Study
MENSTRUAL HYGIENE HYGIENE MENSTRUAL BEHAVIOUR MANAGEMENT: IN KYE-OSSI PRACTICES AND AND BAMOUNGOUM, CAMEROON BAMOUNGOUM, AND Data for this study were collected, processed and verified by Horizon Femmes. WSSCC and UN Women do not accept responsibility for any errors or inconsistencies in the data or in the transcripts of interviews. WSSCC and UN Women conducted the review, analysis and editing of this report.
© 2015 : WSSCC and UN Women Design : ACW, London, United Kingdom Photos : WSSCC/UN Women Further information : www.wsscc.org www.unwomenwestandcentralafrica.com www.unwomen.org/fr Cover photo: Photo taken at a UN Women refugee camp, Cameroon. Photo back cover: Girls and women pledge to break the silence on menstruation during the MHM lab in Senegal. MENSTRUAL HYGIENE MANAGEMENT: BEHAVIOUR AND PRACTICES IN KYE-OSSI AND BAMOUNGOUM, CAMEROON
This report examines a range of issues, from women and girls lack of access to sanitation and hygiene services to their strategies for dealing with menstrual hygiene management while playing their roles in families, communities, at work, at school, etc. The study also addresses the impact of perpetrated beliefs and restrictions they are sometimes submitted to in these two regions of Cameroon.
MENSTRUAL HYGIENE MENSTRUAL HYGIENE MENSTRUAL HYGIENE MANAGEMENT: BEHAVIOUR MANAGEMENT: BEHAVIOUR MANAGEMENT: BEHAVIOUR Study AND PRACTICES IN THE AND PRACTICES IN THE Study AND PRACTICES IN KYE-OSSI STUDY LOUGA REGION, SENEGAL KEDOUGOU REGION, SENEGAL AND BAMOUNGOUM, CAMEROON
A life cycle & Human Rights based approach for sanitation and hygiene for women and girls. CONTENTS CONTEN EXECUTIVESUMMARY LISTOFACRONYMS review ofcameroon publicolicies related Menstruation inCameroon: study findings 21 to w Objectives andmethodolody ofthe study 15 back (general Women andgirlsproductivity duringmenstruation Limitations sample) T 55 during sample onabsences from schoolduringperiods Knowledge andexperience of members of thegeneral menstruation participation atschoolandperformance Menstrual HygieneManagement, girlsexperience: 55 First periodsandknowledge aboutthissubject and Social representations of menstruation,socio-cultural religious taboos 26 in thetarget groups Beliefs aboutandrepresentations of menstruation Limit Data analysisandreport production to Data Nature andcontent of colletion tools the collection Methodology 15 18 Objectives study 18 of Research Bamoungoum the 12 problem Kye-Ossi 11 The study 15 study Main area Results5 9 eaching aboutpubertyandMHMatschool ater andsanitation 19 ground 9 13
5 2 S
54 53 50 28 24 18 18 CONTENTS 61 62
69 57 57 64 ure y infrastruct used sanitary protection Disposal of School infrastructure infrastructure School in public places Infrastructure sanitary protection protection disposal of method of on the beliefs of The influence sanitary CHARTS list of CHARTS 67 recommendations pect and res management menstrual hygiene 62 for the environment 72 references
MHM-Friendl
LIST OF ACRONYMS
BCC Behaviour Change Communication BUCREP Bureau central de recensement et d’etude de la population (Central Census and Population Study Office) CDE Camerounaise des eaux (Cameroon Water Company) CEDAW Convention on the Elimination of all Forms of Discrimination Against Women CLTS Community-led Total Sanitation CSPro Census and Survey Processing System DC Developing countries EA Enumeration area ECAM Enquête camerounaise auprès des ménages (Cameroon Household Survey)
Y MS LIS T OF ACRON EDS Enquête Démographique et de Santé (Demographic Health Survey) FGD Focus Group Discussion IEC Information, Education and Communication INS Institut national de statistique (National Statistics Institute) MDG Millennium Development Goals MHM Menstrual Hygiene Management MINATD Ministère de l’Administration territoriale et de la Décentralisation (Ministry of Territorial Administration and Decentralization) MINDUH Ministère de l’Habitat et du Développement urbain (Ministry of Housing and Urban Development) MINEDUB Ministère de l’Education de base (Ministry of Basic Education) MINEE Ministère de l’Eau et de l’Energie (Ministry of Water and Energy) 2 MINEPADT Ministère de l’Economie, de la Planification et de l’Aménagement du territoire (Ministry of Economy, Planning and Regional Development) MINSANTÉ Ministère de la Santé publique (Ministry of Public Health) OD Open defecation ORSTOM Office de la recherche scientifique et technique outre-mer (Office for Overseas Scientific and Technical Research) PAEPA Projet en alimentation en eau potable et d’assainissement (Drinking Water and Sanitation Supply Project) PRSP Poverty Reduction Strategy Papers RGPH
Recensement Général de la Population et de l’Habitat LIS T OF ACRON Y MS (General Census of Population and Housing) SNEC Société nationale des eaux du Cameroun (Cameroon National Water Company) SOFRECO Consultancy for Sustainable Economic and Social Development SPSS Statistical package for social sciences SVT Sciences de la vie et de la terre (Life and Earth Science) ToR Terms of Reference UN Women United Nations Entity for Gender Equality and the Empowerment of Women UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund UP Unwanted pregnancy WASH Water, Sanitation and Hygiene WSSCC Water Supply & Sanitation Collaborative Council 3 4 EXECUTIVE SUMMARY W omen washing clothesinK ye-Ossi. EXECUTIVE SUMMARY 5
Y Niger On Camero SENEGAL in a series by the Water Supply and Sanitation Collaborative and Sanitation Collaborative Supply by the Water in a series 1
The Joint Programme on Gender, The Joint Programme on Gender, Hygiene and Sanitation was pilot countriesimplemented in three Africa: Central and of West Niger and Senegal. Cameroon,
References for the two previous studies: Menstrual Hygiene Management: Behaviour and practices in the studies: Menstrual for the two previous References 2014, http://wsscc.org/resources-feed/menstrual- of Louga, Senegal, WSSCC and UN Women region Hygiene Management: Behaviour and practices in the Kedougou region, hygiene-management/; Menstrual 2015, http://wsscc.org/resources-feed/menstrual-hygiene-management/ Senegal, WSSCC and UN Women 1 1 At first glance, there are no significant differences in terms of access to information in terms of access no significant differences are At first glance, there and the general sample. sample between the school hygiene practices menstrual and a number of important factors: a deeper analysis of the data reveals However, at the time of attending school to information, girls who were to access regard With lessons attended school, said that they had received or who had previously the study, hygiene at school. However they used the same on body changes and menstrual practices for of sanitary material as those who had not been washing and disposal to school. Thus, 100% of the was even lower. Sometimes the performance of the school group general sample in Bamoungoum washed used cloth pads with soap or detergent, 95.5% of the general sample in Kye-Ossi against 83.7% of the school sample. Similarly, against 92.3% of the school sample. washed used cloth used with soap or detergent, Main results
IVE SUMMAR IVE UT EXEC study is the third This a general sample, for better analysis of the research questions. the research a general sample, for better analysis of Council (WSSCC) and UN Women under the Joint Programme on Gender, Hygiene Hygiene Gender, on the Joint Programme under Women UN and (WSSCC) Council hygiene of menstrual the subject It explores Africa. Central and West Sanitation in and and girls in Cameroon. management by women Kye-Ossi profiles: socio-cultural with very different two regions The study focused on of MHM- state the west. It looks at the current in in the south and Bamoungoum and public policies in the behaviour and analyses infrastructure practices and related of relevance and the availability checks It also sanitation sector. hygiene and water, practices, people’s living and evaluates its impact on hygiene information on MHM, of women and girls. educational levels and the employment conditions, their health, study uses a mixed research levels. The at both central and regional collected Data were than more In total, and a qualitative approach. methodology combining a quantitative sample and into a school was divided 1000 individuals took part. The total sample 6 EXECUTIVE SUMMARY had approached anuncleoranothermaninthefamily. teacher, 1.6%hadapproachedhad theirfirstperiod,and0.9% theirfatherwhenthey Among thegeneralsample,10%hadobtainedinformation aboutperiodsfrom amale Although currently verylimited, it is important tohighlighttheinvolvementofmen. and empowerment. society ingeneral.Theycan have anegativeimpactonwomen’s and girls’ self-esteem directly related tothesocialpositionofgirlsandwomenintheircommunities children, theirfertilityand the importance of menstrual blood. These factors are often to have These includebeliefsassociatedwiththestartofgirls’sex lives,theirability Some perceptionsmenstruation about a riskforgirlsandwomen. mayconstitute lives ofwomen. understanding andmanagementofthisnormal and recurring phenomenon in the holistically (mentally, psychologicallyandphysically)inawaythatensures good girls areprepared fortheonsetoftheirperiods.Periodsare poorly notaddressed happy,and 13%wereunhappy while7%felt indifferent. Thesedataconfirmthat Fear wasthedominantfeeling(60%oftotalsample);15%samplefelt did notunderstandwhatwashappeningtothemwhentheyhadtheirfirstperiod. majority ofthetotalsample had heard of menstruation, more than70% said that they Data onwomen’sandgirls’experienceofmenarche confirmthisinformation.Whilethe – – – and outsidetheeducationsystem. This raisesquestionsaboutthenatureandrelevanceofinformationreceivedwithin the generalsample. 92.3% oftheschoolsampledried sanitary clothsinthesun,compared with48.8% of cloths outdoorsinthesun,compared with44.9%ofthegeneralsample.InKye-Ossi, markedly higher:83.7%oftheschoolsamplefrom Bamoungoumdriedsanitary On thecontrary, theschoolsamplefigures fordryingsanitarymaterialsare – – – (5% ofthegeneralsampleand6%schoolsample). samples); and thingsoractivitiestoavoidduringperiods pain (2%inboth with the 34% oftheschoolsample),howtostayclean(16%inbothsamples),deal (42% in bothsamples), how to use sanitary protection (35% of the general sample, the sources of informationonmenstruation focuson:thetypeofprotection touse Similarly inbothgroup samples, thestudynotesthatupononsetofmenarche, and sistersputanemphasisonamalgamsbeliefs. Drying anddisposalissuesare infrequently orverypoorlyaddressed. Instead,mothers washing andtheuseofsanitaryprotection. the schoolandgeneralsample.Datashowthatmotherssistersfocuson Generally, mothersandsisters were themainsources of informationforboth gave awrong answerand29.5%gaveanapproximate answer. to correctlyable menstrualthe answerquestionsabout cycle,while53.1%ofgirls cycle, they do not necessarily understand it. Only17.4% of the school sample was information about periods. Notably, even if school girls haveheard of the menstrual According tothestudydatafor the school sample, teachers rank third as sources of at secondaryschool. the issueofmenstruationsecondary school.Thisconfirmsthat ismainlyaddressed the menstrual cycle when theywere in primaryschool compared with 80.9% in with girls from the generalsamplewho had attended school: 17.6% heard of those insecondary education. The difference isevengreater whencross-compared 12% ofprimarypupilshadheard ofthemenstrual cycle,compared with38.3%of are less well informed about menstruation thangirlsinsecondary school: only Withingirls inprimaryschool the educationsystem,itshouldbenotedthat
EXECUTIVE SUMMARY 7
, sanitary pads were at the top were sanitary pads protection, sanitary within the water and sanitation sector, do not address address not do sector, sanitation the water and within , the majority of schools visited had latrines. More than had latrines. More of schools visited to infrastructure , the majority regard With menstrual hygiene management. In the education system, menstruation is integrated integrated is menstruation system, hygiene management. In the education menstrual that pupils have to ensure detailed manner but not in a sufficiently into the curriculum cycle. a good understanding of the menstrual 90% of latrines were single sex in Kye-Ossi and a slightly lower number in and a slightly lower sex in Kye-Ossi single were 90% of latrines during their Girls attended school of latrines had doors. than 80% more Bamoungoum; pain, menstrual to various factors: 9% to 47% due from attendance varied periods. Their at school. intimate hygiene to change and manage inability problems, concentration in Kye-Ossi and 42% in clean rate of latrines (only 20% were The poor maintenance during menstruation. in sporadic use by girls, particularly Bamoungoum) results during menstruation. their activities of working women reduce At the same time, 22% given the lack of ingenuity in managing their periods They show considerable neighbours, ask they get by, to manage Many the workplace. in facilities appropriate working public toilets is for help or go home. The absence of colleagues or friends their concern (33%) followed by main (possible) stains on their clothes, the lack of with periods. and the physical discomfort associated a private space to change but visited soap was almost schools was available in the quantity of water sufficient A that handwashing facilities reported 17.6% of respondents never available: only not achievable without soap. are always had soap. Hygiene and health goals for preference users’ Regarding sanitary into reusable cloth made followed by of the list (over 80% in both samples), (preferred sanitary pads preferred mixed use of reported Both samples protection. local or themselves by users made (sanitary protection cloth reusable and protection) societies and women’s groups). than more only average, since are sanitary protection Hygiene practices for reusable if the Even the sun. in outdoors cloths not dry their reusable do the total sample half of does drying in the shade and changed at least twice a day, with soap cloth is washed germs. not guarantee the optimal elimination of of in latrines or toilets – 85% in both the school is mostly disposed Sanitary protection and for the maintenance for the environment and the general samples, posing a risk of the latrines/toilets. policies Cameroon public 8 BACKGROUND Girls on theirwaytoschool. Girls BACKGROUND 9
the overall number of health workers 3 Some 50.6%, of facilities are concentrated Some 50.6%, of facilities are 2
Ministry of Health, Human Resources Directorate. (2011) General census of staff in the Cameroon health in the Cameroon General census of staff (2011) Directorate. Ministry of Health, Human Resources at: http://cm-minsante-drh.com/site/index. Available April 2015). sector [online]. 68 pp. (page viewed 24 php/le-minsante-12 in the central, western and coastal regions with a predominance of private sector with a predominance in the central, western and coastal regions the Adamawa, unlike in the other regions. on the coast, and facilities in the centre 4.1%, 4.4% and 5.1% of with, respectively, north and the south have least access identified facilities. carried out in 2011, to the census According 2 3 Ibid. In Cameroon there are 4351 health facilities. Of belong these, 2428 (55.8%) to the public are there In Cameroon sector and 1923 (44.1%) to the private sector. Data on health in Cameroon The study area other with information from together of the health map of Cameroon, review A and sheds light on the particular context of Kye-Ossi in the southern region sources, Bamoungoum in the western region.
