Wage implications of menstrual health management

Imagine not having to spend a cent on sanitary towels throughout secondary school, but schooling and living next to girls who have to miss class during their menses since they can’t get pads.

This was the experience of Diana Achieng and Janiffer Vaati living in Kibra, Nairobi. They attended different schools but both were lucky to have never missed school while on their monthly period since they had a surplus of sanitary pads, right until last year when they finished secondary school.

Local and international NGOs flock schools within Kibra to donate sanitary products to girls above the age 12 to reduce and, hopefully, eliminate the number of girls missing school due to lack of sanitary pads.

A harsh reality is that girls who do not attend school due to lack of school fees can not access these free products, which are distributed to schools by the government as well. Without sanitary pads, these girls opt to use old pieces of cloth.

In the teenage years, young women should be keen on learning about proper menstrual health management, as these are the formative years of a woman’s life. How you treat your menstrual hygiene impacts your womanhood entirely.

According to UNFPA,  the average age of onset of menstruation (menarche) is 14, while the average age at menopause is 50. This means that a woman will experience menses and its effects for a minimum of 36 years.

Living wage

According to the 2019 Economic Survey, the informal sector’s monthly basic minimum wage in Kenya’s largest cities is Sh15,142. However, not many of those in the informal sector earn this.

According to the Kenya Demographic Health Survey 2014, the average household size in Kenya is 3.9 members. After all major expenses such as food, housing, healthcare and education have been paid, the family is only left with Sh1,400 to cater for miscellaneous costs.

These include clothing, household items, emergency expenses and personal care, such as menstrual health products or medicines for the mother and/or daughter(s).

Many girls and women in their menses are accustomed to using disposable sanitary pads, compared to other products such as tampons, reusable (washable) pads and menstrual cups.

The choice of what to use depends on personal preference and affordability.   The price of sanitary pads varies from cheaper brands which cost Sh50 for a packet of eight to others which cost up to Sh100.

For women who are allergic to sanitary pads material or prefer tampons, they are forced to make the choice of spending between Sh140 to Sh280 for a packet of eight. For women and girls with heavy monthly flows, the cost is double as they have to use at least two packets of pads or tampons every month.

Other options include the use of menstrual cups, which range from Sh1,500 to Sh3,500. While these are cost effective - a menstrual cup can last up to to ten years - they are not as popular as their use is compounded by the added cost of having to ensure they are properly cleaned and stored until the next use.

The reusable (washable) which pads cost between Sh50 and Sh100 are gaining popularity for their affordability as they can be reused for up to 12 months.

However, users have to contend with the challenge of accessing clean water to ensure they wash the pads properly. Other challenges faced by women and girls include basic sanitation facilities such as toilets and appropriate disposal systems.

Disposal of used pads and tampons is a major concern as it can take between 500-800 years for a commercial menstrual pad, such as Always or Kotex, to decompose because they're made from non biodegradable plastics, synthetics, and heavily treated with preservatives.

Almost 90 per cent of a sanitary napkin is plastic. The thin top layer on napkins, known as the dri-weave top sheet, is made of polypropylene (a plastic polymer). The padding is mostly wood pulp mixed with super absorbent polymers and the leak-proof layer is made from an impermeable polyethylene.

But it is not only menstrual health products that women and girls have to contend with every single month. For some women and girls, the onset of menses sparks off other complications which have a huge cost implication.

Additional costs

An additional cost incurred, mainly due to poor menstrual hygiene management , is treating diseases brought about by menses. They include yeast infections, urinary tract infections and Hepatitis B. There is the increased risk of developing cervical cancer. Women also experience discomfort related to menses such as cramps, which often times lead to them seeking medical attention.

MHM includes the use of clean material to absorb or collect menstrual blood, using soap and water for washing the body as required, and access to facilities to dispose of used menstrual material. On a Sh15,142 living wage, a reasonable allowance for healthcare needs would be Sh2,200 for the entire family.

Racheal, a soft-spoken and petite 22-year-old, says that doctors mistook her cramps for abortion.

She dreads the thought of periods because of the pain and discomfort she has to endure.

"On one occasion, I was in unbearable pain and when my parents took me to hospital, the doctors insisted on running tests to find out if I was aborting or in labour," she says.

