Menstrual Health Report - Symposium - Report - English - Web

THE SYMPOSIUM FOR
MENSTRUAL HEALTH
AND HYGIENE
in West and Central Africa
REPORT
THE SYMPOSIUM FOR REPORT
MENSTRUAL HEALTH
AND HYGIENE
in West and Central Africa
BACKGROUND
Menstrual health and hygiene (MHH) is integral to the realization of girls' and
women's rights and is recognized as a component of, and even a condition
for, equality between women and men. In order to manage their menstrual
experiences safely and with dignity, it is imperative that women and girls have
access to reliable, accurate and comprehensive information, adequate health
facilities, protective materials of their choice and emotionally and physically
supportive school and family environments.
H
owever, we know that in many contexts, It is in this context, and in order to start a
particularly in West and Central Africa systematic collaboration on MHH in West and
(WCA), women do not have access to this Central Africa, that UNICEF and UNFPA, in the
information and infrastructure, and are deprived framework of the French Muskoka Fund and in
of certain basic human rights (relating to partnership with UNESCO, have organized this
education, health, work, water, or more generally regional symposium. The transversal nature of
to their dignity) because of their menstruation - this topic calls for the mobilization of all actors
a physiological event which is as natural as it is in the region so that they can work together
normal. to intensify their work in the field of MHH by
designing, implementing, and evaluating holistic
and multi-sectoral interventions.
REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

AND HYGIENE IN WEST AND CENTRAL AFRICA
4
A symposium that is part of a
1
broader agenda...
Ms. Assiatou Baldé, Minister for Youth & Youth
Employment of the Republic of Guinea, introduced
the session dedicated entirely to adolescents
and youth. While recalling the commitment and
ambitions that Guinea has for young people,
"builders of Africa today and tomorrow", she
recalled that menstrual health and hygiene are
fully in line with the roadmap of the African Union
regarding "harnessing the demographic dividend
through investments in youth".
More than one thousand The intervention of Dr. Julitta Onabanjo(link to

speech), UNFPA Regional Director for Southern
(1,000) people from 91 Africa, provided a link to the symposium held in 2018
countries participated. in this region, which had led to the Johannesburg
Call to Action and the creation of an African
Coalition on Menstrual Health Management. She
also insisted on the collaborations to be built
within the African continent on this topic, in the
perspective of setting up "a pan-African coalition
on menstrual health".
This symposium is a continuation of the
Her Excellency Stéphanie Seydoux (link to
initiatives undertaken since October 2020.
speech), Ambassador for Global Health at the
An initial virtual conference was organized French Ministry for Europe and Foreign Affairs
on October 11, 2020 on the occasion of the (MEAE), recalled that menstrual health is a
International Day of the Girl Child. The objective concern for all girls and women around the world.
was to present an overview and highlight the In France, awareness of the challenges related to
situation faced by adolescent girls and women this issue was late but gave rise to a government
in the region in relation to menstruation. commitment to fight against period poverty in its
Following the conference, a large digital territory, as well as within the framework of its
communication campaign (#Soyonsréglos - development policy through The French Muskoka
Let’s Talk Period) was launched to fight against Fund and the AFD.
taboos and encourage an open discussion on
the subject. The digital campaign continued "We must no longer accept the rejection and
for 8 months, culminating in the regional humiliation suffered by women" (Stephanie
symposium. Seydoux)
Finally, Her Excellency Delphine O, Ambassador

Entirely virtual due to the COVID-19 pandemic,
and Secretary General of the Generation Equality
the symposium took place from May 25-27,
Forum (GEF), emphasized that MHH is fully in
2021 in advance of World Menstrual Hygiene
keeping with the objectives of the GEF, and in
Day. It offered the first space for dialogue,
particular those of the "Action Coalition on Bodily
reflection and sharing for actors working on
Autonomy and Sexual and Reproductive Health
MHH in the region. More than one thousand and Rights". Indeed, barriers to menstrual health
(1,000) people from 91 countries participated. impede the realization of women's and girls'
In addition to the significant involvement of human rights. Delphine O also made the link to
West and Central African countries, East and the Global Strategy for Women's, Children’s, and
Southern Africa were also represented. Other Adolescents' Health, for which information and
countries that participated include France, education for girls and women is a key element.
Canada, the United States, Mexico, Haiti, and
several Asian countries.

5
The symposium was able to mobilize a wide h Funding and partnerships,
range of actors, including non-governmental
organizations, technical and financial partners, h Key programmatic approaches and
governments, UN agencies, faith-based interventions, including:
organizations, the press, the private sector, and
Accompanying changes in behavior
research organizations.
and social norms related to
This report summarizes the recommendations menstruation,
from the various sessions, the main discussion
points, and the lessons learned during the three- Improving access to appropriate
day symposium. sanitary products and protection
The full sessions can be replayed by going to the Improving access to appropriate
Let’s Talk Period website. facilities and services
h Research and monitoring/evaluation.

PROGRAMME
The three days of the symposium were structured 3. Special sessions dedicated to topics
along the following lines: of particular interest, such as "MHH in
humanitarian contexts", "MHH for disabled
1. Plenary sessions to discuss global and people", "quality standards for menstrual
transversal issues hygiene products", as well as a round table
between social enterprises and investors
2. More targeted thematic sessions, organized in MHH to connect supply and demand of
in 4 interdependent blocks allowing services.
participants to share their insights around:
4. Virtual spaces to visit: a resource center,
h Multi-sectoral collaboration (including an exhibition hall for social enterprises, an
the integration of MHH into the health, ‘abstract’ room, and a networking room.
education, and public policy sectors),

6
OBJECTIVES OF THE h To create a space for strategic reflection
and sharing of knowledge and experiences
SYMPOSIUM among the various stakeholders on MHH
in West and Central Africa;
Based on the situational analysis presented in
October 2020, this symposium was intended h To facilitate partnerships and synergies
to be more operational, with a view to sharing, at different levels and between different
strengthening, and encouraging activities sectors.
carried out regarding MHH in the region. More
specifically, the objectives were: h To agree on common guiding principles
and priorities for advancing MHH in the
region.
Definition
" Menstrual health is a state of complete physical, mental, and

social well-being and not merely the absence of disease or
infirmity, in relation to the menstrual cycle.
"
Global Menstrual Collective Terminology Action Group, 2021

7
8
SESSION – 01
The transversal and multi-sectoral nature

of menstrual health and hygiene (MHH)
Moderator: Panelists:
h Archana Patkar, Senior Program h Tsedey Tamir, WASH Project
Coordinator - UNAIDS Officer, UNICEF West, and Central
Africa Regional Office
h Yeboua Ban, Advisor to the

Directorate of Mutuality and Service
Projects in Schools (DMOSS),
Ministry of Education, Côte d'Ivoire
h Dienaba Wane Ndiaye, Country

Program Coordinator, UN Women,
Senegal
h Dr. Yves MONGBO, in charge of

Child, Adolescent, and Elderly
Health (SEAJPA), West African
Health Organization (WAHO)
The situation faced by girls and women in the

region, including the various barriers that interplay
Summary of key points
to impede a safe and dignified experience of Example of Côte d'Ivoire: a true intersectoral
menstruation, calls for a multi-sectoral approach collaboration has allowed the development of a
to MHH. Indeed, the improvement of menstrual national guide on menstrual health and hygiene.
health and hygiene requires interventions at The content of this reference document was
different levels and in different sectors; and the jointly developed by the Ministries of Education
approach today advocated by all actors is that and Health, civil society organizations, UNFPA
of multi-sectoral and integrated collaboration, and youth representatives. Carried out in synergy
which, alone, can have a great impact on the lives by several entities, it not only draws on the
of girls and women. experience and technical skills of each sector,
but also helps to strengthen the inclusion of
The experiences shared during this first session
MHH within these different sectors. In the field
highlighted the challenges, but above all the
of education, for example, the guide is currently
advantages of multi-sectorality, as well as the way
being translated into teaching aids that will
in which this approach could be operationalized
support the work of teachers in schools.
to allow for large-scale change in the field of
MHH.

9
Next steps: In the area of health, the guide can menstrual health a priority issue. Since 2016,
be used to create informational leaflets for girls within the framework of the SWEDD initiative2,
and women visiting health facilities. Similarly, the WAHO has built up a pool of instructors on the
family and youth sectors can use this reference topic and developed a training curriculum made
document as a basis for developing activity available to several countries.
sheets for working with adolescents.
Next steps: The updating of this curriculum
Example of Senegal: Thanks to the joint is planned in the near future and must be
"Gender, Hygiene and Sanitation" program (UN accompanied by high-level advocacy in the
Women, WSSCC)1, the country has succeeded countries, so that the political commitment
in strengthening the consideration of menstrual necessary for multi-sectoral collaboration is a
hygiene in public policies and local government reality throughout the sub-region. However, this
budgets. Under this program, the multi-sectoral advocacy should not only concern the health
approach was operationalized through the joint sector, but also all other sectors in order to create
training of government officials working in the synergy necessary for a holistic consideration
different key ministries. Once they were made of MHH. Yves Mongbo (in charge of maternal
aware of the issue, they were able to act as agents and child health within WAHO) also stressed that
of change and bring the issue to the attention the high-level missions of the WAHO General
of each department, thereby encouraging its Directorate, the Assembly of Ministers of
consideration in various sectors. Health, or the ECOWAS forum on best practices
in health represent advocacy spaces to be taken
The multi-sectoral approach to MHH is hold of.
also promoted by the West African Health
Organization (WAHO), which has made
1
The Joint Program on Gender, Hygiene and Sanitation was implemented by WSSCC and UN Women in West and Central Africa. This program aimed to support
governments in formulating inclusive policies based on research findings, in favor of women's and girls' human rights to water and sanitation.
2
The SWEDD initiative, “The Sahel Women's Empowerment and Demographic Dividend" aims at accelerating the demographic transition, triggering the demographic
dividend and reducing gender inequalities in the Sahel region. It is being implemented with support from the World Bank, and technical support from UNFPA and
WAHO.

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Special session: Menstrual health in emergency settings
Moderators: Panelists:
h Adrian Dongus, Intersectoral MHM h Danielle Jurman, Humanitarian Supply
in Emergencies Consultant for the Analyst, Response and Technical Support
UNHCR-UNFPA Unit (RTSU), Humanitarian Office-
h Noemi Dalmonte, Regional Advisor UNFPA
on Gender-Based Violence for West
h Helena Goro, Program Coordinator-
and Central Africa - UNFPA
Netherlands Red Cross - Côte d'Ivoire
h Caitlin Gruer, Head of the Gender,

Adolescent Transitions & Environment
(GATE) Program- Columbia University
h Anita Akumiah, GBV Sub-Group

Coordinator - DRC - UNFPA
h Brigitte Isseta Ilboudo, Regional WASH

Sub-Cluster Coordinator- Burkina Faso -
UNICEF
h Mariam Modibo Tandina, National

Coordinator– International Youth Alliance
for Family Planning (IYAFP)- Mali
By creating a space for exchange between

different humanitarian actors and people from
across academia, this session provided an Women and girls still excluded from discussions
excellent overview of the general challenges and
lessons learned for ensuring menstrual health in The discussion revealed that despite
humanitarian settings. In addition, the session improvements in the area of MHH, women
addressed the specific challenges of menstrual and girls are still excluded from the discussion.
health in the context of the Ebola epidemic. However, in order to create appropriate MHH
programs, it is essential that women and
girls, including in emergency contexts, are
consulted throughout the program design and
implementation process. The success of the Red
Cross initiative in Côte d'Ivoire to improve MHH
in schools, based on extensive consultation with
girls in the intervention area prior to the project,
is a good example. The consultation of women
and girls is highlighted in the toolkit on menstrual
hygiene management in emergency situations.
and is mentioned in the UNAIDS Handbook as one
of the four "Cs" of effective programming, along
with Coordination, Culture and Communication.

