa –aconditionthatleadsto childbirth. Estimates suggest thatthere are more thantwo million women living a hole(fistula)developsbetweenthepelvicandgenitalcavitiesfollowingdifficult to an increased risk of fistula. Obstetric fistula is a medical condition in which infant mortality, preserve theirownhealthandimprove theirnutrition. during childbirth.Theyare alsoinabetterpositiontoprotect theirchildren from reacting tosymptoms,andensuringthattheyare assistedbyqualifiedpersonnel chance ofavoidingtheserisks,byadoptingsimple,inexpensivehygienepractices, diseases causedbyalackofhygieneandsanitation.Educatedwomenhavebetter to thegirlandherfuture children. Everyday, more than800women diefrom and play amore important role withinthecommunity. Thesefactorsposeariskboth get marriedandstarthavingchildren. Shemayalsobegintotakeonhouseholdduties Once agirlisviewedasanadultorpre-adult, shemaydrop outofschool,startwork, among adolescentgirlsinastablerelationship (marriageor common-law union). occur in sub-Saharan Africa, and the highest rates of sexual activity are found According totheWorld HealthOrganization, thehighestratesofearlymarriage Early marriageposesasignificantriskasitisoftenassociatedwithearlypregnancy. first birthday. Approximately onemillionchildren borntoadolescentmothersfailreach their children borntoadolescentmothersthanamongthoseaged20-29. issues intheregion. Stillbirthandnewborndeathratesare 50%higheramong first period.Muchworkremains tobedoneintermsofraisingawareness onthese present and future life – is the belief that a girl becomes a woman once she has her marriage –aphenomenonthathasprofound andharmfulimpactonthegirl’s one oftheprimarycauses(amongothereconomicandsocialconsiderations)early adolescence mayhelptoreduce earlymarriage.This is especially true giventhat Efforts to foster a better understanding of menstruation and the various stages of leading to a greater risk of poverty, greater a to leading exclusion and powerlessness. have anegativeimpactongirl’shealth,education,potentialincomeandfuture, According toarecent studybyUNFPA, however, pregnancy andchildbirthoften West andCentral Africa. Lossoffertilitycanoftenleadtoalosssocialstatus. Fertility iscloselyassociatedwiththesocialstatusofwomen,particularlyin Education Transforms Lives , UNESCO 2013. Lead Researcher and Author: Nancy Williamson PhD,UNFPA 2013. The State of World Population 2013: Motherhood in Childhood, Facing theChallengeof Adolescent Pregnancy, World HealthOrganization data, availableat: Lead Researcher and Author: NancyWilliamson PhD,UNFPA 2013. The State of World Population 2013: Motherhood in Childhood, Facing theChallengeof Adolescent Pregnancy, Health Assembly (March 2012).http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_13-en.pdf?ua=1 Organization and YoungAdolescent Pregnancies Health World 27 www.who.int/mediacentre/factsheets/fs364/en/ and , ReportbytheSecretariat, World HealthOrganization,World Sixty-Fifth www.who.int 26 25 They also lead 28 Early Marriages, 24

