DIVINE DROPS VISITS AFRICA.
Students taking part in a matching game on reproductive health | Makenna Hartwich.
Last month, I had the incredible opportunity to travel to Zanzibar, Tanzania, to help launch Divine Drop’s Tanzanian pilot program. Divine Drops is a nonprofit working to end period poverty globally, beginning with programs in Tanzania and Uganda. Period poverty refers to “a lack of access to menstrual products, sanitary facilities, and adequate education” (Cardoso et al.). Period Poverty afflicts roughly 500 million people who menstruate, affecting women living in poverty in high income countries just as it does those in low and medium income countries (Cardoso et. al). A healthy and safe period is an essential human right; period poverty is not only a public health issue, but also stands in the way of achieving true gender equality. Due to social stigmas and lack of supplies, millions of girls worldwide drop out of school after menarche, their first menses (Ackatia-Armah et al.). Divine Drops, a US nonprofit founded by health workers in 2020, aims to help end period poverty by 2040. Just as no period is the same, the solution to making period care safe, easy, and accessible for all women is not universal. Each culture has their own traditions and practices surrounding menstruation, with most girls following the example set by their mothers. Many cultures celebrate menarche. In South India,when a Tamil girl has her first period, her family gathers for a celebration, she receives gifts and a special meal to mark the occasion. Unfortunately, in many places, girls are taught to be ashamed of their period; menses is something to be dealt with but not discussed. When menstruation is treated as a taboo subject, shrouded in secrecy and shame, it is difficult to change the narrative and provide essential education. In places where people discuss periods openly, the discourse typically focuses solely on hygiene and menses itself, ignoring the rest of the menstrual cycle. Too often, women accept that periods are supposed to be painful, preventing many from seeking medical attention for abnormal cycles and symptoms. Unsafe practices surrounding menstruation are perpetuated by the lack of discussion on the topic. Lacking access to sanitary supplies is a global challenge. Scotland’s recent passing of legislation making period products free of charge for anyone who cannot afford them was a step in the right direction; however, it highlighted the persevering issue of period poverty in nearly every country globally (Sullivan). A survey of low-income women in the US found that nearly half the survey subjects had to choose between affording food or menstrual hygiene products at some point during the year. Participants reported using “cloth, rags, tissues, toilet paper and sometimes even diapers or paper towels taken from public bathrooms” (Carroll). In Tanzania, many women turn to similar materials since disposable pads are difficult to find in many rural areas and prohibitively expensive (Sommer 524).
Sewing reusable pads | Linda Carnell - Brand & Bloom Photography
These alternative methods are prone to leaks and greatly increase the risk of infection. A UN study found nearly 17% of menstruating students in Tanzania miss school during their menses citing reasons including lack of supplies, inadequate washroom facilities, and fear of embarrassment (Unicef 4). Teasing surrounding menstruation is a significant problem in Tanzania. One study found 87% of girls fear teasing attributed to menstrual odor and 80% fear teasing due to leaks (Benshaul-Tolonen et al. 6). Such fears lead to decreased concentration and class participation, as many Tanzanian schools require pupils to stand when speaking. In addition to providing facilities and sanitary supplies, these findings demonstrate that reducing gender gaps in education requires reducing harassment from adolescent boys. The best way to reduce stigma and harassment is by educating boys on menstrual health and creating a more open dialogue. Solutions to ensure everyone has access to easy, safe, and painless period care are not one-size fits all. Many programs globally have sought to tackle this issue by providing extra supplies; however, this is, at best, a temporary fix as it fails to address underlying systemic factors. One sustainable solution growing in popularity is menstrual cups. They offer advantages such as their low cost, low waste, and long lifespan; however, insertable period products such as menstrual cups and tampons are not acceptable for most in the region due to many cultural and religious beliefs (Hennegan et al . Providing supplies of disposable pads is not a long-term solution. The region lacks central waste management systems, making sanitary disposal of sanitary pads challenging (Ntakamulenga 8). Provided supplies are finite and the high cost of pads means that many families cannot afford to buy more. Families that can afford to purchase them will commonly try to make the package last for as long as possible. Experts advise that disposable pads be changed at least every 4-8 hours (American College of Obstetricians and Gynecologists). However, when we asked a room full of secondary school girls in Zanzibar how many receive just one pad to last them the entire day, nearly every hand went up. The material and chemicals in disposable pads can cause irritation and micro-tears when worn for too long. This allows for bacteria to enter and cause infections – an issue far less common when using cloth materials.
Students examine the material the pads are made of | Makenna Hartwich Mikaela Ingram, founder of Divine Drops and a US travel nurse, worked with other healthcare workers to design a reusable pad to overcome several of these challenges. The reusable pads are extra absorbent to prevent leaks and, while it is not ideal, they can be safely worn all day if there are no facilities or opportunities for the girls to change them. They can be made from locally available materials and sewn with a simple pattern. Once washed and rinsed, laying them in the sun to dry is sufficient to kill remaining bacteria. To distribute these reusable pads and to provide women and girls with information on menstrual and reproductive health requires developing programs and forging long-term partnerships in various regions. Divine Drops is working to create community-focused approaches which cater to the specific requirements of each location and to gain the support of local leaders and activists to ensure the longevity of their programs.