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Coordination is essential on this topic. Interestingly, menstrual waste
management and disposal works well in Ebola
Menstrual health and hygiene programs in settings, according to a study that led to a
emergencies involve interventions in various guidance note on MHH management in Ebola
sectors including water, sanitation, and hygiene settings.
(WASH), protection, reproductive health,
education, non-food items (NFIs) and shelter. Preparing for the challenges posed at each stage
Coordination between the various humanitarian of a crisis can improve supply management
actors working in the field is therefore a key resilience. Indeed, there are various challenges
element for effective programming. related to the supply of MHH products in
humanitarian contexts, such as duplication
At the global level, some initiatives have been or omission in distributions, lack of product
taken to improve coordination (see box below). knowledge among beneficiaries, or a general lack
of priority given to menstrual products. Many
of these problems can be mitigated through
Emerging initiative: In recent years, preparation and coordination, such as assessing
a great deal of work has been carried menstrual product preferences, sharing
out in the humanitarian sector in order information on the advantages and disadvantages
to provide the best possible response of different products, and implementingmarket-
to certain challenges that are regularly strengtheninginterventions.
encountered. In 2019, UNFPA and UNHCR
signed a joint commitment to improve the As part of the emergency response, addressing
operationalization of cross-sectoral MHH menstrual health must go beyond the distribution
programming in emergencies. As part of of materials. Although the distribution of
this commitment, UNFPA and UNHCR menstrual products is an essential component
have co-established the Global Task Force of MHH programs, it is important to remember
on MHH in Emergencies. This working that (1) menstrual management facilities (such
group brings together stakeholders as toilets and waste management system), (2)
from the sexual and reproductive health, information about MHH, and (3) addressing
water, sanitation and hygiene, education, harmful social norms, are also fundamental
and protection sectors. In line with the components of comprehensive MHH
recommendations of the menstrual hygiene programming. And all these aspects must be
management toolkit for emergencies, this considered because menstrual management is
group aims to improve the implementation a question of autonomy, protection, and bodily
of interventions through coordinated dignity.
programming/planning around MHH. The
collaborative work of UNFPA, UNICEF and
UNHCR to develop a common specification Moving forward
for menstrual products is a good example In order to move forward with menstrual health
of the work being done to improve inter- in emergencies, a number of shortcomings
sectoral coordination. remain to be addressed. A key factor in this is
to continue to strengthen coordination between
sectors. It is also important to work on the best
Menstrual waste disposal: an often-overlooked possible preparation, taking into account the
factor in emergency situations different aspects of menstrual health, throughout
the different phases of an emergency. Greater
It is essential that the impact of menstrual waste use should be made of methods to improve
be considered in the design phase of a program consultation with the people concerned. In
and during supplying. The Columbia University general, menstruation should be prioritized for
Compendium on managing menstrual waste emergency response.
in emergency situations is a useful resource

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Special session: MHH for disabled girls and women
h Rajah Sy, Director of Special Olympics - h Megan Tucker, Disability Inclusive Water,
Senegal Sanitation and Hygiene Consultant,
UNICEF
h Moctar Sow, National Association for

the Physically Handicapped (ANHM) in
Senegal, Louga section
h Madjiguene Gueye, Regional President of

disabled women in Louga
h Akwasi Sarpong, The Ulti-leaf Foundation,

Ghana
h Barbara Ngeah Achwe, Vision for Action,

Cameroun
h Yatma Fall, President of the Senegalese

Federation of Associations of People with
Disabilities
The session dedicated to the menstrual it is crucial that governments, UN organizations,

health of disabled women and girls brought NGOs and other stakeholders involved in
together national and international experts and menstrual health consult with organizations of
representatives of the disability movement. people with disabilities, health professionals and
It highlighted the particular challenges faced parents, as well as girls themselves, to identify
by women and girls with disabilities during barriers and develop and implement inclusive
menstruation and the need for greater inclusion programs.
of women and girls with disabilities at all stages
of menstrual health programs. Special and inclusive schools should be
integrated into MHH interventions
Summary of key points Girls with disabilities have fewer opportunities

to attend school. To achieve these goals, it is
Girls with disabilities face a double stigma. important to ensure that special and inclusive
schools are integrated into MHH interventions. It
During their menstruation, women and girls with is also essential to involve boys in MHH activities
disabilities face a double stigma. Misconceptions in order to strengthen social support for girls with
and taboos about people with disabilities disabilities. Stakeholders can also improve access
and menstruation prevent young people from to knowledge and skills for girls by developing
meeting all their needs, including access to social educational materials on menstrual health in
support, knowledge and skills, facilities, services different formats (audio, Braille, sign language)
and protective equipment. Girls with disabilities and adapting them for youth with intellectual
are also often overlooked in menstrual health disabilities.
programs. Speakers at the session stressed that

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More and better WASH facilities Moving forward
The lack of adequate WASH facilities (e.g., The discussion on menstrual health for girls
ramps, sinks of appropriate height) is a major and women with disabilities highlighted
barrier to the empowerment and well-being the importance of systematically including
of girls with disabilities. In order to be able disability in programs and policies. Promising
to design facilities and services that are both improvements have been made at the global,
gender-sensitive and appropriate for people regional and national levels, but major gaps
with disabilities, it is essential to include them remain, including:
to make their contribution, including assessing
their accessibility. The same applies to the h A lack of data and statistics on menstrual
development of suitable menstrual material. health and hygiene for young people
with disabilities - there is a need to start
collecting data on these issues.
h A lack of inclusion at all levels, also leading
to limited visibility of the issues.
1.I. Strengthen the integration of menstrual health

into sexual and reproductive health services
h Dr Fatim Tall, Medical Officer, h Dr Ouattara Seydou, Coordinator of the
Reproductive, Maternal and Neonatal Programme National Santé Scolaire et
Health - WHO Universitaire, santé des Adolescents
et Jeunes (PNSSU-SAJ), Ministry of
Health, Côte d'Ivoire
h Prof. Marleen Temmerman, MD, OB/

GYN, MPH, PHD, Aga Khan University,
Nairobi, Kenya
h Prof. Namory Keita, President of the

African Society of Obstetricians and
Gynecologists (SAGO)
h Prof. Joseph Vyankadondera, Advisor

on the Strengthening of Health Systems
and Knowledge Management, UNFPA
Regional Office for West and Central
Africa
h Odette Hekster, Director General, PSI-

Europe
h Emily Hoppes, Senior Technical

Manager, Product Development and
Introduction, Global Health, Population
and Nutrition - FHI 360

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In West and Central Africa, most studies show health centers, school nurse’s offices, community
that girls and women have very little recourse to health). The various stakeholders also
medical care for their menstrual disorders. At the recommended that menstruation be integrated
same time, it appears that health professionals in a holistic manner, in relation to different
do not readily address this issue with patients. circumstances of care:
In view of this situation, all the speakers in this
session were keen to recall the fundamental » As part of the counselling sessions on
role of menstrual health within sexual and reproductive health and more specifically on
reproductive health (SRH) and proposed ways to family planning. In particular, it is important
strengthen its consideration and integration into to explain to users that menstrual changes
health systems (health facilities and community induced by contraceptive methods are not
health). synonymous with pathology or infertility.
As Professor Joseph Vyankadondera (UNFPA)

» As part of prenatal consultations
pointed out, the menstrual cycle (including the » In postpartum care, including information
absence, irregularity or abundance of bleeding) and advice related to bleeding and
tells us a great deal about girls' and women's SRH menstrual cycle variations
and their health in general. It can be considered » In services for people living with HIV
as an indicator of good health, allowing also to
detect certain pathologies in the short and long
» In abortion/post-abortion counselling
term. » Emphasis should also be placed on
supporting self-management (helping
In her speech, Professor Marleen Temmerman girls and women to track their menstrual
recalled that 75% of teenagers suffer from cycle, understand their fertility periods and
menstrual problems. This may include delayed increase the likelihood of conceiving at the
periods, irregular cycles, severe pain or heavy desired time).
bleeding. These disorders are common and should
not be ignored. They may be indicative of an
» Finally, MHH must be integrated into the
framework of community health and more
underlying pathology that can have a significant specifically into information campaigns
impact on the quality of life of the girls. However, and communication actions for social and
only about 10-17% of teenagers seek help, and a behavioral change.
third use alternative medicine.
Odette Hekster (PSI-Europe) also presented Health providers also need to be better trained
MHH as an entry point, an essential prism for and supported to address menstrual health and
observing and understanding the SRH of girls to provide appropriate and tailored contraceptive
and women and their journey from menarche to counseling (including contraceptive-induced
menopause. Some women see menstruation as menstrual changes) to adolescents and women.
a natural part of their lives, that allows them to
ensure that they are not pregnant. Others want a Note: In 2019, PSI Europe developed a "Technical
contraceptive to reduce bleeding. But others fear brief to guide the integration of menstrual health
that contraception will change their bleeding, and sexual and reproductive health".
causing them to lose their fertility. Women have
Professor Namory Keita, President of
different experiences of menstruation and this
the African Society of Obstetricians and
affects their decisions about family planning
Gynecologists (SAGO), said that SAGO could
methods.
play a role in strengthening the integration
of MHH into health systems and ensure that
active members of national societies could be
Recommendations for involved. He recommended that SAGO build
strengthening the integration of on its relationships with universities and health
MHH into health systems schools to develop a pool of instructors, who
could in turn train providers to further integrate
The integration of MHH into sexual and MHH into SRH services.
reproductive health services can take place at
different levels of health systems (hospitals,

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Menstrual changes induced by activities, to policy), FHI 360 has also launched a
Call to Action, which provides recommendations,
contraception. a research agenda, and proposals for action.
Several speakers emphasized the links between
menstrual health and contraceptive use.
Emily Hoppes (FHI 360) spoke specifically
Integration of MHH into SRH
about the menstrual changes brought on by services for adolescents and
contraception. Indeed,these changes can have youth
negative consequences, but also offer certain
opportunities. If women are not aware of the Speakers highlighted the role that sexual and
side effects of contraception methods on reproductive health services for adolescents
menstruation, they may decide to stop using and youth can play in addressing MHH.
them. At the same time, contraceptives can
be prescribed to reduce certain menstrual Dr. Ouattara Seydou (Ministry of Health, Côte
symptoms (pain, heavy bleeding). It is therefore d'Ivoire) shared the example of Côte d'Ivoire and
essential to take menstruation into account emphasized that in the context of adolescent and
when choosing contraception and to explain the youth sexual and reproductive health services
changes in menstrual bleeding, especially to girls (ASRH), all entry points are opportunities to
and women who are concerned about their future be seized to discuss MHH. Similarly, menstrual
fertility. health is an excellent entry point for addressing
SRH issues with adolescents. Odette Hekster
To support health providers, FHI has developed a (PSI-Europe) explained that adolescents need
counselling tool to inform women and girls about information about the changes that accompany
the menstrual changes that can occur with each menarche. Some girls don't want to talk about
type of contraceptive method and to reassure contraception or hygiene, but rather about the
them that these changes are normal: NORMAL changes that come with puberty, both physically,
Counseling Tool for Menstrual Bleeding Changes. emotionally and in relationships. PSI has identified
a need to rephrase the key messages associated
In an effort to integrate this topic at all levels of with menstruation and to address MHH as a
health systems (from consumers, to health care new and positive stage of life.
providers, to education programs, to community

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1.II. Strengthening the integration of menstrual health in
the education sector
h Houraye Mamadou-Anne, FAWE h Xavier Hospital, Regional HIV and Health
Education Advisor, UNESCO Regional
Office for West and Central Africa
h Mary Siby, Gender Specialist, Ministry of

Education, Senegal
h Ellen Gyekye, Ghana Education, School

Health & Education Program Unit
h Barbara Ngeah Achwe, Vision for Action

- Cameroon.
h Marlene Babio, FAWE Coordinator, Benin
Government representatives, UN experts and Summary of key points

civil society specialists gathered for a fruitful
discussion on how to reinforce menstrual health Gaps in WASH services within the education
and hygiene in the education system. The sector remain
discussion highlighted the need for appropriate
The session highlighted the many shortcomings
school environments with toilets and waste
of WASH within schools in countries of the West
disposal systems, strengthening policies to
and Central Africa region. The lack of functional,
improve menstrual health, providing skills-based
sex-segregated toilets and waste management
health education, and providing health services
systems in many schools can have a direct effect
and materials for menstruating girls.
on girls' attendance and performance in education.