IMPACT OF MENSTRUATION on THE LIVING CONDITIONS OF WOMEN AND GIRLS 35

clearly affirms clearly affirms 29 Pupils’ toilets at the CEM Adama Diallo school Pupils’ toilets at the CEM Adama t is important to note that the States Parties to the Covenant undertake to ensure the equal right of men and t is important to note that the States Parties to the Covenant undertake to ensure I women to the enjoyment of all economic, social and cultural rights set forth in the Covenant. the right to work, the right to an adequate standard of living, the right to mental and of living, right to an adequate standard the right to work, the in cultural life, the right toright to education, the right take part physical health, the and its applications, etc. Under article 7, point enjoy the benefits of scientific progress enjoymentthe to everyone of right “the recognise Covenant the to Parties States the b), safe and in particular [...] which ensure, of just and favourable conditions of work designed a set of normative instruments is therefore healthy working conditions.” There that participate fully in women and to ensure eliminate discrimination towards to however? this play out in reality, economic, social and cultural life. How does management Physical limitations and spaces for menstrual including menstruation, during pain they experience Many girls and women state that joint pain, etc. This pain, caused by hormonal headaches, stomach pains, painful breasts, by is surrounded menstruation societies where in silence in changes, is often suffered to hygiene without access to maintain proper taboo. Girls and women also struggle living in LougaAs indicated above, women and girls water and sanitation facilities. They also need up to four times a day. feel the need to change their sanitary material of their material. disposing they can wash before a space where of practice pads conform to the widespread Many of the women who use sanitary as much just disposal. They require before washing their single-use sanitary pads cloths, if not more. water as those women who use sanitary that they had soap at home, but that soapAll of the girls and women questioned stated was not always available in public buildings. 29 “States Parties shall take all appropriate measures [...] to modify the [...] to modify measures all appropriate that “States Parties shall take Article 5, point a) states to achieving the elimination of conduct of men and women, with a view social and cultural patterns based on the idea of the inferiority or and all other practices which are and customary of prejudices for men and women.” roles of the sexes or on stereotyped the superiority of either on Economic, Social and Cultural Rights The International Covenant The data collected indicate that during menstruation 36% of respondents stay away 36% of respondents during menstruation collected indicate that The data in the Kébémersituation is aggravated work. This from and 68% stay away school from impact onpractices has a negative of these The continued application department. on thepoint d) of the Convention Under article 2, of women. the empowerment States undertake to “refrain All Forms of Discrimination against Women, Elimination of women and to ensure any act or practice of discrimination against engaging in from with this obligation.” and institutions shall act in conformity that public authorities Menstruation and participation in daily activities in daily and participation Menstruation 36 IMPACT OF MENSTRUATION on THE LIVING CONDITIONS OF WOMEN AND GIRLS of previous studiesonthissubject. their period,thereby impactingtheireducationalperformance. Thisconfirmstheresults As aresult, severalgirlssaidthattheyfoundithard toconcentrateatschoolduring feelings of anxiety among girls (fear of stained clothing, beingunableto change, etc.). the region. This phenomenon hinders safe hygiene practices and leads to additional It isalsoimportanttonotethatwatersupplystoppagesare aregular occurrence in the toiletwhiletheyare atschooloruniversity. because theyare unhygienic.Instead, they prefer nottochange theirmaterialnoruse they “avoid”thepublictoiletson site Many girlsatschooloruniversityadmitthat is an importantfactorthatdetermines whether or not pupilsuse these facilities. several hundred pupils,thetoiletsare rarely cleanedatregular intervals.Cleanliness Toilet cleaning also poses a major problem. Although schools often accommodate as Ican.”(Translation from French). disposing it off. I’m afraid that peoplewill see meorthat it will smell. I hurryhome as quickly stated that, that theirpeerswillknowtheyare menstruating. OneoftheMHMLabparticipants toilets so blood stainsinthe to changeorwash,avoidleaving unable will be they Similarly, manygirlsstayoutofschool altogether duringtheirperiod,forfearthat facility ordedicated room with aclothes bin orclothes line inanyofthegirls’ toilets. has adustbinorothercontainerformenstrual wastedisposal. There wasnowashing schools, girls andboysshared the sametoilets.Furthermore, noneoftheschooltoilets None oftheschoolsvisitedinstudyhadtoiletsequippedwithsoap.Insome and girls’participation The impactof poorconditions inpublicbuildingsonwomen’s 30 See theUN ICEF study onmenstrual hygiene inBurkina FasoandNiger. According totherespondents, thisshouldbe: What constitutesanappropriateplacetochangeandwashinprivate? – – – – – – – – – – without shame. A placewhere theycandispose their wastesafely, hygienicallyand wash theirhandswithsoap. A placewhere theycanwashawaytheirmenstrual bloodwithwaterand A cleananddryplace. A placewhere theycangowithoutshame. they are menstruating, includingthemenintheirfamily. women andgirlsquestionedindicatedthatmenshouldnotbeaware when by anotherpersonand especially notbyaman or boy. All of theyoung A dedicated,safe,privatespace, i.e. aplacewhere theycannotbeinterrupted “I wrap up the towel and put it in my bag. Then, once I gethome,washitbefore“I wrapupthetowelandputitinmybag.Then,once 30

