Promoting menstrual hygiene and health in communities of Obanliku
Dennis displaying a reusable pad he made.
Christiana during an interactive session.

Promoting menstrual hygiene and health in communities of Obanliku
MHM friendly toilets in Kwaku village.

*We took drastic measures to achieve community development — Obanliku Women

By Iwunze Jonathan

In many parts of Nigeria, the rural woman lives a life that is almost obscure. With limited or no access to modern amenities and facilities, such as transportation, electricity, media, hygiene, health care, amongst others, she is disadvantaged on many fronts.

In her role as a wife and mother, nature appears to do her no justice as she must contend with age-long traditions and myths on menstruation that are unique to her indigenous community. This in turn exerts a strong influence on menstrual practices employed by her.

Professional health organizations like the World Health Organization, WHO, and UNICEF have recommended the introduction and advocacy of menstrual health education and hygiene programs for adolescent females, especially in rural areas.

However, without understanding existing myths and perceptions about menstruation in rural communities around the country, these programs may almost never succeed.

In Obanliku LGA of Cross River State Nigeria, certain rural women stood as a force for positive change. The women, despite limited resources, age-long traditions and myths on menstruation, and limited menstrual education, defied the odds and championed the acceptance and implementation of menstrual hygiene management though in a limited way, in their very community.

Obanliku is made up of 10 wards namely: Busi, Basang, Bebi, Bisu, Utanga, Becheve, Bendi 1, Bendi 2, Bishiri North, and Bishiri South. Blessed with abundant fertile land, which is suitable for cultivation, the people are predominantly farmers.

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All the communities in Obanliku seem to be linked by one common thread as the taboos and socio-cultural practices around menstruation are similar.

A good number of the women in each of these 10 wards said they experienced restrictions on cooking for their husbands, limited to domestic work, social activities they could engage in, and intercourse during menstruation.

It was believed that any man that had intercourse with a menstruating woman and went to war would not return alive. She was also not allowed to lie on the same bed with her husband during the period of her flow. She was forbidden to touch any economic tree as it was believed that the tree would stop bearing fruit and die eventually.

Mrs. Agaga Christiana lives in Bayatu village. The 60-year-old mother of eight recounts her experience during her early years in marriage. She says: “Back in the day as a young wife, I was not allowed to cook for my husband when menstruating. Other women cook for him, or he cooks by himself.

“I was not permitted to sleep on the same bed with him as I was considered unclean during that period. It was also customary that I refrain from serving kolanuts to guests during my periods, as it was believed that the kolanut would turn black.”

Her story, however, is not unique as many of the women living in these communities have had to face a similar challenge or the other.

Victoria Basake who lives in Bayasun village, not only agrees with Christiana, but shares her own experience that impacted on her negatively and thus, her view of menstruation. “Growing up, I viewed menstruation as shameful and as God’s punishment to women because of the restrictions and taboos women and girls had to endure.

“We had no help in the form of menstrual education and thus, had to sort ourselves out in whatever way we could. I recall one time when my teenage daughter asked me why she had not started menstruating like girls of her age. I told her that she had to sleep with a man before she could start menstruating. Not long after she started menstruating, she got pregnant,” she relates.

Victoria’s story affirms that ignorance and misinformation have dire consequences, and, in most cases, even innocent minds are not spared from its effects. In these parts of Obanliku, it is not uncommon to see unwed teenage mothers who barely completed their secondary education.

Victoria agrees that she only handed down a tradition that she had learned in error.

Aside having had to deal with traditions that are synonymous with a flawed cultural heritage, these rural women must also contend with the challenge of a lack of adequate facilities that are MHM friendly, like toilets or changing spaces. Thus, they resort to alternatives that are both unsafe and unhygienic.

The result in most cases for schoolgirls of menstruating age is to miss out on school activities during their periods which in turn impacts negatively on their education. In its article titled “Menstrual hygiene, gender inequality, cultural taboos and poverty can cause menstrual health needs to go unmet,” UNICEF agrees that there is a direct correlation between the availability of sanitation facilities in schools, and the drop-in attendance rate of female students during menstruation.

Hope Urimla, 13, is a Junior High School (JSS) student who lives in Bayatuo village. She attends a school that has inadequate toilet facilities. The toilets were mostly unkempt and had broken doors.

“I missed school most days during my flow because of the condition of the toilets and a lack of privacy about where to change,” Hope said.

Using those facilities during menstruation was no option as the health hazards were enormous.

