Sexual Menstruation and Menstrual Management Practices Associated with Schools Girls in Ghana

INTRODUCTION

Since independence, successive governments in Ghana have pursued educational policies aimed at universal basic education for all citizens. These policies have moderately increased enrollment and educational participation. The quality of information pupils gain equip them with knowledge and tools with which they can plan their future even while they protect themselves from debilitating and fatal conditions such as early marriages and unwanted infection including HIV/AIDS.

Adolescence is a relatively short and transitional stage in which a child develops into and takes on roles of an adult. It is necessary to continually study and discuss the current youth's life experiences and their emerging problems related to puberty and maturation. For many reasons female adolescents are more vulnerable than any other and are biologically more susceptible to STls such as Chlamydia and gonorrhea that could facilitate the transmission of HIV (M. Asachzzon Khan 2002)

The needs of adolescents are unique and pressing but should not be considered and addressed in isolation. Their needs should be integrated into the center of family care, the resources of school and the community, and the training of health providers. All of these institutions should be sensitized to be generally sympathetic to the youth, especially the girl child.

Apart from the Government, international organizations and non governmental organizations have made it their priority to improve the quality of education and ensure access for girls and women by removing obstacles that hamper active participation. This has moderately increased enrollment particularly at the basic level but the issues of equity, retention, and participation have remained unresolved in higher levels. The gender gap widens from primary school through secondary and tertiary education and there is insufficient information about various aspects of a growing child's life (home, school, social clubs, and media) to determine the cause.

Researches have revealed that the gender gap in education is caused by many factors. In addition to poverty, which affects girls more than boys, there are social, cultural and economic factors that prevent girls from getting to school or cause them to be pushed out from school. A research conducted by FAWE Ghana (2001) revealed that one major constraint of girl-child education is the onset of menstruation because of abdominal pains, fear of soiling themselves, change in mood, and lack of appropriate toilet and water facilities.

Puberty and adolescence can be a challenging time for many girls. In most societies menarche is an indication of a girl’s developing sexuality. Johnson (2005) noted that in Western societies it is argued that society conveys conflicting messages about menarche: the beginning of womanhood sexuality, and the discouragement of sexual activity for young girls. In many societies, family and immediate community traditionally provides young people with information and guidance about sex and sexuality. In Ghana information about sex used to be formalized as part of initiation into adult roles in many ethnic groups. But in many parts of the developing world, including Ghana, recent rapid urbanization and migration have meant that families and community networks have become more widely dispersed. This may have impacted sexual socialization and education as well as on the sexual behaviors and sexuality of young people. The effectiveness of traditional family expectations and structures in shaping sexual beliefs expectations and behavior appear to have been substantially weakened with little continuity in sex education within the family and the community.

In Ghana, girls who reached menarche used to be instructed by their mothers and other females in the community in behaviors and taboos associated with menstruation. Queen mothers in the community were responsible for conducting the girls throughout puberty rites involving education in hygiene and marriage.

Menstruation is a natural event throughout much of woman’s life, yet it is a topic which is seldom openly discussed. Many women lack sufficient or accurate knowledge about it and often have misunderstanding and mistaken beliefs that have been passed on by family and communities. Many women do not understand the purpose of menstruation and what happens in their bodies during menstruation.

In-depth studies by population report (2005) found that the adolescents’ knowledge of fertility and menstruation are very poor in many countries, including Ghana. For example in Dakar, Senegal, two thirds of adolescent girls and boys aged between 15 and 19 could not identify the mid point in the menstrual cycle and the time when a woman is most likely to get pregnant. (Pop. Report 2005). In lle, Nigeria, some 40% of school girls surveyed did not know the cause and meaning of menstruation. The report further indicated that among school girls ages 12-17 in Tamil Nadu, India more than half of girls who used old cloth, napkin or only their undergarments as a menstrual product washed them only once or twice a day rather than the recommended four or five times a day. Much of what these girls had learned concerned restrictions to their mobility and behavior during menstruation and superstitions about they being ‘polluters’ of the environment.

Social change has broken down most of these social structure and studies on sexual maturation and menstrual hygiene management among school girls in Ghana. Studies elsewhere also revealed that adolescent girls have very little information about menstruation before they experience their first menstruation and this ignorance leads to worry, shyness, embarrassment, and nervousness. The study also showed a lack of adequate education about the hygienic management of menstruation and a lack of provisions for facilitating the disposal of menstrual materials. This situation is worse among rural communities in the country where information is more difficult to obtain.

STATEMENT OF PROBLEM

Women make up about 51% of the population of the world according to the Population report (2005), contribute two-thirds of all work hours, and raise almost all of the world’s children. Educating girls lead directly to better family health, economic growth and lower rate of child mortality and malnutrition.