IMPACT OF MENSTRUATION on THE LIVING CONDITIONS OF WOMEN AND GIRLS 37 building facilities, as well As 31 Work activities Sports and cultural activities. Certain group Teachers’ toilets at the Masse Massaer Niane 3 school Massaer the Masse toilets at Teachers’ – – – – – – it is also important to schedule regular and effective maintenance and cleaning, effective and to schedule regular it is also important dirty or unused. simply remain or these facilities will during engaging in the following activities from refrain also Louga, women In their period: nterview with Mr Amadou Diallo, Pepam Coordinator. nterview with Mr 31 I Furthermore, while this study did not look at health care facilities, many of the facilities, many care not look at health study did while this Furthermore, out in World set hygiene meet the minimum fail to requirements the region facilities in public facilities several to PEPAM according Similarly, standards. Health Organization and remain not cleaned properly are public spaces) bus stations and other (at markets, cleanliness. state of to their poor due unused largely The reasons given are always the same, i.e. the fear that they will be unable to they will be unable to always the same, i.e. the fear that are given The reasons materials, social blood absorption unavailability of menstrual change if needed, the the lack of a suitable space to manage their norms that lead to their exclusion, and and dispose of waste. menstruation 38 IMPACT OF MENSTRUATION on THE LIVING CONDITIONS OF WOMEN AND GIRLS or leavingthehouseduringtheirperiod. the Kébémerdepartment.However, womenandgirlsare notprevented from cooking rarely workinthefields,collectwaterorgatherwood. This situation isaggravatedin 36% ofrespondentsindicate that table The datainthe rarelygo toschool,and68% during herperiod. “often”. Onlyonepersonindicatedthatshealwayswenttoworkoutsidethehome during theirperiod.Themajorityattended“sometimes”,andotherswenttoschool Only 21girlsintheLinguère departmentstatedthattheyalwayswenttoschool 32 activities Participation ineducational,cultural, socialandeconomic Figure 21 NUMBER OF GIRLS ALL DEPA working outside thehome,visiting friendsand weaving. working inthefields, collectingandcarryingwater, gatheringwood, physicalactivity, religious meetings, The followingactivities were listed: leavingthehouse,cooking,resting orremaining seatedcomfortably,

