Menstrual Hygiene in South Asia
Globally, access to clean water, sanitation and hygiene (WASH) is on the rise, especially in South Asia. According to UNICEF, in India, Bangladesh, Nepal and Pakistan, the percentage of people practicing open defecation—a leading cause of child malnutrition, disease and death—fell from 65 percent to 34 percent. While these WASH initiatives have seen success, they often neglect one important aspect of hygiene that pertains to women, menstruation. The ability for women to menstruate hygienically and with dignity is vital to their empowerment. Here are five facts about menstrual hygiene in South Asia.

5 Facts About Menstrual Hygiene in South Asia

  1. There is a culture of silence around menstruation; discussing it is often treated as taboo. Females on their periods are often excluded from society because they are seen as impure. One study in Nepal found that 89 percent of respondents practiced some form of exclusion or restriction during a menstrual cycle. However, organizations such as WaterAid are working to break the silence through female-led self-help groups. When just a few women came forward to speak, it inspired others to share their experiences and start breaking the taboo.
  2. Many girls do not understand their periods. Because the topic is taboo, it is often ignored in schools. As such, 10 percent of girls in India thought menstruation was a disease, and 66 percent of girls in South Asia do not know anything about periods before their first menstruation. A study of 160 girls in West Bengal found that, though 67.5 percent knew what a period was before their first, 97.5 percent did not know where menstrual bleeding comes from. While schools often neglect to teach about reproductive health, this is beginning to change. UK Aid is creating audiobooks for girls dispelling myths and teaching them about their periods, and non-government organizations are creating extracurricular activities that teach about menstrual hygiene in South Asia.
  3. Menstrual hygiene in South Asia is vital for keeping girls in schools. According to WaterAid, a study done in South India found half the girls in school were pulled out at the time of their first period, often to be married. The girls who stayed in school beyond their first period reported poor performance due to anxiety that the boys in the class would find out they were menstruating.
  4. Access to feminine hygiene products is expensive. According to WaterAid, in a West Bengal study, only 11.25 percent of girls used disposable feminine hygiene products. The most common obstacles to obtaining them are a lack of awareness about them, the high cost, the lack of availability and the need for disposal facilities. Focus group discussions indicated that girls would prefer sanitary pads because they were more comfortable, discreet, and easier to use and carry. WaterAid is working to make low cost disposable sanitary pads as well as facilities to dispose of them. In the meantime, most women and girls rely on reusable cloth, which comes with its own problems.
  5. Maintaining menstrual hygiene in South Asia requires improved sanitation. One of the biggest obstacles to menstrual health is a lack of sanitation practices and infrastructure. Most South Asian women and girls rely on reusable cloth. To sanitize them though, they need to wash them in clean water and dry them in sunlight. However, cultural taboos around menstruation often pressure women and girls to try to dry them in dark places, potentially leading to infection. For those who might have access to disposable sanitary pads, they often lack the facilities to get rid of them. This is especially a problem for girls in schools. However, WaterAid and its partners are working on implementing WASH facilities that are lockable and gender-separated, with at least one toilet or washroom with an opening leading to an incinerator or dustbin for feminine hygiene products.

While countries in the region are making great strides in sanitation, there is still much to be done to improve menstrual hygiene in South Asia. It is vital they do so because the ability for women and girls to menstruate with privacy and dignity empowers them to pursue work, education and gives them the opportunity to have a voice in society.

– Katharine Hanifen
Photo: Flickr

Health App for Youth in Rwanda

Tantine is an app that has been developed for youth in Rwanda. It was created by Sylvie and Sylvain Muzungu Uhirwa to tackle the issue of lack of reproductive and sexual health information. A barrier to sexual and reproductive health information has teens in Rwanda vulnerable to unintended pregnancies and diseases, which can hinder their ability to complete their education as well as find stable employment in the future.

Sylvie and Sylvain Uhirwa are twin medical students at the University of Rwanda who originally won the Youth Spark Innovation Grant in 2015. This grant is an initiative from the Resilient Africa Network in Partnership with USAID and the Makerere University School. It has helped them to build a website containing reproductive health information as well as youth mentorship opportunities.

