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A study has recently been conducted by the WSSCC-UN Women Joint Programme on Gender, Hygiene and Sanitation. In four regions of the country (Kédougou, Kolda, Matam and Sédhiou), a research team attempted to cast light on the links between Female Genital Mutilation (sometimes called female circumcision) and the issue of Menstrual Hygiene Management (MHM).
Download the study’s Policy Brief here.
In Sub-Saharan Africa, MHM is still given very little consideration in public policy - thus there is little data, either quantitative or qualitative, on women’s hygiene practices. WSSCC and UN Women have been working since 2015 to fill data and knowledge gaps and have conducted a first study in the Kédougou region of Senegal. This study showed that women’s knowledge on this subject was very rudimentary, especially in rural areas. Importantly, the study found that in the group of girls that had undergone FGM, nearly one in four had suffered from infections during menstruation. In the study region (Kédougou), 80 per cent of women have undergone FGM. The overall national rate of FGM in Senegal is 28 per cent. It was therefore necessary to conduct a more extensive study in different parts of the country to assess the impact of FGM on menstrual hygiene.
A total of 1250 people were surveyed: 500 women who had undergone FGM, 500 women who had not, and 250 men (to understand their knowledge and perceptions of problems women face). Four regions of Senegal were chosen. Two of these (Kédougou and Kolda) have high rates of FGM and two (Sédhiou and Matam) have average rates. Questionnaires were administered and group discussions were conducted in order to obtain both qualitative and quantitative data.
Fear and embarrassment among circumcised women
The study showed that the way in which menstruation was perceived in society and in religion engendered a significant feeling of fear and embarrassment among circumcised women. Women in this group are more stigmatized or isolated during their periods; seven per cent more of them (than women who have not undergone FGM) go into voluntary isolation or are isolated by other members of their families during this time. On top of the forced isolation, the restrictions imposed on them may include reducing their mobility, restricting their diets or even prohibiting them from conducting certain activities. Overall however, the frequency of isolation is low in the four regions of the study.
Moreover, women in the FGM group have more menstruation-related health problems. Asked about the problems they experience during their periods, they mention “loss of appetite, headaches, stomach ache, and pains in the abdomen and back”. In addition, some conditions related to poor use of sanitary towels, including vaginal infections, are more frequent in women who have been circumcised than those who have not. Taking the study overall, approximately 27 per cent of women (circumcised and uncircumcised) reported health problems during menstruation.
In general, the study shows that disposable or single-use sanitary towels are the most-used types of sanitary protection during periods. In rural areas and partly in urban areas, women also use reusable fabric protection because they believe that it is “safe and hygienic”. Reusable sanitary protection is generally washed using soap or salt.
Good knowledge of the physiology
Whether circumcised or not, women’s understanding of menstruation is good, especially of the reasons why periods occur, the normal length of periods and the menstrual cycle, and the health consequences of poor menstrual hygiene. This finding applies to all the areas of the study except Sédhiou, where knowledge of menstruation is not as good. Furthermore, the study shows that apart from the age of menarche, men know little about menstruation, especially in the regions of Sédhiou and Matam.
Incorporating menstrual hygiene into campaigns against FGM
To facilitate the integration of MHM into public policies and development strategies, the study authors make various recommendations on the basis of their findings. They call, for example, for the introduction of menstrual hygiene in campaigns against female circumcision and early marriage, and for emphasis on the risks to women, particularly in terms of their health and sex lives. Researchers also call for awareness-raising campaigns with girls in schools, in communities and local authorities, and with men, especially in the regions of Sédhiou and Matam.
On the subject of schools, the study authors judge that pupils’ emergency access to sanitary towels should be facilitated and modules on MHM should be developed for the secondary and higher education curriculums.