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TA TA NUMBER OF GIRLS OF NUMBER NUMBER OF GIRLS OF NUMBER Figure 23 Figure social and economic cultural, in educational, Participation activities during menstruation Figure 22 Figure economic social and cultural, in educational, Participation during menstruation activities DA DA 40 RECOMMENDATIONS environment mustbecreated inwhichwomenandgirlsare abletoflourish. and girlsmustnotbedeniedtheireconomic, social andculturalrights.Instead,an of gender-based violence-includingearlymarriagemustbeeliminatedandwomen women andgirls.Women’srespected,must be righttowaterandsanitation allforms menstruation thatinfringeand/or harm the physical integrity and human rights of eliminate allforms of discrimination against women, and social norms surrounding The followingrecommendations areoutcomes ofthisstudy. basedonthe Theyaimto RECOMMEND – – – – – – – – – – – – – – – a normalphaseoftheirdevelopment. longer betreated asadultsorpre-adults, butinsteadasadolescentsgoingthrough without fearwithinthefamily, andgirlswhohavehadtheirfirstperiodwillno lifted, women and girls will be able to discuss menstrual hygiene openly and a lackofknowledgeandcertainbelief-basedpractices.Oncethesetaboosare restrictions thatwomenandgirlscurrently face,whichare linkedprimarilyto with boysandmeninsocietygeneral.Thiswillhelptooverturnthe acceptable topic that women and girls can discuss openly with their families, Break thesilencethatsurroundsmenstruationandmakeitaculturally also needtofocuson: alone cannotprovide a detailed understandingofthistopic.Efforts will therefore relevant andreflect localneeds.However,manuals experiencehasshownthat tailoredThese manualsmustbe tolocalrequirements, toensureare thatthey truly programmes.own training stakeholders todelivertheir management andtrain Improve and disseminate in themediaandwithdecision-makersopinion-leaders. Advocate forchange,addressing menstrual hygieneissues within communities, These dedicatedbudgetswill ensure thatthepoliciesare implementedeffectively. parliament) tocallfordedicatedMHMpoliciesandring-fencedbudgets . Continuing advocacyefforts withdecision-makers(ministers, membersof design mattersare properly considered. WASH, education,healthandenvironment sectors, to ensure thatinfrastructure Building thecapacitiesofprogramme implementation officialsin the working infections causedbypoormenstrual hygienemanagement. Including menstrual hygieneindisease prevention policies,tolimittheriskof – – – Building thecapacitiesofteachersandeducators,toensure thattheyare able Including menstrualhygienemanagementineducationpolicies,toensure be explainedmore effectively. and are abletopass this informationontoothers.Themenstrual cyclemustalso particular. This will ensure thatwomen and girlsreceive accurate information, areto address able girls andwomenin and with patients their thistopicwith Building thecapacities of certainhealthcareprofessionals,toensure thatthey both boysandgirlsexperienceexternalinternalchangestotheirbodies. come torealise thatthisisanormalpartofadolescence,timeduringwhich biological process thatwomenandgirlsneedtomanage.Inturn,pupilswill embarrassment, andtomakethemunderstandthatmenstruation isanatural to address menstrual hygienemanagementwiththeirpupilswithoutfearor menstruation doesnotleadtoreduced participationandperformanceatschool. that thistopicistaughttoallgirls,girlsare notstigmatised,andthat materials tosupporttheteachingofmenstrual hygiene A TIONS

RECOMMENDATIONS 41 young girls take to break the silence surrounding menstruation) surrounding the silence to break girls take young sector-specific indicators to monitor and evaluate policies and sector-specific Young girl holding the menstrual cycle wheel (the back of the wheel features an oath that an oath that the wheel features wheel (the back of girl holding the menstrual cycle Young Developing Increasing the participation of women and girls in discussions and decisions on their lives. matters that affect , including gender-specific data and regional statistics. data and regional budget allocations, including gender-specific – – – – u sion oncl C

Training for researchers and coordinators on menstrual hygiene management and the use of tablet PCs and the MHM application to collect data 42 Conclusion

There are persistent myths, taboos and social norms surrounding menstruation. Menstrual blood is still considered impure. Some women and girls are excluded, or exclude themselves, from social, educational, cultural and income-generating activities. Some are forced to use separate toilets. They do not pray during this time. This study on menstrual hygiene management behaviour and practices covered all categories of females in the Louga region, i.e. girls and women in both rural and urban areas, educated women (from primary to university level), non-literate women, girls in Koranic schools and daaras, pre-pubescent women, pubescent women, girls, women of reproductive age and menopausal women. The majority of the respondents stated that they were Muslims. The study revealed examples of both good and poor menstrual hygiene management practices and behaviour. In terms of good practices, the study revealed that most women and girls shower at least once a day and change their sanitary materials three or four times a day during their period. They wash their hands with soap after changing and wash their pads in the bathroom at home. The data indicated that drinking-water was available in homes. However, the study also revealed numerous poor practices related to beliefs and taboos surrounding menstruation. Girls and women tend to use unsuitable absorption materials to hide their period from their family and peers. This practice often leads to infections. They avoid drying their absorption materials outdoors and prefer to hide them in damp or dark places. Incorrectly dried fabrics can house germs and microbes,

and again lead to infections. They also try to dispose of their menstrual waste in secret, C often causing environmental harm. oncl