As one of four initiatives chosen at the iAccelerator challenge 2017, the pair received $10,000 to further develop Tantine. Half of the funds went to developing the Android app and website content, as well as to continue to advance and develop the platform.

The app was recently shared in the Mahama camp of 50,000 Burundian refugees. The app for youth in Rwanda, specifically in the camp, gives reproductive health information via the web. Tantine works with a medical professional and psychological team to deliver this education, mentorship and counseling services.

Sylvie has stated that members in the camp do not have consistent access to wi-fi and do not own smartphones, so “…that’s why we thought of bringing those tablets and establishing a centre where they come and then access the internet in the camp. So we are going to equip them with those tablets and then a router with wi-fi.”

Therese Karugwiza, a gender and human rights program specialist at UNFPA, has stressed the importance of Tantine also targeting youth who may not be in school, as it is crucial that they also have access to this information. By taking Karugwiza’s account into consideration, the Uhirwa twins are putting Rwandan youth on a multimodal track to better reproductive health.

Gabriella Paez

Photo: Flickr

Family Planning Initiatives in Malawi Help to Stop Population Growth
Malawi is a small, landlocked country, in southeastern Africa, with a population that is expected to triple in the next 30 years. This reality, along with the fact that it remains one of the poorest countries in the world, has led Malawi’s political leaders and health care industry to dedicate time and money into implementing comprehensive access to family planning services (FP). Family planning is defined as a deliberate use of contraceptive methods by a couple in order to limit or space out the number of children that they have.

Through increased service delivery resources, political commitment, improved financial means and communication with receptive communities, Malawians now have more acceptable and affordable options regarding FP services than they did several years ago. The 2015-2016 Demographic and Health Survey reported that 59% of married women were using modern methods of contraception. This compares to only 28% in 2004.

Recognizing that the demand for FP was growing consistently, political commitment to stopping population growth began to reflect in core national policies in the mid-2000’s. The National Sexual and Reproductive Health and Rights Policy of 2009 provided a framework for the delivery of all-inclusive services and encouraged access to information and improved quality of care.

The government of Malawi also recognizes that improvements in sexual and reproductive health correlate directly to the attainment of the Millennium Development Goals. Three areas, in particular, relate: the improvement of maternal health, promotion of women’s empowerment and reduction of child mortality.

In regards to finances, multiple international organizations have contributed heavily to the development of FP services. Financial resources have been put directly into two programs. The first with a goal of establishing and making accessible an Essential Health Package, which includes FP, available for free to all Malawians. The second is working to implement an Emergency Human Resources Program, which focuses on training and deploying certified health professionals.

With the help of these programs, the total health provider density in Malawi increased significantly from 2004 to 2009. Those advocating for FP in Malawi recognize that with most Malawian’s living in rural areas, it is important to bring services and information directly to the people. Awareness of this need is what has allowed for the success of FP in the country.

A culture of acceptance when it comes to the use of modern contraceptives has been indoctrinated in Malawi at a community level. The government of Malawi has made a concentrated effort to emphasize the benefits of FP. Not only does access to FP services increase a woman’s health and economic opportunities, it also goes hand in hand with preventing unplanned births and unsafe abortions, both of which are a common occurrence throughout Sub-Saharan Africa.

The efforts of Malawi’s Government have allowed for substantial strides in family planning. In the past several decades, their commitment has helped tremendously to normalize the use of modern contraceptives and for equitable access to sexual and reproductive health services across the country.

Peyton Jacobsen

Photo: Flickr

Tuungane Project
The Greater Mahale Ecosystem in Tanzania is home to rich biodiversity, but an impoverished human population. Pathfinder International, a global nonprofit organization focused on reproductive health, HIV prevention, and maternal health, has launched the Tuungane Project to address reproductive health and natural resource management.

Because Pathfinder sees a direct connection between the health of the environment and the health of the people, they partner with organizations that focus on threats to biodiversity, while they target what they call “improving health of the communities by increasing sustainable livelihoods and increasing access to contraceptives, adolescent and youth sexual and reproductive health, maternal, neonatal, and child health, and primary healthcare services.”