17
The role of policy
Promising practice: The Town Crier
It is crucial for governments in West and Central initiative aims to include boys in the fight
Africa to create policies that ensure that no against menstrual taboos in Ghana. Within
student, girl or boy, is deprived of an education. this framework, a campaign specifically
In particular, the fact that menstruation is a taboo aimed at boys was organized to break down
subject in many communities, including among "hurtful" norms and harassment situations.
policy makers themselves, has been identified Before the campaign, boys thought
as a barrier to the development of effective menstruation was abnormal. During the
menstrual health policies in school settings. workshop, discussions raised awareness
and led the participants to support the
Appropriate health education is essential. women and girls around them during their
menstruation. This practice highlights the
It was reiterated that it is also crucial to provide importance and potential of including boys
health education that teaches all young people and men in menstrual health interventions.
health and rights skills and competencies,
especially in order to break the stigma surrounding
menstruation in the school environment. However, Moving forward
working only in schools is not enough; sensitizing
caregivers and communities is essential to dispel While the discussions highlighted the commitment
the myths and taboos surrounding menstruation. of different stakeholders (government actors,
This point is also emphasized in the UNESCO UN agencies and civil society) to improve the
brochure on puberty education and menstrual integration of menstrual health in the education
sector, the key points to remember are:
hygiene management.
Strengthening links with health services

» The need for governments to take greater
responsibility and action on MHH and
Linking easily accessible health services to education, including the provision of
schools, as well as providing menstrual supplies appropriate WASH services and health
(sanitary pads, painkillers, underwear), are education, especially in school settings.
essential to enable girls to participate fully in » The need to provide skills-based education
the classroom and thus provide them with true for both girls and boys to break down
equality of opportunity in their schooling. the stigma and misinformation around
menstrual health and hygiene.

18
1.III. Strengthen the integration of menstrual health into
public policies and national strategies
h Rockaya Aidara, Policy & Gender h Dr. Inga Winkler, Associate Professor,
Specialist, UNCCD Lecturer and Director of the Study of
Human Rights, Columbia University
h Dienaba Wane Ndiaye, Program
Coordinator, UN Women Senegal. h Kitch Bawa, Sanitation Project Manager,
African Minister Council on Water
(AMCOW)
h Mr Neville Okwaro, WASH & GHM

Technical Officer, Ministry of Health,
Kenya
h Ms. Rachida Gado, Head of Division,

Development of Sanitation Services,
Ministry of Water Supply and Sanitation,
Niger
h Mr Yao Konan, Adolescents and Youth

Program Officer - UNFPA Côte d'Ivoire
h Dr. Marie Jésus Buabey, Head of the

Adolescent Health Division, Ministry of
Health and Social Action, Senegal
Summary of key points The presentation of the results of the review of

MHH public policies in Senegal, Kenya, India
In West and Central Africa, public policies still pay and the United States3 explored the processes,
little attention to menstrual health and hygiene, triggers, drivers and opportunities that have
even though this issue occupies a very important led to bringing menstrual health to the level
place in the lives of women and girls. In this of public policy. The main key points discussed
session, speakers shared recent developments were:
in the field, such as Kenya's public policy on
menstrual health and hygiene, and the first global
» In the different countries surveyed, the
dilemma most often encountered is
review of MHH policies conducted by Columbia
whether to address MHH via specific entry
University. Analyzing the path taken between the
points or through a holistic approach. These
adoption and implementation of these policies,
countries, through government actors, have
the speakers shared different experiences and
mostly used menstrual hygiene products,
good practices such as the Spotlight Program
facilities or targeted initiatives as entry
implemented in Niger and the national reference
points. This narrow approach leads to a de
guide on MHH developed in Côte d'Ivoire.
facto limited policy scope, while menstrual
Participants in this session discussed policy gaps,
health is also about economic security,
strategies already implemented, and challenges
education and general health.
and opportunities in the region.
3
Columbia University, Sanitation & Hygiene Fund (SHF), Menstrual Hygiene and Health: A Review of Policies in India, Kenya, Senegal, and the United States through
the Lens of Human Rights (unpublished)

19
» The study highlights that the integration
of MHH into public policies is mainly
achieved through "tangible" entry points,
such as menstrual products and sanitation
facilities, which are easier about which It's time to move beyond
to communicate. However, this approach
risks reinforcing the stigma attached the current entry
to menstruation: the danger is that it
reinforces the message that women's points and address
bodies during menstruation are bodies that
need to be managed or controlled.
menstrual needs in a
» It's time to move beyond the current comprehensive way.
entry points and address menstrual needs
in a comprehensive way. This includes
education on menstrual health and hygiene
and addressing specific needs such as
medical diagnosis and access to dedicated
menstrual health care services. » In 2019 in Côte d'Ivoire, the Ministries of
» The study noted a gradual shift in Education and Health, with the support of
terminology on the part of governments. technical and financial partners (including
The focus is shifting from "menstrual the French Muskoka Fund) have initiated the
hygiene" to "menstrual health," a shift that development of a reference document on
has yet to translate into concrete actions. menstrual health and hygiene. Integrating
The examples of Kenya, Senegal, Côte d'Ivoire gender and the rights-based approach, this
and Niger have highlighted the different national guide is intended for all actors
strategies and ways adopted by countries to in the various sectors involved in Sexual
ensure that MHH is taken into account in public and Reproductive Health and Rights. It is
policies: currently available on the French Muskoka
Fund website.
» In Kenya, a policy specifically dedicated to
MHH was adopted by the Ministry of Health » In Niger, the Ministry of Water Supply
in 2016. It is based on a three-pronged has set up a dedicated intersectoral
approach integrating: (1) actions to break committee, bringing together some fifteen
the silence surrounding menstruation, structures. The main national document
(2) safe and hygienic management of integrating the issue of MHH is the "
menstruation, and (3) issues of safe Support Program for the Water, Hygiene
disposal of menstrual products. A budget and Sanitation sector (ProSEHA) - 2016-
of USD 2.3 million was allocated in the first 2030". It is accompanied by a national
year, with an exponential increase every advocacy strategy and explicitly includes
year. This budget includes the costs of a
MHH through two national indicators: (1)
free sanitary products distribution program
the rate of access to menstrual hygiene
for public primary schools.
equipment for pupils and (2) the rate of
» In Senegal, a policy review allowed for access to hygiene equipment for users of
continued advocacy for MHH with policy
health facilities. In addition to ProSEHA,
makers, local authorities, and professionals
several national documents also integrate
in the health, education, environment
this issue: notably the Roadmap for the End
and youth sectors. The results have also
facilitated the establishment of concrete of Open Defecation (FDAL), the Economic
coordination mechanisms such as the inter- and Social Development Plan (PDES) and
ministerial platform under the leadership the National Hygiene and Sanitation Policy
of the Ministry of Water and Sanitation, (PNHA).
and a multi-sectoral task force dealing
specifically with MHH.

20
A number of success factors emerge from these Moving forward
examples:
» It is essential that countries move beyond
» All countries have prioritized intersectoral narrow entry points and policy frameworks
collaboration through the establishment of of hygiene and access to menstrual
coordination mechanisms at national and products, to a more inclusive and holistic
local levels. definition and vision of MHH.
» Most of them have also embarked on » COVID-19 prompted governments to
processes of domesticating their MHH redirect resources for MHH in response to
policies: in Kenya, three counties have the epidemic. However, some have adapted:
initiated the domestication of the national in Senegal, the government has developed
policy and others have created steering a contingency plan for the availability and
committees at their level. use of RMNH services and has initiated a
» In Senegal, a dialogue has been launched resilience strategy for mobilizing resources
with local authorities to consider MHH in for the provision of menstrual products.
the elaboration of budgets and sanitation » The COVID-19 epidemic has underscored
policies at the local level. the need for current MHH programs to
Regional political bodies, such as The African have perspectives that incorporate socio-
Ministers' Council on Water (AMCOW), have geographic or occupational disparities:
the potential to create continental political women and girls are not a homogeneous
momentum on MHH issues. AMCOW has had a group and not all are accessible through
gender mainstreaming policy and strategy since traditional school, home and health facility
2011 and is in the process of revising this policy programs.
to include MHH.

21
Adolescents and young people at the heart of
the programs. Making my period work: why is
menstruation an issue for us young feminists?
h Ténin Traoré, Communication h Néné Fatou MARICOU, Youth Women
Officer, MESSI, Côte d'Ivoire for Action (YWA), Senegal
h Kadiatou KONATE, Young Girl

Leaders of Guinea Club
h Nafissatou HASSAN ALFARI, Nigerian

Branch of the Jeunes Femmes Leaders
(CNJFL), Niger
h Juliette Nathalie BAKYONO, IPBF,

Burkina Faso
h Mariette MONTCHOU, ROALJEF,

Benin
h Chanceline MEVOWANOU, activist

blogger, Jeunes Filles Actrices de
Développement, Benin
h Jonas KINDAFODJI, RICMAO ASSO,

Benin
h Antoine Fassou LOUA, International

Youth Alliance for Family Planning
(IYAFP), Guinea
This plenary session was entirely dedicated to, and Finally, the discussions focused on the role and
facilitated by, adolescents and youth from different involvement of men and boys in helping women and
countries in the region to better understand the girls cope with menstruation.
perspectives, actions and solutions proposed by
young feminist activists from West Africa to promote This time of exchange showed that young people in the
menstrual health and wellbeing. The session also region have already taken up the issue of menstruation.
highlighted the importance of addressing menstrual They identified their difficulties, analyzed their needs
health as an equality issue and promoting a rights- and proposed/developed appropriate solutions, some
based approach (my body, my right, my choice?). of which were shared during the exchanges.

