Last night, I gave a short speech at an event announcing the sanitary hygiene resources developed by Irise International, a group of young volunteers committed to girls’ education in Africa. The group was founded by Emily Wilson, who learned of the obstacle that menstruation poses for girls trying to stay in school when she went to Kenya several years ago.
Emily Wilson, a student at Sheffield, saw something important in Kenya. But the wise old man in DC wouldn't stoop to notice.
Emily told her story as I was waiting to give my little talk. All around the room stood various representatives of NGOs and government agencies and other groups, many of whom were engaged in some way with programs that provide this sort of assistance. As Emily recounted the way that her interest in providing sanitary care to poor school girls had developed, I remembered the origins of my own work and the resistance that our team met. I marvelled at how far we have come.
When our Oxford team first began making inquiries in the winter of 2007/2008, very few (if any) organizations had imagined that sanitary care was a problem for girls in developing countries. Sometimes the attempt to deny or dismiss the question of menstruation was, well, a little belligerent. For instance, we had a meeting early on (maybe February 2008) at USAID in Washington, D. C. I sat at the opposite end of a very large table from an older man whose attack on our suggestion was vitriolic. “These are places where they need schools and books,” he said in a loud, acidic voice, “How can you suggest that we divert development dollars for something so trivial?” I tried to explain that as long as the approach was to build for all children without attention to the barriers of gender, the boys would always benefit more. He just stared at me as if I were some strange creature from space.
You might think that folks looked at such a graph--typical of girls' enrollments in subSaharan Africa--and wondered, "Could this have anything to do with menstruation?" But no.
We went to Africa anyway, thanks in large part to more liberal thinking among the dons at Oxford, who were so shocked to think girls were enduring such circumstances they needed little persuasion to fund a study. We decided to go to Ghana, where a team member had been working. We had good ties to two global charities, Plan and CARE. We arranged to meet in Accra with local representatives to discuss a collaboration.
Despite massive email correspondence in advance of the trip, we were kept waiting for hours in a conference room at Plan Accra while people who said they would work with us pretended not to be there. Finally, they said they had arranged for us to go for some school visits with their staff in Mankessim. When we arrived, no one in the Mankessim office knew we were coming and, once they heard why we were there, none of them wanted to help us. We insisted that they at least show us the “girl-friendly toilets” that they had supposedly built in the area. We saw one: it was stuffed full of furniture and cobwebs.
A man at the school district in Mankessim, however, heard we were there and came over on his motorbike to talk to us. Reemans took us to go speak with a large group of teachers who had assembled for a training meeting of some sort. More than 100 teachers, nearly all male, were seated in a large room. When we posed our question, we saw a huge gender and generational divide emerge. The older men insisted (with the same arrogant finality as my nemesis at USAID) that it was not a problem (arms folded, lips pressed, eyes narrowed)–but they were quickly shouted down by all the women and most of the younger men. It turns out you have to be an approachable person for anyone to ever tell you this is a problem. Those old buzzards emphatically did not fit that description.
It became Standard Operating Procedure to conduct toilet checks at every school and buy a pack of pads at the nearest shop (to check the price). Here are Paul Montgomery and Sue Dopson conducting a scientific observation.
CARE was not much better than Plan. There, the lead officers (all male) postured to the effect that we were imposing our Western perceptions on the local community. These guys insisted there could not possibly be a problem because no one had ever spoken to them about it. The women must have a solution, they said, because it never comes up. It was clear to all of us they had not thought about menstruation and girls in school. And it apparently didn’t occur to them that maybe nobody brought it up because women just don’t talk to strange men about their period.
At CARE and Plan and elsewhere, we were told repeatedly that the “traditional” solution was enough. It turned out the traditional solution was a thin piece of printed red cloth (much like a bandana) hung from a strand of beads and then put on like the bottoms of a bikini. One look told you this silly contraption wouldn’t last an hour, even if you were sitting still. But our informants insisted this was a “cultural thing” and it worked for women there in Ghana. None of the women who made these claims to us had actually tried to use one themselves. (After a while, I was practically shouting, “No, this is not a cultural question–there is no physical way this thing could work!”).
Our first big breakthrough came when I gained an audience with Elizabeth Ohene, then the Education Minister in Ghana. Her reaction was much like my own had been when the problem was first brought to my attention. I was shocked and ashamed that I had not thought of it myself. Mrs. Ohene also was shocked, also ashamed that she had not thought of it, and she cried. She wrote a wonderful letter, telling every teacher and school administrator in Ghana to help us however we asked. We could not have done the study without Mrs. Ohene’s courageous decision.
In poor schools like this one in the far north of Ghana, the girls often stay home because they don't have sanitary care. Women in Accra did not dream it was happening.