and Sanitation Collaborative Council (WSSCC) and UN Women, the UN Entity for Council (WSSCC) and UN Women, and Sanitation Collaborative the Empowerment of Women. Gender Equality and the expertise and skills combines strategic action, the programme of a joint The result but complementary member institutions, each with of two United Nations different contributing and to of having women’s voices heard goal common mandates, with the their rights. the achievement of aims the programme Niger and Senegal), countries (Cameroon, Implemented in three girls will be able to and women which the region’s a framework within to establish and hygiene services (WASH). sanitation water, manner from benefit in a sustained promote is to accelerate policies and practices to The main goal of the programme hygiene and sanitation for the women and girls equity and the human right to water, hygiene is an entry point that makes The issue of menstrual Africa. and Central of West of women’s needs in this area. nature it possible to bring to light the gender-specific practices and Related hygiene management is rare. Information on menstrual out in the regions this study carried After Kedougou, little documented. behaviour are the knowledge gap in this field for attempts to reduce and Bamoungoum of Kye-Ossi of women sanitation needs to the hygiene and a better response better planning and but also in the education, employment, sector, not only the WASH and girls targeting sectors. health and environment
UND BACKGRO on initiated a series of studies in under the Joint Programme is the third This report Supply Hygiene designed and implemented by the Water and Sanitation, Gender, was 38027, 66% of whom were in the public sector and 34% in other sectors. In general In other sectors. in 34% and sector the public in were whom of 66% 38027, was versus men who women make up to 56% of total health professionals in Cameroon, the country is the political capital of where the centre, of The regions 44%. represent better served with the economic capital is, and the west are located, the coast, where This means that 42% of the health personnel with 24%, 18% and 13% respectively. south and the Adamawa, the population is served by 55% of the health workforce. coverage with 3.4%, 3.7% and 4%, in total a little over 11% east, in contrast, have less general practitioners and the west has 116 as a whole. Specifically, of the workforce while the southern region to 1.8 million, close a population of 26 specialist doctors for than for an estimated population of less specialists has 45 general practitioners and 11 2599 nurses in the west and 781 in the south. are 700,000. There 10 BACKGROUND 1990 2001 2000 Year Use of W 1990 2001 2000 Year National estimateof access tosanitationinfrastructure inCameroon (P ater P oints (P Improved 74 62 51 water point to animproved Total withaccess ercentage of population)
Improved with accesstowatersince2000is24%compared with 29%forCameroon. 2000 is 10% against 14% in Cameroon. The percentage of the sub-Saharan population The percentage ofthesub-Saharanpopulation2012withaccesstosanitationsince the averageforsub-Saharan Africa, whichperformspoorlyoverallontheseissues. water are acauseforconcern,itshouldbenotedthatCameroon fares betterthan While thefigures foropendefecation,unimproved watersources anduseofsurface Source :UNICEF, 2014 Access towaterinCameroon (nationalestimate) Table 2 access towaterfrom 1990to2012. had gained access to watersince2000was 29%. Table 2illustratesthesituationof Moreover, itisestimatedthattheproportion ofthe2012Cameroon populationthat Data onaccesstowaterinCameroon Source :UNICEF, 2014 Access tosanitationfacilities inCameroon (nationalestimate) Table 1 one of46countriesinwhichsanitationcoverageisbelow50%. According totheJointMonitoringProgramme Progress Reportfor2014,Cameroon is Data onsanitationinCameroon 7 Ibid. 6 Ibid. 5 OMSetUNICEF, ibid. 4 over time. 2 illustratethisreality andhelpexplainthesituationofsanitationwatersectors population in2012whohadgainedaccesstosanitationsince2000was14%.Tables 1and line] 78pp.(pageviewed 24 April 2015). Available at:http://www.wssinfo.org/documents/ WHO/UNICEF. (2014)Progress onDrinking Water and Sanitation.JointMonitoringProgramme Update.[on connections Domestic 16 13 11 45 42 40 6 5 water points Other improved 58 49 40 Unimproved Shared facilities 15 14 13 ercentage of population) Unimproved facilities Unimproved Unimproved 34 35 36 18 27 35 4 Theproportion ofthe Open defecation Surface water 6 9 11 8 11 14 7 BACKGROUND 11 Total 157 Rain water 3
River 11 Spring 49 ell W 25 yé-Ossi, 2010, Ecole Normale Supérieure, Supérieure, Normale Ecole 2010, yé-Ossi, Borehole 61 opulations à K opulations , it has a fairly dense hydrographic network. The Kye hydrographic , it has a fairly dense 2 ye-Ossi Private water tank 8 8 Kye-Ossi. Indeed, as shown in Table 3, the ways in which water is supplied are 3, the ways in which water is supplied are Kye-Ossi. Indeed, as shown in Table rain cover, mostly traditional (well with no filtering system, seal or protective etc.) and do not include the networks of either river water, spring water, water, private Supply is essentially from des eaux (CDE) or the commune. Camerounaise wells, springs, rivers, and rain water collection. water tanks, boreholes, Education one high school, one technical, 10 nursery schools, The town has 25 primary schools, college (CETIC) and a private catholic school. industrial and commercial supplies sanitation and electricity Water, sanitation in drinking water and with the supply of acute problems are There ye-Ossi Ella J.-B. (2010). Approvisionnement en eau et santé des populations à Kyé-Ossi. Yaoundé : Ecole normale Yaoundé à Kyé-Ossi. en eau et santé des populations Approvisionnement Ella J.-B. (2010). I. Yaoundé Université de supérieure, – – Effective Type of supply of Type 8 The Amban health district has 17 health areas with 37 health facilities. The Kye-Ossi with 37 health facilities. The health areas 17 has Amban health district The which is incorporated into this district, has a district medical centre health area, (CSI) and two private health facilities. (CMA), an integrated health centre Health Situation Kye-Ossi is subdivided into 21 villages and has many ethnic groups. The Ntoumou Kye-Ossi is subdivided into 21 villages and has many ethnic groups. people, the Bamileke people that constitute the indigenous population, the Bamum neighbouring countries. from people, the Bulu people and a range of ethnic groups dominant The Ntoumou and Bamum. French, The main languages spoken are Catholic and Islam. Protestant, are religions Socio-cultural data Access to electricity is another major development and welfare question for the local development and welfare to electricity is another major Access by the national electricity network and population. The fact is, the town is not served can be seen by the ENEO network, although electricity poles and wires is not covered place to place, suggesting the existence of a local power plant. from Source: Approvisionnement en Eau et Sante Des P et Sante en Eau Approvisionnement Source: de Cameroun Université Table 3 Table water supply in K of Types In addition, the absence of a water distribution In addition, the absence of a water distribution network or method of disinfection and diseases. the risk of water-borne increase the lack of any quality controls – – Socio-economic data with Gabon and Equatorial Guinea, the border before Cameroon The last town in south citizens for trade, attracting numerous an important crossroads Kye-Ossi is known as followed by activity is dominated by agriculture, these two countries. Economic from livestock farming, fishing, craft and trade. Geographical data Geographical of the district is the capital Kye-Ossi Cameroon, tip of in the southernmost Located unit local administrative ) and of the (commune) that name. bears its (arrondissement by the to the north bound It is 000. 15 of population has a transit town and border This Guinea, to the east by Gabon and to Ambam, to the south by Equatorial commune of of Olamze. the west by the commune of 710 km a surface area With K a succession of roughly hemispherical hills separated by marshy valleys. hemispherical a succession of roughly is the most important river, with numerous tributaries. Influencing the distribution tributaries. with numerous important river, the most is of flat land, and has some plateaux, a preponderance relief of water points, the 12 BACKGROUND Main townofthedistrictBafoussam III, Bamoungoumcoversasurfaceof93.2km Geographical data Bamoungoum 11 10 9 – Source :ECAM2&3,InstitutNationaldela Statistique, Yaoundé (Cameroon) Proportion of thepopulationwithaccess topotabledrinkingwater(%) Table 4 – Gabon andEquatorialGuinea).There are twotypesofagriculturalproduction: cities of Yaounde andDouala, and evenforneighbouringcountries (in particular, Bamoungoum isconsidered abread-basketmajor of Bamoungoum,the town for the vegetables andtuberslargely meetthefoodneedsofcommunity. Inthisregard, Agriculture isthemainactivityinrural areas. Maize,peanuts,beans,plantains, Socio-economic data – – is estimatedat94,601,spread over57villages. Economy, PlanningandRegionalDevelopment(MINEPATD), thecurrent population women. It hasanestimatedpopulationof81,835,whom38,644are menand43,191are It has one of the highestpopulationdensities in the west and in the whole of Cameroon. Cameroon W – – – – org/downloads/Rapport_de_presentation_3_RGPH.pdf statistique du Cameroun (pageconsultée le 24avril2015).Disponiblesur : http://www.statistics-cameroon. 3e Recensement général de la population et de l’habitat (RGPH)(2010) [en ligne].Institutnationalde la Institut national delastatistique. 203p. INS, ECAM III (2007) Conditions de viedes populations etprofil de pauvreté auCameroun. Yaoundé : INS, ECAM II (2002) Enquêtecamerounaise auprès des ménages. Yaoundé : Institutnationalde la statistique. – four highschoolsandninegeneraltechnicalsecondary schools. schools, 11 statenurseryschools, 13privatesecularandreligious nurseryschools, education sectorhas43stateprimaryschools, 20 privatesecular and religious In thegeographicalarea ofthelocaladministrativeunit of Bafoussam III, the Education the westregion. Thisis14pointslowerthanthenationallevel(seetable4). In 2007,fewerthan26%ofhouseholdshadaccesstoasourcein water ofdrinking Water supply – season fromDecember toMay-June,andarainy to November-December. June-July tropical climatedominated by twomainseasons: a dryseason from November- Like thewholeregion ofthehighwesternplateaux,Bamoungoum has aSudanese Climate to thewestwithvillagesofBamekaandBansoa. of mountainsmarkingtheboundarytosouthwithvillageBandjoun, and The relief is mountainous with numerous plateaux and plains. It consists of a chain Relief est – – growers’ cooperatives. Cash crop production (Arabica and Robusta coffee) organized by agricultural essentially femalelabourforce. Market gardening (potatoes,tomatoes, carrots, green beans,maize,etc.)withan 9 the annualgrowthApplying Ministry ofthe the rateof2.6%calculatedby 40.6 25.1 2007 43.9 29.5 2008 10,11 2 . BACKGROUND 13
12 17
). Nonetheless, it seems that the ). Nonetheless, it seems that the 20 and are also the main users of WASH. also the main users of WASH. and are 18 the Maputo Protocol Menstruation-related issues are now part of discussions of discussions part now issues are Menstruation-related 19 highlighting the lack of information on this issue at on this issue at highlighting the lack of information 21,22 14,15,16 and research. and 13 WSSCC (2013). Rapport final de l’atelier du WSSCC sur l’équité et l’inclusion : 13-14 September, 2013 Dakar, 2013 Dakar, : 13-14 September, l’équité et l’inclusion sur WSSCC l’atelier du (2013). Rapport final de WSSCC Senegal. Attitudes, Beliefs of South East Nigeria: in Rural Igbo Women Umeora O., Egwuatu VE. (2008) Menstruation Available April 2015). (page viewed 24 Health Vol.12 African journal of Reproductive and Practices [on line]. at: http://www.ajol.info/index.php/ajrh/article/download/7961/30519 Bayray A. (2012). Menstrual Perceptions and Preparation of Rural Adolescent Females in Tigray, North Adolescent Females in Tigray, of Rural and Preparation Perceptions A. (2012). Menstrual Bayray 1 pp. 009-016. Ethiopia. Universal Journal of Education and General Studies Vol. de l’Ouest : d’Afrique de deux pays francophones les écoles dans menstruelle UNICEF (2013). L’hygiène Burkina Faso et Niger. : Institut National de Yaoundé 2004. de santé Cameroun INS/ICF International (2005). Enquête démoChart la Statistique/ICF International. : Institut Yaoundé [on line]. 2011 INS/ICF International (2012). Enquête démoChart de santé Cameroun at: https://dhsprogram. Available April 2015). 24 National de la Statistique/ICF International. (page viewed com/pubs/pdf/FR260/FR260.pdf advocacy, Cameroon is a signatory to the two main instruments for the protection and promotion and promotion for the protection is a signatory to the two main instruments Cameroon of women’s rights (CEDAW, 12 13 Ibid. 14 15 16 17 Ibid. 18 3e RGPH (2010). Ibid. (1979). All Forms of Discrimination against Women 19 International Convention on the Elimination of (1995). Africa in Rights to Women’s Rights, relating African Charter on Human and Peoples’ to the 20 Protocol 21 22 As in the majority of the countries of Central Africa, women account for more than than account for more Africa, women As in the majority of the countries of Central half (50.6%) of the population of Cameroon Research problem Research attention more received hygiene management (MHM) has menstrual Long ignored, years on the international scene thanks to various initiatives: intervention, in recent Health situation a severe from sector suffers unit of Bafoussam III, the health In the local administrative inhabitants. only 13 nurses and one doctor for 86,500 with shortage of staff, of the west, with malaria, similar to those are health problems The most recurrent all prevalent. HIV/AIDS diseases and diarrhoeal and one CSI, one CMA unit has the following health facilities: The local administrative health facilities. and four religious a military hospital, a prison healthcentre Socio-cultural data Socio-cultural language is the Ngumba where villages of the West is one of the Bamoungoum explains why eight villages, which and borders chiefdom is a first degree spoken. It as the region when they evoke sides of Bamoungoum” speak of “all eight dignitaries including components religious of range a has unit administrative local The whole. a animists. Originating in Christians and some Muslims and Catholic and Protestant the dominant ethnicity the Bamileke people are west region, several villages in the in Bamoungoum. issue of MHM was not covered by the Demographic and Health Surveys recently recently Surveys Health and Demographic by the covered not was MHM of issue published in Cameroon, national level. Furthermore, no research or data, even sectoral, on MHM can be found found or data, even sectoral, on MHM can be no research national level. Furthermore, in studies conducted to date. on the launched the series of studies Women Given this situation, WSSCC and UN Africa, as part of the Joint and Central West hygiene in management of menstrual the current Hygiene and Sanitation. In addition to remedying on Gender, Programme of these studies will guide actions lack of information and data on MHM, the results the Joint Programme. undertaken by the two agencies through in the Post-2015 Development Agenda and analysts agree that MHM should be that MHM should be Agenda and analysts agree in the Post-2015 Development and objectives. targets included as an indicator in the Post-2015 14 OBJECTIVES AND METHODOLOGY OF THE STUDY A poolof stagnant waterliesnext toadilapidated houseinK ye-Ossi. OBJECTIVES AND METHODOLOGY OF THE STUDY 15
