On February 24, 2018 we welcomed our nine volunteers to Ghana. Our volunteer group included five RNs, one nurse practitioner, and three non-medical volunteers. This mission focused on girls and women, and included something new for Healthy Villages, Inc. Since July 2017, over 100 volunteers in Virginia USA gathered together to contribute their time, energy and money to sewing and putting together 600 kits of washable sanitary pads and hygiene products for school girls in poor villages in Ghana. The kits included two moisture-proof panty shields, ten flannel pads, two pair of underwear, a washcloth, enough pain reliever for one period, body wash or soap, and clothespins for hanging the laundered pads. This huge undertaking by the hardworking and dedicated volunteers in the US was rewarded by clapping, calls of “God bless you!”, and remarks such as “this gift will be life changing for me!” by the girls and women who received the kits.
The main part of the pads distribution portion of this mission extended over two days. We located ourselves in one village each day and school girls from middle and senior high walked to us with their teachers. Some of the girls walked up to two and a half miles. The groups of girls participated in an educational class where they learned about menstruation and menstrual hygiene, reproduction, sexuality, and how to use the kits we provided. The classes were taught by one of our Ghana Health Service staff nurses and the two women from the US who organized the creation of the kits.
We had a glitch in our plans on the second day. There were more students arriving than we had counted on, so we decided to split the kits in half so that every student could get at least something. Things got a little confusing… long story short, when we recombined the half-kits that were left, we had about 150 full kits left to distribute throughout the rest of the mission.
We had one additional day of pads distribution at a remote village in a different municipal district, where their local community nurse and one of the secondary school teachers from the nearby school organized an educational program on menstrual hygiene and sex education for 42 girls. Each of these girls received a kit from us, too. This program was heartwarming in that it was clear that the nurse and teacher were ongoing positive role models for the young girls and were very open about the challenges facing them regarding menstruation and sexuality.
The remaining kits were handed out to women expressing a need for menstrual hygiene products during our three-day health mission.
We administered a short questionnaire to girls receiving the kits to get some background information about their menstrual hygiene and educational needs to guide us in the future, should we continue this project. Giving the questionnaire was a challenge. Our Ghana staff agreed that to get reliable answers, the questions would need to be explained to the students in an interview format. This took a lot of time, so we couldn’t get questionnaires from every recipient. We were also concerned that the girls might have given the answer they thought we wanted to hear, or that was expected of them. However, our nurse volunteers quickly learned how to conduct the interviews to elucidate more honest responses. Nonetheless, the answers given may be skewed. We were able to collect data from 272 of the girls; about half of the girls who received kits. Here are some of the findings:
21.3% of the girls stated they miss at least one day of school during their period. Of the girls reporting missing at least one day of school, they reported the main reason being physical pain/cramps (82.5%). They also reported having a heavy flow that prevented them from going to school (12.7%) and 4.8% said they miss school because they have no access to menstrual hygiene products.
When asked what form of menstrual hygiene they normally use, 75% reported using disposable pads, 22% use a cloth or rag, about 2% said they use toilet paper or napkins. Some girls use more than one form of hygiene product. 75% said their family buys their disposable pads; 16% said they buy their pads with their own money – and reported that this meant the money given to them by their parents for school expenses or meals, or that they sold vegetables or other commodities to get money for their menstrual hygiene. 5% of the girls reported that their boyfriends buy their pads.
We later learned that because of the expense of disposable pads, many girls and women wear the same pad all day, even when their flow is heavy. In this hot and humid climate, that is a sure recipe for vaginal bacterial infection. A private conversation two weeks after the pads distribution, with several of the girls who received kits, revealed that while the family may buy disposable pads, they cannot afford to buy enough pads for their needs. In the future, it would be helpful to find out how many times the girls change their menstrual hygiene product during the day.
Less than 1% reported that “no one” explained menstruation to them. Most of the girls said their mother (63%) or a teacher (22%) explained menstruation. About 3% of the respondents said that “no one” explained sex and reproduction to them. About 49% said that their teacher explained these topics, and about 34% acknowledged their mother as having imparted this information. A few of the girls said that their teacher’s explanation was inadequate. A few girls also reported their grandmother, father or brother had explained menstruation and sexuality to them.
19% of the girls reported being sexually active – one girl stated her first sexual experience was age 9 when she was raped. One of the teachers stated emphatically that “at least 50%” of the girls in her class are sexually active, so the girls we interviewed may have felt uncomfortable being open with us. Interestingly, about 40% of the girls said they were hoping the education class would help them learn how to avoid pregnancy and STIs – leading one to suspect that the teacher is correct in her estimate. About half of the girls reporting sexual activity stated they don’t use any birth control – about half stated their partner uses a condom. Overwhelmingly, the girls did not seem to understand the connection between menstruation and pregnancy, although they did understand that intercourse could lead to pregnancy and STIs. 13% of the girls who are sexually active had been pregnant once already.
During the final day of pads distribution, the community health nurse asked the group, “why are you having sex with your boyfriend?” One girl immediately raised her hand and said, “because our parents don’t give us what we need.” Unfortunately, the nurse didn’t ask further questions about what she meant. It would have been interesting to learn if girls are engaging in sex to get “gifts” of clothing, food, or even menstrual hygiene products, from their boyfriends. In a discussion with a former secondary school teacher, we learned that some teenage girls have sexual relationships with married men much older than they to get what their family can’t afford to provide.
The girls reported a variety of reasons for attending the pads distribution program, but about 60% stated they wanted to get the reusable pads and learn more about menstruation. Contact information for the teachers who accompanied the girls was obtained, and we plan to do follow up interviews with the teachers, and potentially the students, in 3-6 months to find out if they use the pads, and their comments about what they found helpful or not helpful about them.
PLEASE SEE PART TWO FOR DETAILS ABOUT OUR WOMEN'S HEALTH MISSION OUTREACH CLINIC!