In retrospect, it’s clear that our initial conversations foundered on the class divide between the educated people in the city who staffed NGOs and the folks out in the rural areas or living on the streets. It is easy for Western visitors to assume that the locals can speak for their compatriots –but think about it, how much do you really know about the lives of the extreme poor in your own country?
As we continued to push, our research assistant (a wonderful young woman named Boatemah) discovered a woman in the Accra market who still sold the traditional materials. When we interviewed her, the market stall woman scoffed at the very idea that contemporary urban females could work or go to school with no more protection than this. She explained that she sold this bandana-and-beads item purely as a ritual article, as it had remained a part of the ceremonial accoutrements of marriage.
In all the subsequent visits–we interviewed more than 600 people in Ghana–we never spoke to anyone who used this traditional item. Instead, we heard about girls using leaves, animal skin, castoffs from a tailor’s dustbin, cotton wool pulled from a mattress. Most of the time, they cut up their own clothes to get rags for this purpose. Sometimes there was nothing and they just sat home waiting for their period to end. You could eventually see another generational divide: grandmothers and mothers in the rural areas simply stayed home when they were menstruating because they didn’t go to school or work. Sadly, some of the older women we spoke to had been pregnant almost continuously from their first period–they were married off at first blood and that was the end of it. Many of these older women were caring for young girls because the HIV/AIDs epidemic had wiped out the generation in between. These “aunties” did not talk to the girls about menstruation–and it never occurred to them that the younger generation needed a better solution.
Mavis and Barbara were CARE staff who worked hard to get this complex study done in a very remote village. The girls looked up to them because they were urban and pretty, but both were good sports when it came to demonstrating stuff and talking on the most delicate of points. I brought suitcases full of Obama gear as gifts that year. Very popular.
It was at CARE Kumasi that we had our second breakthrough. We spent the first hour sitting around a table listening to the staff tell us we were crazy to think sanitary care was a problem. Then, a huge, handsome man named George Appiah spoke up. He said, in a soft but authoritative voice, that he had been puzzled by this question when he had first heard we were coming. So, as he was making his rounds in the communities, he began asking the question directly. As George starting telling the group details of what he had heard, all the risks and indignities that the girls were experiencing came tumbling out. It was suddenly clear that, yes, there was a very big problem. After that, CARE was on board and we began the field work.
Eventually, Plan became a partner, too, in Uganda several years later. By then, the thinking in many sub-Saharan African countries had changed, in part because of our work in Ghana. Sanitary care had become something people knew was an issue. The question remained what to do about it. So, when we arrived in Uganda, we started working on alternatives to disposable pads and, partnering with Plan, conducted the first of two studies: one was on the acceptability of sustainable pads (and incinerators) and the second, still running, is to further confirm the effect of providing pads on school attendance.
George Appiah (right) took the time to ask. He and Eric (left) stuck with the fieldwork to the end. It always cracked me up, though, the lengths even George would go to avoid actually saying the word "menstruation."
At Irise last night, young women and men took for granted that sanitary care is important and needs a judicious solution, not an insensitive dismissal. One group I spoke with, Theatre for Change, had been doing work in Malawi and found that the absence of sanitary care provision was also a problem among the women and girls out of school.
I was hugely relieved to hear that someone is attending to the needs of those women and girls who are not in school. They constitute the bulk of the female population among the poor of developing countries, as most are pulled out of education when they reach puberty (or soon after). Over the years, I have had too many heart-breaking moments when, as I was discussing schoolgirls’ problems with mothers, one of them would turn to me and say, “We have this problem, too. We cannot go out, we cannot work, we are unsafe because we are bleeding. Why doesn’t anyone care about us?”
No one cares about them. I’m afraid it is true. The girls make for better marketing materials. Furthermore, unless you can create a conceptual tie between an intervention and an economically desirable outcome, the big agencies (like DfID and USAID) will not fund your study or your program. Girls’ education is an easy, “feel good” sell. Dignity for grown women is more difficult. You would have to be able to prove the lack of care reduced their income.
In this mothers' meeting, held in Ashante in 2009, the women wanted to know why no one was asking about their sanitary needs. Good question.
In the beginning, my friends would ask me, “But what if it turns out the sanitary pads won’t keep girls in school?” And I used to answer, perhaps naively, that I really didn’t care about whether the girls stayed in school. Not really. What I wanted was for them to have the pads. That is how I still feel. You shouldn’t have to prove an economic outcome in order to avoid that kind of shame.
Some months back, I had a conversation with someone on the UN staff who works on sanitation matters. That woman said to me, “We all privately feel that sanitary care should be a human right. It is a matter of basic dignity. If we have to sell it as education, we will, but the objective in the long run is to persuade the world community that women need access to appropriate sanitary care, regardless.”
I think we need to keep our eyes on that objective. In the meantime, though, the sincere efforts of volunteer groups like Irise and all the lovely young people who were assembled with them last night, are a welcome addition to the growing movement behind this long overdue bid to help poor schoolgirls.