23 OF Y OF
Deepen knowledge of this field responses. programmatic actions to provide Clarify future Obtain both quantitative and non-quantitative data that provide information on information data that provide Obtain both quantitative and non-quantitative the situation Provide an assessment of the impact of the situation found on the living conditions of an assessment Provide level, on the employment of educational of the population, and on their health and women and girls and on the environment. Ascertain the availability and relevance of information on the management of of information on the Ascertain the availability and relevance hygiene; menstrual Report on practices and behaviour related to MHM in Cameroon, including an in Cameroon, to MHM related and behaviour Report on practices and public policies; evaluation of existing infrastructure analysis and summative ORSTOM (1982) Nature et forme de pouvoir dans les sociétés dites acéphales. Exemples camerounais. et forme de pouvoir dans les sociétés dites acéphales. Exemples camerounais. (1982) Nature ORSTOM ORSTOM and documents from 1978. Paris: Proceedings 1 March science day, Yaoundé of the Proceedings No. 142. 169 pp. – – – The second location, the semi-rural locality of Bamoungoum, was chosen in the locality of Bamoungoum, location, the semi-rural The second behaviour is generally guided by a more of the west. In this area, grassland region have a stricter and cultural norms are to social class. Feudal structures rigid reference impact on social relations. stronger different present characteristics, two localities, with semi-urban and semi-rural These cultural profiles. 23 Kye-Ossi in the south region and Bamoungoum in the west region. The selection of selection The region. in the west Bamoungoum and region the south Kye-Ossi in and sociological factors. was based on a number of programmatic these regions already in which UN Women locality of Kye-Ossi is in an area The semi-rural likely to have are actions future where a location therefore, programmes, implements an impact. of social the structure In this cosmopolitan location in the Equatorial Bantu area, of choice for individuals. freedom is known to be flexible, allowing greater relationships The sites selected for this study: were of Cameroon locations in two separate regions Two – – – Data collection method combining a quantitative methodology and This study uses a mixed research hygiene information on menstrual It seeks to provide a qualitative approach. contexts to: management in several Cameroon Methodology 3. 2. This study aims to achieve the following objectives: This study aims to achieve 1. Objectives of the study of Objectives DOLOG THO ME AN D IVES T OBJEC TUDY THE S 16 OBJECTIVES AND METHODOLOGY OF THE STUDY Total K Region Bamoungoum ye-Ossi 11,018 11,021 3 Urban Number of householdsin2003 aged 10-12onaverage)andsecondary(years12,pupils aged12-13onaverage). These pupilswere takenfrom twophasesofeducation:primary(years5and6,pupils For thatpartoftheresearch inaschoolsetting,pupilswere identifiedbysite. – – Sampling to organize interviews and focus groups (FG) With regard toministerialofficials andopinionleaders,theappropriateness ofplaces establishments fortheschoolsampleandwithinhouseholds for thegeneralsample. To meettheobjectives of thestudy, itproved appropriate tocollectdataateducational accordingly. Thecategoriesadoptedare, therefore, asfollows: modes of education about MHM, and to related publicpolicies, targets have been set As thedatasoughtessentiallyrelate tolevelsofknowledge,customarypractices,and Targets Source :InstitutNationaldelaStatistique, Yaoundé (Cameroon) Demographic dataonthestudysites Table 5 26 25 24 – occasion withthepersonsconcerned. – – – INS/ICF International (2012). Ibid. INS (2007).Ibid. speak. Theleaders of thesegroups invitetheparticipantstospeak,exchange viewsandlearnaboutMHM. Focus groups are small discussion groups composed of 6-8women or girls,withinwhich theyfeelfree to areas (EAs)inthelocalitiesofKye-Ossi(13EAs)andBamoungoum(89EAs). the sampling frame used is therefore formed from the listing of all the enumeration – – the womennotinaschoolsetting. per EA.Within eachselectedhousehold,onesubjectwasdrawnatrandomfrom sampling frame(listingofEAs)ineachlocality, withaselectionof30households of dispersion, this sample was taken from seven EAs randomly drawn in the The sample comprised 445 general subjects and 515 school subjects. In terms Quantitative sample is alsotheframegenerallyusedforCameroon-based studies. To meet reliability requirements, this study used the RGPH III sampling frame, which Sampling frame - - - – Qualitative sample – – – Women’s opinionleadersand/ortraditionalandreligious authorities. (MINSANTE, MINEE,MINEDUB,MINATD) Officials inkeyministerialdepartmentsconcernedwithMHM. (general sample). (the school sample) and women and girls outside the education system Women ofchildbearingagedivided into twogroups: girlsattendingschool the townmayor, etc.). devolved powers toprovide extrainformation(theprincipal ofthehighschool, Lastly, some additional interviews were conducted with other officials with official andacommuneexpert.(See Annex forlistofinterviewees.) MINEE andoneforMINATD.a UNICEF Inaddition,onewas conductedwith were conducted,includingtwoforMINEDUB, one forMINSANTE, twofor Concerning officials from keyministerialdepartments,atotalof eightinterviews of womenandgirlsfrom more modestsocialbackgrounds. These FGs were mostlyofwomen opinion leaders with theaddition,however, Six focusgroups were organized, three inKye-Ossiandthree inBamoungoum. 4,249 7,979 3,730 Rural 15,267 19,000 3,733 Total 57,419 57,441 22 P Urban opulation in2003 24 was discussed and agreed on each 23,777 39,567 15,790 Rural 25,26 Theextractfrom 81,196 97,008 15,812 Total
OBJECTIVES AND METHODOLOGY OF THE STUDY 17 10.8 45.9 27.0 5.6 38.9 45.8 9.7 27.8 16.7 5.6 38.9 4.2 6.9 5.6 26.4 45.8 12.5 5.6 4.2 16.2 Total (%) Total 218 260 3 FGD 3 Bamoungoum ye-Ossi 227 Effective K 255 3 FGD 8 3 0* 0* 0* 0 13 15 7 0 1 0 28 3 3 Bamoungoum 1 4 18 6 3 3 0* Quantitative ye-Ossi 11 4 0 0 2 4 17 10 4 15 18 0 20 K 3 15 15 3 1 0 6 entecostal P None Ntoumou Bamoun Bassa Bamoungoum Baham Others Catholic Protestant Muslim Primary Secondary Higher 21-25 years 26-35 years 36-45 years 46-55 years 56 and over 20 years General Targets School leaders Women Central level decision-makers Local officials Questionnaire Ethnic group Level of education of Level Religion FGD guide guide Interview Tool Age *(missing data) *(missing Table 7 Table characteristics site and socio-demographic participants by group Focus Participants in focus group discussions were mixed together regardless of their their of regardless together mixed were discussions focus group Participants in of the composition 7 shows the detail mutual enrichment. Table with a view to profile of these groups. Table 6 Table and site target sample by of Summary 18 OBJECTIVES AND METHODOLOGY OF THE STUDY guides finallyenabledthistobeovercome. faced the distrust ofsome groups. The support of local leaders and thehelpof In Bamoungoum itwasdifficult toorganize women-onlyfocusgroups. Theteam town toanother. Consequently, thefieldstudytooklongerthanplanned. teams couldnotmovefromits peak, was at strike customers. Whenthe of the onepart part oftraders,whowere demandingfreer border crossings for EquatorialGuinean In Kye-Ossi,atradingtown,datacollection coincided with ageneralstrikeonthe Limits tothestudy content, onthebasisofverbatims. a thematicsummaryofeachinterview,a grouping then and analysisofthematic Qualitative datawere subjected to contentanalysis, permitting, aftertranscription, to SPSS,where themainpartofanalysiswascarriedout. data wereQuantitative entered intoCSPro software andthencleanedtransferred Data analysisandreport production awareness oflocalleadersconcernedwithMHM. to inform andraisethe This datacollectionoperationwasalsousedasanopportunity from 1to11 December 2014forBamoungoum. Data collectiontookplacefrom 24Novemberto2December2014forKye-Ossiand Data collection 4. 3. 2. 1. information beingsought.Theyare asfollows: The collectiontoolswere designedtosuitthetarget group andthenature ofthe Nature andcontent of collection tools crucial subjectofMHMasapartWASH. describing WASH-related publicpoliciesandobservinghowtheyincorporatedthe the WASH sectoringeneralandMHMparticular. Itwasmainlyaquestionof The interviewguideswere designedtoexplore publicpolicyissuesrelated to The interviewguideforindividualinterviews practices onMHMandthebehaviourofgirlsadultwomen. affecting orinterferingwithMHM,andabouttheimpactofthesetraditional was tofindoutmoreThe intention beliefs, practicesandcustomsdirectlythe about The focusgroupguidefordiscussions purposes and,inparticular, explores thefunctionalityofthesefacilities. infrastructure)(equipment, places forwomentousehygiene in public available on MHM knowledge and practices, the questionnaire explores the facilities activities andhousewives.Inadditiontoquestions including incomegenerating For women and girlsnotintheschool system and carryingoutvarious activities The “general”questionnaire the infrastructure availableontheschoolpremises. with questionsaboutMHMknowledgeandpracticeintheschool setting andon This isbasedonseveralareasFor adolescentsinschoolsettings. ofinterest associated The “school”questionnaire REVIEW OF Cameroon PUBLIC POLICIES RELATED TO WATER AND SANITATION 19
clearly 27 TER TION A O WA http://www.minepat.gov.cm/index.php/fr/modules-menu/ doc_ http://www.minepat.gov.cm/index.php/fr/modules-menu/ TED T
Increasing the rate of access to sanitation infrastructure from 15% to 60% by from to sanitation infrastructure the rate of access Increasing for the installation of date, by implementing a programme the strategy target establishments and by latrine blocks with water points in public scaling up the programme. Sanitation (CLTS) Total implementation of the Community-led Increasing the percentage of urban households with direct access to water from access to water from of urban households with direct the percentage Increasing 29% (estimated at 226,638) to 75% by 2020. In the same period (2010-2020), taking priority actions including making 700,000 and areas urban 40,000 water point equivalents in rural water connections, 6,000 water point equivalents in of the refurbishment latrines, and 1.2 million areas. rural download/108-document-de-strategies-pour-la-croissance-et-l-emploi-dsce Republic of Cameroon (2009) Document de stratégie pour la croissance et l’emploi: Cadre de référence référence de Cadre et l’emploi: la croissance stratégie pour de (2009) Document Cameroon Republic of 174 pp. (page : MINEPAT, Yaoundé de l’action gouvernementale pour la période 2010-2020 [on line]. at: Available April 2015). viewed 24 – – – 27 It became immediately apparent that aspects related to MHM are not explicitly to MHM are that aspects related It became immediately apparent in the guidance documents for the country’s policies. provided – T AND SANI – – RELA BLIC POLICIESBLIC PU on water public policies and of MHM-related to a review This chapter is devoted sanitation in Cameroon. and employment (DSCE) An examination of the strategy document for growth REVIEW OF Cameroon REVIEW shows the intention of the State of Cameroon to reach the Millennium Development to reach shows the intention of the State of Cameroon the living conditions of the population. Goals (MDGs), improving by half the 7.C of MDG 7, aiming to “reduce for target The DSCE takes responsibility of the population without access to safe drinking water”. proportion main points taken including three several aspects, covers In detail, this commitment on by the DSCE and other sources: 20 MENSTRUATION IN CAMEROON: STUDY findings Outside view of atoilet atCetic school inK ye-Ossi. MENSTRUATION IN CAMEROON: STUDY findings
This chapter begins with a presentation of a profile of the populations surveyed for this study, through a description of the main socio-demographic categories of each of them. In total, the quantitative part of the study reached 515 girls in school and 445 women and girls outside of school. This second group called general sample, was composed of girls and women who were either economically active, or not engaged in revenue gaining activity or working part-time, etc. The subjects of this sample were selected during the household surveys. 49.5% of the girls in the school sample were from schools in Kye-Ossi and 50.5% from schools in Bamoungoum. MENS T R U A Here, as in the rest of the document, the analysis will both combine and distinguish between the two groups.. –– Overview of the total study sample The age structure of the sample (Chart 1) shows a preponderance of adolescents T ION IN CAMEROON: S TUDY fin d ings and young adults forming more than half the sample. From the age of 20 years, a decrease in line with the age pyramid in Cameroon can be observed.