In another narrative, a 16-year-old Senior Secondary school (SSS) student whom we will call Sarah was reportedly raped by a fellow student during menstruation. Sarah had gone into the nearby bush to ease nature and to change her menstrual pads because the school’s toilets had missing doors and were unkempt. Little did she know that she was been stalked by a male student who in the past had bothered her to be his girlfriend despite her repeated rejection of him.

“Out of nowhere he came out and grabbed me. I struggled as much as I could to cover my nakedness and resist him. But he overpowered me and forced himself on me,” Sarah told us amidst sobs.

Unfortunately, Sarah’s sad tale represents the silent experiences of a good number of menstruating women and girls across Nigeria’s impoverished suburbs and rural areas.

ACTIONAID defines period poverty as “a global issue affecting those who don’t have access to the safe, hygienic menstrual products they need, and/or who are unable to manage their periods with dignity, sometimes due to community stigma and sanction.”

It further estimates that one in 10 girls in Africa miss school because they don’t have access to menstrual products, or because there aren’t safe, private toilets to use at school.

“Girls often miss one or more days of school during their periods, which negatively impacts their education. In Sub-Saharan Africa, for example, some girls will miss as much as 20% of their school year; some may drop out of school altogether. The loss of education can mean girls are more likely to be forced into child marriage,” (ACTIONAID).

Furthermore, around the globe, “2.3 billion people lack basic sanitation services and in Least Developed Countries only 27 per cent of the population has a handwashing facility with water and soap at home. Managing periods at home is a major challenge for women and adolescent girls who lack these basic facilities at home,” observes UNICEF.

These statistics no doubt reflects till date, the challenges of a good number of the menstruating rural woman and girl-child of Obanliku.

In recent times however, the efforts of certain NGO’s and individuals to introduce Menstrual Hygiene Management (MHM) education into rural communities is bearing fruit. In line with its programme objective, the Rural Sanitation and Hygiene Promotion in Nigeria (RUSHPIN) Programme organized by United Purpose, facilitated Menstrual Health Hygiene Management (MHM) activities in communities in Obanliku LGA, Cross River State. The activities were focused on the three prongs of MHM namely, Breaking the silence, taboos and myths around menstruation, safe and hygienic management of menstruation materials, and safe disposal of menstrual materials.

Both men and women were educated and trained on the need to either construct or upgrade their existing toilets to an MHM friendly standard using local materials. The upgrade would include using wood to construct a flat surface inside the toilet where menstrual pads could be kept, avoiding the possibility of it falling to the floor and getting stained. Plastering the toilet floor with cement to aid in keeping it clean and hygienic was also part of the upgrade process. The aim was to reduce or eliminate vaginal-related infections or diseases like Urinary tract infections (UTI), that are consequent of unhygienic menstrual practices.

The challenge though, was that some homes in certain communities did not have a toilet, or in most cases, the men were ‘too busy’ or did not consider the upgrade project as a necessity.

It was found that at the household level, 98% of men do not support women regarding menstrual hygiene and never have they discussed menstrual issues with their wives and daughters. As they are decision-makers at the household level, decisions related to constructing toilets in houses are also taken by male members. So, it is a big barrier in menstrual hygiene as women find it difficult in cleaning and changing menstrual materials in privacy, as most of the toilets in the communities are not MHM friendly.

The story of Mrs. Rose Ikwen is one interesting narrative that changed the status quo in Bayalele Village. Like most men in the community, her husband Dennis Ikwen had grown in an area riddled by myths and taboos about menstruation, thus underplaying the needs of menstruating women was common. Therefore, Ikwen wasn’t equipped to support his wife through her menstrual cycle. All pleas from his wife to construct a MHM friendly toilet for her fell on deaf ears.

Being a tailor, business was slow and no matter how hard he tried, he barely managed to get by. Therefore, his work was his primary concern for the purpose of sustenance. Other concerns were at best secondary or unimportant. His usual daily routine consisted of getting up early in the morning to ride his motorcycle into Sankwala town where his shop was located.

However, on one fateful morning, while he prepared for work, little did he know that his wife had an entirely different plan for him. When he got on his bike to ride off, in what would seem like a scene from an action movie, his wife sprung from nowhere to block his path. It was showtime!

“I was determined that I would detain him and his bike until he decided to give attention to my request for an MHM friendly toilet that had been unimportant to him all along,” Rose recounts.

Dennis, however, was not going to be intimidated by what he thought was a pathetic show of force by his wife. He was determined to break through the human barrier that his wife had formed to keep him from leaving for work.

His wife may have appeared weak and vulnerable all along, but he was wrong about her this time. He had never seen this side of her before. The woman standing in front of him had determination in her eyes. She was firmly planted so much so that even a bulldozer was incapable of moving this human rock.

