Period during a pandemic: The neglected reality of Nigerian girls and women.

Underneath the façade of supposedly bubbly girls, living daily lives in many parts of Nigeria lies the problem of lack of access to proper menstrual hygiene management tools or kits. From schools to business places, religious organizations amongst others, a hive of women and girls face the harsh reality of inability to manage their periods due to poor access to water, sanitation, and hygiene facilities, common in many low- and middle-income countries of which Nigeria sits top. The issue of privacy and dignity during menstruation is still one area in which women and girls in Nigeria are failed every day. All of these further taking a toll on the emotional life, education, productivity of the girl child amongst others. The pandemic further impedes the ability/efforts of non-governmental organizations hitherto saddled with the responsibility of tutoring young girls in mostly rural and underserved communities the art of making re-useable pads to address the challenge of period poverty. Deep-seated Menstrual taboos, common among many Nigerian tribes have also served as major setbacks to proper menstrual hygiene management. With all of these, the period poverty struggle, made worse by poor water sanitation and hygiene facilities in Nigerian communities continues. There is still an urgent need to increase sensitization, and advocacy to break menstrual taboos, reduce cost and improve access to menstrual hygiene products and facilities especially following the COVID-19 pandemic and its attendant overbearing effects.

Introduction

A fundamental part of our human rights is a right to health, and this has menstrual health inclusive. However, with an increase in the number of girls and women menstruating, a fundamental right to health with an emphasis on sexual and reproductive health is less exercised. This right includes; availability of water and awareness on health information regarding menstrual health, and most especially right to access clean, soft absorbent sanitary products. Menstrual Hygiene Management refers to when “Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose used menstrual management materials.” [1] Period poverty is a vital but often disregarded public health crisis. Globally, over 500 million women and girls lack adequate facilities for menstrual hygiene management (MHM) [2]. In Nigeria, 25% of women lack adequate privacy for menstrual hygiene management [3]. The impact of period poverty in the lives of menstruators can be felt on their education, emotional well-being, health, discomfort and nation's economy. Nigeria as one of the poor resource countries finds it challenging to make available good menstrual hygiene management (MHM) infrastructure [4]. Even though effort is being put in place to curtail menstrual hygiene management problems by free distribution of pads to school girls as reported in Kenya and also training of girls on how to make reusable pads as seen in Nigeria [5], the COVID-19 pandemic has caused a shortage in the supply of menstrual product, a hike in price, difficulty in accessing clean water to manage period, an unconducive environment to dispose of sanitary products. The hike in menstrual product price has led some girls to involve in sexual violence or trade sex with men in order to afford menstrual products; this has equally caused harm because of the exposure to sexually transmitted diseases [6].

Menstruating before the pandemic in Nigeria

With highlights on the inability of Nigerian women and girls to access their reproductive health rights, the state of Period poverty as well as menstrual hygiene management in Nigeria is left as a part of the public health crisis. There are few statistics for proper investment to help deal with this issue; sadly, this has been a contributory factor to the increase in period poverty and unhygienic menstrual behaviors. This can be seen in the substitute of clean, soft absorbent sanitary products with rags, tissue papers, newspapers, and pieces of clothes. The effect of this can be seen as an impact on the girl-child education, as they become vulnerable to harmful outcomes that could affect them physiologically, emotionally, socially, and physically, with cases of increase in anxiety when approaching that time of their cycle as well as their susceptibility to reproductive and urinary tract infections. “Materials used for absorbing menstrual blood could introduce these infections to the reproductive tract as well as poor personal hygiene during the menstrual period.” [7] The state of period poverty and menstrual hygiene management has been seen to be affected by factors such as; inadequate knowledge about menstrual hygiene practices and menstruation, this gap can be linked to improper or absence of proper education. However, this can be addressed with a synergistic effort between parents/wards, relatives and the ministry of education-schools, through an introduction of well developed sexual and reproductive health education schemes in the school syllabus; as well as other external supports. Statistics show a rapid increase in the knowledge level about menstrual hygiene management through the synergistic efforts of the previously mentioned sects from 60% of adolescents, and a deficient of knowledge in about 40%, and the family primarily responsible for this increase [7], to 94.3%. Still, there is a wide gap between knowledge of menstrual hygiene management and its practice.