Chart 1 Age distribution of total sample
21 22 MENSTRUATION IN CAMEROON: STUDY findings Religious affiliationof thetotalsample Chart 4 and other(seeChart4). Every majorreligious group inCameroon isrepresented: Catholic,Protestant, Muslim Educational levels of total sample Chart 3 phase, thosewhoaccessedhighereducationandneverattendedschool. secondary school.Theremainingcomprises thosewhocompletedtheprimary quarter With regard to educational level (see Chart 3),nearlythree outof four subjects reached Marital statusof thetotalsample Chart 2 those livingwithaspouseorpartnershowslowincidenceofearlymarriage. were generally found within households (general sample). The correlation of the ages of The vastmajorityofthesampleissingle(seeChart2).Individualslivingwithapartner MENSTRUATION IN CAMEROON: STUDY findings 23
28 The remaining 12.4% were mainly members of born-again churches. 12.4% were The remaining Marital status (69.7%),partner or spouse a with living were subjects ten of out seven than More with an almost equal distribution between Kye-Ossi and Bamoungoum. Religion in the country: major groups is dominated by the three Religious affiliation Christians (30.8%) and Muslims (12.1%). Catholic Christians (44.7%), Protestant Place of residence (75%). As in the school sample, the majority of the subjects lived in urban areas Educational level and occupation the women interviewed had not attended to schooling, the majority of regard With of secondary education. Some had neverschool beyond the fourth or fifth year the As shown below, beyond the primary phase. attended school or had gone barely resources financial of lack the were school leave to them forcing reasons main three (11.5%). (34%), marriage (12%) and pregnancy In terms of occupation, housewives formed 33.9% of the sample, followed by those worked in agriculture. of the sample, the majority, working in trade, at 25.2%. The rest of school students were living in single parent households with their mother or households with their mother or living in single parent of school students were alone and 2.7 % with their father or male guardian. guardian Age years, with an average of 29 years in Kye-Ossi 16 to 67 ages ranged from In this group, 27 and 31 years respectively. ages were and 32 years in Bamoungoum. The median Region of origin in stratum 1 in the sampling plan communities emerge: main groups Two Bantu and Semi-Bantu people, and featuring of the centre/south/east), (regions of the west/north-west), featuring people stratum 2 (regions communities from the grasslands. from Household members (mother parents biological their with live (54%) students school the half over little A Only 23.7% (female and male guardians). and father) or their adoptive parents Place of residence in urban or suburban 60% of the subjects lived of residence, to place regard With setting). a rural (against 40% in areas Religion number by respectively with, whole a as Cameroon reflect data affiliation Religious Christians, Muslims and others. of followers, Catholic Christians, Protestant Educational level in secondary were the majority of the school students (87%) of their age, As a result one and two (years to the “observation cycle” corresponding education, at level 1, 3 of primary education in level 13% were The remaining of secondary education). (the final two years). Age 18 years. The average 10 to aged from of girls composed sample is The school and 14 in Bamoungoum). (13 years in Kye-Ossi for the sample overall age is 14 and adolescents. includes pre-adolescents therefore The sample This refers to new churches proclaiming Christ but being perceived or described as more active than the as more or described Christ but being perceived proclaiming to new churches refers This traditional Christian religions. – – – – – – – – – – – 28 – – – – Socio-demographic characteristics of the general sample Socio-demographic characteristics – – – – – – Socio-demographic characteristics of the school sample of the school characteristics Socio-demographic – 24 MENSTRUATION IN CAMEROON: STUDY findings are related tothemoonandflowofblood. from theirnamesthrough totheassociatedbeliefsandtaboos.Thecommonmeanings One can,therefore, seearelative transversalityofculturalsignifiersformenstruation, flow ofblood. and blood andtotheearth.Thus,GwanSunmeanseemoon;manewo, The meaningsare similarandgenerallyrefer tothemoon(lunarcycle),flowof interviewed inBamoungoum. Au chieutaméfortheBamoungoum,Bahampeopleandothergrasslandgroups or and In eachlocallanguagethere isaspecificexpression todesignateperiods.Gwan decoded inorder tounderstandtheirmeaning. The namesgiventomenstruation inlocallanguageshavebeentosomeextent Social designationsandculturalsignifiersofmenstruation target groups Beliefs aboutandrepresentations of menstruationinthe delay periods. what sometimes drives the use of traditional recipes or concoctions to bringon or Other ethnicgroups have similar practices and beliefs, withsimilarmeanings. This is for marriage. active, as it is for the Bamum people, who consider menarche as a sign of readiness belong totheNtoumoupeople,menarche isseenasan“on”switchforbeingsexually daughters tobecareful whentheyare withboys. According torespondents who for sexuallife.Somemotherssuggestthisintheirwarnings,whentheyask is) interpreted bythegirl,atapsychologicalandsociallevel,asbeingnowmature The implicitmeaningrefers totheabilityhavechildren, butitmaybe(andoften Once shestartsmenstruating,agirlbecomeswoman general. Thesebeliefsare asfollows: regard tosexualandreproductive health,contraceptionandmenstrual hygienein pseudo-scientific nature, according totheimpacttheycanhaveonbehaviourwith here from otherculturalbeliefs.Thesebeliefshavebeenisolatedonthebasisoftheir A numberoferroneous beliefshavebeenidentified,whichwillbedistinguished Erroneous beliefsaboutmenstruation (FG, Kye-Ossi) make periods start. There are also Quranic verses that stimulate the onsetof periods.” remedy, abark called “kamout”, which meansroot of the moon (to haveperiods)to get togetherto find a solution to the problem. Most often, thegirl is givena traditional the daughter hasalreadythis because been betrothed. Inthisparticularcase,theparents “There are womenwhostarttheirperiodslateandusuallytheparentsdo notknowabout ready tolivewithaman.”(FG,Kye-Ossi) and are nowready formarriage.Becauseitisassumedthatatageagirlalready “Mothers are gladtogoandtellfathersthattheirdaughtershavehadfirstperiod Sigma fortheBamumpeople;andauFitseu, mo sigieuwflower(thechildseesitsflower;Iseemyflower)refer tobloodandthe Manewo fortheNtoumoupeople;SunBassaSigmantsié, Fitseumegui, or Mo sigieuwfloweror sigmantsié Yieumot
MENSTRUATION IN CAMEROON: STUDY findings 25
does, she will fall pregnant. contracting a disease nother ask to have you her period, having that when a woman is somewhere gathered “I (FG, Bamoungoum) to walk, as she could get ill or become pregnant.” “They also told us that disposable sanitary cloths were bad for our health.” cloths were “They also told us that disposable sanitary (FG, Bamoungoum) away them and can take a women’s “chances” “When a woman has not yet started her periods, she should not run after men because as she should not run after men because as has not yet started her periods, woman “When a is, it is The fact get smaller. pregnant getting of your chances all soon as he mounts you, sperm received believe that I also yet or not. woman a are you determine if periods that the age of 15, most At her. destroy will by a girl who has not yet started her periods maturity. bodies have not yet reached this age women’s women have their periods; before this could be what is and growth, Running age slows down women’s after men at that (FG, Kye-Ossi) behind the difficulty in having children.” “When my mother came she realized that I was having my period. She discreetly took took discreetly my period. She that I was having mother came she realized “When my use it. explained to me how to sanitary cloth and she out a she took her bedroom; me into as soon as a boy approached is why, That any boys anymore. She told me not to greet also because that if a boy touched she told me I would my hand me I went away immediately, married without knowing men.” (FG, That is why I got immediately fall pregnant. Bamoungoum) A girl can no longer greet a boy as soon as she starts her periods, because if she a boy as soon as she starts her periods, because if she girl can no longer greet A One needs to avoid walking during periods, to avoid falling pregnant or or periods, to avoid falling pregnant One needs to avoid walking during Sanitary cloths are harmful to health Sanitary cloths are makes the blood black during menstruation Eating mackerel or shorten painful can make them during menstruation relations Having sexual To menstruate is to be pregnant menstruate To Periods should last five days, not three – – – – – – – – – – – – – – In the same vein, the respondents report that many mothers tell their daughters tell their daughters many mothers that report vein, the respondents In the same lead could even everyday contact that on the grounds company male to avoid or This belief “Periods = pregnancy” fuel the sayings, has helped to pregnancy. Other erroneous beliefs are worth noting: beliefs are Other erroneous Conversely, the chances of having one’s period would be reduced by any sexual period would be reduced of having one’s chances the Conversely, menarche. activity before “Periods + boy = pregnancy”. “Periods + 26 MENSTRUATION IN CAMEROON: STUDY findings blood andsanitaryprotection andontheprohibitions thataccompanymenstruation. periods andrelated practices.Thesebeliefsare mostlytodowiththemanagementof Cultural andreligious beliefsare importantdeterminantsofcommunication about find ituncomfortabletodiscussthissubject. communication aboutit.Thisiswhy, according tothewomeninterviewed,menoften Menstruation, then,issurrounded by multiplebeliefsandsocial taboos thathinder sometimes worktowards good menstrual hygienemanagement. These beliefsare common to allthe culturalgroups studied.Paradoxically, they - Killingthechild - Decidingthewoman’sfate - Preventing thewomanfrom gettingmarried - Killingthewoman - Preventing thewomanfrom conceiving Sanitary protection canbeusedformysticalpurposestoharmwomen.Inparticular: Management ofbloodandsanitaryprotection not beingabletohavechildren. associates risk withallsexual activity before menarche, particularly withtheriskof as a genuine“on” switch for women’s sexual and maternal lives. Popular imagery For otherrespondents, people whobelongtoNtoumou,periods are alsoconsidered promises andthreats. evidencing ambivalence.Theyare bothdesired andfeared atthesame time, made of menstruation are generallymetaphorswithvariouspositiveornegativeconnotations, According torespondents whobelong totheBamoungoum people, thenamesgivento utmost secrecy, reflecting strong determinismofsilenceandtheforbidden. onset ofperiods. the know about daughters tosilenceoncethey Advice isgiveninthe In general,inalllocations, mothers sometimes, implicitly orexplicitly, bidtheir Social representations religious taboos Social representations of menstruation,socio-cultural and 29 Editor’s note:Wait29 Editor’s sixorseven menstrual cycles before having anysexualactivity withaman. ancestors leftus.” will have trouble givingbirth(...).Yes, forme,all this istrue,becausewhatour then youcanstartgoingwithmen. “What we sayisthat when youstartyourperiods,needto wait 6 or 7times,and (Interviewwithamatriarch, Kye-Ossi) 29 Butifyouhavesexbefore yourperiodsstartyou MENSTRUATION IN CAMEROON: STUDY findings 27 “You mustn’t go near trees bearing fruit or in vegetable gardens when you have bearing fruit or in vegetable gardens trees go near mustn’t “You Explanation and testimonies Explanation It will not cook them that told their grandmother always that me told “I have a friend who with those cook, like that a woman having her period must not dishes are there tried to find out.” because I’ve never tell you why, pistachio or koki. I couldn’t It turns the blood black the catch It will ruin does not go out with people “For us Ntoumou, a woman having her period we go out, we being no fish. Before fishing because that brings a risk of there is a woman among us having her period.” always check if there It may make them rot at all fruit or stop producing sour fruit may produce The trees that a women having her pick fruit, for period must not “I heard somewhere sour fruit, and I don’t or only produce may not fruit any more, fear that the tree true or not.” know if it’s of a traditional plant-based remedy the curative effects Fear of reducing from your period, because you run the risk or weakening or killing the produce told when we younger.” were what we this because it’s respect the garden. We and for mystical reasons On hygiene grounds prescription Respect for a religious Due to impurity Due to impurity Due to impurity prescription Respect for a religious
Food pistachio containing any food Do not cook people) Bassa Ntoumou people, people, (Fan (Bamum people) Do not eat mackerel agriculture Domestic | fishing | people, (Fan out with fishermen Do not go people) Bassa Ntoumou people, Ntoumou people, sugar cane (Fan Do not take people) Bassa people, tomatoes cucumbers, into fields of Do not go or peppers. people) Bassa Ntoumou people, people, (Fan - Do not pick fruit remedies - Do not pick traditional peppers - Do not cook bearing fruit near trees - Do not go Sexual people, (Fan relations sexual Do not have people) Bassa Ntoumou people, (Muslims) relations sexual Do not have Religious (Catholics) Do not fast the altar and do not sing Do not approach denominations) (some Protestant and touching the Quran on praying Prohibition (Muslims) the purification rituals periods, carry out After (Muslims) the Quran by prescribed rohibitions, restrictions and prescriptions and restrictions Prohibitions, rohibitions linked to menstruation and justification to menstruation linked Prohibitions Prohibitions linked to menstruation Prohibitions 8 Table 28 MENSTRUATION IN CAMEROON: STUDY findings Awareness of menarche Chart 5 did notknowwhatthebloodflowwaswhentheyhadtheirfirstperiod. As shown in chart5,nearly72%ofgirlsattendingschool in Kye-Ossi and Bamoungoum Awareness ofmenarche Age of menarche (totalsample) Table 9 of menstruation and9yearstheearliest(seetable9). of 13years,whileatbothends of thesample, 20 yearsmarksthelatestageforonset The results ofthesurveyshow a concentrationofstatisticalindicators around theage Age ofmenarche(totalsample) Menarche, knowledgeandemotionalexperience cognitive reality, andonstudyparticipants’knowledgeaboutit. This sectionfocuses more particularlyonmenarche and itssingular, emotionaland First periodsand knowledge aboutthissubject School sample Age of menarche 13 Mean Median 13 Mode 13 Maximum 20 Minimum 9 MENSTRUATION IN CAMEROON: STUDY findings 29 12.5 13.0 13.9 11.6 12.6 12.5 13.3 12.2 15.0 Indifferent 6.3 7.4 7.8 6.5 7.1 9.6 5.1 7.3 7.1 Unhappy 1.6 16.9 15.2 14.6 14.6 12.1 17.6 14.1 17.3 Glad/happy 1.6 0.9 1.0 1.0 1.0 0.8 1.2 1.1 0.8 Disgust Emotional experience during menarche (%) during menarche Emotional experience 78.1 61.7 62.2 66.3 62.5 65 62.8 65.2 59.8 Fear/anxiety
