RHINO REFUGEE CAMP, Uganda – Mary* got her period a couple of years ago, while she was living in her home country of South Sudan. When it came, she went to her mother.
“She couldn’t give me pads,” says the 16-year-old schoolgirl. “There are pads in the shops in South Sudan, but they’re expensive.”
“I used clothes. When they got dirty, I washed them and put them out to dry.”
Mary now lives in the Rhino refugee camp in Arua district, northern Uganda, after fleeing the conflict in South Sudan with her parents in November 2016. But she no longer has to stuff her underwear with rags every time she gets her period. Instead, she uses a menstrual cup.
The bell-shaped device, made from medical-grade silicone, can collect three times as much fluid as a tampon and is less likely to leak than other sanitary products. It can be worn for up to 12 hours at a time, unlike tampons or pads, which should be changed several times a day. And since the cup can be washed and re-used for up to a decade, it’s usually more cost-effective than disposable sanitary pads.
For Mary, the cup means no more rags or worrying about leaks that reveal that she’s having her period to everyone in school. “Now, of course, I’m feeling good,” she says.
Mary got her cup from health NGO WoMena Uganda, as part of a pilot program it ran together with the Netherlands organization ZOA in Rhino camp, which has an estimated population of 90,000. The six-month program, which ended in July, aimed to find out whether women and girls would accept the use of menstrual cups and reusable pads.
Menstrual hygiene management is a challenge for many women across Africa. Sanitary pads are expensive, meaning many women use rags or even leaves to protect their underwear, putting them at greater risk of infection. A lack of sanitation at schools leads to many girls staying home during their periods or dropping out altogether when they start menstruating.
According to one 2016 study, over 90 percent of Ugandan primary schoolgirls struggle with maintaining their menstrual hygiene.
“There is a girl who told us that she [got married] because she thought that she would receive pads,” says Shamirah Nakalema, a project officer and master trainer in menstrual health at WoMena.
Through the organization’s pilot across four primary schools in Rhino camp, 108 schoolgirls, mothers and teachers – both South Sudanese refugees and Ugandan nationals aged between 14 and 46 – were given reusable sanitary products and material educating them on menstruation. Some girls and women were given cups, some were given reusable AFRIPads, some girls were given both, and others were asked to choose one product.
Similar programs have already provided menstrual cups to women in other African countries, including Kenya and South Africa. In Uganda, the cups have been available to buy through health clinics and pharmacies since at least 2010, says Anna Gade, a project manager at WoMena and one of the authors of the pilot report. Depending on the vendor, they can cost between $7 and $20. But not many women in the country are familiar with the cups or know how to use them.
An overlooked problem
The main goal of WoMena’s pilot program was to assess whether menstrual cups and reusable pads are feasible options for displaced women and girls.
Uganda is home to one of the world’s fastest growing refugee crises, with more than 1.5 million South Sudan refugees now living in camps alongside locals. About 86 percent of them are women and children.
Experts say menstrual hygiene management is often overlooked in emergency settings. Proper menstrual hygiene management is dependent on factors like adequate water and soap for washing reusable products, and supplies of underwear, all of which are limited in refugee camps.
Diana Manilla Arroyo was a project co-ordinator for Medecins Sans Frontieres (MSF) in Rhino camp for six months. “There’s a lot of problems with water supply” in the camp, she says. A survey by MSF in May 2017 revealed that just under 20 percent of households had received any menstrual supplies, despite almost 90 percent of them having at least one menstruating woman or girl living there.
Grace Fuambe, a teacher at Vurra Cope Primary School in Rhino camp tells News Deeply menstruation is a problem for the schoolgirls there.
“They miss school, one day a month,” she says, adding that the school has experienced shortages of reusable pads, water supply issues and at one stage had only one girls’ toilet.
Addressing the stigma
Through WoMena’s pilot, all women and girls at Rhino camp received training on how to insert and remove the cups, wash the AFRIPads and manage menstrual pain. Participants were given menstrual calendars to track their cycles.
In highly religious and conservative Uganda, the biggest challenge in getting females to use the cups was stigma related to virginity, says menstrual health trainer Nakalema.
“They think that when you insert the cup, it is going to tear your hymen and you’re not a virgin anymore.”
But after training, which also involved parents and teachers, product uptake was high, with 61 percent using the cups and 100 percent using the reusable pads, according to WoMena’s report on the pilot.
Of the women using cups, 11 percent said they had challenges with insertion, removal and, in some cases, cleaning. Others worried that other people would see them emptying the cups. But the vast majority – 81 percent – said there was nothing they didn’t like about them.
Before coming to Rhino camp from South Sudan, Jovia*, 16, would use old clothes or emergency pads from school whenever she got her period. Now in Uganda, she uses menstrual cups.
“The first time I saw the cups I was really afraid. I said, ‘This thing is too big, how can I use it?’” she says.
“I have now used them for almost three months.”
“I have not missed school.”
*Last names have been withheld to protect their identities.