The Tuungane Project’s projects include land and fisheries management, health system strengthening, and reproductive health services. As a result of their efforts, seven new medical personnel have been posted, 66 community health workers have been trained, and 1,106 new latrines have been built by community members. Prior to these improvements, populations of between 3,000 to 5,000 people sometimes had access to only a single health professional.

Key players in sanitation efforts are the beach management units, which have eliminated cases of cholera, a bacterial disease usually spread in water, for the past two years.

The lives and livelihoods of the population depend on the rich natural resources of the Greater Mahale Ecosystem. The Nature Conservancy, a charitable environmental organization, partners with Pathfinder to create a healthy future for this area. By teaching best practices regarding how to best extract resources from their environment, the organization helps villages meet community needs and attain food security. One of the Nature Conservancy’s major efforts aims to enhance fisheries management on Lake Tanganyika, which holds 17 percent of the world’s fresh water.

By uniting conservation efforts with community development, local governance is strengthened, family health is possible and the population can achieve a sustainable livelihood.

Emily Ednoff

Sources: Pathfinder International, The Nature Conservancy
Photo: Flickr

There are more than 1 billion teenagers worldwide. Seventy percent of them live in developing countries. According to the Demographic and Health Surveys and the AIDS Indicators Survey, the average age that young people in impoverished countries have their first sexual encounter is, at the lowest, age 16 or younger, and, at the highest, 19.6.

Just like in developed nations, with sexual activity comes the risk of sexually transmitted diseases and unwanted pregnancies. Unlike wealthier nations, these impoverished countries lack adequate healthcare. In places such as Sub-Saharan Africa, AIDs is an epidemic. Two-thirds of those infected are adolescents.

Adolescent girls run the greatest risk for sexual and reproductive health threats. A young girl that becomes pregnant who lacks access to healthcare faces many serious health risks. Pregnancies, child-birth and abortions are all perilous. The likelihood that a 15-year-old girl in a developed nation could ultimately die of maternal complications is 1/3800. Compare this to just 1/150 in the developed world.

Meet Reem: she is a 15-year-old girl living as a refugee in a camp. Her two-month-old baby is underweight because it was born prematurely and because Reem was never taught how to breastfeed. She has no one to help her, her husband was killed before the baby was born, and her mother was separated from her in the national conflict.

In other instances, girls marry older men. Hibo is a 13-year-old girl living in a Somalian refugee camp. The oldest of five children, she is responsible for helping her mother care for the family. Her parents are planning to marry Hibo to a wealthy landowner that will bring the family much-needed money and honor. She has been told that it is her duty to marry, serve her husband, and bear him children.

Married women like Hibo are encouraged to have children as soon as possible. Their social status and identity are associated with raising children. Being childless is frowned upon. Unfortunately, wedding older men who have had previous partners bring the potential for STDs.

Young people also face the danger of sexual violence. A national survey in Swaziland revealed that one-third of girls aged 13-24 suffered sexual abuse before the age of 18. Boys face abuse as well but are reported as being less likely to reach out for help from healthcare providers.

Although young people are getting married at an older age, the amount of premarital intercourse is increasing. At the same time, contraceptive use for all teens is low. In Sub-Saharan Africa, contraceptives are used by a low of 3% of sexually active adolescents in Rwanda and a high 46% in Burkina Faso.

Due to the U.N.’s Millennium Development Goals, more youth have greater access to formal education. Health officials decided that school-based sexual/reproductive health programs were the perfect way to educate adolescents. Yet, a survey of these programs and their effects have produced varied results. Not all adolescents attend school, and the funding for these programs is not always there.

The Save the Children organization understands that if there are no programs that specifically reach young people with sexual health programs and education, they will never access the care and knowledge they need. The organization has set up teen-accessible places to teach them about safe sex and offer health services.

Their methods and the continuation of school-based programs have been yielding promising results in places like Mexico, Nigeria and the Dominican Republic. Young people are taking more measures to prevent STDs and unwanted pregnancies.

Lillian Sickler

Sources: Guttmacher Institute, Women and Children First (UK), Alliance for International Youth Development
Photo: The Times

With the second highest maternal mortality rates, Chad falls drastically behind the fifth United Nation Millennium Development Goal in diminishing the mortality ratio by three quarters. There are approximately 1,100 maternal deaths for every 100,000 live births, illustrating a dire need for solutions.