22
"Menstruation should not
limit girls and women in their
ambitions and dreams".
Mariette Montcho (Benin)
"Whatever the possibilities

or wishes of civil society
organizations, the objective is to
have the support of governments
to facilitate the implementation
of activities (...) The issue of
menstruation must be taken "Embracing menstrual hygiene
into account in the policies and issues is also anticipating for the
strategies of our countries". future and helping us to assume
Nafissatou Hassan Alfari (Niger) our future responsibilities as
men, husbands and fathers.''
Antoine Fassou LOUA,
"Young girls must be able to be the (Guinea)
agents of change."
Nafissatou Hassan Alfari (Niger)
''Menstrual management contributes
to the emancipation of girls: we
''The taboo around menstruation need girls to assert themselves in
is a social injustice.'' their communities, defend their
Juliette Nathalie BAKYONO rights, take on leadership roles and
(Burkina Faso) show off. The myths and taboos
surrounding menstruation are
obstacles to emancipation, to the
"Menstruation should be considered defense of girls' and women's rights
as a social issue that does not only and, in the long term, to achieving
concern women or girls" gender equality."
Nafissatou Hassan Alfari (Niger) Chanceline Mevowanou (Benin)

23
24
SESSION – 02
Financing and partnerships
h Stephanie Kim, Associate Director, h Eneida Licaj, Structured Finance
Advocacy and Communications, PSI Manager, UNICEF
h Odette Hekster, Executive Director, PSI h Margaux Chinal, Project Manager,

French Development Agency
h Ina Jurga, International Menstrual Hygiene (AFD)
Day Coordinator/Behaviour Change
Communication Officer, WASH United h Virginie Arnaud Le Pape, Investment
Officer, French Development
h Milena Bacalja Perianes, Associate Agency (AFD)
Director, Strategy, Menstrual Health
Hub h Joy Anderson, Founder and
President, Criterion Institute
h Elin Bergenlöv, Independent, Expert

Group for Aid Studies (EBA),
Sweden
h Rosette Nanyanzi, Social

Development Specialist, Ministry
of Education, Uganda
h Brittney Dudar, Investment

Manager, Grand Challenges
Canada
h Antara Ganguli, Director, UN Girls'

Education Initiative Secretariat
(UNGEI)
Discussions on financing and partnerships

included contributions from academics, activists,
governments, donors and private sector partners. Funding for MHH remains limited, fragmented
After an initial discussion that presented the and non-holistic.
current landscape of MHH funding, three
sessions were devoted to » A study recently published on investments
in MHH revealed that this issue receives
(1) Public partnerships for menstrual health, very modest funding and does not benefit
from dedicated funds. Donors rarely fund
(2) Innovative financing and
it directly, but rather through programs on
(3) A roundtable discussion between social water, sanitation and hygiene (WASH),
enterprises working on MHH and investors. education, sexual and reproductive health

25
(SRH) or programs to end child marriage, Evidence is essential to attracting investment.
among others. This makes it difficult to
keep track of MHH funding. It should be In order to obtain adequate funding for MHH,
noted, however, that a survey by Swedish donors need data demonstrating the impact of
Aid revealed that about USD 36.5 million initiatives in various sectors. Service providers
has been channeled into MHH since 2012, should also analyze interventions to determine
mainly through the health sector. Most which initiatives will have the most impact.
of the funding for MHH has been for Among the elements that could facilitate the
specific contexts, mainly schools, and for financing of MHH by donors, the use of a simple
menstrual products or infrastructure. At and coherent definition of MHH and the inclusion
this time, holistic funding that integrates of a specific budget line for MHH (which could
different services/sectors to enable thus be easily monitored) were also mentioned.
women and girls to properly manage Beyond increasing investment, another key
their menstruation and break taboos in element of funding is to ensure the effectiveness
all settings is still rare. of existing investments in the MHH sector.
In particular, a gendered approach should be
used when funding programs so that MHH
is addressed as a gender issue and not just a
biological issue. Reducing the MHH to a biological
dimension does not make it possible to address all
the challenges raised by the issue, thus reducing
the effectiveness of interventions. This includes
building the capacity of families, communities
and service providers on the gender approach
and involving girls in the design of interventions.
Donors and funders can also promote a gender-
For funding for MHH, donors need based approach by: a) requesting a specific
data demonstrating the impact of budget line for a gender expert/organization for
any MHH-related program or project, b) adding a
initiatives in various sectors.
budget line for a gender audit of initiatives, and c)
requesting gender balance in the program team.
CURRENT STATE OF INVESTMENT
Who is Institutional Foundations/ National

Multilaterals Private sector
investing Donors philanthropy Governments
Knowledge
Area of Menstrual Social norms Research & Health/SRH
and WASH Policy
investment products & practices Innovation services
information
Progress Slow- Slow-

Medium-good Medium Medium Medium Slow
Gaps medium medium
Area of Humanitarian
Schools Households Workplace Out of school Health centers
intervention Settings
Progress Good Medium Medium Slow-medium Slow-medium Slow

26
At the session, the following key principles were
recommended for investing in MHH:
Promising practice: Uganda provides an
example of how high-level political will, » Cross-sectoral investments that
coupled with the production of reliable (1) include WASH, education, health, and
data on MHH, has helped to mobilize gender, among others; (2) engage all
funding from different government levels of implementation; and (3) foster
departments. partnerships to build capacity, knowledge,
and innovation in MHH.
Indeed, the former president pledged
to ensure the availability of menstrual » "Leave no one behind", by providing
protection materials for women and MHH services to all, including homeless
girls in the country. However, an analysis women and girls, migrant women, women
revealing the impact of MHH in the and girls with disabilities, living in fragile
different sectors was necessary for all or humanitarian contexts, etc.
actors to fully understand the issue in » A rights-based approach, which implies
their respective fields. The results of this that duty bearers assume their obligations
analysis paved the way for a costed multi- and that everyone can claim their rights to
sectoral strategic plan, implemented menstrual health services as part of basic
by a coalition of ministries (including human rights (right to health, dignity,
education, gender, health, water and water, sanitation and gender equality)
environment, and finance). This plan
has mobilized resources from various
» Evidence-based interventions to ensure
data collection, leverage additional
ministries, in addition to development
funding and attract additional investment;
partners, and addressed the issue of
and
MHH beyond the school setting.
» Context-specific programs based on the
needs of the targeted individuals.

27
Implementing these principles requires
coordination between actors in different sectors, Emerging initiative: In Ethiopia, the MHH
and at different levels of service delivery, to Development Impact Bonds (DIB), supported
advocate for additional funding for MHH and to by the French Development Agency
hold governments accountable for its financing. (AFD), aims to change the environment
There is also a need for champions among donor for MHH through a holistic program
groups to bring together different ministries and including advocacy and awareness raising,
strengthen the integration of MHH into their increasing the availability of menstrual
policies. products, and building WASH facilities in
schools. The program is pre-financed by
Tapping into innovative financing is one way
private investors, who will be reimbursed
to broaden the resource base for MHH. The
by the AFD only if results are achieved. This
financing of MHH could, for example, be based
innovative funding mechanism gives service
on a combination of public (governments or
providers the freedom to experiment with
donors) and private funds (e.g., via social impact
certain practices and make adjustments
investors). Governments can facilitate this type of
as necessary; it increases accountability
financing by lowering barriers to the participation
through a rigorous monitoring framework
of domestic banks, social entrepreneurs and the
and improves service provider performance.
diaspora in MHH financing, which could generate
more sustainable financing flows.
The private sector also has an important role

Innovative financing mobilizes additional to play, both as an investor and as a service
resources through new structures or provider for MHH. Social enterprises working
instruments to generate greater resource on MHH and investors stressed the importance
flows, use resources more efficiently of selecting the right financial partners and
and increase transparency in the use of developing win-win partnerships. Most social
resources. enterprises need flexible and patient capital
until they can generate profits and thus attract

28
larger investments. It is important to know which » generate data on the impacts and
partner is appropriate for which stage of growth programming of interventions to attract
of the business, as the source of funding varies additional investment
at different stages of growth. Companies are
advised to take their time in choosing a partner
» strengthen the efficiency and quality of
investments
and avoid rushing into potentially unsuitable
partnerships. Experienced investors can guide » exploiting innovative financing mechanisms
social enterprises in choosing the right partner. » harnessing the potential of the private
sector for MHH (social enterprises and
A key element of the funding relationship between investors).
social enterprises and investors is the value of
the coaching, mentoring and advice provided by
investors to social enterprises, which can extend Stakeholders in West and Central Africa are
over several years. As one of the panelists said, encouraged to keep these key principles in mind
the relationship between the investor and the when investing in MHH as they strive to attract
social enterprise is "like a marriage" and must be more funds and financing.
carefully chosen. This was the case for AfriPads
and its investor The Case for Her, as well as for
KmerPads and its investor FADEV. These flexible,
long-term partnerships have enabled these social
enterprises to grow and access larger sources of
funding.
Other lessons learned by social enterprises

working on MHH include: (i) to really operate as
businesses, i.e., according to market principles
(the objective being to generate profits); (ii) to
invest in understanding their market and their
business (by carrying out market research) in
order to grow; and (iii) not to hesitate to ask
for help (by being as specific as possible in their
request) in order to keep learning as they grow.
Moving forward
The discussion on funding and partnerships for
MHH offers promising avenues for increasing
resources for this underfunded topic. These
include:
Promising practice: in the Pacific Islands, the Trade Finance Vehicle (TFV) aims to change the
power dynamics in the financing ecosystem to help small MHH businesses participate more
effectively in the market. The TFV has helped companies to access cheaper and more consistent
materials, without putting them in debt or at risk, so that they can reduce their production costs.
The key to this work is to change the power dynamics in financing relationships to allow firms
to control how they participate in the market. This also highlights the value of focusing on the
overall financing of enterprises, rather than on supporting specific enterprises. It is a question
of considering the MHH as a real industry with significant economic activity which requires
identifying the activities on which it is necessary to invest, i.e., the activities whose financing
would enable it to: a) grow or, b) stabilize (make it more predictable)? For example, thanks to
FVT, one company working on MHH hired more staff, another became a hub for other small
producing companies working on MHH.

29
30
SESSION – 03
Programmatic approaches and
interventions
3.I. Building knowledge and skills related to MHH
h Sandisile Tshuma, Regional Project Officer, h Marni Sommer, Associate Professor
Education for Health and Wellbeing in - Sociomedical Sciences, Columbia
West and Central Africa at UNESCO University
h Arushi Singh, Program Specialist,

UNESCO
h Ramatou Toure, Senior Child

Protection Specialist, UNICEF
Regional Office for West and
Central Africa
h Xavier Hospital, Regional HIV

and Health Education Advisor,
UNESCO Regional Office for West
and Central Africa
One of the key factors for good menstrual health menstruation, the average length of a cycle and
and hygiene is access to information for women the fertile period is often incomplete. In general,
and girls. Girls must have access to scientifically the information that girls receive only covers the
accurate, age- and developmentally appropriate basics of menstrual management. Mothers are
information, which can be provided through often cited as their primary source of information
formal and non-formal education programs. about menstruation, yet their knowledge is
often based on social and religious beliefs that
However, in West and Central African countries, perpetuate discrimination against women and
girls do not have access to the knowledge girls. Teachers and the education system offer
and skills, as well as the safe and trusting potential avenues for comprehensive menstrual
environments that they have clearly identified learning. However, menstrual education is rarely
as essential for the appropriate management of included in the region's school curricula and even
their rules. Lack of access to accurate knowledge more rarely discussed in the classroom. In the few
about MHH before and after the first menstrual cases where it is integrated into formal education
experiences is a major barrier for girls in the systems, the content is often introduced after
region, who have little or no knowledge about girls have begun menstruating. Most teachers,
the issue before their first menstruation. the majority of whom are men, do not feel
Although most girls know the approximate date supported or responsible in discussing this issue
of their period, their knowledge of the biology of with their students.

