Access to Menstrual Products in East Africa

Menstrual Health Management education continues to be our priority here in East Africa. The pandemic largely affected, and continues to affect tourism, the source of livelihood for many communities in Kilimanjaro and Arusha, where our headquarters are based! This has consequently impaired other mutually beneficial sectors like agriculture, transport, and many have lost their purchasing power. In Kenya, our Mathare Slum home base also suffers pandemic losses. Women living there survived mainly through various house/home management jobs which are now restricted due to Covid-19 regulations and fears. Many are left home earning little to no income. Overall, the pandemic continues to exacerbate the economic circumstance of many parents, guardians or financial providers who must not only cater to their children's basic needs, pads included!

Our work has been even more trying in the pandemic times; we had to learn to pivot (Did you know we now have a social enterprise - Twende is currently being Piloted in Tanzania), and mainly just try to sustain our mental health (S.O.S!) in this past years’ global shift. However, Periods don’t stop for pandemics, and neither will we!. Our teams across Kenya and Tanzania continue working tirelessly to provide even more access for better menstrual health education and distributing high-quality menstrual products to our beneficiaries. This quarter, we worked with students in secondary and primary schools, out-of-school girls, young and teen mothers, women, and even more men!

Your support motivates and continues to help us grow and reach even more beneficiaries, thank you! Here is what we have been up to!

TWAWEZA MENSTRUAL HEALTH WORKSHOPS 

This past quarter we reached 240 girls from 2 regions in Tanzania and 350 women and girls in Kenya. This makes a total of 590 women and girls who benefitted from access to menstrual health information and reusable menstrual products. In addition, we were able to train 36 teachers from two schools in the Kilimanjaro region who will continue supporting students in their schools with adequate information, increasing our overall impact. 

Femme International collects baseline data on key indicators before project implementation. The baseline exercise was conducted with240 students in the Kilimanjaro region from two secondary schools with 210 students and one primary school in Arusha with 30 pupils. In Kenya, we conducted 9 need assessments with a total of 100 girls aged between 11-17 and 50 women aged between 26-45. 

Our Data showed that Out of all 210 girls and women  in Tanzania 66% have little knowledge of menstrual health, while 44% have not enough information about menstrual management; 25% thought it was an injury, 19% thought it was a curse

• Out of 350 girls and women in Kenya, 76.9% stated that they have clean washroom facilities at schools to change their products but the facilities have no bins to dispose of menstrual products; and the facilities have limited privacy.
• Access to medical facilities was a challenge because of the reduced movement during lockdown and fear especially for something not considered a life-threat or illness; PERIOD PAIN. 

The baseline has been used as a road map in workshops training the students, as the facilitator will know where to put emphasis when teaching, the students/pupils and have a preliminary understanding also which product suits them better. 

School clubs

Sexual health, reproductive rights, and menstruation is the most important subject that students/pupils need to have a clear understanding of before and during puberty period. Recently and especially at the time of Covid 19 lockdown, teenage pregnancy has increased in most of the regions in Tanzania and Kenya with Nairobi, Kilifi, and Kakamega topping up in the list, teenage pregnant girls aged 15-19years https://www.un.org/africarenewal/magazine/february-2021/breaking-silence-led-surge-teenage-pregnancies.Among the reasons that lead to an increase of the problem is the lack of access to education and knowledge on SRHE from the guardians or parents, as most of them do not spend time talking about the subject openly and most girls and boys shy away from talking about the issue. Femme International has started the school club program where the students have free space to ask questions about sexual reproductive health and menstruation in general. Through this program, 350 beneficiaries from two schools were reached, 200 girls and women  (89M, 121F) and 150 pupils (71M, 79F).  

From the school clubs program, the facilitators gathered information based on question and answer, one on one sessions that included the students using family planning methods without enough information, and in Kenya, the most used method was emergency pill (P2). Most of them only fear getting pregnant and not sexually transmitted diseases as they have very little knowledge of sexually transmitted diseases. 

