Over the past two years, Uganda has responded to an immense influx of refugees from its neighbouring countries. While new arrivals from South Sudan have slowly reduced, Congolese refugees are crossing the border in large numbers. As a result, Uganda is currently hosting the largest number of refugees in the country's history. It’s estimated that there will be 300,000 Congolese refugees in Uganda by the end of 2018 and the vast majority of them are women and children.
Globally, girls and women often lack the ability to manage their menstruation safely and with dignity due to a lack of adequate facilities, products and knowledge, which can be further exacerbated in refugee settings. In many cases, Menstrual Hygiene Management (MHM) is overlooked in emergency situations, which has an impact on areas like personal hygiene, education, gender equality and health. Reusable pads in this context have rapidly gained interest from development and humanitarian partners as a more sustainable, costeffective and environmentally friendly solution for MHM related challenges in emergencies.
In collaboration with AFRIpads, UNHCR Sub-office Mbarara implemented a three month pilot intervention in three southwestern settlements to test the appropriateness and acceptability of introducing reusable sanitary pads to schoolgirls in the refugee context. Product distribution (AFRIpads Menstrual Kit with 4 reusable sanitary pads, underwear, soap and bucket) was accompanied by a menstrual hygiene training as well as instruction for the appropriate use and care of AFRIpads. Data collection for the pilot evaluation was carried out at baseline and endline via individual interviews and focus group discussions.
Results from the baseline study indicated that schoolgirls in the southwestern refugee settlement context lacked access to the menstrual hygiene knowledge and products required for them to manage their menstruation in a healthy and dignified manner. Although UNHCR mandates that all women and girls of reproductive age are to receive distributions of disposable sanitary pads, soap and underwear, 71% of the girls reported not having enough menstrual products, 65% reported not having enough soap and 59% reported not having enough underwear. 44% percent also reported that they didn’t have enough information about menstrual hygiene. Access to water was not, however, reported to be a major challenge with 65% reporting they always had enough water to manage their menstruation (the remaining 35% reported “sometimes”) at baseline.
Participants generally reported being satisfied with the facilities available for changing, washing and drying their AFRIpads. The number of girls that reported missing school during their period was cut in half when using AFRIpads and the girls indicated a significant drop in the number of leaks they experienced (59% to 9%) as well as a significant decrease in itching or burning (73% to 24%). During the wet season, when drying times are longer, girls mentioned they need more AFRIpads to manage their cycles. However, respondents generally reported being satisfied with the infrastructure and facilities available to them to wash and change their pads at school.
Prior to the intervention, girls reported that their main challenge was not having enough products and 20% even admitted reusing disposable sanitary pads because they had no other options. Many refugee girls could not remember the last time they had received disposable pads from a general distribution. This underscores the ongoing logistical challenge that UNHCR currently struggles with in sustaining timely replenishments. After the intervention, not having enough products was no longer reported to be a top challenge, implying that the AFRIpads provided in the MHM kits met that challenge for many.
Access to enough soap and underwear remained top challenges even after the intervention, indicating that there is a larger, structural challenge in providing enough supplementary MHM necessities. It is important to note that access to enough soap and underwear is crucial, irrespective of the solution used (disposable or reusable). Reported access to water, however, went up at endline with 73% reporting they always had enough water to clean their AFRIpads.
Product uptake among the study participants was 99% and respondents reported high levels of satisfaction with all aspects of the AFRIpads. The girls retained the instructions provided during the MHM training and adherence to the use and care guidelines was also close to 100%. Even before AFRIpads were introduced, 52% of the participants indicated a preference for reusable pads over disposables.
At endline, 84% indicated they’d prefer to use AFRIpads over disposable pads (8% preferred a combination of both kinds of products and 8% chose disposable only). Reusable menstrual pads were clearly culturally and socially accepted in this refugee context.
Considering the difficulty of continuously distributing disposable pads throughout the settlements and the waste management challenge disposable pads create, AFRIpads reusable sanitary pads are an appropriate, highly preferred and effective solution to managing menstruation in a safe, dignified and culturally acceptable way.