31
This section of the symposium was devoted to requires the development of a complementary
the latest evidence of successful practices in approach to provide equitable access to services
MHH knowledge and skill development. The and knowledge about MHH. Finally, the issue of
discussions built on existing adolescent-focused menstruation is still not sufficiently addressed
programs and identified key strategies for in health facilities/community health workers
ensuring access to knowledge and skills for all (advice, prevention, care).
girls (including those not in school).
What lessons can be learned from

What do girls need? related ongoing programs?
Girls need two types of information:
Lessons Learned in Health and Wellbeing
1. Practical information: how to use the Education Programs
products; how to wash, dry and store
Menstrual health education is one of the areas
reusable products; how to dispose of waste
addressed in health and wellness education,
properly; how to manage menstrual pain and
specifically through programs that countries
intimate hygiene during menstruation.
call 'Family Life Education', 'Reproductive Health
2. Biological information: basic definition of Education' or 'Integrated Sexuality Education'. In
menstruation and the menstrual cycle, how the region, UNESCO speaks of "Comprehensive
the reproductive system works, emotional Education and Information (CEI)", while
and physical changes that occur during recognizing the social and cultural specificities of
puberty. each country.
Studies suggest that key elements of quality In 2008 and again in 2016, UNESCO and several
puberty education include: partners commissioned major reviews of the
scientific literature on sexuality education. The
» Information from a trusted source: the results of this work have helped to identify
information should come from a reliable effective menstrual health programs and how to
and informed source (e.g., a trained support the development of positive attitudes
teacher, books, health worker, etc.). It is and behaviors. They have also shown that
often assumed that parents or guardians Comprehensive Information and Education (CIE)
will provide information, but they may be programs in schools contribute to a decrease
afraid to talk about it, feel that it is not their in the age of sexual debut, a reduction in risky
role, and/or lack adequate knowledge. behaviors, and an increase in condom and
Even teachers may feel uncomfortable and contraceptive use. These programs also promote
need support in addressing puberty and greater self-esteem and attitudes conducive to
menstruation. gender equality.
» Education should be provided before the
To arrive at these results, the review of the
onset of puberty and menstruation.
scientific literature highlights several elements
» A safe and supportive learning of programs that are most likely to have positive
environment: trust and confidentiality effects on menstrual health. These effective
are crucial but can be very difficult to programs:
achieve due to stigma and embarrassment
in discussing MHH (including among » are broad in scope, covering a wide range
teachers). of topics: it is important to address not
only menstruation, but also pregnancy,
In addition, most programs in the region dealing
STIs, gender norms, life skills and school
with MHH knowledge and skills building have
violence.
focused on producing educational materials
for girls, boys, teachers and (sometimes) » are effective, even when adapted to a
parents. The majority of these interventions different context - this is important for
are implemented in schools. However, the large countries that can, while contextualizing
number of out-of-school children in the region interventions and approaches, move faster
and save money to implement effective
programs.

32
» are carried out faithfully, i.e., they address Relevant lessons learned from the
all the content originally planned. For implementation of the Global Program to End
example, one of the success factors is Child Marriage
the training of educators to be prepared
to address all topics (including taboo The Global Program to End Child Marriage
subjects), and to master the techniques has been implemented by the United Nations
of active learner-centered pedagogy. In Population Fund (UNFPA) and the United Nations
adapting programs to a new country or Children's Fund (UNICEF) since 2016. It supports
context, therefore, it is important to resist at-risk girls in making choices, empowers them
the temptation to delete key content and to direct their own futures, strengthens the
messages. various services that enable them to do so, and
helps families to demonstrate positive attitudes.
» take into account the context of the It also addresses the conditions that support
learners, including their school, community, child marriage, advocating for laws and policies
family or health services they may use - that protect girls' rights while emphasizing the
this context should be addressed during importance of using sound data to inform these
the sessions and discussed. policies. Of the 12 countries targeted by the
» include discussions on rights: the right program, four are in West and Central Africa:
to health, education, the right to protect Burkina Faso, Ghana, Niger and Sierra Leone.
oneself from HIV or unwanted pregnancy,
harassment and discrimination. This Adolescent girls are placed at the heart of this
approach also helps to develop the self- program as agents of change and rights holders.
confidence and communication skills of Based on the principle of "leaving no one behind,"
young people. the program targets the most vulnerable girls.
These include girls living in rural areas or in
» integrate the notion of gender. This disadvantaged urban communities, pregnant
is particularly relevant to the issue of adolescents, girls who are out of school, have
menstrual health, as we know that limited access to services and are therefore not
gender norms lead to harassment and heard.
discrimination of menstruating girls.
» involve the young people themselves, Key activities of the program include life skills-
which is important because the programs based education and comprehensive sexuality
are about their lives, their experiences and education. These activities are carried out in
their families. and out of school. Although MHH was not an
explicit target of the initial activities, it did appear
» include the following elements: in the results of the program, which supports
community links, protective equipment, adolescents by providing them with information
health services by trained professionals, on health services with a focus on sexual and
parents and families. It is also necessary to reproductive health, including MHH.
rely on verified information.
We now know enough to develop effective In the life of a girl living in West and Central
programs leading to better menstrual health and Africa, child marriage and menarche very often
wellness. coincide. However, a number of obstacles
limit programmatic collaboration between
One of the elements also highlighted by the professionals working on child marriage and
panelists is that the issue of menstrual health those working on MHH. One of the main
is not addressed early enough, as girls are obstacles is the double taboo surrounding these
menstruating at younger and younger ages. issues, which makes it very difficult to discuss
The information must then be adapted to the with communities. Furthermore, professionals
child's age and cognitive development. Similarly, often work in silos and with the same partners,
it would be advisable not to limit the session to which limits intersectoral collaboration. Yet the
one year, but to ensure that the information is evidence shows that programming related to child
repeated several times. marriage would benefit from including menstrual

33
health. At the same time, the community-
centered vision and endogenous processes that Promoting Adolescent Safe Spaces (PASS)
underpin programs against child marriage could in Ghana:
also be put to use in the service of MHH.
The Promoting Adolescent Safe Spaces (PASS)
The session highlighted the following messages, project is implemented by NORSAAC
which can inspire future action: (Northern Sector Action on Awareness
Centre) in the Northern, North Eastern and
» Where possible, new menstrual health
Savannah regions of Ghana. Developed as
education interventions should build
part of the Global Program to Accelerate
on existing programs that have proven
Action against Child Marriage, this project
effective, even if they are implemented in
has enabled many vulnerable adolescent
different contexts. While this may seem
girls to build support networks, strengthen
counter-intuitive, this approach has a
their skills and knowledge about their
potential impact on cost reduction.
rights, and learn how to access the services
» Although they are a trusted and reliable they need, including child protection,
source of information, teachers are not reproductive health and puberty education.
always comfortable and willing to discuss Access to these spaces became more
certain taboo subjects. This may be related difficult during the COVID-19 pandemic.
to the fact that they are predominantly male, In order to avoid losing the gains of the
but similar dynamics have been observed initiative, the transition to virtual spaces
with female teachers. Teachers are also and radio was made, thus mitigating the
under great pressure from the curriculum interruption in service delivery.
they must cover throughout the school
year. A quick solution is to create learning
materials on puberty, which children can
also go through on their own or with an
open-minded and willing educator.
» Programs must meet children where they
are, i.e., where they are socialized. Programs
should also be integrated into the wider
community, extend beyond the school and
systematically target all members of the
community, including teachers, parents,
grandparents and service providers.
» The integration of the MHH into regional
flagship initiatives must be more systematic
and proactive. This is particularly the case
with the Global Program against Child
Marriage, which addresses MHH and
provides a platform and mechanisms that
can be used to promote menstrual health.
» Ultimately, menstrual justice is about
power relationships and the commitment
to transforming those relationships so that
girls and women are not disadvantaged in
seeking to meet their needs.

34
3.II. Supporting changes in behavior and social
norms related to menstruation
h Prof. Abdou Salam FALL, Director h Sarah Memmi, DSSR Project Officer, NGO
of Research in Sociology, Université RAES, Senegal
Cheikh Anta Diop (UCAD) of Dakar and h Sandrine Bacquaert, President of the
Coordinator of the Research Laboratory NGO Casamasanté, Senegal
on Economic and Social Transformations
(LARTES) h Yaikah Joof, Country Director, Childfunds,
Senegal/Guinea
h Chanceline Mevowanou, feminist
activist/influencer, Benin
h Mahaman Bachir Elh Oumarou,
theologian and Islamologist, President of
the Alliance des Religieux de l'Afrique de
l'Ouest pour la promotion de la Santé et
le Développement (ARAO/SD), Niger
h Ndeye Mingue Ndiate NDIAYE Gacko,
Gender Unit Coordinator, Directorate
of Planning, Research and Statistics
(DPRS)/ Ministry of Health and Social
Action, Senegal
We know that the social perceptions and norms Central Africa illustrate, even more strongly than
associated with menstruation carry considerable in the other regions of the world, the persistence
weight, leading to the stigmatization of girls of taboos, the weakness of the knowledge of the
and women and creating behaviors that are girls, the women and their entourage as regards
detrimental to their health and quality of life. The menstrual health, as well as the influence of
testimonies and studies carried out in West and myths and false ideas.

35
However, as Professor Abdou Salam FALL pointed Involve all stakeholders to enhance the impact
out in his introduction to this session, social of SCCC actions
perceptions and norms are evolving, and it is
possible to bring societies to rethink them. There » The strategy and tools of the C'est la Vie!
is room for the co-construction of new norms, project have been specifically designed to
and the challenge lies in how to grasp the levers work with teenagers (girls and boys), but
of social transformation. It is in this perspective also with their parents, thus reinforcing
that the symposium presented and discussed the impact of the actions carried out on
the different approaches and tools used in West behavior and social norms.
and Central Africa to promote and support the » Similarly, the importance of involving boys
adoption of safer behaviors in the field of MHH. and men in MHH-related activities was
widely emphasized during the discussions.
The power of education through entertainment In the framework of its project "Bien
(or Edutainment) and the use of TV series vivre mes règles" (Living Well with My
The use of mass media and television series to Period) (Casamance-Senegal), the NGO
support behavioral change has already been proven Casamasanté implements educational
in various contexts. During this session, Sarah activities specifically for boys. Although it
Memmi (NGO RAES) presented an innovative is still too early to measure the impact, the
edutainment approach and tools on menstrual president of the NGO, Sandrine Bacquaert,
health and hygiene, based on the series C'est la Vie! emphasized that boys have been very
which is broadcast in 11 countries in the region4. supportive of the program. Teachers
have observed less embarrassment and
Playful and adapted to the context, C'est la Vie! teasing when puberty/sexuality topics
harnesses the power of the show's storylines and are discussed, as well as a liberation of
characters. The use of video allows us to capture speech among adolescents regarding
attention and mobilize emotions, which play a menstruation. But the most interesting
major role in the adoption of our behaviors. This impact, which will have to be confirmed,
strategy of communication for social and behavioral concerns early pregnancies. In two
change (CCSC) makes it possible to stage and then institutions where activities were carried
make communities react to situations they have out, no pregnancies were recorded after
experienced (access to care, fear, shame, ignorance, one year5, whereas the average was
stigmatization, taboos, etc.). Community activities previously 8 pregnancies per month
encourage young people and their parents to per institution. Although it is difficult to
mobilize their knowledge, question their perceptions attribute this result solely to the activities
and practices, and make decisions related to their of Casamasanté, it should be noted that it
menstrual health, thus strengthening their sense of is the only organization to have intervened
autonomy. in these establishments during this period.
The C'est la vie! educational kit was produced » Mingue Ndiate NDIAYE Gacko (Ministry
with the support of the French Muskoka Fund of Health, Gender Unit, Senegal) also
and four United Nations agencies (UNFPA, emphasized that the involvement of men
UNICEF, WHO and UN Women). In addition to in MHH projects helps to lift taboos
the TV series, it offers a radio adaptation, a digital on this subject, to deconstruct certain
ecosystem and community activities that allow beliefs and also to empower women. This
for the implementation of 360° SCCC campaigns. approach promotes positive masculinity
Adapted to the regional context and already tested and gender equality.
in the field, CLV tools are also developed in local » Finally, in his intervention, Sheikh
languages (Bambara, Wolof, Haoussa, Peulh, Mahaman Bachir Elh Oumarou (President
Malinke), which is fundamental to improve the of the Alliance des Religieux de l'Afrique
appropriation and impact of messages. de l'Ouest pour la promotion de la Santé
et le Développement/ARAO) insisted on
All these tools are available free of charge on the the involvement of opinion leaders (heads
digital library C’est la Vie !
4
Burkina Faso, Guinea, Côte d'Ivoire, Niger, Nigeria, Democratic Republic of Congo, Togo, Benin, Mali, Chad and Senegal
5
The program started in February 2020