In other words education of girls is a simple and attainable strategy that helps overcome poverty. Education is a right for these girls. Girls as well as boys are encouraged to enroll in school, however studies show girls are at a disadvantage when it comes to retention and performance. One of the many causes of this gap is menstruation and menstrual management practices.

​

Recently, girls have been reaching menarche at an earlier age. In the past, girls were educated about menstruation through existing social structures, but with the changing environment girls are left to their own fate. Lack of adequate information for these girls, especially those of the rural areas, leave many girls frustrated. They often find their own solutions for managing their menstrual cycles, which are often not adequate. Most of these girls end up dropping out of schools. This raises some questions such as:

• Is it the family ties that are breaking apart?

• Why is the community not doing its work through the queen mothers?

• Is the school curriculum not teaching girls sex education?

• What are policy makers doing about these pressing issues?

It is on this note that Alliance for African Women Initiative (AFAWI Ghana) collaborated with other NGOs like FAWE Ghana , Ministry of Women and Children’s Affairs, Ghana Integrity Initiative with funding from Mama Cash Fund For Women. AFAWI conducted this research in three regions of Ghana: Brong Ahafo, Northern, and Upper East regions. AFAWI wanted to find out where the problems lie so we can team up with advocates, stakeholders, and government policy makers to find lasting solutions to the problems of menstrual and sexual management in society.

RESEARCH METHODOLOGY

The study was both qualitative and quantitative and used both primary and secondary data. The primary source was solicited from school children, teachers, educators, opinion leaders via semi structured interviews and key informant interviews. Secondary data was gathered from journals, text books, magazines, newspapers, television news, internet, and past project documentations.

MAJOR FINDINGS, SUMMARY, CONCLUSION AND RECOMMENDATIONS

MAJOR FINDINGS

This section summarises the major findings of the study. This includes the relationship between the respondents’ demographic characteristics and sexual maturation and menstrual management practices; the knowledge of respondents about menstruation, traditions ,and customs and its relationship with sexual maturation; and menstrual management practices and management of menstruation and hygiene practices.

• Education is an important tool in the development of every society. Age and religion were used as variables in the study of the sexual maturation and the management of menstrual practices. The respondents were in categories: 10.4% of primary school pupils and 89.6 Junior high school pupils. The study showed that menstruation does not only start with girls at Junior high school but also also at the primary school level between the average age of 9 and 13 years.

• Out of all the boys who were interviewed, about 87% teased the girls who were menstruating. This attitude and behaviour makes the girls uncomfortable.

• Christianity dominates in all the communities that were studied except in the Northern region where Islam was the dominant religion

• The study revealed that as far as menstrual management practices are concerned, Christians do not prevent menstruating girls from participating in any religious activity with the churches. It preaches against pre-marital sex.

• Islam on the other hand prevents menstruating girls from participating in the Islamic activities; menstruating women are not supposed to fast or pray during menstruation.

• The effect of religion on the sexual maturation and menstrual management practices was seen most prevalently within the African Traditional religion.

• The African Traditional Religion prevents menstruating women from entering the chief’s palace, entering the house of a traditional herbalist, visiting river bodies, visiting a community fetish, cooking, or going to the farm. Menstruating women are essentially segregated from the society during menstruation.

• The findings revealed that despite all these restrictions, menstruating girls are not prevented from going to school.

• Menstruation is not something new in the society, the study revealed that 70% of the respondents had full knowledge of menstruation. This knowledge was passed down from mothers, friends, sisters, teachers, meetings and public fora.

• 86% of the respondents had ever menstruated, and this percentage confirmed the earlier information about the knowledge about menstruation.

• According to the respondents, menstruation is not a positive experience; about 98% said they felt bad whenever they are menstruating because it makes them uncomfortable.

• 66% of girls say that they report to their mother when they are menstruating. This shows the important role of mothers in the management of menstrual practices and the maturation of their young girls.

The knowledge of cultural practices affecting girls who are menstruating is not restricted to the teacher or the general public. The menstruating girls are also fully aware of the practices, especially the negative practices which have already been mentioned in the summary.

Items used in the management of menstruation include sanitary pads, toilet paper, used cloth, cotton, and wool. The study showed that toilet roll and used cloth are in high usage in the management of menstruation (48), 3% and 42.3% respectively. These items are not the best, but because of poverty they can not afford to buy sanitary pads. Those who can afford sanitary pads do not have access to these manufactured protective sanitary materials to due to factors like availability since distribution in rural areas is uncertain. Because of these factors, we found that young women often a variety of materials such as leaves, toilet paper, and pieces of sacks. These unhygienic materials may have long-term effects on their health.

