SEED Madagascar

Since the first Menstrual Hygiene/Health Day was held on May 28th, 2014, the priorities of the international community have shifted considerably to both recognise and address inadequate access to menstrual hygiene/health management (MHM) as not only a concern to health, but also as an impediment to gender equality and human rights. Yet, an estimated 500 million people globally are currently experiencing ‘period poverty,’ a number which has undoubtably risen in the wake of the COVID-19 pandemic and the economic hardships that followed.¹

“Period poverty” describes a global issue, particularly widespread in low-income countries, whereby access to menstrual products, healthy spaces to manage menstruation with privacy, and menstrual education is partially – or entirely – out of reach.²

In Madagascar, a country that sits amongst the top three worst for water, sanitation, and hygiene (WASH) conditions globally, insufficient access to MHM facilities, materials, and information, continues to disrupt education for menstruating students.³ Inadequate or non-existent MHM facilities, compounded by a lack of knowledge on menstruation, as well as pervasive fady (stigma/taboo), has contributed to the decrease in rates of enrolment and an increase in dropout rates.⁴ Girls may participate less or miss school altogether out of fear of menstrual accidents in the absence of facilities to discreetly manage their menstruation.⁵ A UNESCO report suggests that one in 10 girls in sub-Saharan Africa miss school during menstruation. Given that 97% of people in the Anosy region do not have access to basic sanitation, and 92% of Malagasy citizens live below the national poverty line, estimates for Madagascar are likely far higher.⁶ Access to adequate MHM supplies as well as safe and dignified spaces to manage menstruation – both physical and social environments – are key to investing in girls’ education, and the opportunities that are unlocked by attending school.

Taking a comprehensive, community-led approach to tackle these challenges, SEED built its first school based MHM facility in 2019, developing an approach that would incorporate MHM provision into all of its school projects. The MHM infrastructure provides students a private space equipped with lockable doors, running water, and soap to manage their menstruation at school. In 2021, SEED piloted ‘Ready for Rights’, which delivered sexual and reproductive health and rights (SRHR) training with 50 teachers, and reusable-pad making sessions with 347 female students across four lower secondary schools in Anosy. SEED’s Sekoly (school) Programme is continually evolving its approach to promote inclusive educational environments, and in November 2022 expanded MHM activities further to introduce MHM education and reusable pad-making sessions at Mandiso Lower Secondary School, using lessons learnt from Ready for Rights. Sekoly adopts a programmatic approach that focuses on two target areas: enhancing the capacity of SEED community liaison officers (CLOs) to teach pad-making sessions to students, and delivering comprehensive MHM and health education sessions to all students.

Reusable Pad-Making Sessions

In addition to compromising comfort and dignity, the lack of reliable, affordable, and safe menstrual products also undermines health. According to a report published by UNICEF, the use of vorotsembo (old cloth) – the most popular method for MHM in Madagascar – has been associated with a host of health concerns, including rashes, skin irritations, and urogenital infection.⁷ Whether a consequence of poor material, improper use, or other factors, the need for an alternative menstrual product is evident.

With these considerations in mind, SEED senior community liaison officers (SCLO) and MHM experts, Clara and Julia, launched the reusable pad-making sessions at Mandiso Lower Secondary School. Given the enthusiastic reception and resounding success of the pilot, pad-making sessions were permanently integrated into the Sekoly Programme. Sessions are delivered to girls at the lower and upper secondary school level, being the most critical age group for menarche and menstruation. Over the course of three sessions, students learn how to trace, cut, and sew their own reusable pads, and are tested on their ability to autonomously assemble them in their final lesson. The pads are made using a soft cotton fabric for comfort, accompanied by a removeable insert to facilitate easy changes. For security, the pads are designed with wings which are fastened with buttons around the underwear. By the end of the sessions, students have three reusable pads and soap for cleaning, with pad maintenance covered within the lessons. SEED’s SCLOs have observed that following the sessions, students are both confident and capable of making cost-effective, durable, and sanitary menstrual products: a skill that can then be passed on to sisters, mothers, friends, and neighbours. At Sarisambo Lower Secondary School, one of SEED’s active school construction projects, students expressed their excitement:

Learning how to make a reusable pad is a useful skill […] Before, we were using old cloth and now, with this pad, we feel more comfortable in public and at school when we have our period.