(%) Understood it was a period was it 19.7 29.6 26.2 31.5 28.3 24.4 32.2 24.8 38.9 Yes ye-Ossi ye-Ossi Rural 15 years 15 years and over Secondary Bamoungoum Urban Under 15 Primary K Total Setting hase of Phase of schooling Age Site Understood it was a period Understood Emotional experience during periods Emotional experience Table 10 Table in the school sample menarche of Experience Emotional experience Emotional summarizes 10 Table and anxiety. them to feel fear understanding caused This lack of this event on emotional impact of its onset and the and on menarche the data collected the school sample. the girls in 30 MENSTRUATION IN CAMEROON: STUDY findings understood thatthebloodcamefrom menstruation. more respondents intheurbansetting(55%)thanrural setting(43.6%)had school, primary school(41.7%).Contrarytowhatwasobservedingirlsattending periods thanthosewhohadneverbeentoschool(53.3%)andonlyattended attended secondary school (56.8%) said that theywere ready forthearrivalof their If welookattheresults compared toeducationallevels,more womenandgirlswho nearly 49%hadnotunderstoodwhatwasgoingon. Nevertheless, thisresult,than intheschoolsamplealsoreveals thoughbetter that understood that thefirstflowsofbloodmarkedarrivaltheirperiods. More thanhalf(52.5%) ofthewomen and girls inthisgroup said that theyhad The generalsample happy, and12.6%indifferent. fear andanxiety,were14.6% ofthegirlssaidthey in62.5%ofallthosesurveyed.Only revealemotional experience Responses givenonthe aconsiderablepredominance of that thebleedingwastodowithperiodsthanthoseinurbanareas (26.2%). primary school (19.7%). Similarly, more girlslivinginrural areas (31.5%)understood secondary school (29.6%) were more prepared for this event than those attending When consideringthephaseofeducation,resultsgirls attending showthat attending school)didnotunderstandthattheflowofbloodwastodowithperiods. remains thatevenintheBamoungoumsamplemore thantwothirds (67.8% ofgirls Even iftheresults from Bamoungoum seem better thanthose from Kye-Ossi,thefact upset astheydidnotknowwhatwashappeningtothem. werethey members that by surprisewiththeirperiodandsometimes mostlytaken focus groupstatements madeby was aperiod.Thisconfirmsthe it school knewthat At thetimeoftheirfirstperiods,barely more(28.3%) ofgirlsattending thanaquarter (FG, Bamoungoum) me intoherroom togivemesomeclothsandexplainedhowputthemon...” she noticedbloodstainsonitandwasthenthatItoldherthetruth.Shetook I didn’twas lyingaboutmyhavingperiods.Because sister properly, washmyunderwear I wassoashamedtotalk to heraboutit.Whensheaskedmeit,Itoldthatmy from my mother thefirstmonthsIhad a period. Itwasmy sister whotold her, because hid it who advisedme. Ieven I hadoldersisters because first timeIwasnotsurprised “Yes, girlsare told,butitallontheindividual. depends WhenIhadmyperiodforthe (FG, Kye-Ossi) it was a sign of maturity in a woman and that the same thing had happened to her.” I wentstraightto my guardian’s room to tell her about the situation. She told me that “I hadmyfirstperiodonemonthbefore mymarriage.OnemorningIwokeupwet;
MENSTRUATION IN CAMEROON: STUDY findings 31 31.6 34.0 30.3 36.4 32.2 26.0 38.6 25.7 32.4 39.3 20.0 33.8 32.0 Indifferent 1.9 3.8 1.7 3.9 2.3 0.9 3.9 3.7 1.2 2.7 0.0 3.1 2.1 Unhappy 15.6 4.7 14.1 10.1 12.9 15.5 10.1 17.6 11.6 8.9 26.7 12.3 12.5 Glad/happy 1.6 0.0 1.7 0.0 1.2 1.4 1.0 1.5 1.7 0.0 0.0 1.5 1.1 Disgust Emotional experience during menarche (%) menarche during experience Emotional 49.4 57.5 52.2 49.6 51.4 56.2 46.4 51.5 53.2 49.1 53.3 49.2 52.3 Fear/anxiety (%) was a period Understood itUnderstood 55.0 43.6 51.0 54.9 52.2 49.1 55.3 51.0 54.5 48.7 53.3 41.7 56.8 YES ye-Ossi Living with aLiving spouse/partner Primary at most Secondary or more Rural 25-34 years 35-67 years Bamoungoum Single Urban Under 15 been Never to school K Status Total Setting Level of of Level schooling Age Site Emotional experience during periods Emotional experience Understood it was a period Understood Table 11 Table sample general in the menarche of Experience 32 MENSTRUATION IN CAMEROON: STUDY findings sometimes inspiteofhavingbeenforewarned bytheirfamilies. Several participantsexperiencedtheirfirstperiodsasattacksonbodies, sexuality andintimatehygieneingeneral. periods withtheirmothersandshowedhowlittlediscussionthere wasabout These testimoniesreveal thatseveralgirlsvoluntarilyrefused totalkabouttheir moment intheirlivesasgirls. Others thoughttheyhadaninternalinjury, makingitdifficult tomanagethiscrucial Others hadpainfulperiodsandonlylittleinformationinthisregard. mental health. of themenstrual flow, sometimeswithdisastrous results bothtotheirbodilyand of girlshavenotevenbeenprepared bytheirmothersorteachersforthefirstonset depending onthelocationwhere ittakesplace. According toEllis Some womenandgirlsmaybevariouslyaffected bytheonsetofmenarche, women andgirlsinthisgroup were indifferent. emotions ofanxiety(62.5%),discontent(7.1%)anddisgust(1%),while12.6%the Moreover, theresults showthattheiremotionalreality isdominatedbyunpleasant 30 Ellis,H. (2003)Studiesin the PsychologyofSex New York, RandomHouse. girl isoftenrequired towashseveraltimesaday. However, practicesforablutions orbodilyhygieneexistineverygroup, where the – – prescriptions. Itconsistsof: According tosomerespondents (Bamum),culturalpracticeisbasedonreligious groups inthesurvey, apartfrom theBamumpeople. There are noculturalmodelsforthemanagementofmenstrual hygieneintheethnic Traditional andsocialmodesofeducationonMHM – – it was.”(FG,Kye-Ossi) whereeven mymotherdidn’t theytoldusthatitwasmyperiod,because knowwhat was injured, Iwenttotellmymotheraboutit.Itwasthenthatshetook me tothehospital I realizedto thetoiletswhen One dayIwent coming out.ThinkingthatI thatbloodwas “My periodsstartedwhenIwasaged9inthelastbutoneyearatprimaryschool. (FG, Bamoungoum) mother to tell her about the situation as Ithoughtthat I wasinjured insidemy belly.” what wasgoingon,Istartedtocry.understanding my to see Allinapanic,Iwent “I wokeuponemorningwithbloodeverywhereNot onmybodyandthesheet. injured“The firsttimeIhadmyperiod(...)thoughtbeen Kye-Ossi) inside.”(FG, (FG, Bamoungoum) I wouldfallpregnant straightaway. ThatiswhyIgotmarriedwithoutknowingmen.” to mehowwearit.Shealsotoldnotgreet anyboysanymore,if Idid because she discreetly took meintoherbedroom andtookoutasanitaryclothexplained I didn’t sayanythingtomymother...when mymotherrealized thatitwasmyperiod, “My periodsstartedwhenIwasinthefieldwithmymother.I wasashamed Since times. side ofthebodyandfinishingwithrightside.Eachpart hastobewashedthree Reciting verses from the Quranwhile washingprivateparts,thentheleft Taking ashower 30 , alarge number
MENSTRUATION IN CAMEROON: STUDY findings 33 Chart 8 menstruation about Explanations received Chart 7 menarche before Information A large majority (80.7%) of respondents had some information on menstruation before before some information on menstruation had majority (80.7%) of respondents large A this initial information did above show, Nevertheless, as the results their menarche. when the first period, and time came to manage this difficulties them from not spare the risk of psychological trauma. in particular from School sample about information periods before In the school sample, 81.6% said they had received the urban sample received higher number (84.8%) in A they had their first period. (76.8%). one information than in the rural had not about periods sample who had heard On the other hand, 27.6% of the school any specific information or an explanation about them (see Chart 7). received Chart 6 menarche before Information Advance information about menstruation (total sample) menstruation (total information about Advance about information who received of women and girls the proportion Chart 6 shows of their first periods. the arrival before menstruation yours started? before you heard of periods Question: Had 34 MENSTRUATION IN CAMEROON: STUDY findings associated problems about periodsand would notlike totalk P talk aboutperiods would mostlike to P periods turned during P periods information about Source of first erson withwhom erson towhom erson withwhom
4% 53.1 61% 32% Mother/female guardian turned toatthe onsetofmenarche (seeChart9). Taking thesampleasawhole,itcanbeclearly seenthatmothersare thepeoplegirls Confidant ontheoccasionof firstperiod(totalsample) teachers (0.4%). grandmothers (1.1%),female friends(0.7%),femalefamilymembers(1.3%)and or sources of informationaboutmenstruation, followed by theirsisters (3.1%), Also, womenandgirlsconsidered theirmothers(76.4%)aspreferred confidantes and fathers(2%1.6%),femaleteachersmalefamily members (both0.5%). older sisters(16.5%)femalefamilymembers(7.2%), friends (7%),grandmother same trends asfortheschoolsample.Thus,theirmotherscame first(49%),followedby Upon their first periods, the constellation of persons to whom they turned followed the grandmothers (1.7%).(SeeTable 13) friends (10%each),femaleteachers(8.2%),womenfamily members(3.8%)and was mothers(40.5%)followedbyoldersisters(25.8%), male teachersandfemale In this sample, as in theschool sample, the main source of information about periods The generalsample among preferred confidantes. are, nonetheless,thesource offirstinformationaboutperiodsfor22%girlsare not with whom girls wouldnotliketoaddress these questions.Notethatteachers, who male guardians andothervariousacquaintancesincludingfemalefriendsare persons female membersofthefamily. For36%and38%ofthemrespectively, theirfather/ their mothers as theirpreferred confidante(53.1%),thentheirsisters(26.5%)andother With regard to the persons with whom they prefer to talkaboutperiods, girls choose other confidants(4%)andteachers(1%). guardian (61%), their sister (22%), and other female members of the family(12%), After menarche, girlsturntodifferent peopleforinformation:theirmother/female Sources of information about menstruation(schoolsample) Table 12 from herfollowedbysisters(29%)andteachers(22%),others. information aboutperiods.Infact,32%ofgirlsobtainedtheirfirst Table 12showsthatthemother/femaleguardian isthemainsource ofinitial School sample Sources ofinformationaboutmenstruation - 26.5% 22% 29% Sister
- 0.2% 1% 22% Teacher
7% the family): other manin (Uncle or 5.1% 12% - Other female family members (aunt, cousin, etc.)
36% - - - Father/male guardian
(15%) friend(s) Female 38% + 13.5% 4% 17% Others
MENSTRUATION IN CAMEROON: STUDY findings 35 Others
16.4% - 15.4%
family member family Uncle of other male male other of Uncle
- - 0.9% Father
0.2% - 1.6% Male teacher Male
0.2% 10% -
Female teacher Female
0.4% 8.2% 0.5% Female friend(s) Female
0.7% 10% 7% Sister
3.1% 25.8% 16.5%
member
female family family female Aunt or other other or Aunt
1.3% 3.8% 7.2% Grandmother
1.1% 1.7% 2% Mother 76.4% 40.5% 49% “She (my mother) also forbade me to play with boys. I didn’t understand what that “She (my mother) also forbade me to play with boys. I didn’t of my concern and boys. My mother became aware meant, as most of my friends were ‘not exactly what she meant by me to explain to not wanted she has still this day to up that I understood what it meant.” It was when I grew playing with boys any more’. (FG, Bamoungoum) erson erson erson besterson P to give placed to theadvice girl about periods P to on spoken of occurrence period first Source Source first of information about periods Chart 9 That said, the qualitative data reveal discomfort on the part of mothers to talk about talk to mothers the part of on discomfort reveal the qualitative data said, That periods. That is why they about often limit themselves to cursory information the on personal hygiene and sexual of the blood or to basic recommendations nature prohibitions. about breaking with threats Sometimes, this information comes relations. of mothers when talking about the predominance The qualitative data confirm often too skewed is mothers from that this information show But they also periods. any the girl from protect to by the desire guided it is because misguided, even or and dishonour the family. her future which could compromise unwanted pregnancies, Identity of confidant at occurrence of first period first of at occurrence confidant Identity of Table 13 Table sample) (general about menstruation information of Sources 36 MENSTRUATION IN CAMEROON: STUDY findings Nature of information received onwhattododuringmenstruation Chart 11 (see Chart11). Additional questionswerenature askedtodefinethe information received of the Information onhow tobehave duringperiods Chart 10 considerable accesstoinformation. had beengivenadvice on whattheyhadtododuringtheirperiods, thus confirming Chart 10shows that thevastmajorityofgirlsattendingschool (82%) said that they School sample on whattodo. For thesampleoverall,someeightoutoften(81%)saidthattheyhadreceived advice management ofmenstruation. This studymainlyfocusedonpracticalinformationprovidedarethat by related tothe Information onmanagingmenstruation
MENSTRUATION IN CAMEROON: STUDY findings 37 Chart 13 on how received information of Type periods to manage 80% 20% What (activities, for example) to avoid during menstruation (6%) example) to avoid during menstruation What (activities, for (2%) How to deal with pain The nature of the sanitary protection to use (42%) to of the sanitary protection The nature be used (34%) should which sanitary protection The way in clean (16%) to take to keep The precautions – – – – – Overall, it was found that some of the results of the variables studied are slightly slightly of the variables studied are Overall, it was found that some of the results lower in this sample than in the school sample, but follow the same trends. Chart 12 periods to manage on how Information These results suggest that the more information is precise and specific, the less it is and specific, the less information is precise more suggest that the results These hygiene and certain difficulties the management of menstrual in particular on shared, that arise during periods. The general sample quarters (79.3%) of three than as with the school sample, more Chart 12 shows that, given information on in this sample said that they had been the women and girls is even higher than the school sample. what to do during their periods. The figure received. Chart 13 shows the type of information – – – – Five precise themes emerge: Five precise – 38 MENSTRUATION IN CAMEROON: STUDY findings Site Total setting Type of level Educational Age K Urban Primary Under 15 Bamoungoum Rural Secondary older 15 years and ye-Ossi 58.3 64.0 57.9 61.8 50.8 64.1 59.1 66.3 54.4 uberty / biological Puberty /biological maturity (ability to maturity (abilityto have children) this figure hidesother, more complex,realities. (47.7%) saidthattheyknewwhatthemenstrual cyclewas.Detailedanalysisreveals that is andknowledgeofone’sowncycle.Intheentire sample,fewerthanhalfthesubjects By informationonthemenstrual cycle,wemeanknowledgeofwhatthemenstrual cycle Knowledge ofthemenstrualcycle difference isnotstatisticallysignificant(p>0.05). subjects intherural area (64%)andthoseintheurbansetting(57.9%)evenifthis becoming significant.Ontheotherhand,there isadifference inproportion between of informationincreases withageandlevelofschoolingwithoutthedifference female puberty, against54.4%inKye-Ossi.Theresults alsoshowthatthe level In Bamoungoum,66.3%ofgirlsinthisgroup knewthatperiodswere related to Reasons statedfor whywomen have periods(schoolsample) Table 14 The detailoftheresults gathered intheschoolsampleisTable 14. The results showthatnearly40%ofthetotalsampledonotknowwhywomenhaveperiods. why dogirlsandwomenhaveperiods? and girls’menstrual reality. Forthis,respondents were askedtoanswerthequestion, This sectionmeasures thelevelofinformationonhormonaldeterminisminwomen’s Perceptions onmenstrualreality 0.2 0.0 0.3 0.2 0.0 0.0 0.3 0.4 0.0 Reason related to hormones Sin 0.4 0.5 0.3 0.5 0.0 0.8 0.3 0.0 0.8 37.7 35.5 41.4 37.6 49.2 35.2 40.4 33.3 44.8 Don’t know MENSTRUATION IN CAMEROON: STUDY findings 39 Don’t know Don’t 38.3 47.9 45.7 37.5 37.5 43.8 40.2 49.2 43.5