Highlights of the project 

• We have continued facilitating our workshops in schools and women community groups in both Kenya and Tanzania, in Kenya, we concentrate on guardians, parents, and out-of-school girls.
• Working with Disability group known as Wote kwa Wote in Dandora slum of  Nairobi that we look forward to expanding in other slums and counties in Kenya, we have a discussion of starting a sustainable menstrual products campaign for women and girls with disabilities in Nairobi
• Collaborating with other organizations in education and awareness on Menstrual Health Management 
• Parents, teachers, and community leaders are keen to know how they can benefit from Menstrual Health Management education directly. During the community reach out there been questions asked like how would 

Hi friends!

We are settling in well to the new year, but just like everyone else, in recovery mode from, 2020 and the eruption of COVID-19! which affected our activities at Femme International. We mainly work with communities, schools, and due to lockdown it was not easy to implement activities as the schools were closed, people were scared, and finally, the financial issue!. Our programming and operations are still highly reliant on your donations, and with the challenges the globe was facing during the pandemic, it was not our best donation year, (don't worry, we totally understand!).

To learn more about how we’ve been keeping this March 8th, International women’s day, Join us on a live webinar featuring our Managing Director, Florence Akara; Rachael Ouko, and Sia Towo, our Country Managers, Kenya, and Tanzania, respectively.

Periods, however, don't stop for pandemics, and we won't either! We have continued our work, facilitating workshops using our Technical Brief for post-pandemic workshops which we developed in May, last year, as well as strictly complying with directives from the Ministry of Health about social distancing, wearing masks, and washing/sanitizing hands. Programming in Tanzania was not much affected by lock-down or government regulations; a catch 22 for our team in Tanzania, because it allowed our programming to proceed with little/slight interruption. We assure you that our team is keeping safe, at all times! Check out our stylish branded masks! Psssttt... You can also buy one, to support us! Message us on info@femmeinternational.org, if you are interested.

In Kenya, however, since COVID-19! started, and lock-down was enforced, the challenges of managing menstruation, and accessing menstrual products, have been even more evident. We were able to reach participants in workshops implemented through our technical brief, and provide them with access to menstrual and sexual reproductive health education, as well as distributed our handy Femme Kits which contain a sustainable menstrual product option that would reduce the need for the repeated month by month costs, and movement, that menstruators normally have to endure. In addition to learning from our participants about how they manage their periods during the pandemic, we also learned the following:

1. Single-use disposable menstrual products, particularly during the pandemic are not easily accessible, and more specifically that they are unaffordable options in this time where priorities for everyone shifted drastically. The food vs menstruation dilemma menstruators in East Africa continues being severely affected during this time.
2. Access to medical facilities was a challenge because of the reduced movement during the lockdown, especially for something not considered a life-threat or illness; PERIOD PAIN!.
3. Perhaps the toughest challenge for most menstruators was the inaccessibility of water, and soap, especially for those living in the slums; which usually only have a few water points that are privately owned, and require a facility fee (daily or monthly cost). In addition, most of the wash facilities lack containers to dispose of disposable menstrual products and are connected to nearby rivers for easy drainage causing even more pollution. The facilities also limit the menstruator’s privacy.

Twaweza Menstrual Health Workshops

This past quarter, we reached 200 girls in Kenya, and 405 girls in Tanzania, direct programme beneficiaries who received full education and menstrual kits. We also reached a total of 265 indirect beneficiaries in both countries (not including print, radio, and social media audiences). If you do not yet follow us on social media, now is the chance to do it! Instagram, Twitter, Facebook, Linkedin.

We managed to reach 3 regions in Tanzania and 5 in Kenya. Communities, local leaders, and students of Kariobangi, Majengo, Korogocho, and Mathare slums in Kenya, were visited by our team and received MH education. In Tanzania, we taught in seven primary schools in the Kilimanjaro, Arusha, and Dare-salaam region; including, Mshikamano, Mzimuni, Marurani, Maweni, Majimoto, Agape, and Tuangoma that were partially funded by third party sponsors, and partners.

