Normalising menstruation by 2030: Lessons from the UK-funded Strengthening Climate Resilient Services in WaSH Technical Assistance Project in Ethiopia

The lack of openness and understanding of menstruation as part of the natural reproductive process can have serious consequences, particularly for adolescent girls in low-income countries who often lack access to affordable and quality menstrual hygiene products and adequate sanitation facilities. To address this issue, the international community has designated May 28th as Menstrual Hygiene Day, with the goal of making menstruation a normal fact of life by 2030. 

In Ethiopia, up to 75% of women and girls do not have access to menstrual hygiene products and more than half of adolescent girls have never received information about menstrual health. As a result, girls are often forced to miss school due to the inability to manage their periods. Some of the barriers to sustainable menstrual hygiene management (MHM) include lack of access to affordable and quality menstrual products, inadequate sanitation infrastructure in schools, limited awareness and education, social stigma, cultural beliefs, and inadequate policy frameworks. These challenges are not unique to Ethiopia but are faced by girls in many other parts of the world as well.

Greater access and affordability 

Several initiatives and programmes have been launched to address the issue of ‘period poverty’ in the country, including the UK’s Foreign Commonwealth and Development Office (FCDO)-funded Strengthening Climate Resilient Systems for Water Sanitation Hygiene (SCRS-WaSH) Technical Assistance Project (TAP) in Ethiopia. As part of this effort, NIRAS is providing Technical Assistance to the Ministry of Education and Regional Education Bureaus to tackle constraints related to the absence of affordable quality menstrual hygiene products for adolescent girls by piloting innovative private sector supply of menstrual hygiene products in 150 schools, primarily in drought-affected regions of the country, complementing its financial aid to WaSH at schools in the same area. The project also includes essential behavioural change activities to improve healthy MHM practices in targeted schools and establish evidence for scaling up efforts by government and other donors.

To improve access to and the affordability of menstrual hygiene products for adolescent girls, SCRS WaSH TAP is providing reusable menstrual hygiene kits (four reusable pads in a kit) together with two pairs of underwear to schools and supporting local businesses that produce and sell menstrual hygiene products. The reusable sanitary pads and underwear are distributed to targeted schools across the country with the aim of improving girls’ school attendance and educational performance. Even though the project's original intention was to provide MHM kits, it was decided to also include pairs of underwear because preliminary learnings revealed that girls living in remote regions might not have any.

De-stigmatising menstruation 

The project also focuses on breaking taboos surrounding menstruation and addressing menstrual stigma in schools by training female gender focal teachers and school directors about menstruation and MHM. The aim is for teachers and educational staff to continue to educate girls about puberty, menstruation, and hygienic behaviours by cascading this knowledge throughout their communities.

In addition, SCRS-WaSH TAP is addressing language barriers by providing MHM education booklets in local languages. During stakeholder workshops and training of trainers (TOT) conducted at the regional level, schools are trained how to use the booklets to educate schoolgirls about MHM. They are also trained to advocate and share information about MHM with the local community in meetings and through Parent-Teacher Associations (PTAs). SCRS-WaSH TAP team believes that by providing accurate and comprehensive menstrual hygiene education, schools and communities can help break the taboo surrounding menstruation and promote better menstrual health outcomes for girls and women.

At the end of the workshop and TOT, participants develop an action plan to outline steps that they will take to continue to roll-out educational and awareness training in their schools and wider community. The plans also include efforts to collaborate with other stakeholders to address related MHM challenges by engaging the community and PTAs to mobilise resources for school MHM supply and address negative social norms.

These plans have already resulted in some encouraging results:

• To tackle stigma around menstruation, school directors and gender focal teachers have planned to conduct MHM campaigns using WASH clubs, gender clubs and MHM clubs to discuss issues through community campaigns. Recognising the need for collaboration and a coordinated effort on the part of communities, schools and government alike, gender focal teachers are encouraging schools to have stronger collaboration with health extension workers to jointly address MHM-related social taboos.   
• To address barriers to access, schools have started to allocate budgets for purchasing MHM products from the local market. To help elevate these efforts, the project team is engaging key regional and woreda education offices in each region to allocate budgets to supply schools with MHM products to improve access for girls in the long term.

SCRS WaSH TAP is making significant progress in addressing barriers to menstrual health, with a focus on improving menstrual hygiene challenges in schools across Ethiopia. The initiative targets 150 schools in 11 regions, and the intervention plan has already been put into action in 5 regions: Afar, Amhara, Oromia, Somali and SNNP. The team has successfully completed stakeholder workshops, TOT sessions, and the distribution of MHM products in 2 of the regions and is currently working on the remaining 3 regions. Notably, the initiative has already distributed products to 36 schools, to reach a total of 7,863 schoolgirls. So far, 7,863 kits of reusable sanitary pads, 15,726 underwear and 1,620 puberty and MHM educational booklets have been distributed. In addition to these, the project has distributed 72 facilitation guides to schools in order to help them cascade the training to students. These efforts are crucial in promoting a healthy learning environment and ensuring the well-being of students in Ethiopia.

MHM is a critical issue that requires a comprehensive approach grounded in evidence-based policies and programmes. The SCRS WaSH project provides valuable lessons on how to address the barriers to sustainable MHM in Ethiopia and beyond. By working together, #WeAreCommitted to make menstruation a normal fact of life by 2030 and ensure that no one is held back because they menstruate.

This piece was written by Rediet Seleshi, Menstrual Hygiene Management Lead with support from Fikralem Alemu, Monitoring, Evaluation, and Learning (MEL) Lead and Taylor Martin, NIRAS Senior Project Manager.