How period poverty, lack of access and participation impacts menstruating women and girls with disability 

Olajide Adelana (Abuja)

Her choice of lipstick may not be a good match for her skin-tone but her smile which portrays her optimism certainly compensates for it. Lounging around on a hot afternoon with a matching headdress overflowing unto the ground, Amiru Najatu, whose livelihood is reliant on almsgiving has never used a sanitary pad since she started menstruating 5 years ago.

Paralysed in her limbs when she was a child due to a polio infection, Najatu says access to menstrual hygiene kits and sanitation facilities including toilets whenever she is menstruating is characterized by hardship.

Without access to a wheelchair or crutches, 20-year-old Najatu says, her disability which affects her income and also limit her ability to buy 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 realise from begging for alms to buy food and water to clean myself whenever I am on my period. But, I cannot buy sanitary pads because the money is oftentimes not enough,” Najatu whose face is daubed with a blue powdery substance says of her proceeds from alms-begging.

Gladys Ajebe lives in Kado, a suburb in Abuja, Nigeria’s capital. She shares the same fate as Najatu. Ajebe whose right limb is halved as a result of an auto accident 17 years ago, walks with the aid of an old pair of crutches. The 40-year-old mother of two faces huge hurdles whenever she is menstruating.

“I don’t look forward to my menstrual period,” she said of her hardship.

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 said she rarely make use of sanitary pads because she cannot afford it.

“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 mess of myself,” she said with a defiant smile that seems to betray her condition.

Despite being a natural phenomenon, without which human existence would be threatened, menstruation is still a nightmare for many women across the world who lack access to basic hygiene and sanitation during their periods.

Described as the inability of menstruators to afford proper menstrual hygiene products including tampons and sanitary pads during menstruation, period poverty, has been a nagging issue in Nigeria.

Water, Sanitation and Hygiene (WASH) experts acknowledge that period poverty predisposes menstruating women and girls to unhygienic practices and it is even made worse by the huge statistics of poor people in Nigeria. With a staggering statistics of 82 million people living below the poverty line of 137,430 naira/year, according to the National Bureau of Statistics (NBS), purchasing menstruation sanitation products becomes a tall order for most women and girls.

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Wanda Adu, Executive Director, Wanda Adu Foundation has seen quite a lot in her years of working with vulnerable women and girls. Adu admits period poverty is rife and women who are not sure of a meal in a day for their children sees 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 pad. Hence they improvise,” she said.

But this unintended lifestyle preference enables poor menstrual management which increases women’s vulnerability, especially those living with disability, towards potentially life-threatening ailments. While this concern is valid in Nigeria as elsewhere, efforts to address this issues have started gaining attention.

“Water Supply and Sanitation Collaborative Council (WSSCC) together with in-country partners and stakeholders in the sanitation and hygiene sector have been providing the much needed support to the Nigerian government in ensuring that sanitation and hygiene issues are mainstreamed at all administrative levels in the country,” Ms. Elizabeth Jeiyol, National Coordinator for WSSCC Nigeria said at an event to commemorate the Menstrual Hygiene Management (MHM) Day in Abuja last May. This collaboration with stakeholders such as UNICEF, Sanitation and Water for All (SWA) including WSSCC, who’s transitioning into Sanitation and Hygiene Fund (SHF), offers more opportunities for Nigeria to address her sanitation, hygiene and menstrual health realities.

Groundswell of measures

Issues of sanitation and hygiene have begun to experience a groundswell of attention from policy makers, civil society organizations and the organized 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, earmarking of N10bn for the construction and rehabilitation of water schemes, launching of the distribution of one million sanitary pads to indigent women and teenage girls, and also collaborating through the Ministry of Women Affairs (FMWA) with in-country partners to establish, for the first time, a technical working group on Menstrual Health and Hygiene Management (MHHM) in Nigeria. Whilst these efforts are commendable, WASH sector practitioners have argued that, addressing obstacles to menstrual health and hygiene in Nigeria requires a bucket  list of factors  be considered.

“These factors 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 PLWDs

There is a widespread convergence that enablers of unhygienic practices during menstruation, has an unpleasant effect on women and girls’ health, lifestyle, and livelihoods. But these enablers further widens the gap of exclusion in menstruating women and girls living with disability (PLWD) like Najatu and Ajebe.

Furthermore, when access to menstrual hygiene and health management in PLWDs is benchmarked against those without disability on the basis of equality, queries thrown up often points at programmatic and design lapses. Ms. Ekaete Umoh is the National President, Joint National Association of Persons with Disability (JONAPWD). Umoh posits that there is need to 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 disability may not be able to get there. If the water point is in a place where it is high, someone living with 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 wheelchair,” she said.

She added that different factors particularly the impairment type should be considered when addressing unhygienic menstrual practices in women and girls with disability.

“The way a blind person will manage menstruation is different from the way a wheelchair rider or paraplegic will do. 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.”

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To address these concerns and mainstream women and girls with disability in menstrual hygiene management, government must step up and address issues of access and participation and not see PLWDs as recipients of charity, says Umoh.

“For instance, 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 about government programmes in this regard.”

But, that is not all. Inclusion of PLWDs in projects and programmes should begin with allowing them take part in designing government projects and programmes, says Umoh.

“In any WASH programme, PLWDs should be factored from the design to the implementation stage. They should not only be recipients of charity. PLWDs also want to participate in the decision making process that affects them as it were, “she said.