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In developing countries, the longer girls stay in school, the rosier their future. When girls are educated, they tend to marry later and have fewer children, which improves their chances of surviving childbirth. They are more likely to be able to work, and generate income for their families, and their children are healthier, and more likely to go to school. The knock-on effects of longer schooling for girls is felt by the entire community.
The recently released results of a Kenyan study on menstrual cups and girls’ education show just one of many ways to help girls stay in school.
A couple of years ago, I travelled to Kenya with the Gates Foundation to report on maternal health issues for Mumsnet. I contacted a blogger in Nairobi for advice, and asked what presents would be appreciated by the people we met, and she suggested sanitary towels, as girls often miss school when they have their period.
For many girls, starting their first period is the beginning of the end of their schooling. The girls stay at home to prevent being embarrassed by bloodstained clothes, and because the onset of menstruation is seen in some communities as the girl becoming sexually mature. This puts the girls at risk of unwanted attention – 45 percent of young Kenyan women report that their first sexual experience was non-consensual.
At the time I was in Kenya, Liverpool School of Tropical Medicine were starting a research project, in cooperation with KEMRI/CDC, Ministry of Health, and a number of other agencies and NGOs, to look into the feasibility and safety of providing teens with menstrual cups. I wrote about the study here.
I recently caught up with Dr Penelope Phillips-Howard to find out how the study went. The initial report is encouraging. While some girls were worried about the size of the menstrual cup, or had issues with insertion, they were helped by receiving further instructions from their peers, the attending nurse or their teacher. Girls were often encouraged by their parents to use the cup, as it eased financial pressure for the family.
“Some parents will just urge you, just use it my daughter i don’t have money, will i be looking for money to buy maize [food] or to buy pads for you?!… So you will just use”
The study compared use of menstrual cups with sanitary pads or ‘traditional’ methods of protection. In comparison to the other methods, the girls using cups reported less leakage, which was an immense relief. It meant they felt less self-concious and were better able to concentrate on their lessons.
“It has helped me because before if I use [san pro brand] sometimes I could find blood stain on my clothes and you know that is embarrassment, but since the Mooncup was brought, if i insert it i just feel free and do not even have it in my mind that blood can leak”
The absence of leakage, and the comfort of use, were the main reasons that girls’ enthusiasm for using the menstrual cup. Once properly inserted, they could not feel it, and the girls favoured cups over sanitary pads. They also enjoyed the freedom of movement, without worry that cloths or pads would become dislodged.
“Before when we had the pads on, we used to worry that maybe the pads or cloths can fall. But now you can find someone running very fast and when playing ball games such as netball, she jumps very high without even getting worried of other things”
The researchers had been concerned that the girls might be put under pressure to share their cup with other family members, but this doesn’t seem to have been an issue. The girls were asked, but refused, stating hygiene concerns, as had been emphasised by the study nurses.
The initial findings were positive, in that they showed cultural taboos and discomfort were not necessarily a barrier to uptake of the use of menstrual cups. The researchers also noted the importance of peer and adult counselling during the familiarisation phase, to support the girls’ update and correct use. Further research is needed to see if providing girls in developing countries with menstrual cups will have a long-lasting effect on absenteeism in school, particularly in areas of poorer hygiene facilities.
Dr Phillips-Howard from Liverpool School of Tropical Medicine told me that she is currently interested in looking at menstrual cups vs other unmet needs of girls,
“As you know girls have a number of unmet needs – while menstruation is a top need, they have others which makes them vulnerable to coercive sex for money – so it would be really exceptional to have a chance to evaluate if cups alone are sufficient to tip the balance and keep girls in school, and reduce pregnancy and drop-out, or if menstruation is one of a number of competing needs, and greater resources are required than this one – off item”