The nature of the problem varies, with deaths ranging from hemorrhage, HIV/AIDS, limited access to health care and obstructive labor. There is also a high Total Fertility Rate in Chad, with women averaging about 5 children.

Many disparities exist between Chadian women who live in urban and rural areas, where the latter averages a much higher TFR. This is partially due to the lack of access to antenatal care as well as limited availability of contraceptives.

Similar to many other patriarchal societies, men play a big role in hindering women from receiving family planning services, consequently endangering their spouse.

High maternal mortality rates pose serious social and economic repercussions for Chadians, further sinking affected families in poverty and decreasing the nation’s economic growth.

A mother is the foundation of a family and research has shown that when a mother passes, there is a greater likelihood for a child to drop out of school, in addition to becoming malnourished.

To address the problem at hand, the Chadian government should focus on increasing access to health facilities, strengthening family planning services and educating young mothers on proper antenatal care. Establishing clinics with trained health professionals  increases the rate of women with medical supervision during childbirth.

Chad has witnessed inadequate human resources for health; thus, more midwives and physicians are in need of proper training. In addition, 20 percent of women have an unmet need for contraceptives, indicating that family size is out of their control.

Better access to family planning allows births to be spaced out and reduces unwanted pregnancy. Furthermore, education is key in developing countries. Teaching Chadian women about reproductive health will ensure that women are making choices that are best for their bodies and will give them a sense of empowerment.

– Leeda Jewayni

Sources: CIA, Safer Birth in Chad, World Bank
Photo: The Guardian

Astellas Pharma
About 75 percent of women with obstetric fistula have gone through labor that has lasted three days or more. Obstetric fistula affects mostly the poorest women who live in the poorest countries of the world because they do not have access to proper medical help. When a woman’s labor is obstructed she most likely could have intense pain for days before she actually has the baby.

So what exactly is an obstetric fistula?

“The soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow … Her baby likely dies and she is often left with obstetric fistula, a small hole created by constant pressure from the fetus, which renders her incontinent.”

An estimated one million women get obstetric fistula and only 20,000 of those get treated a year. The surgery that these women would need takes under an hour and costs around $450. The need is there for these women to receive medical help and that is why Astellas Pharma EMEA decided to dedicate $2 million to help the cause.

Over the course of three years, Astellas will be partnered with the Fistula Foundation and put that $2 million to work. This is believed to be the largest and most focused effort ever against fistula according to Kate Grant, CEO of the Fistula Foundation.

The money will allow 1,200 women to get surgery in Kenya for this life-changing condition. As part of Astellas heritage, one of the key things that this organization wants to bring to communities is hope.

“Astellas knows the difference good medicines make to peoples’ lives. That‘s why we focus on providing treatments that are a genuine advance on the current standards of care – particularly in disease areas where options are limited.”

Here in the United States, the obstetric fistula was a common term that most people knew about, until the early 20th century. Since the U.S. has the resources for great medical care, there are procedures like a cesarean section, that we can use to prevent fistula. Kenya doesn’t have what the U.S. does, so companies like Fistula Foundation and Astellas are doing something about it.

– Brooke Smith

Sources: ONE, Astellas, Fistula Foundaiton
Photo: Flickr

Improving access to reproductive health services in the developing world is critical to poverty alleviation. Pregnancy and childbirth-related complications are a leading cause of death of girls, aged 15 to 19, in developing countries. An estimated 7.3 million girls under age 18 give birth each year, and a great percentage of births occur in Africa. To counter this, the United Nations Population Fund (UNFPA) has announced it will partner with eight African countries to improve access to reproductive health services for millions of girls. The programs will span over the next three years, and will hopefully make a difference in lives of millions of young people.

“We are working specifically to ensure that the continent’s adolescent girls, between the ages of 15 and 19 – some 45 million of whom live in sub-Saharan Africa – get a good education, are able to decide whether and when to marry and have children, are protected from HIV, remain safe from violence, and have their fair share of opportunities to work and contribute to the economic development of their countries,” said UNFPA Executive Director Babatunde Osotimehin.