In Louga, the majority of the respondents stated that they use sanitary pads to manage u sion their periods. Due to their beliefs and superstitions, they wash these pads before disposing of them. As a result, they require just as much water as those women who use cloth if not more. Many of the respondents do not go to school or to work during their period due to a lack of WASH facilities and services. The topic is not covered in the media, and is absent from school curricula. This makes it difficult to determine the availability of water, soap, disposal facilities and appropriate menstrual hygiene management spaces. This study reflects a desire to give greater exposure to the question of menstruation, and to ensure that it is given full consideration by policy-makers. This will deliver greater respect for the human rights of women, promote their well-being, and improve the lives of the communities in which they live. Decision-makers, practitioners and professionals across the water, sanitation and hygiene (WASH), women’s rights, health, education and environment sectors have a responsibility to help break the silence surrounding menstrual hygiene management.

43 LIST OF FIGURES

Page Graph / Table name Figure number

Respondents’ age – ALL DEPARTMENTS 1 18

Marital status – ALL DEPARTMENTS 2 18

Ethnic groups – ALL DEPARTMENTS 3 18

Religion – ALL DEPARTMENTS 4 19

Availability of information before the first period in the 5 20 three departments

Availability of information before the first period in the 6 20 Linguère department – LINGUÈRE VILLAGE

Educational attainment – LINGUÈRE VILLAGE 7 21

Educational attainment – ALL DEPARTMENTS 8 21

Sources of information before the first period 9 22 – ALL DEPARTMENTS

Sources of information after the first period 10 22 – ALL DEPARTMENTS

Material used – ALL DEPARTMENTS 11 24

Material selection criteria – ALL DEPARTMENTS 12 25 LIS T OF FIG U RES Sanitary material replacement frequency in the region – ALL 13 25 DEPARTMENTS

Bathing frequency during menstruation – ALL DEPARTMENTS 14 26

Frequency of handwashing with soap after changing 15 26 sanitary material – ALL DEPARTMENTS

Source of water – ALL DEPARTMENTS 16 26

Preferred location for changing sanitary material 17 27 – ALL DEPARTMENTS

Location for washing sanitary material – ALL DEPARTMENTS 18 27

Location for drying sanitary material – ALL DEPARTMENTS 19 28

Menstrual waste disposal – ALL DEPARTMENTS 20 30

Participation in educational, cultural, social and economic 21 38 activities during menstruation – ALL DEPARTMENTS

Participation in educational, cultural, social and economic 22 39 activities during menstruation – LINGUÈRE VILLAGE

Participation in educational, cultural, social and economic 23 39 activities during menstruation – KÉBÉMER VILLAGE

44 references

1. Cartographie du mariage précoce en Afrique de l’ouest- Une étude des tendances, des interventions, des méthodes efficaces, des bonnes pratiques et la voie à suivre, par Judith-Ann Walker, Septembre 2013 2. Données de l’Organisation Mondiale de la Santé, disponible sur le site www.who.int 3. Education transforms lives, UNESCO, 2013 4. Etat de la population mondiale 2013 : la mère enfant – Face aux défis de la grossesse chez l’adolescente, Auteur et chercheuse principale : Nancy Williamson Phd. Pour le FNUAP, 2013 5. L’adolescente et ses menstruations. Vécu et représentation à travers le temps et les cultures. Enquête auprès de quinze adolescentes. Thèse de doctorat en médecine, Annaïg Mainguet, 2006 6. L’âge légal du mariage : approche législative, jurisprudentielle et doctrinale, par Aguibou Ly, Université Cheikh Anta Diop de Dakar, Maitrise de droit privé 2010 7. L’éducation traditionnelle en Afrique et ses valeurs fondamentales, par Dr A.S. Mungala, 1982 8. L’hygiène menstruelle dans les écoles de deux pays francophones d’Afrique de l’ouest : Burkina Faso et Niger – Etudes de cas en 2013, UNICEF, 2013 9. La grossesse chez les adolescentes, Organisation Mondiale de la Santé, Septembre 2014 www.who.int/mediacentre/factsheets/fs364/fr/ references 10. Liquides sexuels féminins et rapports sociaux en Afrique Centrale, Edouard Vincke, 1991 www.erudit.org/revue/as/1991/v15/n2-3/015181ar.pdf 11. Louga, Sénégal : Représentations autour de la migration auprès d’une communauté d’origine – Rapport de recherche projet ‘Mémoires audiovisuelles de la migration sénégalaise’, Maggi Sarr/Amadei, Avril 2008 12. Mariages précoces, grossesses chez les adolescentes et les jeunes femmes, Organisation Mondiale de la Santé, 65éme Assemblée Mondiale de la Santé (Mars 2012), Rapport du Secrétariat http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_13-fr.pdf?ua=1 13. Menstrual Hygiene Matters – A resource for improving menstrual hygiene around the world, Sarah House, Thérèse Mahon, Sue Cavill (SHARE), 2012 14. WASH in schools empowers girls’ education in rural Cochabamba, Bolivia – An assessement of menstrual hygiene management in schools, UNICEF, 2012

