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Without access to a wheelchair or crutches, Najatu says her disability, which affects her income and also limits her ability to purchase sanitary pads during her monthly menstrual cycle, forces her to make use of rags, newspapers and toilet paper during menstruation.
“I use the little money I get from begging for alms to buy food and water to clean myself whenever I am on my period. However, I cannot buy sanitary pads because the money is oftentimes not enough,” Najatu says of her proceeds from alms-begging.
Gladys Ajebe, a 40-year-old mother of two, shares the same challenges as Najatu when she is menstruating. She lives in Kado, a suburb in the Nigerian capital of Abuja. Ajebe’s lower right leg was lost as a result of a car accident 17 years ago, and she has been walking with the aid of an old pair of crutches.
“I don’t look forward to my menstrual period,” Ajebe confides.
While acknowledging that menstruation is a natural process, Ajebe says it is a constant reminder of the many troubles she needs to contend with every month. With a meager income, compounded by her disability, Ajebe explains she rarely uses sanitary pads because she cannot afford them.
“I fold a piece of clothing, sometimes with tissue paper to absorb my menstruation. During this period, I also avoid going out to avoid being stained and making a mess of myself,” she said with a defiant smile.
Despite being a natural phenomenon, which is integral to human life, menstruation is a nightmare for many women across the world who lack access to basic hygiene and sanitation during their periods. Period poverty, which is the inability of menstruators to afford proper menstrual hygiene products, such as tampons and sanitary pads, remains a serious issue in Nigeria.
Water, sanitation and hygiene (WASH) experts warn that period poverty predisposes menstruating women and girls to unhygienic practices, made worse by the vast numbers of people living in poverty in Nigeria. A staggering 82 million people in Nigeria live below the poverty line of 137,430 Naira (US$354) per year, according to the National Bureau of Statistics (NBS). In this context of limited resources, purchasing menstrual hygiene products can be a tall order for many women and girls.
Wanda Adu, Executive Director of the Wanda Adu Foundation, confirms that period poverty is rife in Nigeria, with women who are struggling to ensure a meal for their children viewing sanitary pads as a luxury.
“They are left with forgone alternatives. Should they buy food or pads? There and then they conclude that food is more important than a pad. Hence they improvise,” she said.
But this choice has a direct impact on health. Poor menstrual management increases women’s vulnerability, especially those living with a disability, towards potentially life-threatening infections.
Efforts to address this issue have started gaining attention.
During an event to commemorate Menstrual Hygiene Management (MHM) Day in Abuja last May, Ms Elizabeth Jeiyol, WSSCC’s National Coordinator for Nigeria, explained, “Water Supply and Sanitation Collaborative Council (WSSCC) together with in-country partners and stakeholders in the sanitation and hygiene sector have been providing much-needed support to the Nigerian government in ensuring that sanitation and hygiene issues are mainstreamed at all administrative levels in the country.”
This collaboration with stakeholders such as UNICEF and Sanitation and Water for All (SWA) offers more opportunities for Nigeria to address issues related to sanitation, hygiene and menstrual health.
Groundswell of measures
Issues of sanitation and hygiene have begun to gain attention from policymakers, civil society organizations and the private sector. A raft of measures by the Nigerian government has resulted in the inauguration of a steering committee for the campaign to end open defecation by 2025 as well as the earmarking of 10 billion Naira for the construction and rehabilitation of water schemes.
In addition, the distribution of one million sanitary pads to women and teenage girls living in extreme poverty has been launched. Through the Ministry of Women Affairs (FMWA) and in-country partners (including WSSCC) the first technical working group on Menstrual Health and Hygiene Management (MHHM) in Nigeria has also been established.
Whilst these efforts are commendable, WASH sector practitioners have argued that addressing obstacles to menstrual health and hygiene in Nigeria requires consideration of a myriad of factors.
“We must address misinformation, belief, poverty, access to sanitary pads, inclusion and provision of functional sanitation facilities that promotes dignity,” said Founder, Toilet Kulture Initiative, Mrs Elsie Ozika in an interview in Abuja.
Access and participation important to persons living with a disability
While there is increased understanding of the impact of unhygienic practices during menstruation upon women and girls’ health, lifestyle, and livelihoods, for women and girls living with a disability - like Najatu and Ajebe - lack of access to menstrual hygiene tools during menstruation serves to further compound their exclusion.
When access to menstrual hygiene and health management in women and girls with a disability is benchmarked against those without disability, the gaps expose issues with programming and design.
Ms Ekaete Umoh, National President of Joint National Association of Persons with Disability (JONAPWD) highlights the need to better understand the barriers women and girls with disability are experiencing in accessing sanitation facilities on an equal basis with others.
“If you cite a toilet or borehole facility in a place where the terrain is poor, someone living with a disability may not be able to get there. If the water point is in a place where it is high, someone living with a disability would not be able to access it. It is good that you have constructed a toilet, but how accessible is the toilet to the blind, and those on a wheelchair?” she said.
She added that different factors, particularly the type of impairment, should be considered when addressing menstrual hygiene in women and girls with disability.
“The way a blind person will manage menstruation is different from the way a wheelchair user or paraplegic. Many of them will depend on support persons but how available are these support persons to help them access the right level of hygiene that they should get.”
Ms Umoh went on to urge the government to step up and address issues of access and participation and not see people living with disabilities (PLWDs) as recipients of charity, to address these concerns and mainstream women and girls with disability in menstrual hygiene management.
“For instance, the government is distributing sanitary pads. How are they factoring women and girls with disabilities? Some of them are not even in the cities where you are distributing these sanitary towels. Most of them are living in rural and hard to reach communities, and they don’t even know what we are talking about. They don’t even have access to information concerning government programmes in this regard.”
Highlighting the need for better participation by PLWDs in programme design, she goes on to argue that there is also an issue of participation.
“How many persons with disability participate in designing government projects and programmes? They are often excluded and are seen as the recipient of charity. In any WASH programme, PLWDs should be factored from the design to the implementation stage. They should not just be recipients. PLWDs also want to participate in the decision-making process that affects them as it were,” she said.