I first heard about menstruation when I was in Junior High School. I learned about it when a girl in my class was teasing another girl who was having (what I later learned) was menstrual cramps. I approached the girl who was in pain to ask what was happening to her, as she held her abdomen with both hands and put her head on the desk. But I was scolded by the other female classmates and was told to stay away. One girl told me the girl in pain was experiencing ‘women illness,’ so I asked her what that was. She quickly yelled at me and told me to stay away and out of their business, without explanation. At that moment I had the feeling that I was asking too much. Not long after, I saw the girl who was experiencing the cramps pick up her bag and leave for home. For the next four days, she never came to school.

Filled with mixed thoughts, I approached a male friend who was in the same class as me and asked him what he knew about ‘women illness,’ to which he replied that he didn’t know either. I told him what I witnessed that morning in class, and he told me that maybe she was pregnant. I became surprised by his response, and I felt as though I needed to find answers elsewhere.

After school that day, I told my sister that one of my classmates was maybe pregnant. She asked surprisingly how I got to know that the classmate was pregnant and I told her about what I experienced earlier that day. It was then that she explained menstruation, and the painful experience that comes with it. My sister was very direct and clear with her explanation and it left me with no further questions.

I am certain that I was not the only student ignorant to the details of menstruation and it became very clear that there was a missing opportunity to educating boys in school. I also believe that in order for boys to grow into supportive men, then information concerning the physiological make-up of their female counterparts should be made opened to them (particularly issues on menstruation). Likewise, as girls grow into adults who will in turn transfer knowledge on menstrual hygiene to future generations, then they equally need to be equipped with the right information on menstrual hygiene and its practices.

Understanding our Impact

In April of this year, our WASH Coordinator in Ghana, Margaret Mary Debre, authored a Transparency Talk that described our WASH program in Ghana, with a particular focus on the great work being done in menstrual hygiene education. This work includes not only raising awareness about menstruation among both boys and girls in the school, but also involves demonstrations of how to make sanitary pads, as an effort to make these products affordable. Recently, students from the Columbia University School of Nursing and the Pencils of Promise (PoP) WASH Team worked together to teach girls in school how to make their own pads, which were ultimately called “Pads of Promise.” The Ghana Learning & Evaluation (L&E) Team wanted to highlight the assumed success of these efforts and worked to develop an evaluation of the program. Therefore, in collaboration with the WASH team, the L&E team developed an assessment to understand the current student perceptions on menstrual hygiene education. Our survey was administered in 10 PoP schools with WASH programming and focused on the following areas:

• Knowledge on menstruation
• Attitude and practices of menstrual hygiene
• Cultural restrictions during menstruation
• Ideas for how to improve the menstrual hygiene program

Results from the survey indicate that the majority of the respondents understood that menstruation is a natural process. Only few of the female students, however, knew the cause of menstruation and the source of the menstrual blood. This could be explained by the possible emphasis on managing menstruation rather than the details on its cause, as all the female respondents had a good understanding of managing it in terms of personal hygienic practices.

On the attitude and practices of the female respondents, it was reported that they (female respondents) were scared and shy, and also the pain was unbearable and emotionally uncomfortable during their first menstrual cycle. Many of the respondents used sanitary pads during their first menstrual cycle with a few respondents said to have used other materials, such as pieces of cloths and/or toilet tissues. Almost all the female respondents practiced safe disposal of their used sanitary pads.

In regards to menstrual education, male respondents between the ages of 11 and 19 revealed that they did not learn about menstruation from their families, and instead first learned about menstruation from a PoP Hygiene Club. On the contrary, almost all the female respondents in the same age range first learned about menstruation from their families. This revealed that boys were still being kept in the dark about issues on menstruation in their various families and shows the great influence in exposure that our WASH program is making. One worrying revelation was that almost all the female respondents who heard about menstruation from their families learned about it on the day of their first menstruation. This suggests that until a female respondent experienced menstruation, there was no need for menstrual hygiene education.

I was, however, not surprised when ‘Father’ was not mentioned as the first source of menstrual education. Because if males are still being excluded from the sensitization on menstruation in their families, and only have to learn about it by chance, as it was in my case, how can they serve as the first source of menstrual education to their children?

There were no cultural restrictions identified during the survey for female respondents who experience menstruation. In most cases, girls experiencing menstruation can be prevented from performing certain household duties such as preparing meals and fetching water. They can also be discouraged from sitting in the company of other people. However, no such cultural restrictions were mentioned in our target communities from which the respondents came from.

Changing Attitudes

Students in PoP schools with WASH programming do not have go through my experience of learning about menstruation because of the various engagement models delivered by the WASH Team on menstruation and other adolescent reproductive health topics. PoP Hygiene Clubs create an avenue where members (mostly students in grades 3–6) receive education on menstrual and other health topics on a weekly basis. The Hygiene Club also provides a platform where members themselves freely interact and share issues on their reproductive health and personal hygiene, while serving as agents of change in their communities. The PoP WASH Team also delivers programming to all students during general assembly meetings, unlike in the Hygiene Club where only members are served. I directly witnessed the impact of our work during one of my monitoring visits to a WASH school. During this visit, students in KG were able to answer basic personal hygiene questions perfectly. All the aforementioned approaches are breaking the barrier of shyness, and stigmas about menstruation and other adolescent reproductive health issues — while also giving rise to student confidence in relation to these issues. Most importantly, members of the PoP Hygiene Clubs, as well as the other students in WASH schools, are empowered with the requisite knowledge to lead an informed and healthy lifestyle and serve as agents of change.

The WASH program does not only target students. Parents are also engaged during the Parent Teacher Association (PTA) meetings in the various WASH schools. This is because so far the WASH engagement activities are limited within the confines of the school environment. Thus, the WASH Team take advantage of every gathering with parents in the WASH schools to promote adolescent health issues, and particularly menstrual hygiene. This I consider a novelty, since the majority of the female respondents first learned about menstruation from their families. It is thus important that parents are empowered to transfer the knowledge to their children in their families. This approach will also ensure long-term sustainability of menstrual hygiene education.

I commend the PoP WASH program for demystifying menstrual hygiene and making it accessible to both boys, girls and parents.