45 Study team (in alphabetical order) –– Rockaya AIDARA –– Mbarou GASSAMA –– Archana PATKAR –– Diénaba WANE NDIAYE Acknowledgements –– The team of researchers who collected the data. –– The team of coordinators who ran the menstrual hygiene management laboratory. –– All staff at the UN Women West and Central Africa Regional Office. Thanks to Aminata Camara for technical and logistical support. –– All staff at the Water Supply and Sanitation Collaborative Council in Geneva (Switzerland). Thanks to Eileen Palmer, Katherine Anderson, Saskia Castelein, Alma Felic, Hakim Hadjel and Carolien Van der Voorden. –– Members of the Joint Programme’s Advisory Committee which revised this report.

UN Women

In July 2010, the United Nations General Assembly created UN Women, the United Nations Entity for Gender Equality and the Empowerment of Women. The main roles of UN Women are: –– To support inter-governmental bodies, such as the Commission on the Status of Women, in their formulation of policies, global standards and norms. –– To help Member States to implement these standards, standing ready to provide suitable technical and financial support to those countries that request it, and to forge effective partnerships with civil society. –– To hold the UN system accountable for its own commitments on gender equality, including regular monitoring of system-wide progress. Grounded in the vision of equality enshrined in the UN Charter, UN Women, among other issues, works for the: –– elimination of discrimination against women and girls; –– empowerment of women; and –– achievement of equality between women and men as partners and beneficiaries of development, human rights, humanitarian action and peace and security.

Water Supply and Sanitation Collaborative Council (WSSCC)

The Water Supply and Sanitation Collaborative Council (WSSCC) is a global multi-stakeholder partnership and membership organization that works to save lives and improve livelihoods. It does so by enhancing collaboration among sector agencies and professionals who are working to improve access for the 2.5 billion people without safe sanitation and the 748 million people without clean drinking water. Through its work, WSSCC contributes to the broader goals of poverty eradication, health and environmental improvement, gender equality and long-term social and economic development. WSSCC supports coalitions in around 20 countries, members in more than 160 countries, and a Geneva-based Secretariat hosted by the United Nations Office for Project Services (UNOPS).

Water Supply and Sanitation UN Women West Africa Sub Regional Office Collaborative Council Ngor Virage, Immeuble N°3 SCI Diama 15 chemin Louis-Dunant BP 154 Dakar, Senegal 1202 GENEVA Tel: +221 33 869 9970 Switzerland Fax : +221 33 860 5495 Tel : +41 22 560 8181 [email protected] Fax : +41 22 560 8184 [email protected] [email protected] www.unwomenwestandcentralafrica.com www.wsscc.org UN Women 220 East 42nd Street New York, NY 10017, USA Tel: +1 646 781 4400 Fax: +1 646 781 4444 www.unwomen.org