Irregular 28.4 17.7 22.5 22.9 25.0 22.5 25.9 16.9 22.6 Subject’s menstrual cycle (%) menstrual cycle Subject’s Regular 33.3 34.4 31.8 39.6 37.5 33.7 33.9 33.8 33.9 Heard of the of Heard menstrual cycle (%) menstrual cycle Yes 35 32.5 37.3 34.3 36.9 12.1 38.3 37.1 31.7 ye-Ossi Rural 15 years and 15 years older Secondary Bamoungoum K Under 15 Primary Urban Site Total Type of of Type setting Age Educational level Chart 14 the menstrual cycle of Understanding In girls attending school, the results reveal that there are gaps in knowledge of are that there reveal In girls attending school, the results of subjects think they know what 15). Just one third cycle (see Table the menstrual When the girls who said they knew what a menstrual cycle is were asked to asked were is cycle menstrual they knew what a said who When the girls reality. a quite different answers reflect explain their understanding, their a menstrual cycle is (35%). A significant difference can be seen especially as a function a as especially be seen can significant difference A (35%). is cycle menstrual a have girls who primary school of only 12.1% of education (p=1x10-4). Indeed, level of for against 38.3% was, cycle menstrual what a they knew said their periods started especially in in school, addressed that the issue is not well secondary girls. This shows 43.5% was, cycle they knew what a menstrual said who Of those the primary classes. cycle. and 22.6% an irregular cycle, did not know their 33.9% had a regular own cycle, 53.1% whereas response, Only who said they 17.4% of subjects knew gave a correct answers (see Chart 14). answers and 29.5% gave approximate gave incorrect nowledge of the menstrual cycle (school sample) (school cycle the menstrual of Knowledge School sample 15 Table 40 MENSTRUATION IN CAMEROON: STUDY findings Age Total Status setting Type of level Educational Site Under 25 Single Urban to school Never been K older 35 years and 25-34 years Bamoungoum spouse/partner Living witha Rural more Secondary or most Primary at ye-Ossi
62.5 67.4 60.3 46.8 67.7 76.3 36.6 25.0 53.8 66.1 65.0 69.3 55.9 Yes menstrual cycle (%) Heard of the Heard of the in secondaryeducationsaidthattheyknewwhatthemenstrual cycleis. had notbeentoschool, 17.6% ofsubjectsinprimaryeducationand80.9% of knowledgefollowsthelevelstudiesalmostsymmetrically:1.4%subjectswho settings (81.3%)thaninrural settings(18.7%).Itshouldalsobenotedthatthelevel than inunder 25 yearolds (33.8%) and over 35 yearolds (22.9 %), and in urban higher inBamoungoum (54.3%) thaninKye-Ossi(45.7%),25-34yearolds (43.3%) The detailedresults show that thisdeclared knowledgeissignificantly(p=0.004) was higherthanintheschoolgroup, almostdouble,from 35%to62.5%. In thisgroup, theproportionknew whatamenstrualthey ofthosesayingthat cycleis, Knowledge of themenstrualcycle (general sample) Table 16 Table 16summarizesresults gathered from womenandgirlsinthegeneralsample. General sample 51.5 54.5 50.0 62.0 49.1 53.9 41.3 33.3 58.3 52.3 47.3 58.9 43.2 Regular Subject’s menstrualcycle (%) 41.0 40.9 41.0 30.0 43.5 41.9 39.1 0 35.0 41.4 44.1 34.8 48.0 Irregular 7.5 4.5 9.0 8.0 7.4 4.1 19.6 66.7 6.7 6.3 8.6 6.4 8.8 Don’t know MENSTRUATION IN CAMEROON: STUDY findings 41 most often produced and sold locally by most often produced private entrepreneurs. Reusable handmade sanitary pads Reusable handmade pieces of themselves from cloths made by the women Reusable sanitary reusing. before wax fabric or synthetic) that they wash cloth (cotton, linen, – – – rags, sponges, nappies, old clothes, include cotton wool, Other types of protection ash, etc. among the factors that influence theHousehold incomes and local beliefs are choice of sanitary protection. – Overview of different types of sanitary protection types of sanitary of different Overview and produced commercially single-use cloths sold the pads are Sanitary The choice is very limited, imported. these cloths are In Cameroon, industrially. areas. especially in rural product: cover several types of Reusable sanitary pads Chart 15 used sanitary protection of Types More than eight out of ten women and girls surveyed used sanitary pads (81.5%), eight out of ten women and girls surveyed used sanitary pads (81.5%), than More (1.4%) of the sample rest The sanitary cloths. reusable used of the sample while 17.1% (see Chart 15). used other types of protection The user’sThe influence significantly information/education of level her and income between interchange can that women be noted also materials. It should of the choice accessibility their on depending other sanitary protection and cloths sanitary pads, and financial resources. Preferred protection (total sample) Products used during menstruation Products 42 MENSTRUATION IN CAMEROON: STUDY findings Types of sanitaryprotection usedby schoolsample Table 17 Total setting Type of level Educational Age Site Urban Primary Under 15 K Rural Secondary older 15 years and Bamoungoum ye-Ossi 84.7 78.5 88.7 86.0 75.8 84.6 84.7 80.0 89.4 Sanitary pads during menstruation. pads and handmadesanitarypads, depending onthefinancialresources available It shouldalsobenotedthatqualitativedatasuggestacombineduseofcommercial secondary schools(86%)versusprimary(75.8%). rural settings(78.5%). Additionally, there isanotabledifference insanitarypaduse There isalso a notabledifference betweensanitarypaduse in urban(88.7%)and More girls in Kye-Ossiuse sanitary pads (89.4%) than inBamoungoum (80.0%). old clothes. (over 84.7%ofthesample),followed by handmade sanitary cloths,rags,diapersand Tablepads aredisposable sanitary 17 showsthat most usedformofprotection the Sanitary protectionusedbymembersoftheschoolsample 13.8 19.0 10.3 13.4 16.7 14.6 13.5 17.7 9.8 Handmade sanitarypadscloths Type of protection used(%) 1.6 2.4 1.0 0.7 7.6 0.8 1.8 2.3 0.8 Other protection MENSTRUATION IN CAMEROON: STUDY findings 43 Other protection 1.0 1.5 1.1 2.2 0.0 1.4 1.1 0.9 0 0.7 1.4 1.5 0.0 Type of protection used (%) protection of Type Handmade sanitary pads cloths Handmade sanitary 22.9 16.3 20.9 19.4 22.5 11.9 16.1 40.2 50.0 35.8 12.5 15.0 38.7 Sanitary pads 76.1 82.2 78 82.8 59.0 50.0 63.4 86.1 83.5 61.3 78.4 77.5 86.7 yé-ossi Rural with aLiving spouse/partner Primary at most Secondary or more Bamoungoum 25-34 years and 35 years older K Single Urban Never been Never to school Under 25 Site Status Total Type of of Type setting Educational Educational level Age Table 18 Table sample general used by protection of Types Sanitary protection used by the general sample used by the Sanitary protection sanitary they used said this sample girls in and women of 78% 18, in Table shown As who 1.1% and pads sanitary handmade reusable used who against 20.9% pads, that pads the use of sanitary reveal also The results used other protection. said they people. than older more sanitary pads younger people use age. Thus, with decreases 83.5% with the Finally, level of studies. In addition, the use of sanitary increases pads areas. in rural use sanitary pads, against 61.3% areas of subjects in urban 44 MENSTRUATION IN CAMEROON: STUDY findings – – Preferred typesof sanitaryprotection Chart 16 – School sample – – – (10.3%), fearofevilpracticesonmenstrual blood(9.1%)and convenience(4.6%). discreet placeinthehouse.Thereasons givenare: modesty(73.6%),hygiene the sun.Themajoritydryitintheirhomes:toilet,bedroom oranother reusable protection saythattheywashitafteruse.Ofthese,only23.6%dryin The results showninTable 19reveal that86.7%ofgirlsattendingschoolandusing Hygienic careofwashableprotection capacity (7%)andothers(4%). inherited fromcleanliness (14%),habits parents andelders(7%),absorption the conventionalwisdomscausedisease–(18%),perceivedis thatthey comfort/ (50%) followedbybeliefsaboutorlackofknowledgedisposablepads–one The topcriteriawhenchoosingwashableprotection are, firstly, financialreasons (they are whatmothers,sistersetc.choose16.2%)andotherreasons (11.5%). and easeofuse(9%),outrespect fortheadviceandrecommendations of elders the perceived qualityoftheproduct (particularlytheabsorptioncapacity(16.5%) and cleanliness (comfortable/convenient andless messy). These are followed by Disposable sanitarypadsare preferred by46.6%ofthesample for reasons of comfort Selection criteria washing anddrying. pads, whichare considered lessexpensive butneedparticularhygieneroutines for they preferpads (90.3%).Ofthese,8.7%,saythat reusable handmadesanitary Chart 16shows that subjectsintheschool sample mostlyprefer disposablesanitary Preferred sanitaryprotection MENSTRUATION IN CAMEROON: STUDY findings 45 Yes Has good reasons for not for reasons Has good in the sun (%) drying cloth 84.2 75.8 82.9 63.6 77.8 79.1 79.2 78.6 78.8 Yes Dries washed cloth in the sun Dries washed cloth in the Dries washed sun (%) 26.9 21.7 22.2 27.8 35.7 20.7 21.9 25.0 23.6 Yes ashes cloth with soap/ ashes cloth 92.3 83.7 89.1 80.0 92.9 85.2 90.9 83.3 86.7 W (%) detergent ye-Ossi K Rural 15 years and 15 years older Secondary Bamoungoum Urbain Under 15 Primary Hygienic care of reusable handmade sanitary protection (school sample) sanitary protection handmade reusable of Hygienic care Table 19 Table ashes cloth with soap/detergent Site Total Type of of Type setting Age Education level Has good reasons for not drying cloth in the sun for reasons Has good W 46 MENSTRUATION IN CAMEROON: STUDY findings Management of menstrualpain Chart 18 up withthepain. medications, often self-medicated, while themajorityadoptastoic attitude andput To manage menstrual pain,thesurveynoteduseofmodernandtraditional plus thefeelingofunpleasantbodyodours(refer totable20). emotional problems such as bad moods, stress, fatigue and a lack of self-confidence, sufferedlower abdomen, and22.5%saidthey periods, especiallyinthe their from during theirperiods.Nearlytwothirds (60.6%)ofthemsaidthattheyfeltpainduring A totalof 96.3% of girls attendingschool said that they washed at leasttwiceaday Personal hygiene,physicalpainandemotionduringperiods depends onthegirl’sresources orlocationwhenherperiodstarts. protection before reusing itorthrowing itaway. Thetypeofprotection usedoften once ortwiceaday. Ineverycase,theadviceisalwaystocarefully washsanitary Those with heavyperiods change three timesaday; thosewithlighterperiodschange once aday. change more thantwiceaday. Theremainingprotectionchange their 4.1%saythey sanitary protection at least twice a day: 48.5% say they change twice and 46% say they As showninChart17,more than95%ofgirlsattendingschoolsaythattheychangetheir Number of timesadaysanitaryprotection ischanged Chart 17 Changing sanitaryprotection isanimportanthygienemeasure duringperiods. How oftensanitaryprotectionischanged MENSTRUATION IN CAMEROON: STUDY findings 47 Yes Emotion (%) 25.0 22.1 24.6 20.3 23.4 23.5 25.6 20.4 23.5 Yes Physical pain hysical pain (%) Physical pain 69.4 51.9 60.3 61.5 56.1 61.2 64.8 54.1 60.6 Yes ashes at least twice a day twice ashes at least 95.6 96.9 95.5 98.4 95.5 96.4 96.1 96.6 96.3 W (%) ye-Ossi K Rural 15 years and 15 years older Secondary Bamoungoum Urban Primary Under 15 ashes at least twice a day ashes at least twice ersonal hygiene during menstruation and associated problems (school sample) problems and associated during menstruation hygiene ersonal Site Total Type of of Type setting Education Education level Age Table 20 Table P Emotional problems W 48 MENSTRUATION IN CAMEROON: STUDY findings W Preferred sanitaryprotection Hygiene andpreferred sanitary protection (general sample) Table 21 Site Age Total Status setting Type of level Education ashes clothusedwithsoap/detergent K Under 25 Single Urban toschool Never been spouse/partner Living witha Rural or more Secondary most Primary at 35-67 years 25-34 years Bamoungoum yé-ossi 97.8 90.9 100.0 97.6 98.0 100.0 97.9 87.5 95.7 100.0 100.0 100.0 95.5 W during period with during periodwith soap/detergent ashes cloth used ashes clothused Yes 46.7 38.1 49.3 50.0 44.0 45.9 51.1 25.0 50.0 42.9 44.4 44.9 48.8 Dries washed cloth Dries washedcloth in thesun Yes Dries washedclothinthesun
88.7 94.1 86.4 80.7 91.3 93.5 78.9 81.3 78.4 91.1 93.7 88.9 88.5 Sanitary pads Preferred sanitaryprotection 11.3 5.9 13.6 19.3 8.7 6.5 21.1 18.8 21.6 8.9 6.3 11.1 11.5 Reusable sanitary protection MENSTRUATION IN CAMEROON: STUDY findings 49
Women and girls in this sample change their sanitary protection very often. Those with very often. Those sanitary protection and girls in this sample change their Women times a day; those with lighter periods change once or heavy periods change three In every case, the advice given by mothers and women family members twice a day. it away. it or throwing reusing before wash sanitary protection is always to carefully the and on the place where used often depends on resources The type of protection woman or girl is when her period starts. Number of times a day sanitary protection is changed is changed times a day sanitary protection Number of Chart 19 Responses of women and girls - from the general sample girls - from the general of women and Responses sanitary protection Preferred the women slightly lower extent, sample, but to a that, as with the school 21 shows Table sanitary reusable to (88.7%) pads sanitary disposable prefer sample this in girls and washthey that say them of 97.8% pads, sanitary reusable using those Of (11.3%). pads them in the sun. hand, fewer than half of them (46.7%) dry them. On the other Selection criteria sanitary pads, for using disposable reason as the most common Ease of use is cited less the fact they are and practicality of the material (20%), followed by the comfort of the material (10%). and the highly-absorbent nature messy to use (20%) for their use at top reasons sanitary pads, cost and comfort are to reusable regard With messy (19%). less fact that they are 30.7% followed by the day sanitary protection is changed Number of times a women and girls in the general majority (97.5%) of a very large As with the school group, group said they changed their sanitary protection several times a day. Only 2.5% several times a day. said they changed their sanitary protection group 50.5%and changed twice who 47% against day, once a protection they changed said than twice. who changed more 50 MENSTRUATION IN CAMEROON: STUDY findings adolescents’ schooling. obtained showthatperiodshaveasignificantcumulative impactonthedynamicof moments whenabsenceswere recorded forgirlsonschool rolls. Theresults The studymadeitpossibletooperationalizethisvariablebytargeting theprecise impact ongirls’schoolingandfurtherincrease educationalequalitiesrelated togender. school couldbeadverselyaffected compared withboys.Thiswouldhaveanegative a review ofscientificliterature, itwasassumedthatgirls’presence andparticipationin Due totheconstraintsanddiscomfortassociatedwithmenstruation andbasedon pupils’ performance. periods hadanimpactonparticipationineducationand,therefore, potentiallyon periods wasanalysedfortheschoolgroup. Itwasacase,aboveall,ofknowingif The questionofparticipationinlearningactivitiesatschoolduringmenstrual at schoolandperformance Menstrual HyieneManagement, girlsexperience: participation Management of menstrualpain Chart 20 put upwiththepain(seeChart20). to acertainextent,resignation onthepartofwomenwhodecide to donothingand pain killers,antibioticsandtraditionalmedicines than amongtheschool group and, The resultsmanaged theirpainindicatedagreater onhowthey incidenceoftheuse Finally, 37.8%saidtheysuffered from emotionalproblems duringtheirperiods. they suffered menstrual pain,while18.9%saidtheyhadsuffered from itinthepast. said theywashedatleasttwiceadayduringtheirperiods.Inaddition,36.9% The results are close to thoseoftheschool group. Thus, nearly allthewomen (97.3%) Personal hygiene,painandemotionalproblemsduringperiods their periodsaffect theirfullparticipationinlearningactivities. during theirperiods (see Table 22).However, thenumerous inconveniences caused by The resultsthe great showthat majority(95.9%)ofgirlscontinuetoattendschool School attendanceduringmenstruation