Additionally, the accessibility and affordability of sanitary products is one factor that impacts MHM and the issue of period poverty, particularly in consideration of girls and women of menstruating age in rural areas [8]; proper distribution of sanitary products through the channels of distribution has been seen to be a problem affecting hygienic menstrual health behaviors, as the concentration of these sanitary products is mostly in the urban areas, despite the reality of women and girls especially in rural areas being more likely to be unable to afford these disposable sanitary materials [8,9]. Data from National Bureau of Statistics (NBS) shows that, “40.1% of the total population, or almost 83 million people live below the country's poverty line of 137,430 naira ($381.75) per year.” [10] More so, water and soap hygiene is an aspect of the girl child education that cannot be overemphasized. Sadly in Africa, having access to facilities that aid water, sanitation and health are quite challenging.

Period during a pandemic

Since the inception of COVID-19, women and girls around the world are facing increasing struggles to access sanitary products and facilities, the need to handle their periods hygienically and with dignity, as countries have been pushed into lockdowns to combat the spread of corona virus particularly in Nigeria.6,11 These women are challenged with Period Poverty as they lack access to clean water, female-friendly decent and private toilets, sanitation facilities, and sanitary products to handle their menstruation. Unfortunately lack of these necessities contributes to poor menstrual hygiene practices among women and girls, preventing their full potential from being achieved [11].

Additionally, the source of livelihoods and household income was greatly affected with Inflation in the Nigerian economy including increase in the cost of sanitary products making women and girls unable to afford these sanitary products even when available.6,11 The increase in the cost of sanitary products forces young women and girls who lack the funds resort to unhygienic alternatives [6]. These challenges doubled the burden of menstrual hygiene, making period poverty increasingly high among girls and woman in Nigeria."11 Consequently, the lockdown cut off the free MHM products, basic information and services which occur majorly in schools and workplaces [6]. Shortage of products due to disrupted supply chain, inadequate water and sanitation facilities to manage periods due to staying at home especially for women and girls in the rural areas, has drastically increased the risk of reproductive health diseases [6].

Following several negative outcomes linked to period poverty, there is likelihood of some girls to trade sex for MHM products [5], in light of the pandemic and inflation, the probability that the number of girls who menstruate will accept this offer is high thereby giving an increased risk of contracting sexually transmitted infection (STIs) and exposure to other forms of sexual & gender-based violence (GBV) [5].

Conclusion

Period poverty has been an issue of great concern to the reproductive health and rights of women and girls globally before the outset of COVID-19, worse still, in low and middle-income countries like Nigeria. Infrastructural inadequacies in WASH and socio-economic, cultural, and educational integration of this essential reproductive rights of women and girls has led to the heart-wrenching state of menstrual hygiene management in Nigeria; An already challenging issue which the few interventions targeted towards it was halted in the face of world and Nigeria trying to combat corona virus. Periods do not wait due to a pandemic and the resultant consequences of period poverty and poor MHM reiterates the need to build back better beyond COVID-19.

Recommendations

Given the increasing evidence in LMIC countries about the challenges faced by girls and women in managing menstruation and inadequate guidance, it has become a neglected public health issue that needs to be prioritized, and invested into. Government, CSOs, and private institutions should make it a priority to invest in core public health infrastructure; including water and sanitation systems. Furthermore, community-based responses on the felt need for interventions on period poverty and improving menstrual hygiene management must be generated. Also, there should be adequate incorporation of menstrual hygiene management into remote and online learning curriculum to ensure that individuals, particularly; adolescent girls have the understanding they need in menstrual hygiene management. There is a need for more research as well as to push for policies and implementation work plans on interventions that can best address the unique challenges experienced by women and girls on menstrual hygiene management.

Authors’ contributions

Goodness Ogeyi Odey, Olayemi Amusile, Praises Okiriguo Oghenetejiri, Success David, and Abenmire Adi developed the concept and prepared the initial draft, Don Eliseo Lucero-Prisno III proofread the manuscript with important intellectual additions. All authors approved the final version.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.