AUSTIN, Texas — There are significant barriers to properly managing menstruation in Kenya, especially in low-income, remote areas. These obstacles include unaffordable sanitary products, menstrual stigma and poor sanitation, resulting in Kenyan teens missing school during their periods. School absenteeism puts these youth at risk of dropping out and having unexpected pregnancies. Some organizations aim to address the issue by providing menstrual products and reproductive education. The solution, however, may involve a multifaceted approach.
Managing Menstruation in Kenya
Over the past two decades, Kenya has introduced legislation to support menstruating people. In 2004, “Kenya became the first country in the world” to eliminate period product taxes. Today, Kenya is one of only a handful of countries without a “tampon tax.” In 2017, President Uhuru Kenyatta signed a law mandating that Kenyan schools provide free sanitary napkins to all female students. The following year, Kenya planned to supply 140 million pads to schools countrywide. However, unreliable distributors and theft meant only a portion of the pads from the government distribution project made it to schools.
Some view these legislative policies as insufficient. Even untaxed, pads and tampons remain unaffordable for many Kenyans. A 2016 Menstrual Hygiene Day report states that roughly 65% of Kenyan females cannot afford sanitary pads. In rural Western Kenya, two-thirds of girls report exchanging sex for period products. Furthermore, sanitation continues as an issue inadequately addressed, making menstrual hygiene difficult. Kenya’s Ministry of Health reports that most school bathrooms and latrines still lack running water.
What Product to Provide
Distributing disposable period products, according to public health epidemiologist Dr. Penelope Phillips-Howard, is often impractical. In an interview with The Borgen Project, she states, “… providing any single-use item… to cover every girl every month in every school in every region would be almost impossible.”
Phillips-Howard, of the Liverpool School of Tropical Medicine, has studied menstrual health for decades. She has done extensive research on the effectiveness of menstrual cups — silicone or rubber-based products that are inserted vaginally to collect fluid. Menstrual cups are washable and reusable, and unlike pads, they can be worn for up to 12 hours.
In a 2016 study, Phillips-Howard found that menstrual cups lowered the risk of vaginal infections caused by wearing a pad for too long. While her research demonstrates the advantage of menstrual cups, she also found that both pad and menstrual cup distribution helped reduce incidences of girls exchanging sex for period supplies.
No One Size Fits All
Providing period products to teens is an important part of addressing period poverty in Kenya, however, it is not an all-encompassing solution. This was the realization of Dr. Molly Secor, a public health professor at Montana State University.
Secor studies adolescent health, particularly among vulnerable populations. In 2014, she distributed washable pads and provided reproductive health education to youth in Kenya’s Tharaka-Nithi County. The following year, Secor founded the nonprofit For the Good with current executive directors Kayce Anderson and Sadler Merrill, co-owner of Thirsties diaper company. For the Good distributed pads as part of its mission to make education more accessible for Kenyan girls.
The organization’s efforts were met with notable success. For the Good distributed an estimated 21,000 pads in Kenya and Malawi. On a 2015 return visit to Kenya, girls’ school attendance rates were higher. Secor recalls that many students attested to the pads’ usefulness and remembered the health lessons nearly verbatim.
Yet, Secor soon found that reusable pads did not work for everyone. Some girls refused to use the pads at school because of odor concerns. Secor tells The Borgen Project that the girls do not have lockers or backpacks, “they’d have to carry a bag and put it in the corner of the classroom.” For Secor, this experience was a reminder that as an outsider to the community, considering context is essential. She notes that well-intentioned NGOs often bring in products that are not actually useful to the people they aim to help. Secor says that this was a major lesson, “trying to figure out, do people want this? Are these pads acceptable?”
For the Good has since shifted its focus from pad distribution to opening schools and encouraging education in remote Maasai communities. Secor is no longer directly involved with the organization, however, she continues to support communities in Tharaka-Nithi County.
Removing the Stain of Stigma: Period Education
Dr. Marni Sommer of Columbia University is also an adolescent health expert. In 2004, Sommer began the Girls and Boys Puberty Book Project, developing and distributing illustrated books for kids ages 10-14 in several countries across the world, including Kenya. The books include information on menstruating, body changes and proper hygiene as well as aspects of male development. Sommer started the project not only to provide education on puberty but to also discourage the bullying arising from menstrual stigma.
Sommer and her co-authors developed the Kenyan version of these books, “Ukuaji na Mabadiliko (Growth and Changes),” in 2018. The books, printed in both English and Swahili, feature true puberty stories written by Kenyan students.
Sommer and her collaborators are currently distributing 15,000 copies of these books to the Kenyan government and organizations in the country. She has received solely positive feedback so far. Sommer has witnessed girls and boys share these puberty books with each other to learn more about the experiences of the opposite gender.
However, just as providing menstrual products is not a period poverty cure-all, Sommer asserts that reproductive education is only part of the solution. She says, “… one book is not going to keep them [in school]. They need toilets, they need water, they need supportive teachers.”
Going with the Flow
Millicent Garama is the co-founder of Faraja Center, which provides programming and resources to at-risk Kenyan youth. She is also the program director at For the Good. Through her work with these organizations, Garama helped distribute reusable pads in her native land of Kenya. However, today, she says many girls refuse cloth pads because the pads not only carry the shame of periods but also that of poverty.
As for better sanitation, Garama believes it is the responsibility of local communities to do the work the Kenyan government is not doing. She says, “… the government will never give money to build those toilets. It’s also [the job of]the parents to [take]that initiative…”
Yet, Garama has also witnessed progress. She says, in recent years, many nonprofits have reduced the access gap to period supplies with a variety of products. Garama also notices that discussing menstruation in Kenya is less stigmatized. The youth seem more comfortable advocating for themselves and “… the parents are also [becoming]aware of [period poverty],” Garama affirms. Additionally, “the girls themselves also talk about it in school.”
Period poverty is complex and still present in Kenya, however, both the government and community stakeholders aim to address it from multiple angles. By reducing the barrier to menstrual product access, providing reproductive education and advocating for adequate sanitation, these leaders strive to help Kenyan youth not just manage their periods but also secure a flourishing future.
– Annie Prafcke
Photo: Courtesy of Dr. Molly Secor