MENSTRUATION IN CAMEROON: STUDY findings 51 Yes Does not participate asDoes not participate (%) much in lessons 31.6 19.6 26.0 24.0 34.8 24.2 23.4 28.8 25.5 Yes Has missed a lesson a lesson Has missed (%) 23.2 9.2 13.8 23.1 13.6 16.5 16.8 15.1 16.1 Does not participate as much in lessons Has left school early because of periods school early because of Has left Yes Has left school early school Has left (%) 16.9 6.9 10.4 16.2 15.2 11.4 12.9 10.2 11.9 Yes 96.1 95.8 95.6 96.9 95.5 96.0 96.8 94.6 95.9 Generally goes to goes Generally school (%) ye-Ossi Rural 15 years and 15 years older Secondary Bamoungoum K Urban Primary Under 15 ersonal hygiene during menstruation and associated problems (school sample) problems and associated during menstruation hygiene ersonal Site Total Type of of Type setting Education Education level Age Table 22 Table P Has missed a lesson Has missed Generally goes to school during periods goes Generally 52 MENSTRUATION IN CAMEROON: STUDY findings part ofthegirls attendingschoolinKye-Ossi. difference canbeobservedthathighlights greaterin thisregard vulnerability onthe participation inlessons. For each of these three factors, a statisticallysignificant with regard to all factors: interruption of a day at school, absence, or reduced Girls’ educationseemstobeclearly more affected inKye-OssithanBamoungoum Absence from schoolbecauseof periods Chart 22 Question: Haveyoueverhadtomissalessondueyourperiod? (25%) said that duringherperiod, she did not takeas part inlessons as much as usual. in thelessoncanbereduced duetodiscomfort caused byperiods:onegirlinfour In fact,evenwheninclass,participation Chart 22).Theimpactcanalsobequalitative. fact that16% of themsaid that theywere absentfrom class because oftheirperiods (see or leavetheclassroom earlytomanage them.Thislatterobservationiscredited bythe These girls, therefore, havetoeithercuttheirdayatschool short duringtheirperiods Interrupted schooldaysduetoperiods Chart 21 of yourperiod? Question: Has it ever happenedthat you have not beenable to complete a day at school because of theschoolyear. (X=3), with extreme cases reaching ninetimes, in otherwords, practically everymonth in questionsaid that theyhadtointerrupt theirdayatschool three timesonaverage these respondents, since in thecourseofschool year preceding the survey, thegirls this isnotaone-offperiod (seeChart21).Itshouldbenotedthat phenomenonamong More thanonegirlinten(12%)wasunabletocompleteaday’slessonsbecauseofher Participation inlearningactivitiesduringmenstruation MENSTRUATION IN CAMEROON: STUDY findings 53
Question: Personally, has it ever happened to you that you have has it ever happened to you that you Question: Personally, because all, school at or not gone to school at day not finished a of your period? Chart 24 period because of Day at school cut short Chart 23 when lessons from absence a case of of Knowing a period having Information drawn from women and girls in the general sample is similar to those of those to similar is in the general sample girls and women from drawn Information group. the school of any cases when a girl missed Question: Do you know of her period? a day at school because nowledge and experience of members of the general sample sample the general of members of and experience Knowledge during periods school from on absences Charts 23 and 24 confirm that absence from school and interrupted school days due school days school and interrupted from Charts 23 and 24 confirm that absence neither is it a practice confined to the school to periods is not a new phenomenon and these phenomena remember the general group pupils surveyed. The women and girls in their own school days. This shows that it is a long-standing social phenomenon. from 54 MENSTRUATION IN CAMEROON: STUDY findings physical changes duringadolescence? Does your schoolteach pupilsaboutissues related to Teaching onphysicalchanges andmenstrualhygieneatschool Table 23 Total setting Type of level Education Age Site Urban Primary Under 15 K Rural Secondary and older 15 years Bamoungoum ye-Ossi 76.3 75.1 77.0 75.9 78.8 74.6 76.8 79.2 73.2 adolescence? (%) issues related tobodilychanges during Does your schoolteachpupilsabout unpreparedness. Furthermore, the feeling of fear and anxiety which is predominant is a proof of their Therefore, the content and relevance of the lessons received might bereconsidered. got theirfirstperiod. to themwhenthey school knewwhatwashappening attending Even ifthedataisencouraging,itimportanttoremember thatonly28.3%ofgirls or onpubertyaspartofthecurriculum. fromboth phasesofeducationhadbeenabletobenefit informationonmenstruation phase andsecondarypupilsisnotlarge, whichmeansthatgirlsattendingschoolin is alsohigh(64%).Itwasfurthernotedthatthediscrepancy betweendataforprimary The proportion ofthosewhohadreceived teaching onhygieneduringmenstruation on the physiological and bodily changes that occur during puberty(see Table 25). moreIt wasnotedthat three than girls (76.3%)hadreceived quartersofthe lessons Teaching received to MHM. sciences, childcare andlifeearthsciencesdoesincludeanumberofissuesrelated a curriculumitemwasnotpartofanyprogramme. Nevertheless,teachingonnatural Interviews withadministrativeofficials atministeriallevelshowedthatMHMas Teaching aboutpubertyandMHMatschool Yes and hygieneduringperiods? Does your schoolteach how totake care of your health (%) your healthandhygieneduringperiods? Does your schoolteachhow totake care of 64.1 69.6 60.4 63.3 69.2 63.8 64.1 73.7 54.2 Yes
MENSTRUATION IN CAMEROON: STUDY findings 55
Question: Are there clubs just for girls in your school? clubs just for girls in your there Question: Are Chart 26 schools girls-only clubs in of Existence Other (praying/using the Bible, being near a fire, chatting, etc.): 6.2% Other (praying/using the Bible, being near a fire, husband): 54% jobs, sports, going to the night club or the market, going to the field, doing difficult etc.): 29% no sugar mackerel, no to food (no sweets, do not drink water, related Prohibitions etc.): 8.3% fruit, cane, no red Prohibitions related to household, sports and recreational activities (cooking, activities (cooking, to household, sports and recreational related Prohibitions Prohibitions related to sexuality (no sex, do not sleep in the same bed as in the same bed as to sexuality (no sex, do not sleep related Prohibitions omen and girls productivity during menstruation omen and girls productivity – – – – – – – – In order to assess women and girls’ productivity during menstruation, the study during menstruation, women and girls’ productivity to assess In order on the general sample which counts the highest number of women and girls in relied The women and girls in this sample experience moments of inactivity the labour force. of 22% affects in activity reduction This activity during their periods. reduced or as a whole. respondents up a list of activities that they refrain drew girls in this sample also and women The doing during menstruation: from W sample) (general Limitations during menstruation Limitations The study showed that of pupils impose limitations on themselves when they 77% are not take part in sporting do 58% these include: In the analysis, having their periods. playing handball or leaving the classroom. activities such as running, or recreational 10.7% avoid the company of boys, including talking and chatting (15%) Furthermore, or carrying out household activities (10.7%). According to the girls surveyed, pupils do not change their to them during attitudes According their periods. is an attitude that someone has their period, there aware when others are However, far as excluding people: “They say taunting, even going as of mocking and sometimes feel comfortable and that I have to withdraw myself at this time.” that they don’t Attitudes of peers during menstruation Chart 25 health clubs in schools of Existence Teaching about puberty and menstrual hygiene could be delivered as part of extra- as part be delivered hygiene could puberty and menstrual about Teaching why the That explains girls only. in clubs for activities, in particular curricular (see Chart 26). health clubs of such clubs, in particular at the existence study looked Question: Is there a health club in your school? Question: Is there The responses indicate that there are clubs in three out of four cases (73.2%) and that (73.2%) and that out of four cases three clubs in are there indicate that The responses only rare: only are so, clubs for girls (68.4%). Even quite common are health clubs Chart 27. 7.2% of cases, as in 56 MHM-FRIENDLY INFRASTRUCTURE Separate toilets for girlsatK ena highschool inBamoungoum. MHM-FRIENDLY INFRASTRUCTURE 57
The data show that in more than 60% of cases there is no soap available and that it is there than 60% of cases The data show that in more only “always” available in fewer than two cases out of ten (17.6%). Chart 27 soap near handwashing facility of Availability Question: Is there any soap available there? (near handwashing facility) any soap available there? Question: Is there Handwashing had a water point establishments visited of that 83.9% Examination of the data shows including when they have changed their that pupils could use for hand-washing, point to the the handwashing of the proximity indicates This sanitary protection. Kye-Ossi than in in Bamoungoum common more toilets. Handwashing facilities are nearly In than in primary schools. establishments in secondary often found more and of a tap; other facilities included (73.9%) the facility consisted quarters of cases three Chart 25 not specified (11.6%). or were a fixed well (3.5%), a bucket of water (9.3%) facilities. shows the availability of soap near hand-washing School settings: existence of a private space to change of a private space to change School settings: existence a girl out of four said that pupils establishment had a place where their Some three the toilets, or a place This was usually her sanitary protection. could go to change their periods. bush, for girls to change during surrounding or the behind the classroom, of the space available. It appears that most The analysis also focused on the specifities separated for used by both boys and girls. Only 23% of existing spaces are spaces are commonly found in Bamoungoum than in Kye-Ossi (p=1x10-3). boys and girls, more interventions of the situation that targeted a quantitative picture 23 provides Table could improve. School infrastructure School infrastructure RERUCTU T INFRAS and public places, in in school settings on the infrastructure This chapter focuses conditions to support better MHM. it offers particular whether MHM-FRIENDLY MHM-FRIENDLY 58 MHM-FRIENDLY INFRASTRUCTURE changing your sanitaryprotection? In your school,canyou washyour handsafter your sanitaryprotection? Is there aplace atschoolwhere you canchange Availability of MHM-friendlyinfrastructure Table 24 Ensemble setting Type of level Education Age Site Urban Primary Under 15 Rural Secondary and older 15 years Bamoungoum K ye-Ossi sanitary protection? (%) where you canchange your Is there aplace atschool 73.9 81.8 68.7 74.1 72.7 83.6 70.7 76.4 71.4 Yes 23.3 43.3 9.9 25.7 7.6 41.7 17.2 43.7 2.8 protection? (%) your clothesorsanitary only where you canchange Is there aplace for girls clothes orsanitaryprotection? Is there aplace for girlsonlywhere you canchange your Yes 83.9 87.3 81.6 87.7 57.6 89.2 82.0 93.4 74.1 protection? (%) changing your sanitary wash your handsafter In your school,canyou Yes MHM-FRIENDLY INFRASTRUCTURE 59 Yes Do the latrines have have Do the latrines (%) doors? 80.8 82.6 84.3 77.7 81.7 Yes Are they available available they Are at this and clean moment? (%) 20.6 58.1 24.4 62.7 39.6 Are these latrines separate for boys and girls? boys for these latrines separate Are Do the latrines have doors? Do the latrines have Yes Are these latrines these latrines Are boys for separate and girls? (%) 9.2 78.1 31.2 64.0 44.2 Yes 98.8 100.0 99.4 99.5 99.4 Are there latrines there Are pupils in your for school? (%) ye-Ossi Rural Bamoungoum K Urban Site Total Type of of Type setting Table 25 Table settings latrines in educational gender-specific of Availability Are they available and clean at this moment? and clean at this available they Are Are there latrines for pupils in your school? in your pupils for latrines there Are 60 MHM-FRIENDLY INFRASTRUCTURE access bypeoplewithreduced mobility. infrastructure. Designs do not haveanyspecial access ramp ormeans of ensuring constructionthis dimensionwasnottakenintoaccountinthe that ofexisting concerns, was notexplored inthe questionnaires. Fieldobservationsreveal, however, The adaptationoflatrinesforpeoplewithdisabilities,whichalsoraisesgender During thevisitsitwasnotedthatallwaterpointsare locatedoutsidethelatrines. only 25% of thesewaterpointshad soap (45% in Bamoungoum and 4.8 % in Kye-Ossi). Finally, while68% of latrines had a water pointwhere pupils could wash their hands, and 74%fortheformer21.4%68.4%latter. female staff reveal furtherdifferences between Kye-Ossiand Bamoungoum, with 55%, Figures fortheseparationoflatrinesbetweenstaff andpupils, between maleand and girls. only theKye-Ossibilingualhighschool was equippedwithseparatefacilitiesforboys in Bamoungoum.Fieldvisitsconfirmed this reality. Thus,atthetimeofobservation, 10% oflatrinesinKye-Ossiwere separatedforboysandgirls,compared58% with (an index for assessing gender-sensitivity) show even greater disparities: fewer than significant difference. Figuresare forlatrinesthat separatedforboysandgirls of latrineswere inworkingorder, compared with58%inBamoungoum, a statistically The contrastbetweenthetworesearch sitesisworthnoting.InKye-Ossi,only20.6% were inworkingorder. the pupils’ point of view. When the study team visited, just four out of ten latrines cleanliness are takenintoaccount.Only39.6%oflatrineswere considered cleanfrom doors. In addition,thelikelihoodoflatrinesbeingused is questionablewhendataon As Table 25shows,whilealmosteveryschoolhaslatrines,notalllatrineshave function, cleanlinessandmaintenanceofthefacility. the majorityofschoolshavesomesortlatrinefacility. Itismore aquestionofthe and helpsensure theystayinschool.Inplacesvisited,access to latrinesisnotanissue, of latrinesinschoolsenhancestheexperiencepupilsschool The availability Availability oflatrinesinschoolsandgender-sensitivity 31 MINEDUB, 2013,ibid.