36
of neighborhoods, heads of families or Chanceline Mevowanou (young Beninese
grandparents) and the role that religious activist) spoke about the role of influencers, who
leaders can play in changing social norms are now recognized as opinion leaders among
regarding menstruation (particularly young people. Having actively participated in
through preaching and sermons, or within and relayed the #Soyonsréglos digital campaign
the framework of Koranic schools). Indeed, , she emphasized the impact of this campaign on
within the framework of national and sub- the attitudes and habits of her digital community.
regional networks of religious associations Indeed, many people spontaneously spoke out to
(intra- and inter-faith networks), the share their reality and deconstruct certain myths;
development of religious arguments has young boys agreed to take part in the challenges
favored the evolution of positions. After and went to buy protective equipment; others
an initial stage of refusal, a consensus has agreed to take part in sanitary napkin making
been reached that now makes it easier to workshops.
talk about subjects such as menstruation
and to fight against the taboos and stigma
associated with it.
"In terms of impact, we
(influencers) manage to
engage people in action to
"We must allow young girls motivate behavior change"
to have access to knowledge Chanceline Mevowanou
about their bodies, because
today it is no longer possible to
talk about abstinence without
This session highlighted the following
talking to young people about messages:
their bodies”.
h Social norms are not fixed. It
Cheikh Bachir Elh Oumarou, is possible to get societies to
theologian and Islamologist, deconstruct them in order to co-
construct new norms for the
President of ARAO/SD, Niger realization of women's and girls'
rights
h In order to change behaviors and
social norms in a sustainable way,
Using social networks and influencers it is essential to combine different
approaches and tools, but also to
Based on the example of the digital communication
target and involve different groups
campaign #Soyonsréglos, the session
simultaneously (youth, parents,
highlighted how social networks can be used to
girls/boys, men, religious/traditional
fight against taboos and discrimination related
leaders, teachers, influencers, etc.)
to menstruation and encourage the adoption
of behaviors favorable to menstrual health: h In West and Central Africa, a number
disseminating reliable and verified information, of communication tools for social
relying on influencers who, while sharing their and behavioral change on menstrual
experiences, play the role of "models" to young health already exist. Adapted to the
people; soliciting emotions via the broadcasting context and to specific targets, some
of web-series or even organizing challenges exist in local languages and have
to encourage young people to take action already been tested.
(Link to video+++).

37
3.III. Improving access to menstrual health and hygiene
facilities and services
h Dr. Virginia Kamowa, Global Menstrual h Priya Nath, Rights, Inclusion and Equality
Collective, Co-founder and Coordinator Advisor, WaterAid
h Emile Niessougou, WASH Specialist,

WaterAid, Burkina Faso
h Tsedey Tamir, WASH Project Officer,

UNICEF West and Central Africa Regional
Office
Based on the most recent data, this session menstruate face difficulties in accessing water
discussed the current state of facilities and and appropriate spaces/infrastructures for safe
services for MHH in West and Central Africa, and and private changing. These challenges affect
presented the latest global guidelines on facilities all environments, including homes, markets
for people with disabilities, including a case study and schools. In the majority of studies, existing
from Burkina Faso. WASH services in homes and public spaces are
described as inadequate, lacking privacy, security
and cleanliness. Facilities are sometimes located
Highlights far from home, forcing girls to travel considerable
distances, sometimes exposing them to violence.
z The realities of the region:
In addition, these facilities are often dirty and
Less than 50% of the population has access to dilapidated, which discourages girls from using
basic water, sanitation and hygiene services. them, especially when they are not segregated
Because of this situation, girls and women who by sex.

38
Facilities in schools are equally poorly equipped, with UNICEF and WSUP6, has developed a
with limited access to water, soap and lockable guide for urban planners and policy makers
doors for privacy. Sometimes school toilets on "Public and community toilets for women
are locked and require permission, which can and girls". This guide is intended for managers
discourage girls from using school facilities. In and officials responsible for funding, planning,
addition, even where schools have access to designing, regulating, monitoring or managing
water, handwashing facilities are not always these facilities. It provides a better understanding
available, and rarely have soap, although this is of the needs of women and girls for public and
a key component of good menstrual health and community toilets. It provides guidance on how to
hygiene practices. take these needs into account in urban planning
and implementation at the local level.
Most of the formative study results show that
current facility to student ratios prevent girls The guide presents six general requirements for
from having access to clean and functional which it provides essential and desirable context-
toilets to manage their menstrual periods in a specific features. These general requirements are
timely manner. Although countries set their own fundamental for all users. However, by focusing
minimum standards for facility to student ratios, on the specific needs of women and girls, the
the current ratios are inadequate to meet the guide maximizes the benefits for them and
needs of menstruating girls. minimizes the disadvantages, while addressing
the needs of the male audience and a wide range
The studies noted the even greater lack of MHH of other users, such as the elderly and disabled.
facilities and services in non-school settings such To meet the needs of women and girls, public and
as health facilities, workplaces, public spaces community toilets should:
(e.g., markets) or prisons.
» Be safe and private (ensure complete
z The need for women-friendly community security and privacy)
and public toilets
» Enable menstrual hygiene management
Lack of access to sanitation disproportionately and other hygiene measures (access to
affects women and girls due to several factors: water, soap, menstrual products, a trash
can, a shelf to put her things on)
» Biology and physiology of women and
» Be accessible to all users (including people
girls: women and girls cannot urinate
as easily as men (they need more space, with disabilities)
privacy and time) and this becomes » Be affordable and available when needed
even more difficult during menstruation. » Be well maintained and well managed
Women are also more affected by urinary
incontinence. » Meet the demands of caregivers and
parents
» Socio-cultural roles, responsibilities and
restrictions: social expectations and taboos Authorities should provide a city-wide network
influence girls' and women's behaviors, of public and community toilets suitable for
such as not being able to urinate in a women and girls. It is then recommended that a
yard or on a secluded path (as men can). participatory evaluation be conducted throughout
Women and girls are also at greater risk of the urban area to analyze: 1) public spaces
sexual violence and harassment. They are and informal settlements lacking public and
also the main providers of care for children, community toilets; and 2) the capacity of existing
the sick, the disabled and the elderly, key infrastructure to meet the needs of women and
populations that have specific needs in girls. Planners can then use the results to develop
terms of infrastructure (accessibility, etc.). strategies for city-wide coverage, including the
provision of new sex-sensitive toilets and the
There is therefore a need for public and community upgrading and renovation of non-compliant
toilets that are more suitable for women and toilets.
girls. In this context, WaterAid, in collaboration
6
Water & Sanitation for the Urban Poor

39
City-level assessments in Nepal and Tanzania have yielded the following lessons:
» All the evaluations identified problems with cleanliness, with varying causes.
» All the assessments made recommendations to strengthen the government's role in setting
higher standards for girl- and woman-friendly toilets.
» Water supply problems are a major issue
» Accessibility must also include wheelchair users.
» There are no facilities for changing or breastfeeding babies.
WaterAid Burkina Faso case study:
In 2013 and 2014, WaterAid, in collaboration with UNICEF and the Direction de la Promotion
de l'Education Inclusive des Filles et du Genre (DPEIEFG), conducted surveys in schools in the
Eastern and Northern regions of Burkina Faso on MHH-specific issues. In 2016/2017, WaterAid
received funding to improve menstrual hygiene management in 50 pilot facilities. During the
implementation of this project, a baseline study was conducted in the intervention institutions
and communities to assess the existing situation and to understand the knowledge and practices
of the communities. In this context, focus groups were organized with the girls to determine the
type of toilet best suited to their needs.
The results of this study led to the establishment of a unit to support the design of facilities
and equipment to promote menstrual health and hygiene in schools. WaterAid then designed
and tested a dedicated MHH cabin (attached to the girls' latrine block) in the Sahel, Houet and
Cascades regions.
The feedback from the beneficiaries on this cabin is very positive (clean, pleasant to use, avoids
stigmatization, takes into account dignity and intimacy, reduces school absenteeism during
menstruation). WaterAid is now pursuing the scaling up of this prototype and is engaged in
advocacy: (i) with the General Directorate of Sanitation (Ministry of Water and Sanitation) for
the integration of the cabin in the technological package of institutional works; and (ii) with the
DPEIEFG for the integration of MHH in school curricula.
7.95
1.30 1.30 1.30 1.30 1.30 1.30
1.20 Fosse
0.5 1 2 3 4 5 6
0.5
2.80
0.65
Pente
0.65
0.5 Pente
Cobine pour
1.00 0.70 0.60 0.70 0.60 0.70 0.60 0.70 PV handicap)
Mur de protection (d’in timité)

Bloc de 05 postes
1) 1 cabine adaptée pour GHM 2) 3 cabines classiques 3) 1 cabine pour PV. Handicap
Plan of the MHH latrines and cabins designed by WaterAid Burkina Faso

40
Moving forward Countries are encouraged to conduct city-wide
participatory assessments to analyze (i) public
MHH represents a starting point for a broader spaces and informal settlements lacking public
discussion on the varying and evolving needs of and community toilets; and (ii) the extent to
women and girls for adequate WASH facilities. which existing toilets meet the specific needs of
girls and women. These analyses can then be
With the support of their partners, governments used to develop strategies to achieve broader
need to establish and ensure compliance with coverage. Finally, we need to broaden the scope
minimum standards for MHH-friendly WASH of what we mean by "disability-friendly facilities"
facilities and services, suitable for people with in operations, which is not limited to wheelchair
disabilities in all settings, while increasing accommodation.
budgets for the operation and maintenance of
facilities to support their sustainability. Where
national guidelines do not exist, international
guidelines can be used as a reference.

