A member of the Rotary Club of Kampala Nalya, Nkutu started paying greater attention to menstrual health issues when free sanitary pads for school-age girls became an electoral campaign issue in 2015. “The argument put forward is that provision of free sanitary pads will reduce the high school dropout rates among adolescent girls,” she says. “However, menstrual health management has many tenets, and sanitary pads are only a small part.”
Nkutu has long believed that solutions must be systemic, so she joined others in Uganda, many of them Rotarians, in advocating for public policies related to menstrual health management. This first required breaking down the silence and taboos around menstruation, so that members of Parliament could talk about it. “Menstrual hygiene was one of those things that until recently was not really spoken about,” she says. It was seen as a women’s issue, and “men don’t feel like they should be involved. Then when girls went to school, well, the schools are run by men who don’t even think about [menstrual hygiene]. So girls would rather stay home than possibly be the joke of the school.”
Nkutu and many others cheered in 2018 when the Ugandan government developed national guidelines, which still need to be formally approved, to promote and require menstrual health management standards. According to Uganda’s Ministry of Education and Sports (MoES), these guidelines establish minimum menstrual health management standards, guiding principles, and illustrative strategies for the country’s schools and institutions.
Nkutu and other Rotary members in Uganda are now focusing on the enactment of those guidelines. “We have been working to ensure we integrate menstrual health management in schools and also get parents and communities involved,” she says. “We hope that this endeavor will raise awareness so that parents begin to understand what girls go through and what kind of support and information they require.”
Adequate menstrual health management includes ensuring that girls have access to clean, blood-absorbing products that can be changed in private as often as necessary; soap and water to wash themselves as required; convenient facilities to dispose of used menstrual products; and sufficient information about menstruation, including how to manage pain.
Rosette Nanyanzi, technical adviser for gender at MoES, says that one key challenge to enacting the new guidelines has been obtaining funding. “We have already come up with a national strategic plan that brings together many stakeholders because we realize we cannot do it alone,” she says. “That is why we are happy to work with partners like Rotary.”
Since 2019, Ugandan Rotary clubs and USAID’s Uganda Sanitation for Health Activity (USHA) have had a formal collaboration on projects related to water, sanitation, and hygiene, with menstrual health management a key component. The Rotary-USAID strategic alliance, Rotary’s largest partnership effort outside of polio, pairs USAID’s technical expertise with the grassroots energy of activists like Nkutu, who work with the communities to ensure that standards are met.
To date, 29 Rotary clubs in Uganda have participated in the partnership. USAID is working to improve sanitation and hygiene in schools by providing infrastructure — including female-friendly toilets and incinerators — as well as any associated training. Meanwhile, Rotary is taking the lead on advocacy, working with district water and sanitation coordination committees and school management committees to support the implementation of the national guidelines. Rotary also manages the construction of water supply systems such as wells and rainwater-harvest tanks.
“The Rotary-USAID Partnership complements the strengths and amplifies the impact of both organizations — completing the WASH equation,” says Jonathan Annis, chief of party at USHA.
At Natabi’s school, for instance, the partnership has contributed to the construction of a borehole and latrine block for girls, including a changing room, and an incinerator to help in the disposal of sanitary waste. Says the school’s head teacher, Ronald Katambala, “Now we have access to a changing room, running water, and soap. Girls will no longer miss classes.”
But a girl’s plight doesn’t change until attitudes do, so MoES has developed a training manual to help teachers and other stakeholders promote menstrual health management within the school setting and in their communities; Rotarians and their partners are helping disseminate the information. “We realized that communities did not have information, and parents are also not comfortable discussing issues of menstruation with the girls,” Nanyanzi says. “We need to provide them with that empowerment.”
With manufactured and store-bought menstrual products still financially inaccessible for most Ugandans, Rotary-supported initiatives are teaching students how to make their own sanitary pads from cheaper, locally sourced materials. Inside one of the classrooms at Ndoddo Primary School, a group of pupils listens attentively as the instructor, Resty Nakatudde, demonstrates how to make reusable pads.
A typical session begins with the teacher giving a talk on sexual reproductive health and menstrual hygiene in general. She talks to the boys as well, to ensure they also understand. “Now we are going to make pads,” she says as she demonstrates. “We shall have a cotton cloth, polythene paper, a liner, a needle, threads, and a button. The cotton cloth is going to be on the top so that when we menstruate, the blood is absorbed and it does not leak.”
After going through each step in the pad-making process, students come forward one by one to demonstrate what they have learned. They also receive printed instructions for making the pads. After the training, girls are encouraged to make pads for their own use. The boys donate theirs to their sisters or other girls in the community.
Says Nakatudde, “Our focus is to present menstruation as a natural step in a girl’s growth and not something to be ashamed of.” Involving boys helps to destigmatize the topic and limit any teasing. “From the feedback we have been getting, boys no longer shame girls when they stain their uniforms. They are offering all the support that they can give.”
To achieve maximum benefit, the training has also been extended to parents, which Nakatudde says is critical in passing on basic knowledge and information about menstrual hygiene management, including how parents can help support their daughters in managing menstrual symptoms such as pain. Most have been supportive; at some schools, parents are contributing money for materials to make pads that can be distributed to girls when they need them.
Nakatudde says there is still a need for increased sensitization and advocacy to break long-held menstrual taboos. “Perceptions about menstruation, especially in communities where we have been doing work, are changing. But we still haven’t reached as many people as we have wanted to.”
For Natabi, the effort has changed her life forever. With the skills she learned, she now can effectively manage her period. “Since I started making my own pads,” she says, “I can engage in activities like cooking and fetching water without worrying. And I never have to skip school.”