Briefing Note: "Breaking Menstrual Silence" May 2024 Report by Send Ghana

Send Ghana is a reputable Non-Governmental Organization specializing in policy research and advocacy among other things. The May 2024 “Breaking Menstrual Silence” report discusses a research study implemented by several research groups around Ghana and was funded by Global Affairs Canada through Oxfam in Ghana. Additionally, the report writers consulted relevant research literature to corroborate conclusions and make policy recommendations.

Link to the complete report through Send Ghana’s site: https://sendwestafrica.org/nu/gh/breaking-menstrual-silence-unveiling-the-hidden-struggles-among-adolescent-girls-in-ghana/

The study’s main objective was to assess the impact of period poverty on adolescent girls and young women in Ghana. Period poverty refers to lack of access to menstrual products, hygiene, facilities, and education. Researchers administered 1183 questionnaires with 927 female respondents with an average age of 17, the other 256 were boys/young men. Over 80% of respondents reported a monthly household income of less than Ghc 1500 (about USD 100) which is considered low to average income. 49.4% of respondents reported less than Ghc 500 (about USD 30) monthly household income which is about minimum wage. Researchers also completed Key Informant Interviews with 24 teachers, 24 parents, and 6 health officials as well as Focus Group Discussions with 10-12 participants (boys and girls separately) across two disparate areas.

The report points out the prevalence of social taboos and misconceptions which keep girls/young women in the dark about menstrual education and discourages them from seeking help. Findings showed that girls/young women receive little support by way of menstrual education from parents with next to no involvement from fathers. One respondent stated “they [parents] speak to us in proverbs which we hardly understand … we are not encouraged to speak to them about our menstrual cycle”. Nearly 50% of respondents “associate it [menstruation] with dirt and shame”. At school, home, and the workplace pads are hidden when using the washroom to avoid embarrassment and shaming. In interview, a parent noted that “girls [who are menstruating] are not allowed to cook because they may stain themselves while cooking”. The report maintains this attitude is pervasive among Ghanaian women and mothers as well as boys, men, and the wider society. In turn, education, awareness, and acceptance of menstrual health and safety is low, further exacerbating risks associated.

95% of respondents use disposable pads because of reduced risk of infection and discreet disposal whereas reusable pads can easily lead to infection and need to have blood washed from them. However, disposable pads are very expensive and often unaffordable, in part due to high import duties and taxes. Report writers cite that a woman earning minimum wage would need to spend 10% of monthly income to service menstrual needs using disposable pads. When asked to identify their major constraint in accessing safe menstrual products 70% of respondents selected high cost as the major barrier, and 37.7% reported that during their last menses they bought pads using money they acquired on their own.

Controversially, 98% of respondents indicated they practice handwashing when navigating menstruation. Report writers found that this disagreed with the literature, identifying that although respondents did wash their hands there were still significant barriers due to the state of washroom and change room facilities in schools. For the most part washrooms and change rooms in schools are not equipped with water, soap, and disposal bins which adds extra steps, and therefore barriers, to menstrual hygiene.

Some girls/young women who cannot access sanitary products or experience unanticipated menstruation use improvised items such as toilet paper and cloth. One respondent noted that when improvised items fail and her uniform is soiled she leaves school and runs home. The report mentions that up to one in ten girls in sub-Saharan Africa misses school during their period, potentially representing 20% of the school year missed. Another respondent said “whenever I’m menstruating I don’t go to school because I don’t want to stain myself and people will laugh at me”. One of the consequences of this inaccessibility to menstrual products and education is a significantly lower participation and inability to focus in school further widening the equality gap between girls and boys in Ghana.

When asked to to indicate the most devastating consequences of menstruation, in order of highest magnitude first participants responded: sexual exploitation to acquire menstrual products, infection, missing school, teenage pregnancy, school dropout, and child marriage. A teacher commented, “to a large extent, when a parent cannot buy the pad for her adolescent girl, we all know what happens at this stage; she is compelled under the circumstance, to look elsewhere for the product. She will have a boyfriend and might walk to him for the money to buy it for the month. Because of her vulnerability, she trades sex for the pad. So far as the guy keeps on buying her the product, he takes advantage of her, and this can lead to unwanted pregnancy.”

A health officer interviewed in Ashaiman emphasized the lack of access to sanitary menstrual products resulting in infections and teenage pregnancies: “This half year, we have attended to about 200 girls for pregnancy cases, and I can say emphatically that the pad issue is indirectly contributing to the rise of teenage pregnancies in the municipality and elsewhere. If the government takes the necessary steps and pays attention to the pad issues, the trend of teenage pregnancy, UTI cases, STI cases and adolescent with HIV cases, would reduce drastically and enhance the reproductive health and wellbeing of adolescents.”

Given the extreme risks associated with period poverty in Ghana, the report puts menstrual health education programs and increasing public awareness and sensitization drive as its highest priority in the policy recommendations. Second, the report calls for improvements in school facilities so girls/young women will be able to privately and hygienically navigate menstruation. For instance, separate washrooms for girls with sufficient access to water, soap, and waste baskets for disposing pads. Third, pads must be reclassified as ‘Essential medical necessities’ which has a zero tax rating making them more accessible. The report concludes that other support systems, for example targeted distribution of pads to deprived schools, would also help to address the problem.