UNFPA will partner with the Democratic Republic of the Congo, Ethiopia, Mozambique, Niger, Nigeria, Sierra Leone, South Sudan and Tunisia. The programs will deliver comprehensive sexual and reproductive health services for young people. The hope is to reach disadvantaged and impoverished girls who are most at risk for poor sexual and reproductive health, violence and exploitation.

UNFPA programs will ensure young people have access to age-appropriate sex education, whether they are in school or out, to prepare them for adult life. The programs will bring together governments, young people, the private sector and other stakeholders to access the needs of young people.

UNFPA is the lead United Nations agency that promotes sexual and reproductive health services. They are at work in 150 countries, ensuring that young people have the information, services, and supplies they need to make safe and healthy decisions.

“Over the next three years, in partnership with governments and young people themselves, we will commit to making a tangible difference in the lives of millions of young people right across the continent. It is their rights we must uphold and it is they who are our best hope for a prosperous and peaceful Africa,” said Dr. Osotimehin.

Catherine Ulrich
Sources: UNFPA, UN News
Photo: Join Tokyo

The world has made huge strides towards reaching the halfway point of the Millennium Development Goals (MDGs) in terms of reducing global poverty. However, there are many African countries that will likely fall short in women’s rights standards established by the United Nations. These countries include Nigeria, Sierra Leone, Djibouti, Senegal, and Guinea. Many of these areas are deemed the worst places in the world to live in and be a woman.

The women living in these African countries lack fundamental reproductive rights, like family planning, access to contraceptives, and health counseling. When a young woman unintentionally becomes pregnant, she and her child are at risk for numerous health complications. In addition to health risks, the unexpected child puts a severe financial strain on the mother and, if the mother is in school, increases the probability that she will drop out. Thus, reducing the likelihood that the woman will obtain a high paying job later in her life contributing to gender inequality.

Another aspect of reproductive rights is the prevention of sexually transmitted diseases (STDs). Without access to contraceptives, women are at risk for STDs as well as HIV and AIDS. When women have the right to use condoms, the spread of these diseases and viruses is reduced. Condom use will also decrease the number of orphans whose parents die from HIV and AIDS. In spite of all of these benefits reproductive rights have on women and on society in general, many countries still discourage it.

Culture and social norms play an important role in determining women’s rights in many of these African countries. These are complicated issues, but a key way to ensure that a country will change is through foreign investment. By investing in health and education for women, foreign aid organizations are creating a new generation of women who will fight for their rights and demand equality. Although some countries may not meet the MDGs by 2015, with the help of foreign investment, we may see women’s rights taking a huge step forward by 2030, when the UN plans to have ended global poverty.

– Mary Penn
Source: GBN
Photo: AJWS

US AID Praises Filipino Volunteer OrganizationThe United States Agency for International Development (USAID) and the Department of Health commended a volunteer-based organization in the Philippines named the Family Planning Organization of the Philippines (FPOP). The group, located in Iloilo City, teaches young students in poor villages about preventing unplanned pregnancy and provides reproductive education. Many low-income families living in the Philippines do not have access to family planning services, so the Filipino volunteer organization has been working diligently to provide this much-needed information.

Volunteers for FPOP complete extensive training in preparation to teach adolescents about reproductive health. These volunteers are able to educate students on family planning, the importance of preventing teen pregnancy, and birth spacing. The FPOP also reaches out to the LGBT community for peer counseling, thus providing a safe and open place for these students to ask questions and learn about sexual health.

The FPOP in Iloilo City has partnered with the Department of Education to incorporate reproductive education and family planning into the current school curriculum. Now, students in the 5th and 6th grade may learn about preventing pregnancy in science, health or social studies classes. So far, one elementary school and one high school have begun to include FPOP information in their classrooms.

Six barangays, or small villages, have seen the benefits of the FPOP. Not only are students better educated on topics that greatly affect their futures, but they also have the opportunity to positively interact with mentors from the FPOP. Clearly, this is a wonderful organization that deeply impacts its community and deserves praise from USAID.

– Mary Penn

Source: Sun Star Iloilo
Photo: Flickr