41
3.IV. Improve access to appropriate, quality sanitary
products and protection
h Dr. Virginia Kamowa, Co-founder and Roundtable on lessons learned to improve access
Coordinator of the Global Menstrual to protective equipment:
Collective
h Masséni Diomande, Medical Coordinator,
Médecins du Monde (MDM), Côte d'Ivoire
h Marina Gning, CEO, ApiAfrique
h Elisabeth Zambelis, Fondatrice, Just-a-Cup
Roundtable discussion for feedback from
adolescents and young people:
h Sandrine Naguertiga, Digital

Communication Specialist, UNICEF, Chad
h Maimouna Thioune, member of the
association Parole aux jeunes, Senegal
h Octavie Bacourine, member of the
association Parole aux jeunes, Senegal
h Pamela Badje, Junior data analyst, U-report,
UNICEF, Chad
h Epiphanie Dionrang, Initiative #YALIROSE,
co-initiator of the "Street Slam" concept
and of the "Verses and Proses" workshops,
project manager of INKHAZ, Chad
h Maïmouna Abdelhamid, General
practitioner, co-founder of the start-up
Kadja Health, Chad

42
The keynote address presented in this session context, and disposal. The guide developed
shared some key points about access to menstrual by UNICEF on this issue provides more
protective materials: details and practical advice on how to
collect this information.
» It is important to differentiate between
menstrual protection materials and » There are several models for the provision of
menstrual hygiene products, as both materials, ranging from direct distribution to
are necessary and must be accessible. models based on strengthening and regulating
Menstrual materials are used to absorb markets for menstrual materials. The table
menstrual flow (cloths, reusable and below outlines some activities that can be
disposable pads, menstrual cups, tampons, implemented to improve access to menstrual
menstrual underwear), while hygiene materials:
products refer to support items for MHH in » The main obstacles to access to menstrual
general (soap, underwear, trash cans, etc.) materials identified in the framework of the
» The most common types of material used formative research carried out in West and
Central Africa, and which must be addressed
in the region are reusable cloths (loincloths,
clothes), tissues, or absorbent cotton that by the various actors, are the following:
are washed and reused. Girls and women Lack of information on available options,
also express a preference for disposable
The unavailability of protective
materials (more comfortable, safer and
materials,
maintenance-free), but these are often too
expensive and difficult to access, especially The cost of materials and supplies,
in rural areas.
Cultural and social acceptability of
» No one type of menstrual material is popular certain materials (e.g., tampons and
with all girls or women in all circumstances; menstrual cups) and waste disposal
all protective materials have aspects that practices,
girls and women may like and dislike for
different reasons. Lack of access to free hygiene products
(soap, private washing and drying
» When choosing the protective materials facilities, water, etc.)
to be distributed, various elements must
be taken into account: culture and context Limited information and options for
(including beliefs and practices), health waste management and environmental
risks, economic and financial aspects, sustainability considerations.
use and maintenance of products in the
Examples of activities to improve access to sanitary protection
Understanding h Usage and preference assessment

preferences and h Evaluation of product availability
availability
h Evaluation of products and interventions
h Development of national standards for menstrual products

Improving
h Supporting businesses to meet people’s needs and preferences
supply
h Making products more affordable, for example by removing taxes
Direct provision/ h Provide protective materials (especially in the

distribution of health care facilities and in humanitarian settings)
services to school h Supporting waste management and disposal

43
» The session was then devoted to two round Free product distribution is a good
tables: way to raise awareness of new types
The first roundtable shared key lessons learned from of products, but it can also inhibit
the social enterprises ApiAfrique and Just a Cup, as willingness to pay for them; free
well as the MDM program in Côte d'Ivoire, which distributions should be combined with
promote and distribute different types of protective making products available in markets.
equipment. Among the key elements of the exchanges, In the second panel, adolescent girls and young
we can mention the following: women from Chad and Senegal shared their
In Côte d'Ivoire, Médecins du Monde experiences with the different types of sanitary
proposed to young girls to use menstrual materials, the difficulties they faced in accessing
cups (more economical in the long term these products, and the strategies they used to
and requiring less water and maintenance) address this issue with their parents and other
and observed a good acceptance rate adults. According to the young panelists, the
(only 3 girls out of 50 refused to use the main obstacles to accessing protection are (1)
cup). However, the program has been a lack of financial means and (2) the shame of
confronted with the reluctance of girls to talking about this subject with those around
use an internal protection that could alter them, whether their parents (to ask them to buy
their hymen. After discussion with the protection) or salespeople in shops. The girls also
youth, it was decided that only girls who reported the anxiety, stress and shame they feel
were already sexually active would be when menstruating, as the subject is still largely
included in the program. taboo. They also raised concerns about virginity
when using internal products such as tampons or
In Senegal, the company ApiAfrique menstrual cups. Finally, they pointed out the lack of
manufactures and promotes reusable water and soap, especially in non-urban areas.
materials that are locally manufactured,
environmentally friendly (no waste) and Moving forward
safe for health (organic cotton). According
to users' feedback, these products have » Menstrual materials should be culturally
helped to reduce certain irritations, accepted, safe, affordable, available,
improve comfort and make them more environmentally friendly (if possible) and
independent over time. easy to wash, dry and dispose of.
In Zimbabwe, the company Just a Cup » Efforts to improve access to protective
has tested the distribution of menstrual supplies and equipment should be integrated
panties because this product addresses with other interventions targeting knowledge
two major problems: the difficulties of and skills, MHH facilities and services, and
drying washable pads and access to improved social support.
underwear. The test distribution was » It is essential to consult with girls, women and
a success and generated significant all menstruating individuals to understand
demand. Two challenges remain: the the different types of menstrual materials
need to have access to water to clean the available to them, which ones they use most
panties properly and stock management often and which ones they prefer in a specific
as this product implies offering different context, and the common practices around
sizes. their use.
But the major challenge of access to » Girls and women have different needs and
protective materials is to offer affordable preferences, which may change depending
quality products. If social enterprises on their environment (school, home, work,
want to offer good working conditions public places): the aim is not to promote
to their employees and use quality raw a single solution, but to provide a range of
materials, they cannot go below a certain options to enable girls and women to make
cost and many users cannot afford them. informed choices.
To address this problem, ApiAfrique » As stakeholders we need to think about
needs to find third party payers, to enter sustainable service delivery models for
into partnerships with donors, who will menstrual products that go beyond direct
pay for part of the product. They are also distribution and are more market driven.
sometimes women living in Dakar who
buy sanitary pads for their families living
in rural areas.

44
Special Session: Quality Standards for Menstrual Products
h Haley Millet, Advocacy Manager, Days h Sophia Grinvalds, Co-founder and Director,
for Girls AFRIpads
h Neville Okwaro, MHH Expert, African
Coalition for MHM- Kenya
h Honourable Soipan Tuya, Women's
Representative, Narok County, Kenya
h Naana Abena Afadi, Program and Advocacy
Officer, Days for Girls, Ghana
h Mr Mahesh Nagessar, South African Bureau
of Standards
Eastern and Southern African countries such Standards provide a common definition of
as Kenya, Uganda, Tanzania, Ethiopia and South quality: some products with more rigorous
Africa have led the way in developing standards quality control have a competitive advantage
for disposable and reusable menstrual health in the marketplace. Standards also increase
products. Countries in West and Central Africa the number of certified products that move
are now also moving in this direction, with Ghana across regional and international borders,
leading the advocacy efforts in the region. reducing the cost to consumers. The creation
of a regulatory framework finally allows for
The objectives of this session were to support the the protection of consumers.
actors and actresses of the region to:
Standards improve consumer access to
» Better understand the landscape of products by creating pathways to market for
menstrual product standards in Africa. new product categories, such as reusable
» Communicate the role that standards can products (e.g., menstrual cups or pants),
play in ensuring access to quality menstrual for which manufacturers may not have
products and providing informed choice for the resources to invest in marketing and
menstruating individuals. education. Standards then help to build
» Share lessons learned from experiences in consumer confidence. The definition of
Eastern and Southern Africa, with a view standards for all product categories also
to supporting standards development makes it possible to include all of them in
processes in West and Central Africa. policy discussions.
» Encourage and guide advocacy efforts Standards reduce costs in the long run
in West and Central African countries to because governments, donors, and NGOs
support the development of standards for that distribute free or subsidized menstrual
menstrual products. products can use national and international
standards instead of having to develop
Why are standards needed? quality standards in isolation and on an ad
hoc basis.
Standards build consumer confidence
In the Eastern and Southern African region, the
and empowerment: consumers have
following countries have quality standards for
access to quality products through an
reusable and/or disposable products: South Africa,
open and regulated market. They can make
Kenya, Malawi, Uganda, Tanzania, Zimbabwe and
informed decisions about which product or
recently Zambia. It should be noted that South Africa
combination of products to use. They are
has recently committed to developing standards for
in a better position to assess the quality of
menstrual cups. In West and Central Africa, few
products and make an informed choice.

45
countries have national standards to date, with
the exception of Ghana (for disposable sanitary
pads). However, they can draw on the experience
of Eastern and Southern African countries.
Regional and international standards help to

limit barriers to trade and reduce the need to
develop national standards. There is an African
Organization for Standardization (ARSO), which
is working to develop pan-African standards for
reusable and disposable protection. 32 countries
are now using these standards.
Regarding reference standards (applicable at

international level), the UNGM7 has just launched
technical specifications for menstrual cups and
reusable/disposable pads. These specifications
are used by UN agencies working in Africa
(UNFPA, UNHCR, UNICEF).
What do the standards include?
Harmonization parameters Objectives
Physical parameters • Products are identifiable by

• Materials and components consumers on the basis of common
definitions
• Construction
• Consumers have sufficient
• Size (related to dimensions or absorption capacity) information on the packaging to
• Dimensional stability (to prevent shrinkage of make an informed choice.
washable products) • Consumers have information on
Packaging requirements the disposal of used menstrual
products.
• Materials - Type and construction
• The packaging itself is safe and
• Labelling - manufacturing details, expiry date, raw suitable for disposal
materials, shelf life (related to absorbency and
• The product must perform the
hygiene), disposal method.
desiredfunction: absorption or
Specific performance parameters to test absorption, collection of menstrual blood or
retention and sometimes dispersion rate of the other fluids, without leakage
product; or blood collection capacity • The products must not be harmful
Hygiene/microbiology parameters involving a to the vaginal flora or cause
number of tests. infections
Biocompatibility parameters for raw materials, which • The products are safe
must be tested to ensure that there is no toxicity,
irritation or skin sensitivity due to the materials.
7
United Nations Global Marketplace

46
Highlights Moving forward
h Existing menstrual product standards and h Training for students and researchers can
advocacy efforts developed in some East help build technical capacity in the sector
and Southern African countries can help
inform efforts in West and Central African h Building the capacity of small enterprises
countries. and providing technical support to enable
them to offer products that meet standards
h Standards are an important tool to enable can help achieve many socio-economic
informed choice for menstruating people - objectives.
ensuring safe access to a variety of reliable,
quality products. Open markets also ensure h Developing standards in Ghana - and in
that products are profitable and accessible. any country that embarks on standards
development - involves broader efforts to
h It is essential to involve the various inform the population and raise awareness
stakeholders, including the ministries about menstrual health and hygiene.
of trade, textiles, health, education and Consumer awareness is essential to ensure
research. that standards are enforced once they are
created.
h Training and capacity building for small
businesses, with the support of regulators, h To ensure that MHH policies are
is very important. properly implemented and that they are
a reality for consumers, government
h Specialized training programs on product support is fundamental. Policymakers
design and business development can and parliamentarians have a key role
stimulate innovation and ensure the quality to play in promoting the adoption and
of feminine hygiene products. implementation of quality standards.
h It is important to create a culture in which h Much work has already been done to
standards do not scare manufacturers, but develop pan-African quality standards.
instead improve outcomes and promote West and Central African countries can
opportunities. refer to the standards and lessons learned
by Eastern and Southern African countries
h If governments prioritize the global
and other low- and middle-income
MHH agenda, support and funding can
countries.
be obtained for the development and
implementation of MHH product quality h Washable sanitary towels offer an effective
standards. solution in emergency situations, which
has been clearly established by the
h Standards help address issues of
experience of the pandemic - the standards
preference, quality, safety and access to
for washable sanitary pads help to increase
affordable products.
this access.
Refer to the study commissioned by the Reproductive Health Supplies Coalition (RHSC) on quality
standards in Asia and Africa, which will be published shortly.