The ways most of the female participants managed their menstrual cycles also compromised their quality of education.

The study again revealed that:

• The usage of the above items is not a permanent solution and the materials needed to be changed at least twice a day

• Menstrual symptoms include painful menstruation, heavy flow, inconsistency of the flow, and abdominal pains. Many managed these problems by taking pain killers, applying hot compresses, sleeping, lying flat on their belly, and visiting to the nearby clinic.

• Menstruation, according to the study, is no longer considered a sickness. 70% of the participants explained that if menstruation is a sickness then every woman in this world is sick.

The study further revealed that most of the schools visited did not have facilities appropriate for menstruating girls. Many participants expressed discomfort with the current facilities. The respondents said they need facilities such as wash rooms and toilets to make them comfortable.

Many schools visited were underprivileged and lacked sufficient sanitation facilities which are vital not only during a girl's period but at all times generally. Due to inadequate water, toilet, and dumping facilities for sanitary wear at school, many menstruating girls would rather stay at home. The lack of appropriate facilities to help them manage their periods discouraged many from regularly attending school.

There was a medium of teaching sex education in most of the schools visited. It is taught in subjects like general science, life skills, and religious and moral education. But the findings revealed that these subjects do not emphasize menstrual management practices.

Sexual intercourse is well known among the respondents. 14% responded that they have had sexual intercourse while 86% declined. Participants were also fully aware of STIs, and responded that STIs can only be prevented via using condoms, sticking to one partner, and abstaining from sex until marriage.

• Most of these diseases according to the study are curable except HIV/AIDS.

• It was realised that the most common reason that many girls dropped out of school was not the negative cultural practices of menstruation, but rather teenage pregnancy.

• Those who were pregnant found it difficult to return to school.

• The study also revealed that there are no meaningful educational programmes on sexual maturation and menstrual management practices in the society.

SUMMARY

Sexual Maturation and Menstrual Management Practices Associated with school Girls in Ghana particularly in the case study areas, (Brong –Ahafo region, Northern region. and Upper East region) is still a problem to some extent. The problem is due to the inadequate teachings the girls are receiving in school and home and is largely not due to ignorance of the girls or negative socio-cultural practices. The girls receive the information too late. The practical aspect of the lessons on sexual maturation are not taught, although the schools and families have improved in imparting knowledge to the adolescents. Another major problem is poverty, which still persists in the rural areas of Ghana. The respondents knew that sanitary pads are good and hygienic but could not afford them. Many of the respondents used unhygienic materials due to poverty and unavailability. The government and other stakeholders have yet to provide girls with school environments that are suitable for these areas, which does not make for a conducive learning atmosphere.

RECOMMENDATIONS

• Institute program to teach girls about menstruation and sexual management practices. Education about menstruation should start at an early age before girls reach puberty so girls would be better prepared emotionally and psychologically for the experience of menstruation. This will help girls have fewer negative reactions and make them more able to care for themselves during menstruation, especially in regards to hygiene.

• Intensify the teaching of girls about menstruation as part of adolescent and reproductive health education in our basic and secondary schools. This teaching should be part of the school curriculum and teaching should be practical. Since the study revealed that in some schools, health education is non existent, this would go a long way to improve the knowledge of girls about menstruation.

• Provision of sanitary facilities in the schools to take care of girls who are menstruating. The current facilities available in the basic schools are inadequate, and more wash rooms are still needed for menstruating girls

• Materials or books on menstruation should be provided for girls to read and understand the changes that occur in their bodies. The books should teach the various menstrual management and hygiene practices

• There should be massive sensitization of the public about the traditional beliefs and practices relevant to menstruation; this will go a long way to erase the negative beliefs about menstruation within the community.

• Mothers should also be concerned about their girls who are menstruating since the study revealed that girls talk more with their mothers. They should educate their girls about menstruation.

• Teachers should encourage girls who are menstruating to participate in class activities and allow them to answer or ask questions while sitting. They should also encourage girls who are menstruating to report to the lady teachers in their schools.

• Head teachers/Masters should set up a fund to take care of menstruating girls. Money from this fund can be used to buy toiletries, cotton, and other materials that can assist girls during their menstrual cycles.

• Religious organisations that prevent menstruating girls from participating in prayer or any religious activity should be educated on the dangers involved and the effects that it has on the menstruating girls. This type of education should call for attitudinal change.

• NGOs should try as much as possible to create programmes on sexual maturation and menstrual management practices. They should assist girls especially those with menstrual problems so as to improve their condition.