These menstrual health workshops consisted of participants of diverse religious backgrounds, allowing us to explore very many local cultures and ideas from different perspectives regarding the usage of menstrual cups, and maintaining the cleanliness of the external parts of the female reproductive system.

Topics covered include the reproductive system, and its function, this is hosted in interactive sessions led by our facilitators, The participants learn about menstruation, and its related PMS and its management. In addition, we also demonstrate how to wear, and manage a sustainable menstrual cup, and pads, which is engaging for all participants.

We also talk about menstrual stigma, debunk myths and taboos by offering factual and practical information. We challenge the participants to be open and unafraid to explore innovative products that could possibly ease their burden of menstruation.The lack of understanding of what virginity is, is the biggest barrier, a complex issue that is covered in our comprehensive MH curriculum.

Here is what our beneficiaries say/think:

We conducted a follow-up session to see how the girls were managing their periods after the workshop if they had any challenges and what had improved and we found out that:

• 35.1% of the girls think it is important to teach boys about menstruation while 64.9% think it is NOT important to teach boys about it.
• 72.5% think it is important to teach girls and boys about sex education, while 27.6% think it is NOT important to teach.
• 84.2% feel comfortable using Afripads, while 15.8% do NOT feel comfortable.
• 73.8% use Afripads regularly
• 13.1% do NOT use Afripads while 13.1% use Afripads sometimes.

Training of Trainers (T.o.T)

As part of amplifying our impact, and agenda to increase even more awareness, and reach new communities with our Twaweza programming, we hosted T.o.T workshops for 10 teachers in Arusha, Tanzania. This was the first official cohort of our T.o.T services and was funded by our friends from Made with Hope. The trainees are now certified to host Twaweza style workshops, with little need for dependence on our team facilitators.

Project Highlights

1. Many girls got the confidence to try and demonstrate the instruction of how to wear a menstrual cup and the washable pads. Participants wanted to share their personal stories, one participant said: ” I used to have a friend who used to make her own menstrual product using pieces of clothes because she couldn’t afford to buy disposable pads”.
2. Best of all, the participants demonstrated that they felt free in the safe spaces we created, openly shared, and were very curious about menstruation. They displayed newfound confidence and eagerly asked questions, such as;

• What can one do when they can not access a toilet when their pad is already full?
• Is tissue good to use when menstruating? How long should menstruation last?
• What is the white fluid that comes out of the vagina?
• Can the washable pad move while wearing it?
• Are you supposed to throw the pad after using it?
• When removing the menstrual cup, is there blood around the cup?

Test Your Knowledge: How good is your menstrual health and product knowledge, can you answer these questions?

That's it friends! Till next time, from all of us at Femme, stay safe!

As part of our engagement in the Tanzania MHM Coalition, we participated in a menstrual health awareness check-in with the Buigiri School in Dodoma, Tanzania. The students at Buigiri school have visual impairment disabilities, including blindness. 

Our team, lead by Elia, our team's first-ever-male menstrual health facilitator of our comprehensive menstrual health programme, Twaweza (We can - Swahili). Elia and three Femme volunteers were accompanied by the larger menstrual stakeholder community in Tanzania, comprising of educators, researchers, manufacturers,  and health sector players, both private and government with the overall investment in the greater impact of ensuring better policies and reform for menstrual health management in Tanzania. Reported highlights from the visit debrief minutes included:

An evaluation of the impact of the Hedhi Salama (Safe Periods) training by the TZ MHM Coalition group:

1. 4 teachers acknowledged receiving of Hedhi Salama Training last year on 28^TH May 2019.
2. They acknowledged setting 1 out of 6 of the available toilets as a changing room and equipping the room with disposable pads, soap, dustbin, water and khanga(fabric/cloth) as the result of the training.
3. Also, they have set aside a special area where they use for burning used menstrual pads; students also are aware on the importance of using dustbins to dispose of their used pads; before the training, the management of menstrual waste was a bit challenging and contributed a lot to the blocked sewage systems; but for now, they have managed to at least cease the impact of menstrual wastes to that school
4. The school established a special fund for buying 36 disposable pads every month to cater for 15 menstruating girls age 14-16.