Student at Sarisambo 

Education Sessions

Though accessibility to MHM facilities and products remains a top priority, gender-responsive education systems cannot be achieved without addressing the underlying stigma and lack of information on topics that disproportionately affect women and girls. According to the UNICEF & WHO, the social attitudes of peers hold significant weight in achieving improved gender equitable education in low-income countries.⁸ Community members surveyed across other SEED projects, including 'Ready for Rights' and 'Project Safidy', revealed that topics like menstruation, MHM, puberty, and sexual health were rarely (if ever) discussed in public, and often not even amongst individuals of the same household. Schools come to represent a key point of entry to facilitate healthy conversation and create more inclusive and effective educational environments, especially for girls.

To address these nuanced barriers, Programme Sekoly updated its standard approach to WASH education, expanding the MHM section, whilst also introducing topics related to STIs, contraception, and puberty. These comprehensive sessions are contextually appropriate, interactive, and inclusive of all students irrespective of gender. Programme Sekoly SCLO and MHM expert Julia reported that these sessions are helping to foster a positive, dignified, and respectful understanding of menstrual health inside and outside of the classroom.

Students are always very excited to learn about menstruation […] For many, it is the first time that they are exposed to this conversation.

Julia Harimalala

Investing in women and girl’s education is transformative. Staying in school longer can lead to higher incomes, improved health and well-being, increased participation in political processes, and the knowledge to advocate for one’s rights. Increased education means girls are less likely to marry young, more likely to become leaders in their community, and better motivated to prioritise their children’s education, thereby raising the next generation to elevate gender parity. Through the recent expansion of programming, reusable pad-making sessions have successfully reached 144 students across two lower secondary schools, while approximately twice that number have received comprehensive MHM education. 

SEED will continue to expand and evolve our Sekoly programme, ensuring we strive for gender equitable education across the Anosy region. For these students, the start of their period will not mean the end of their education.

References

1. The World Bank, (2018). Menstrual Hygiene Management Enables Women and Girls to Reach Their Full Potential. https://www.worldbank.org/en/news/feature/2018/05/25/menstrual-hygiene-management
2. Bodyform, (n.d.). What is period poverty? Accessed at: https://www.bodyform.co.uk/break-taboos/our-world/period-poverty/
3. UNICEF Madagascar, (2018). Challenges and Opportunities for Children in Madagascar. Available at: https://www.unicef.org/madagascar/media/1246/file/Defis%20et%20opportunites%20des%20enfants%20%C3%A0%20Madagascar%20(EN).pdf
4. Kirk, J., Sommer, M., (2006). Menstruation and body awareness: linking girls’ health with girls’ education. Available at: https://www.susana.org/en/knowledge-hub/resources-and-publications/library/details/1200
5. UNESCO, (2014). Education & Menstrual Hygiene Management. Available at: https://unesdoc.unesco.org/ark:/48223/pf0000226792
6. UNICEF & WHO, (2018). Drinking water, sanitation and hygiene in schools: Global baseline report 2018. Available at: https://washdata.org/report/jmp-2018-wash-schools-final ; UNICEF Madagascar, (2018). Challenges and Opportunities for Children in Madagascar. Available at: https://www.unicef.org/madagascar/media/1246/file/Defis%20et%20opportunites%20des%20enfants%20%C3%A0%20Madagascar%20(EN).pdf
7. UNICEF & WHO, (2018). Drinking water, sanitation and hygiene in schools: Global baseline report 2018. Available at: https://washdata.org/report/jmp-2018-wash-schools-final
8. Ibid.