47
48
SESSION – 04
Research, Monitoring and Evaluation
Moderator: Panelists and presenters:
h Tom Slaymaker, Senior Statistics h Dr Julie Hennegan, Senior Research
and Monitoring Specialist (WASH) Fellow at the Burnet Institute, Australia
UNICEF HQ
h Dr Funmi OlaOlorun, Senior Lecturer,
h Fatou Mbow, Population Council Family and Reproductive Health Unit,
representative in Senegal Department of Community Medicine,
College of Medicine, University of
Ibadan, Nigeria
h Bénéwendé Bonaventure Segueda,

Inspector, specialized in the analysis,
management and planning of
education systems DSS/DGESS/
MENAPLN, Burkina Faso
h Didier Monteiro, WASH Specialist,

UNICEF, Guinea Bissau
h Fabienne Bertrand, WASH Specialist,

UNICEF, Republic of Congo
h Dr Penelope Phillips-Howard,
Professor at the School of Hygiene
and Tropical Medicine, London
h Olufemi Oludare Aluko, Environmental

Health Specialist, University College
of Health Sciences, Nigeria.
h Prof. Honoré Mimche, Senior Lecturer,

Institute of Demographic Training and
Research, University of Yaoundé II,
Cameroon
h Dr. Vishna Shah, Research Assistant

and Trial Manager for the MEGAMBO-
Gambia project
h Dr Belen Torondel, Assistant Professor,

School of Hygiene and Tropical
Medicine, London
h Job Ominyi, WASH Specialist, UNICEF,

Nigeria
h Dr Ghislain Mukuna, Project Manager,

Catholic Relief Services (CRS), DRC

49
This session allowed participants to: PMA 2020 surveys provided some of the
first national data on menstrual health.
» Share different approaches to strengthening
monitoring and evaluation systems, and » Indirectly, UNESCO's Sexuality Education
present specific monitoring systems in Review and Assessment Tool (SERAT).
place in some countries. Discuss how While there is not yet enough evidence to
monitoring initiatives at the international, recommend a comprehensive set of validated
national and non-governmental levels can indicators, there are simple measurement tools
be harmonized. that can be used now to strengthen monitoring
» Summarize the state of MHH research in of MHH:
the region, as well as its gaps, and to initiate
a regional research agenda based on the
» Measurement tools, such as the one
developed by UNICEF which provides ways
experiences and learnings of researchers to assess the relationship between MHH
and practitioners. programs and interrelated outcomes in
Despite the relevance of the MHH for the education, health and well-being. The tool
achievement of the Sustainable Development provides a range of indicators that can
Goals (SDGs), and despite the growing interest in be used to monitor and evaluate MHH
the topic, this attention has not been accompanied in institutions (schools, health facilities,
by a coherent follow-up of the initiatives, making it workplaces) and households.
difficult to assess their impact. Today, many MHH
programs are being developed and implemented,
» The Rapid Assessment Tool for MHH in
Humanitarian Settings (M-RAT) developed
and require monitoring to understand their by the International Rescue Committee
impact. Monitoring and evaluation can be used to (IRC) and Columbia University, which can
improve investment in MHH because measuring be used in a variety of settings, including
progress and gaining a deeper understanding refugee/displaced camps, informal schools,
of the magnitude of needs can both motivate urban neighborhoods or host communities.
and reassure investors. Another difficulty with
monitoring and evaluation of MHH activities is » The Menstrual Practice Needs Scale
that when it exists, it considers MHH only as a (MPNS-36), developed by Hennegan et
hygiene issue. The intrinsically transversal nature al (2020), which focuses on a woman's
of the MSS thus represents a challenge for the experience of her last menstrual period and
current monitoring and evaluation models, which captures menstrual management practices
are mainly organized in a sectoral manner. and environments.
However, more and more monitoring systems

(and thus data sources) on MHH are available.
Highlights of the discussion:
UNICEF's global guide to MHH programming » All the speakers stressed the need to
gives some examples: find common ground so that the various
sectors can implement coordinated and
» The WHO/UNICEF Joint Monitoring
harmonized monitoring of the MHH. A
Program (JMP), tracks global progress
concerted choice of indicators is important
towards the SDG targets for water,
to ensure that we all speak the same
sanitation and hygiene, based on nationally
language. This will require a standardization
representative data sources8. At the time
process that will also allow us to compare
of writing, the JMP has compiled and
different contexts.
harmonized MHH-specific national data
for 13 countries in the region9. » Many MHH interventions are based on
quantitative monitoring (e.g. number of
» The survey Performance Monitoring
adapted toilets). But we need qualitative
and Accountability 2020 (PMA 2020),
monitoring to ensure that the activities
Multiple Indicator Cluster Surveys (MICS)
also lead to behavioral change. In Guinea-
and Demographic and Health Surveys
Bissau, for example, UNICEF has developed
(DHS) are three types of population
a program that includes infrastructure and
data collection conducted in the region
training for teachers, health professionals
to varying degrees that have included
and parents. Focus groups with young girls
questions on MHH in recent years. The

50
were also conducted to assess the impact range of experiences of menstruating
of the activities on behavior change. individuals and an agreed-upon
» Even with the incorporation of qualitative definition of menstrual health.
approaches, the survey methodologies The language used in the
currently used do not allow us to fully questionnaires is sometimes
understand the unmet needs of women and misunderstood in the field. The use
girls. We need methodological approaches of alternative question formats and
that are contextually appropriate and terminology could help clarify and
relevant to each stage of women's and improve understanding of certain
girls' lives. The tools currently in use must concepts (terms such as confidentiality
also be adapted to the working methods and safety of menstruating women and
of the different actors (e.g., national data girls).
collection systems use different methods
from those of international organizations' » The region can be proud of the growing
programs). Nevertheless, programmatic number of formative research studies
data can inform what is integrated into conducted in recent years, mainly in school
broader monitoring systems. settings. However, most of these studies
» Measurement tools must be adapted have focused on the psychosocial states
to the cultural and religious contexts of of girls at the time of menarche, rather
the programs. We cannot separate the than on the long-term impact on their
health and well-being of women and girls psychosocial well-being. It would also be
from "menstrual justice" and the gender useful to generate more knowledge about
norms that prevail in different contexts. the underlying factors of social norms
It is important that this relationship is surrounding menstruation, both negative
reflected in the data we collect, so that and positive, including the specific roles of
we can reflect the impact of programs as influential people in communities.
accurately as possible and convey the right
»
policy messages in the right context.
Julie Hennegan's presentation on PMA
Conclusion
2020's experience in monitoring MHH
offers some key insights for the future: This first symposium organized on menstrual
We need to pay particular attention to health and hygiene in West and Central Africa
who is included in the survey samples: allowed the countries of the region to benefit from
are the samples representative and the reflection and experience already developed
comprehensive, capturing the needs in other regions of Africa and the world. Links
of a wide range of women and girls? have been forged between all the stakeholders
involved in the issue well beyond West and
In research efforts, the description of Central Africa and have enabled organizations
menstrual practices (what women do) working in the region to join working groups
may not tell us the extent of unmet and participate in the reflections currently being
need: the type of protective menstrual conducted on the issue at the global level.
material used may be an indicator
to measure penetration or uptake It is now crucial to be able to disseminate the
of certain products but usage alone operational recommendations formulated during
cannot be used to assess material the various sessions of the symposium and
needs being met, especially for synthesized in this report, so that they can be
disadvantaged groups. More effort is reinvested by all the partners to strengthen the
needed to identify or develop accurate integration of MHH in all the sectors concerned.
indicators of menstrual health at the At the end of the symposium, the following
population level that reflect the full recommendations were made:
8
This includes education management information systems, national censuses and surveys, and secondary sources where primary data are not available (e.g.
UNESCO Institute for Statistics)
9
More information is available at https://washdata.org/monitoring/menstrual-health.

51
» Capitalize on the dynamics and links
created during the symposium, continue the Reminder of some key advocacy messages:
exchanges by networking the participants
and ensure the animation of this network h MHH must be recognized as a public
by mobilizing dedicated resources. health issue
» Continue to collect and share the resources h Menstrual materials must be free and
developed on the topic, make the link with accessible
existing resource centers and make the h MHH must be taken into account in
tools available to all stakeholders. all schools and integrated into the
» Transform into action the advocacy school curriculum.
messages identified during the regional h MHH should be seen as a factor
events dedicated to MHH in West and in the realization of the rights and
Central Africa (virtual conference of empowerment of girls and women
October 11, 2020, digital communication
h MHH must be promoted as a research
campaign #SoyonsRéglos and regional
topic in its own right
symposium of May 2021).
The digital campaign on Menstrual Health and Hygiene #Soyonsreglos
In the run-up to the symposium, and to maintain the mobilization of all stakeholders between the
virtual conference organized in 2020 and the symposium, a large digital campaign on Menstrual
Health and Hygiene (MHH) in West and Central Africa was conducted from October 11, 2020 to
May 28, 2021. Carried online by the hashtag #soyonsreglos, this campaign was relayed by the
platforms of all the partners of the French Muskoka Fund (UNICEF, UNFPA, WHO, UN Women,
as well as UNESCO, the NGO RAES and Equipop) both at a regional and country level, as well as
by feminist influencers and activists in the region.
The objectives of the campaign were to remove taboos, free speech, strengthen communication
and access to information, but also to support regional and country advocacy on MHH.
Among the many media disseminated as part of the campaign, we can mention: infographics,
videos of testimonies and influencers, the launch of challenges, a web series and animations.
Thanks to the 420 publications and the media coverage obtained (Canal Plus, RFI, Allodocteurs.
Africa, TV Sud), more than 16 million people were reached by this campaign. All materials are
available on the campaign website www.soyonsreglos.com/ Letstalkperiod.com

52
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THE SYMPOSIUM FOR

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

More than one thousand The intervention of Dr. Julitta Onabanjo(link to

Finally, Her Excellency Delphine O, Ambassador

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

h Research and monitoring/evaluation.

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

" Menstrual health is a state of complete physical, mental, and

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

The transversal and multi-sectoral nature

h Yeboua Ban, Advisor to the

h Dienaba Wane Ndiaye, Country

h Dr. Yves MONGBO, in charge of

The situation faced by girls and women in the

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

h Caitlin Gruer, Head of the Gender,

h Anita Akumiah, GBV Sub-Group

h Brigitte Isseta Ilboudo, Regional WASH

h Mariam Modibo Tandina, National

By creating a space for exchange between

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

h Moctar Sow, National Association for

h Madjiguene Gueye, Regional President of

h Akwasi Sarpong, The Ulti-leaf Foundation,

h Barbara Ngeah Achwe, Vision for Action,

h Yatma Fall, President of the Senegalese

The session dedicated to the menstrual it is crucial that governments, UN organizations,

Summary of key points Girls with disabilities have fewer opportunities

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

1.I. Strengthen the integration of menstrual health

h Prof. Marleen Temmerman, MD, OB/

h Prof. Namory Keita, President of the

h Prof. Joseph Vyankadondera, Advisor

h Odette Hekster, Director General, PSI-

h Emily Hoppes, Senior Technical

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

As Professor Joseph Vyankadondera (UNFPA)

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

h Mary Siby, Gender Specialist, Ministry of

h Ellen Gyekye, Ghana Education, School

h Barbara Ngeah Achwe, Vision for Action

h Marlene Babio, FAWE Coordinator, Benin

Government representatives, UN experts and Summary of key points

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

Strengthening links with health services

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

h Mr Neville Okwaro, WASH & GHM

h Ms. Rachida Gado, Head of Division,

h Mr Yao Konan, Adolescents and Youth

h Dr. Marie Jésus Buabey, Head of the

Summary of key points The presentation of the results of the review of

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

REPORT ON THE SYMPOSIUM FOR MENSTRUAL HEALTH

h Kadiatou KONATE, Young Girl