On challenges arising and way forward, they reported that:

1. Visual disabilities made the management of washable pads very tricky, students didn’t know whether the pads were thoroughly cleaned, and if the environment they hanged them was sanitary.  Consequently, teachers decided to re-call the washable pads and burned them; however, the number of how many washable was burned was not available.
2. Students complained a lot about menstrual cups; some students reported that the cups were painful; some students reported that they can’t sit when they use cups. Teachers decided to re-call all the cups from 3 students and burned them.
3. The school did not establish WASH clubs in schools as they promised last year, and this has contributed to the continued silence among students, as well as teachers not to maximum utilize the knowledge they received during the Hedhi Salama training to bring a sustainable impact at Buigiri.

Menstruation is not a one-size-fits-all solution:

In the end, even when solutions are available, as we often note, through field lessons/experiences such as these, there is no one-size-fits-all solution to menstruation. 

Call to Action: Do you or someone in your network have ideas on a suitable product for menstruators with visual impairment?

What is the best product for those with visual impairment? Is there a way we can ensure that products include braille instructions to enable thorough cleaning? email us at info@femmeinternational.org

The session concluded with donations from the TZ MHM Coalition in donations made by individual organizations. We did not distribute menstrual products at this particular workshop under the circumstances. The full minutes of the meeting are attached to learn more about the events of the visit. 

• Complete Minutes, Buigiri workshop (PDF)
  

The COVID-19 pandemic has been especially tough on us because not only is the core of our programming education, but, in order to serve the lowest-income menstruators, we rely on community gatherings and field trips to schools. In addition, these communities are usually remote/difficult to reach, and now impossible without exposing our staff or beneficiaries to the risk of infection. 

In response to global efforts towards flattening the curve of the spread of the virus, the Femme team has been staying indoors brainstorming, and developing the Twaweza curriculum further for when schools re-open, as well as strategies for the way forward for our Twaweza and Twende programmes in case the lockdown lasts longer than the given estimated time-frame. 

So far, we have managed albeit having very limited resources; including frequent power failures, poor or no internet connectivity, and old computers with faulty batteries or “fridges” as we refer to them jokingly for their lack to stay on without AC power supply.  We, however, cannot ignore that the beneficiaries of the Twaweza programme most likely/do not have the option of connecting with us over various VoIP or other forms of internet/digital media. A pandemic like this doesn’t equalise; instead, it amplifies existing inequalities, and those struggling the most beforehand will be even harder-pressed as the situation continues. This applies to access to menstruation, particularly in rural East Africa where period poverty is prevalent!

For our beneficiaries, the situation is even more dire now. Manufacturers are making the decision to shut down, stocks quickly are depleting in shops, leaving many people jobless and increasingly desperate. For some people, every last penny becomes a decision on the magnitude which basic necessity can they do without. Menstruation is, however, not an option or choice, but a necessity and just like other necessary daily body/health care products and needs including water, food, and soap; access to products is vital for healthy and hygienic menstrual health management. 

What Now? … We hosted our first/trial Post Corona Twaweza Session!

We remain dedicated, in spite of circumstances, to our cause to eradicating period poverty, the myths and stigma relating to menstruation. Consequently, we have been exploring ideas on how we can continue serving whilst safely adhering to the social distancing government regulations. Our workshops look quite different. Groups are smaller to enable the 2-metre physical spacing, and outside when the rains aren’t too severe. Workshop budgets now include soap and water and/or hand wipes for frequent hand-washing, and as hard as it is, we strictly avoid all handshakes.

The Femme Kits we hand out have always had a bar of soap included, which during this pandemic has become more valuable than ever. Help us continue the fight against #periodpoverty and Donate a Femme Kit today. 