She constantly gets panic attacks during her four to five-day period and always has to be rushed to hospital when it gets worse.

"I once got a panic attack at home because of my period. I had to be rushed to hospital. Another time I was in school and my period started when we were lined up for parade," she says.

"It got really painful and I had to be taken to class by a first aider and when the pain got worse, I got into a panic attack and had to be rushed to Nairobi Women Hospital before my parents came for me."

The University of Nairobi student says she once started throwing up and having diarrhoea as she came from class at a local college.

"I was going home from Zetech and my periods started. I alighted from the matatu I was in and went to a nearby hotel because I was feeling ill," she said.

"The hotel manager took me to a chemist and called my mother and auntie to come pick me up."

She has resorted to walking around with Ponstan which she has been prescribed to deal with menstrual pain and to prevent migraines associated with menstruation.  She has to take the medication whenever her periods are about to start.

"I try to go out less because of the bad experiences I have. I also sweat heavily and struggle with stomach upset as well as body weakness. I hate periods!" she says.

On average, Rachel spends Sh300 for her menstrual health products per month and an additional Sh600 for the medicine she needs to manage her health during this time.

Janice, a high school graduate from Samburu county, states that she did not know she was having her period the first time it happened.

The 19-year-old states that it began with really bad cramps when she was 14.

"I fainted because of cramps and I could not eat foods that had sugar because those made me feel nauseated," she says.

However, her flow did not begin immediately and she only noticed a few spots when she got home.

"I was prescribed Buscopan to ease the pain of the cramps because I could not do anything at all," she says.

Other symptoms Janice has include breast sensitivity, body aches and mood swings. She has cravings for cold foods and her flow lasts four days.

"My signs start showing about three days before and that involves cramping until a day into my period. It's the worst," she says.  On average, Janice spends Sh500 per month on the medicines and an average Sh800 for her sanitary products.

Government promises

According to the Basic Education Amendment Bill (2017), the government should provide free, sufficient and quality sanitary towels to every girl registered and enrolled in a public basic education institution and has reached puberty.

In the financial year 2018/19, Treasury allocated Sh460 million toward the National Free Sanitary Towel Distribution Programme, which will cater for 3.7 million girls in public primary schools, special primary and secondary schools in the country.

Even with this programme in progress, still girls in rural areas and urban slums miss school since they can’t afford sanitary products. With the help of non-governmental organisations, the number has significantly reduced over the past couple of years. It is estimated that one in 10 girls in Africa is absent from school during their menses.

Everlyne Bowa, the founder of Agape Woman and Child Empowerment Foundation, has been manufacturing reusable pads for the first three months after observing that sanitary products are not readily affordable to everyone, especially in the slum areas, and this leads to young girls engaging in risky behaviour just to get them, such as transactional sex. She distributes to five informal schools and sells to community members at Sh50.

When the prices of materials for production are hiked, Bowa feels the pinch, yet she chooses to produce more and provide employment to local youths.

“Distribution of sanitary pads should be done equally to all schools and not just government schools”, Bowa says. She further urges the government to form subcounty distribution channels for the pads and standardize prices.

More women are choosing to wear washable pads, not just for the affordability, but also because they contribute to environmental conservation.

Way forward

Sanitary products are a basic need in any household that has women and adolescent girls. Therefore, employers should evaluate the whole economic situation and offer better wages in order for families to meet these needs.

Ironically, condoms, which are not a necessity, are issued freely at public institutions and hospitals, yet sanitary towels are issued at a cost. This goes to show that menstrual health management is just an afterthought, and until it is taken seriously by the government and its partners, girls will keep missing school and the healthcare needs will keep going up.

Life after secondary school education means that Diana and Janiffer have to purchase sanitary products for themselves. Luckily, their guardians can afford to buy them.

But it breaks their hearts seeing their neighbours and peers lack, yet they can’t provide for them. They have taken it upon themselves to offer lessons on menstrual hygiene to young girls, and urge them to speak freely about their menstrual experiences with their parents and peers.

With additional reporting by Esther Mbugua. This story was produced in partnership with Code for Africa’s iLAB data journalism programme, with support from Deutsche Welle Akademie.