Rose recalls, “before long, we had caused quite a scene that many people gathered to know what the cause of our fight was about. But I was determined to make him lose out on something that was equally important to him, his work. He would remain with me at home as long as my wish remained unfulfilled.”

At that point, Dennis realized that this was one battle that he was never going to win. He risked losing more financially than any imagined gains of salvaging his wounded pride. He decided to raise the white flag.

Before long, he got to work. With the help of some of his friends, he sourced local materials and constructed an MHM-friendly toilet for his wife. That act impelled a good number of the community to follow his steps, and they started constructing or upgrading their toilets to an MHM-friendly standard for the benefit of their wives and girl-children.

However, not everyone was attuned to change. Certain homes still lacked a toilet and its inhabitants appeared to be unbothered. Others used ‘lack of funds’ as an excuse for not building toilets. Yet, they were building new houses and having a toilet was just not part of the building plan.

Inspired by Rose’s bold stance that had impacted positively on many in the village, it didn’t take long for the chieftains of the community to enact a law that ensured that anybody that desired to build a house, will build a toilet first. That way, ‘lack of funds’ will no longer be a viable excuse.

This will not be the first time that women in Obanliku resorted to drastic measures to achieve community development for their collective interests. A few years ago, before Obanliku Local Government Area was officially declared as open defecation free (ODF), cases of diarrhea were common amongst children, and not a few adults experienced recurring bouts of illnesses. It was not uncommon to hear of deaths from diseases that are sanitation related.

A solution was urgently needed to stop the growing plague that was gradually stealing the joys and smiles from families and replacing it with bitter tears because of the loss of loved ones.

The solution adopted by these rural women was quite unimaginable.

“We met among ourselves (housewives) to discuss how open defecation affects us, affects our children, how we have so many flies in our communities.

We suggested and agreed among ourselves what could be done to make our husbands responsive to the challenge and we resolved to hold fast to no sexual relations except they build toilets in each household.

Now there is no house you visit that does not have toilets, nobody defecates in the open anymore, we are all aware of the dangers,’’ Mrs Lydia Bisong, a resident of Obanliku Local Government Area of Cross River, said.

Presently in Bayalele village, there is hardly a home without a toilet, and most of them have been either upgraded or constructed to be MHM friendly. Mr. Ikwen now uses his profession as a tailor to make reusable pads at a reduced rate for the women and girls in the community, while training other men and women to do same.

Thanks to the bold stance of Mrs. Ikwen, who never knew that her impulsive display would set the wheels of change rolling and thus, change the narrative of the menstruating woman in her community.

However, without the introduction of menstrual education into her community by NGO’s that are determined to change the story of the rural woman, the flames of passion that were geared towards changing her narrative may never have been ignited in the first place.

Till date though, several communities around Obanliku still struggle with age-long myths and taboos on menstruation, and both genders are not adequately armed with crucial information to break the cycle of ignorance, and deal with its consequences.

Therefore, without proper awareness and access to facilities to help manage the menstruation process, the cycle of ignorance and harm only worsens and continues. There is an urgent need to globally prioritize hygiene and menstrual health.

Most men do not know about the physiological changes in women during menstruation and her menstrual cycle, so it is difficult to change their perception regarding menstruation and menstrual hygiene. But by engaging them into group discussions and regular community meetings, they can change their perception and be made aware of their roles regarding menstrual hygiene management.

Workshops and training sessions should also be organized to train rural communities on how to make affordable reusable pads for and by themselves. More Non-government organizations should sponsor programmes to educate rural people about menstruation, menstrual hygiene management, importance of MHM- friendly toilets at homes, diseases related to reproductive tract due to poor hygiene, and so forth.

In 2015, the government of India launched National Guidelines on Menstrual Hygiene Management to respond to nearly 113 million adolescent girls at risk of dropping out of school due to the start of menarche (their first period). One of the surveys that informed the National Guidelines found that in 14,724 government schools only 53 percent had a separate and usable girl’s toilet.  In addition, 132 million households reported not having a toilet.

In a similar vein, governmental interventions can also be felt when core policies that should spotlight the needs of the rural woman are either enacted, or further strengthened.

These measures will undoubtedly impact greatly on a positive note on the rural woman and girl-child, thus changing her narrative. As the world will have become a safer place for the menstruating rural woman ‘to bleed.’

Jonathan is a WASH, Solutions and Data PhotoJournalist

Vanguard News Nigeria

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Comments expressed here do not reflect the opinions of vanguard newspapers or any employee thereof.