Talking about the ‘unmentionable’ – menstruation as a development opportunity

One of the most common searches that brings people to Hopebuilding wiki is about sanitary pads for young women. People search on this topic from all over the world. Clearly, awareness of the importance of this issue has greatly increased. Social entrepreneurs are running projects. Campaigns to increase girls’ education talk and think about menstruation. School and community-based economic development projects make sanitary pads. Talking openly about menstruation as a developmental issue has encouraged projects to build separate toilets for boys and girls in community schools.

Discussion and activity has come a long way in a few years. I first began to research this topic in 2006, when I read a story about a refugee camp whose staff had not thought about providing sanitary pads for women as a necessity, along with shelter, food, and water. At first I thought about the apparent inadequacies of the camp planning process. Then I began to wonder how those women coped with the flow of blood each month. And that led me to wonder what women did when they had no way, and no place, to buy pads or tampons.

I learned that many women used old pieces of cloth which they washed over and over again. Some used leaves of plants, or grass. In some cultures, menstruating women are placed in an isolated hut during their period. In many places, girls’ education was disrupted, when they were sent to such huts by their parents or when they stayed home from school at that time of the month because they had no reliable protection or because the school did not have separate toilets for girls and boys.

Unhealthy solutions
Clearly I was not the first person to be thinking about this problem. In Uganda in 2002, Dr. Moses Kizza Musaazi learned that many girls didn’t attend school during their periods because they couldn’t afford to buy commercially-made pads and their improvised solutions weren’t reliable. Almost all of the urban poor were using banana fibers, grass, leaves, old newspapers, or pieces of cloth. Not only were those not reliable solutions, but they were unhealthy.

Dr. Musaazi, who worked at Makerere University in Kampala, was a specialist in appropriate technology. He began to think about how to provide a low-cost solution, and that led him to the abundant papyrus reeds that were growing in swamps and on river banks all over Uganda. Since ancient times, papyrus – which is more than half cellulose – has been used to make everything from baskets, rope, and sandals to mattresses and even boats.

He began to experiment with using papyrus to produce sanitary pads. During 2003-4, he got support from the Rockefeller Foundation. The result was to create Makapads, which were much cheaper because they were made from local materials. But the impact was much more than just a cheaper product. Because he focused on locally appropriate technology and local materials, making Makapads created jobs – in harvesting papyrus, in making the pads, and eventually, in distributing them.

Makapads thus became much more than just cheap sanitary protection for girls and women. It became a sustainable, integrated, economic development enterprise that is now spreading outside Uganda. One NGO in Kenya, for example, sees distribution of Makapads as a way for women to create small local businesses by distributing the pads in villages and cities.

Addressing the health issues
People in India came up with a different solution. One local NGO, Goonj, collects old clothes, cleans them, and makes them into sanitary pads that are distributed very cheaply in poor areas of the city and villages. In this case, old clothes represented a different kind of renewable, sustainable resource. But Goonj went beyond providing cheap pads – they also began to use the pads as a way to educate women about menstruation.

In 2004, they had learned that many women didn’t realize that their ad hoc solutions made them vulnerable to potentially life-threatening infections. Village women used and re-used pieces of dirty cloth because they thought menstruation was dirty – and those cloths rarely got properly cleaned. In villages, where people got water from hand pumps, there was no private place to wash them. Drying them openly in the sun was not possible because of the same lack of privacy. It was a massive health problem, Goonj discovered, made worse because no one talked about it. So Goonj began to use the pads as part of an educational campaign, Not Just a Piece of Cloth.

Another innovative solution developed in India after a young girl asked at a UNICEF workshop why it wasn’t possible to have a vending machine that would give her a pad for a few rupees. UNICEF, to its immense credit, followed up. That led to the development of the Napivend machine, which now is available in many Indian schools. (And it also led to the development of a napkin disposal machine – because making napkins much more widely available means that there is a disposal problem akin to the waste management problem posed in western dumps by disposable baby diapers.)

Not only is the Napivend increasing girls’ school attendance and performance (because they are not missing days of school), but it turns out that it is helping the girls’ mothers as well. Many girlsbuy the pads in the vending machine and bring them home to their mothers as well. (And in other parts of India, women’s self-help groups make sanitary pads and use the sales proceeds to finance their other developmental activities.)

An opportunity wrapped in a problem
Talking about menstruation openly, and talking about menstruation as a developmental issue, thus has turned a problem into a solution that addresses a variety of problems all at once. It has made it possible to find practical, locally relevant solutions that are improving women’s health, improving girls’ school attendance and marks, and creating jobs for women (including women who are refugees, and elderly women) and sustainable local economic development.

A year ago, I was observing a small group of young men and women in a small village in Zimbabwe. They were asked, separately, to identify the biggest problems they faced, and to think about opportunities to address them. I was delighted to see that the young women had identified the lack of affordable sanitary protection as a problem for them. After they had finished their discussion, I told them about Makapads, and about the other varied projects throughout Africa and south Asia where making sanitary pads is providing income for elderly widows as well as providing affordable protection for young women. It was not a solution they had ever thought about. It turned the problem upside down – from just a problem, to an opportunity that could solve several problems at once.

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