MHM-FRIENDLY INFRASTRUCTURE 61
Copes (finds a solution on the job, discreetly asks for help): 22.6% Copes (finds a solution on the job, discreetly Other: 20.7% Calls on neighbours or relatives/goes out to the fields/finds a place: 30.1% Calls on neighbours or relatives/goes home: 26.4% Quickly returns Physical discomforts related to periods (itching, pain): 16.4% Physical discomforts related Others: 10% Non-functional public toilets (no water, toilet paper or soap): 33% Non-functional public toilets (no water, Stains (dirt): 22% to change): 17.5% An absence of public toilets (nowhere – – – – 4. 5. 1. 2. 3. The two responses “copes” and “others” account for more than 40% of answers. “copes” and “others” account for more The two responses – – – – In Kye-Ossi, there are toilets at the market place and on the main road in the town. the main road toilets at the market place and on are In Kye-Ossi, there two public toilets in the only were the study stated that there Some participants in whole locality. issue of their upkeep, the availability of public toilets is the Above and beyond authorities in the town of this, the address To working order. maintenance and a cleaner for the market toilets. Kye-Ossi have employed Responses to the manage their question of how women periods in the workplace public facilities, include: no appropriate are when there appropriateof lack a of face the in demonstrate women creativity the demonstrate They spaces in which to manage their periods. to the management of their faced by women relating problems The most common hygiene in public places are: menstrual The women and girls in the general sample were asked to say if their place of work or if their place of work asked to say were in the general sample and girls The women their specific capable of meeting had infrastructure places they frequented the public as such infrastructure took this to be Many menstruating. they were needs when toilets. of toilets and public to the existence by referring replied therefore, toilets and, places they frequented. girls did not have toilets in the public 64% of the women and Infrastructure in public places in Infrastructure 62 MENSTRUAL HYGIENE MANAGEMENT AND RESPECT FOR THE ENVIRONMENT The results inChart32showthesametypesofenvironmental riskasfortheschoolgroup. washed it. their usedsanitaryprotection away. Very fewburnedorburiedit(0.7%)and10.9% Trends were identicalforthewomenandgirlsingeneralsample:88.4%threw potential related diseases. protection posesenvironmental risks,from blockedpipes,physicalpollutionand down flushingtoiletsorinthebush,fields,riverscreeks, sanitary preferred places for pupils to dispose of used sanitary protection. Whether thrown In schools,thetoilets,whetherlatrines,pitlatrinesorflushingwere the beliefs, somegirlswashdisposableclothsbefore throwing themaway. and washablepadswere washed.Qualitativedatashowthatbecauseofcultural only 12.5% wash it and less than 1% burn it (see Chart 29). Both disposable cloths out of ten pupils (96.6%) throw their used sanitary protection away directly, while In thevastmajorityofcases,usedsanitaryproducts are thrown away. Nearlynine Disposal of usedsanitaryprotection (totalsample) school versusgeneralsamplegroup andlocation. overview ofthedatacollectedforallsamples, followed bymore specificanalysisof of used sanitary products was alsoconsidered inthisstudy. This section provides an Menstrual hygienemanagementandtheimpactonenvironment ofthedisposal ENVIRONMENT RESPECT FORHE MANAGEMENT AND MENSTRUAL HY GIENE GIENE
MENSTRUAL HYGIENE MANAGEMENT AND RESPECT FOR THE ENVIRONMENT 63 Chart 30 used of Management sanitary protection Chart 32 used sanitary protection Disposal methods of Chart 29 used of Management sanitary protection Disposal methods of used sanitary protection Disposal methods of Chart 31 Question: What do you do with your sanitary protection after you have used it? after your sanitary protection What do you do with Question: used of Management sanitary protection Chart 28 64 MENSTRUAL HYGIENE MANAGEMENT AND RESPECT FOR THE ENVIRONMENT Obviously, thesebeliefsleadtospecifichygienepractices. This belieftooiswidelyshared amongalltheculturalgroups interviewed. necessity nottothrow sanitaryprotection justanywhere, asitissoakedin blood. malevolent powers.Hencethe by particularly put, can be use towhichit explains the According tothesurveyresponses, thehighvalueplacedonmenstrual bloodalso Menstrual blood,beliefsandtheenvironment menstruate isnotawoman. feminine lifeforce. Forthewomen and girlsinterviewed,awoman who does not cultural groupsIn allthe interviewed,menstrual bloodisvaluedasasymbolof Perceived valueofmenstrualblood the managementofwomen’sintimacy. of menstrual blood, on theonehand,andtoitsmysticaluseother, aswellto sample. The informationcollected shows that choices are influenced by perceptions girls attendingschoolandthewomeningeneral is notneutral,inboth the choiceofmethoddisposalsanitaryprotectiondata tellusthat The quantitative protectionsanitary The influence of beliefs onthemethodof disposalof something badwithit,suchasstopherconceiving.” just donewasdangerouscould takeitanddo of questionablecharacter a person because fun ofher. Thegirlinquestionthentook it back.Iexplainedtoherthatwhatshehad saying that if she didn’t I would put it on the road so that everyone would see it and make throw hersoiledcloth into anotherperson’s field. I askedhertoremove itimmediately, “We buryitintheground; wedigtheground andburyitinthere. Oneday, Isawagirl use salttowashit.”(FG,Bamoungoum) always toldusnevertowashitwithbleach(becauseisdangerous). You havetojust a loinclothortoweltohideit.Becausebadpeoplecantakeitanddoharm;ourmothers rinse itseveraltimesbefore dryingitoutofviewthatis,behindthehouse,andcoverwith “With washable sanitary protection, youhave to soakit for a long time in water and then opportunities.” (FG,Kye-Ossi) That is to say, they make sure that you do not find a husband, theytakeaway all your Here where weare talking now, it was my paternal family that made my life impossible. your mother’seven could takethemanddoyouharmormakeyourlifeimpossible. sister these are thingswejealouslyguard.Eveninthefamily, youneedtohidethembecause Yambassa,“For us because knickers sanitary clothsorher her awomanmustnotexpose marry, becausebehindperiodsyoucanbeprevented from marrying.”(FG,Kye-Ossi) has herperiodsbecauseit is herperiodsthat mean shecanhavechildren, conceiveand a woman’s wholelife is “inside”;awoman’s wholelife comes downtothefactthatshe they always tell us that the life of your family and your ownlife depend on this because not bethrownmust cloths period, her a girlhasher “When anywhere.away just Indeed, (FG, Bamoungoum)
MENSTRUAL HYGIENE MANAGEMENT AND RESPECT FOR THE ENVIRONMENT 65 ye-Ossi. omen washing clothes in K “With regard to washable pads, I wash and dry them in the toilet or in the bedroom, out or in the bedroom, them in the toilet pads, I wash and dry to washable regard “With spots gives me the sun because this in (loincloth) cloth drying my like I don’t sight. of or itching. And it and do something bad to you.” on top of that, someone could take (FG, Kye-Ossi) W In short, it is socio-cultural concerns that count for most in the eyes of the women and concerns that count for most in In short, it is socio-cultural impact. an unintended environmental even if they have the survey, girls who took part in Management of menstrual blood and women’s privacy blood and women’s of menstrual Management to manage sanitary desire the ethnic groups, in some to the respondents, According throwing Thus, privacy. to women’s related by concerns also hampered is protection linked to it. the sense of privacy means betraying it in the bin because in the sun, to dry the material not advised is it to the study declare Participants in this seeing that even, paradoxically, expose it to the view of all, some people would a risk of skin eruptions. RECOMMENDATIONS
66 Pupils enjoying playtime at St Antoine primary school in Bamoungoum. RECOMMENDATIONS 67
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Convention on the Elimination of All Forms of Discrimination against Women, Right to Water Right to Water All Forms of Discrimination against Women, Convention on the Elimination of Work, and Sanitation, Right to Education, Right to Information, Right to Health, Right to including decent conditions of work. * Rights Critical Elements for the Fulfilment of W the Fulfilment of Critical Elements for D RECOMMEN multiple management unlocks hygiene menstrual dignified and safe Ensuring better can participate fully in society and informed girls who are and benefits. Women work and leisure. play, leading fuller lives in terms of school, the economy, with monitoring out in national policy with budgets and must be clearly spelled MHM on the services key together with to implement this policy is to match. Capacity and girls can use with confidence. that women ground that informs action-oriented research Filling evidence gaps is important through the policymakers and practitioners. facilities must improved and transformation goPolicy hand-in-hand withbetter and institutions that for public spaces state responsibility governance including services. guarantee women’s access to safe and suitable s t lis t of char
68 At college St Antoine Bamoungoum, students are in charge of cleaning the toilets and have no water to wash their hands after using the toilets. List of charts
TABLES
Page TABLE NAME Figure number
Access to sanitation facilities in Cameroon (national estimate) 1 10
Access to water in Cameroon (national estimate) 2 10
Types of water supply in Kye-Ossi 3 11
Proportion of the population with access to potable drinking water (%) 4 12
Demographic data on the study sites 5 16
Summary of sample by target and site 6 17
Focus group participants by site and socio-demographic characteristics 7 17
Prohibitions linked to menstruation and justification 8 27
Age of menarche (total sample) 9 28 lis t of char Experience of menarche in the school sample 10 29
Experience of menarche in the general sample 11 31
Sources of information about menstruation (school sample) 12 34 t s Sources of information about menstruation (general sample) 13 35
Reasons stated for why women have periods (school sample) 14 38
Knowledge of the menstrual cycle (school sample) 15 39
Preferred types of sanitary protection 16 40
Types of sanitary protection used by school sample 17 42
Types of protection used by general sample 18 43
Hygienic care of reusable handmade sanitary protection (school sample) 19 45
Personal hygiene during menstruation and associated problems (school sample) 20 47
Hygiene and preferred sanitary protection (general sample) 21 48
Personal hygiene during menstruation and associated problems (school sample) 22 51
Teaching on physical changes and menstrual hygiene at school 23 54
Availability of MHM-friendly infrastructure 24 58
Availability of gender-specific latrines in educational settings 25 59
69 ChartS
Page Chart name Figure number
Age distribution of the total sample 1 21
Marital status of the total sample 2 22
Educational levels of total sample 3 22
Religious affiliation of the total sample 4 22
Age distribution of the total sample - SCHOOL SAMPLE 5 28
Information before menarche - TOTAL SAMPLE 6 33
Information before menarche - SCHOOL SAMPLE 7 33
Explanations received about menstruation - GENERAL SAMPLE 8 33
Identity of confidant at occurrence of first period - TOTAL SAMPLE 9 35
Information on how to behave during periods - SCHOOL SAMPLE 10 36 s t Nature of information received on what to do during menstruation - SCHOOL SAMPLE 11 36
Information on how to manage periods - GENERAL SAMPLE 12 37
Type of information received on how to manage periods - GENERAL SAMPLE lis t of char 13 37
Understanding of the menstrual cycle - SCHOOL SAMPLE 14 39
Types of sanitary protection used - TOTAL SAMPLE 15 41
Preferred types of sanitary protection - SCHOOL SAMPLE 16 44
Number of times a day sanitary protection is changed - SCHOOL SAMPLE 17 46
Management of menstrual pain - SCHOOL SAMPLE 18 46
Number of times a day sanitary protection is changed - GENERAL SAMPLE 19 49
Management of menstrual pain - GENERAL SAMPLE 20 50
Interrupted school days due to periods - SCHOOL SAMPLE 21 52
Absence from school because of periods - SCHOOL SAMPLE 22 52
Knowing of a case of absence from lessons when having a period - MEMBERS OF THE GENERAL SAMPLE WHO HAD ATTENDED SCHOOL 23 53
70 Day at school cut short because of period - MEMBERS OF THE GENERAL SAMPLE WHO HAD ATTENDED SCHOOL 24 53
Existence of health clubs in schools 25 55
Existence of girls-only clubs in schools 26 55
Availability of soap near hand-wash facility 27 57
Management of used sanitary protection - TOTAL SAMPLE 28 63
Management of used sanitary protection - SCHOOL SAMPLE 29 63
Management of used sanitary protection - GENERAL SAMPLE 30 63
Disposal methods of used sanitary protection - SCHOOL SAMPLE 31 63
Disposal methods of used sanitary protection – GENERAL SAMPLE 32 63 lis t of char t s
71 references
1. Tossounon A. (2013). Hygiène menstruelle : Enfin briser le silence autour de cet événement de la vie. West Africa WASH Journalists Network [on line], (page viewed 24 April 2015). Available at: https://washjournalists.wordpress. com/2013/11/19/hygiene-menstruelle-enfin-briser-le-silence-autour-de- cetevenement-de-la-vie/ 2. Bayray A. (2012). Menstrual Perceptions and Preparation of Rural Adolescent Females in Tigray, North Ethiopia. Universal Journal of Education and General Studies Vol. 1 pp. 009-016. 3. BUCREP/UNFPA (2010). Journée mondiale de la population : tout le monde compte. Yaoundé, 34pp. 4. Cadre communal de développement. Monographie de la commune d’arrondissement de Bafoussam III. 5. Ella J.-B. (2010). Approvisionnement en eau et santé des populations à Kyé-Ossi. Yaoundé : Ecole normale supérieure, Université de Yaoundé I. 6. Ellis, H. (2003). Studies in the Psychology of Sex New York : Random House. 7. INS, ECAM II (2002). Enquête camerounaise auprès des ménages. Yaoundé : Institut national de la statistique. 8. INS, ECAM III (2007). Conditions de vie des populations et profil de pauvreté au Cameroun. Yaoundé : Institut national de la statistique. 203pp. 9. INS/ICF International (1999). Enquête démographique de santé du Cameroun 1998. Yaoundé : Institut national de la statistique/ICF International. 10. INS/ICF International (2005). Enquête démographique de santé Cameroun 2004. Yaoundé : Institut national de la statistique/ICF International. references 11. INS/ICF International (2012). Enquête démographique de santé Cameroun 2011 [on line]. Yaoundé : Institut national de la statistique/ICF International (page consultée le 24 avril 2015). Available at: https://dhsprogram.com/pubs/pdf/ FR260/FR260.pdf 12. Kar K. et Chambers R. (2008). Handbook on Community-Led Total Sanitation London: Plan UK/IDS. 100pp. 13. MINATD (2004). Laws on decentralization: Matrice des compétences, lois de décentralisation du 22 Juillet 2004. 14. MINEE (2011). Stratégie nationale d’assainissement liquide: Rapport diagnostic, aspects institutionnels, financiers et techniques, Yaoundé. 92pp. 15. MINEDUB, 2013. Annuaire Statistique. 16. MINEPAT (2009). Cameroun vision 2035 : Document de travail [on line] Yaoundé: MINEPAT. 76pp. (page viewed 24 April 2015). Available at: http://www. minepat. gov.cm/index.php/fr/modules-menu/doc_download/106-vision-2035du- cameroun 17. Republic of Cameroon (2009) Document de stratégie pour la croissance et l’emploi : Cadre de référence de l’action gouvernementale pour la période 20102020 [on line]. Yaoundé : MINEPAT, 174 pp. (page viewed 24 April 2015). Available at: http:// www.minepat.gov.cm/index.php/fr/modules-menu/doc_download/108- document-de-strategies-pour-la-croissance-et-l-emploi-dsce 18. Ministère de la Santé/Direction des ressources humaines (2011). Recensement général des personnels du secteur de la santé du Cameroun [on line]. 68 pp. (page viewed 24 April 2015). Available at: http://cm-minsante-drh.com/site/ index. php/le-minsante-12
72 19. Tiokou Ndonkou F. (1993). Représentation culturelle des excréments : Étude comparative des déchets du corps chez les populations de la savane et de la cote du Cameroun. Hamburg: Münster, 346pp. 20. WHO/UNICEF (2013). Progress on Drinking Water and Sanitation. Joint Monitoring Programme Update [on line]. 40pp. (page viewed 2015). Available at: http://www.who.int/iris/bitstre am/10665/81245/1/9789241505390_ eng.pdf 21. WHO/UNICEF (2014) - Progress on Drinking Water and Sanitation. Joint Monitoring Programme Update. [On line] 78 pp. (page viewed 24 April 2015). Available at: http://www.who.int/water_sanitation_health/ publications/2014/jmp-report/en/ 22. ORSTOM (1982). Nature et forme de pouvoir dans les sociétés dites acéphales. Exemples camerounais. Proceeding of the Yaoundé science day, 1 March 1978. Paris: Proceedings and documents from ORSTOM No. 142. 169 pp. 23. Plan communal de développement Kyé-Ossi, 2014. http//www.cdr-cvuc.cm/ index.php/fr/ 24. 3e Recensement général de la population et de l’habitat (RGPH) (2010). [on line] Institut national de la statistique du Cameroun (page viewed 24 April 2015). Available at: http://www.statistics-cameroon.org/downloads/ Rapport_de_presentation_3_RGPH.pdf 25. SOFRECO (2014). Rapport sur l’état des lieux et l’étude diagnostique : references Étude sur la stratégie d’assainissement en milieu rural dans le cadre du projet d’Amélioration en eau potable et d’assainissement en milieu rural (PAEPAMRU) Cameroun : AfDB 53pp. 26. Umeora O., Egwuatu VE. (2008). Menstruation in Rural Igbo Women of South East Nigeria: Attitudes, Beliefs and Practices [on line]. African journal of Reproductive Health vol.12 (page viewed 24 April 2015). Available at: http:// www.ajol.info/index.php/ajrh/article/download/7961/30519. 27. UNICEF (2013). L’hygiène menstruelle dans les écoles de deux pays francophones d’Afrique de l’Ouest: Burkina Faso et Niger. 28. WSSCC (2013). Final report of WSSCC workshop on equity and inclusion : 13- 14 September 2013 Dakar, Senegal.
73 Study team Review Team
Data collection and first drafts UN Women
HORIZONS FEMMES –– Paulette Béat, Programme Officer, Cameroon –– Adonis Touko, Mss, Analyst Evaluator –– Chantal Ekambi Kingue, Programmes Officer, Cameroon –– Pierre Célestin Mboua, Phd, Phd, Researcher –– Anne Marie Rachelle Mian Djangone, Representative and Country Director, Cameroon –– Sandrine Dongmo, Mph, Research Assistant –– Mbarou Gassama Mbaye, Programme Coordinator, Dakar –– Carole Kom Tagne, Programme Officer –– Denise Ngatchou, Executive President WSSCC acknowledgements : –– Archana Patkar, Programme Manager – –– Joint Programme on Gender, Hygiene and Sanitation – Rockaya Aidara, Programme Officer team –– All staff at UN Women West and Central Africa Regional Office and at WSSCC (Geneva).
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Through its work, the WSSCC contributes to the more general goals of the elimination of poverty, and the improvement of health and the environment, equality between men and women and long-term economic and social development. The WSSCC supports coalitions in twenty countries and has members in more than 160 countries. Its secretariat, based in Geneva, operates under the auspices of the United Nations Office for Project Services (UNOPS).
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