Founder Mikaela Ingram with uterus and vulva anatomical models | Makenna Hartwich
When I joined Mikaela in Zanzibar, as part of the photography team capturing the Tanzanian program launch, she had already been in Africa for two months. She split her time between Uganda and Tanzania, working on the ground to learn how her nonprofit could make the most meaningful impact. I had the chance to meet with representatives from the Tanzanian Ministry of Health, who Divine Drops is partnering with to create youth health clubs around the country. Ten “Afya Yangu” or “My Health” clubs are launching in secondary schools in Zanzibar and mainland Tanzania this year, with plans to expand to more schools in upcoming years. These clubs will educate girls on how to have healthy cycles, combat misinformation and unsafe practices, and provide a supply of reusable period pads for every girl. They will also provide the supplies to make more pads the girls can sell in their community, helping more women to access them while also developing key business and entrepreneurial skills.
Shufaa Nassor teaching girls how to track their cycles | Linda Carnell - Brand & Bloom Photography
I also had the chance to meet with a remarkable young activist and nursing student, Shufaa Nassor, who calls herself Madame Hedhi Salama (Madame Menstrual Health in Swahili). When she first started advocating for safe periods and teaching about menstrual health, she was dismissed by many and ridiculed by others, including some of her own family members. However, driven by a goal of eliminating the stigma surrounding menstruation, she persevered. She is an invaluable educational partner for developing the Divine Drops programs in Zanzibar. My favorite part of this experience was visiting the schools in the pilot program and seeing the girls excited to receive their own supply of reusable pads in addition to extras to give to their family members. It was exciting to see their enthusiasm for and participation in the learning activities grow throughout our time with them, despite their initial shyness and hesitation.
Students holding up their reusable pads and educational guide | Linda Carnell- Brand & Bloom Photography Madame Hedhi Salama translating questions | Makenna Hartwich There is still much work to be done worldwide to give everyone who menstruates the supplies, resources, and support they need. We must eliminate the harmful social stigmas surrounding a natural part of life for half of the population. I am grateful to have had the chance to work with inspiring people enacting real change in their communities. I am so glad I was part of the team helping to document the program launch, and thankful to the girls involved with the program for welcoming us and allowing us to share their experiences and stories. If you would like to follow the development of the Tanzanian programs or donate to help expand programming to more schools, please visit www.divinedrops.org. To learn more about period poverty globally, the links provided below are a great starting point. Menstruation and Human Rights FAQ Around the world in 28 Periods.
The rest of the photography team:
Annabelle Hartwich, videographer
Linda Carnell, photographer, Brand and Bloom Photography
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Works Cited Ackatia-Armah, Nana and Marni Sommer, Susan Connolly, and Dana Smiles. “A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia,” Compare: A Journal of Comparative and International Education, vol. 45, no. 4, 24 Jan 2014, https://doi.org/10.1080/03057925.2013.871399 American College of Obstetricians and Gynecologists. “Your Changing Body: Puberty in Girls.” ACOG, www.acog.org/womens-health/faqs/your-changing-body-puberty-in-girls. Benshaul-Tolonen, A and S Aguilar-Gomez, N Heller-Batzer, R Cai, and, EC Nyanz. “Period Teasing, Stigma and Knowledge: A survey of adolescent boys and girls in Northern Tanzania,” PLOS ONE, vol. 15, no. 10, 2020, https://doi.org/10.1371/journal.pone.0239914 Cardoso, L. and A. Scolese, A Hamidaddin, et al. “Period Poverty and Mental Health Implications Among College-aged Women in the United States. BMC Women's Health 21, 14 (2021). https://doi.org/10.1186/s12905-020-01149-5 Carroll, Linda. “Even in the US, Poor Women Often Can’t Afford Tampons, Pads.” Reuters, 10 January 2019. https://www.reuters.com/article/us-health-menstruation-usa/even-in-the-u-s-poor-women-often-cant-afford-tampons-pads-idUSKCN1P42TX Ntakamulenga, Robert. “The Status of Solid Waste Management in Tanzania.” Coastal East Africa Solid Waste Workshop, 10 September 2012, Flic En Flac, Mauritius. Sommer, Marni. “Where the Education System and Women’s Bodies Collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania,” Journal of Adolescence, vol. 33, no. 4, 2010, pp. 521-529, https://doi.org/10.1016/j.adolescence.2009.03.008. Sullivan, Becky. “Scotland Becomes the First Country to Offer Tampons and Pads for Free, officials say.” NPR, 16 Aug 2022,https://www.npr.org/2022/08/16/1117748486/scotland-tampons-pads-menstrual-free-period-products. Unicef. “Menstrual Health and Hygiene Situation Among School Girls In Tanzania” https://www.unicef.org/tanzania/media/2726/file/2021%20MHH%20Brief%20-%20Main%20summary%20report.pdf.