Follow us on Instagram, Twitter, Facebook and Linkedin and help spread the word #periodsdontstopforpandemics!

Check out our latest blog entries!

1. Social Influence barries to facilitating menstrual health workshops (Field Stories - Nairobi) -  by Judith Atieno, Twaweza Programme Facilitator
2. We, as societies, cannot succeed when half of us are being held back! - by Júlia & Antonio, Founders of Periodo Solidario (Femme Partner)
3. The “othering” of homeless women and girls is usually naturalized thus further perpetuating their marginalisation - by Elizabeth Gimba, Founder Go with the Flow Period (Twaweza programme partner )

That’s all folks. With love from all of us at Femme international. #staysafe #alonetogether

Links:

• April 2020 Newsletter
• The "othering" of homeless women and girls is usually naturalize
• Social Influence barries to facilitating menstrual health worksh

In September 2019, our social business idea; the “Twende Initiative” was awarded first prize, and a ticket to represent Tanzania in the Netherlands, Amsterdam, at the largest global green business idea competition - Climate Launchpad. 

"Twende" is a Swahili word that means "let's go" and resonates with our efforts, values and drive as a team to ensure that menstrual health education and products are available, affordable and accessible by everyone even in the most remote regions of East Africa. 

Within the first quarter of 2020, we will appoint our first cohort of sales-agents or "Twende ambassadors"  to receive training on menstrual health facilitation and learn how to efficiently implement Femme's tools; education and conversation to eradicate menstrual stigma and taboos. 

Once certified, our Twende ambassadors will then travel door to door, community to community, targeting the most remote, and hard to reach regions. They will host community workshops to educate its members about menstruation and introduce reusable menstrual products emphasizing the menstrual cup which is still new and needs a lot of guidance to use.

After running our Twaweza programme for the past 6 years, we have identified four key hinging factors that result in women opting for alternative and usually unsanitary products during menstruation, these are:-

1. Cost of products - particularly paying a high cost for a poor quality product that is not satisfactory.
2. Lack of access/stock of menstrual products in rural shops.
3. The limited number and variety of product stock - most of which are usually overexposed to sunlight or overstayed their shelf-life giving the user discomfort, itching or stinging.
4. Shame and stigma in purchasing the products because most shops are run by men.

Twende was borne from feedback shared by our beneficiaries and their families about our Twaweza programme. Twaweza currently only serves in-school girls and severely economically disadvantaged communities, but after receiving several purchase requests from friends and families of our beneficiaries, we soon realized that there is a niche outside the Twaweza programme that we can also serve. 

A customer survey enabled us to identify that our customer base is very pragmatic and desires products that will save them money. A pair of so-sure reusable pads will last the user up to 12 months and Hedhicup up to 10 years making them both very desirable to our identified customer base.

Reusable menstrual products are however not readily available in the market and the local buying culture here is predominantly an in-person transaction, therefore buying online is not an option, not to mention mail and shipping costs which will make the cost even more exorbitant.

Twende ambassadors will enable access to high-quality reusable menstrual products to the last mile at no additional cost. In the first phase of our project, we will offer for sale, So-sure pads (a social enterprise arm from our partner Afripads) and Hedhi cup (a female-owned Tanzanian Menstrual cup company). Both products are sourced locally and through partnerships aimed at ending period poverty.

In addition to receiving comprehensive Menstrual health education, customers will have access to various customizable payment options if they are unable to afford the upfront payment. 

The success of the Twende Initiative will help our sustainability as an organization. Twende will become a profit-generating arm of Femme International that will generate profits thus empowering us to continue funding our Twaweza non-profit programme's project and operational costs even when donor and grant cycles are slow or not targeted towards our cause.

We thank you for the continued support and look forward to continuing growing with you. 

From all of us at Femme, happy holidays and best wishes for 2020.

Links:

• WHO Africa Innovation Challenge 2019
• CBC Canada Feature

• Twende Initiative One Pager (PDF)