Importance of menstrual hygiene for women with disabilities

Aisha Namugga was born with a physical disability and had to undergo several surgeries to correct the position of her limbs. She started her period while in Primary Five. 

“My parents had never talked to me about menstruation but I would see my older sisters buy what I thought were biscuits. One day, I insisted that they share some with me. One of them told me they were pads which every girl must use when their period starts. She assured me it was normal and even showed me how to use them,” Namugga recalls.

However, Namugga’s period was irregular and after only three cycles, she did not menstruate again until she joined O-Level. Her mother, who thought Namugga had not or would never get her period due to her disability was surprised.

“When my mother told a relative who had sterilised her daughter living with disability to avoid the ‘burden’ of having to keep her clean, that relative advised my mother to take me for sterilisation as well. Fortunately, my mother declined the suggestion,” Namugga says.

Believing that her autistic daughter would never get her period, Madina Namatovu is now remorseful that she did not prepare her for this critical stage in a girl’s life. When her 14-year-old finally started her period, she was so scared that she cried for days. 

“Although I have taught her how to use a pad, she still asks why she bleeds every month. I hope that with time, she will understand that this is a normal part of growing up,” she says.

The bigger problem

Globally, more than one billion people are living with some kind of disability or impairment but more women and girls face disability (about 19 percent) compared to men and boys (about 11 percent). 

In many countries, sanitary pads are not affordable and according to Dr Immaculate Nabukenya, a researcher at Makerere University in Kampala, desperate girls and women use unsanitary means (such as leaves, sitting in sand, using rags) to address menstrual hygiene. Even worse, some engage in transactional sex to obtain sanitary products.

Research also highlights the relationship between period poverty and moderate or severe depression. However, girls and women with disabilities face even greater challenges in managing their menstruation hygiene with dignity. 

“We face double stigma due to both social norms around gender, menstruation and disability. One day, I went to buy pads and the shocked shop attendant asked if I also menstruate. I politely replied that I did but since then, I ask someone else to buy the pads for me,” Namugga says. 

Challenges

A 2019 systematic review of menstrual hygiene management requirements, its barriers and strategies for persons with disabilities found that menstruation challenges were a source of shame for girls and women with disability.

Different disabilities come with different challenges. For instance, Namugga says, those with vision impairments may not know if they have stained their clothes or cleaned themselves properly. 

Also, menstruating girls and women with physical impairments in their upper body such as the arms may have difficulties placing their sanitary protection materials in the correct position and washing themselves, their clothes, and menstrual materials. 

The additional stigma of menstruation makes girls with disabilities less likely to receive the information, supplies and support they need for menstrual health and hygiene. Namugga says the inability to belong to a certain group of peers because of a disability limits one’s access to information.

“Some people with physical disabilities associated with their hands have no privacy since they need someone to help them place the sanitary material, change and wash. If the helper is busy, such a person will not change the pad or even take a bath, which exposes them to infections,” Dr Nabukenya says.

It is often assumed that girls with disabilities do not menstruate. Many of the girls do not get information about menstruation health and hygiene and the facilities are not disability-friendly, posing a bigger barrier. 

The stigma, misunderstandings and exclusion of such people often leads to harmful practices such as forced sterilisation for girls with intellectual disabilities in order to manage menstruation according to a systematic review of disability and menstrual health and hygiene by the United Nations Children's Fund.

"Girls with disabilities also face a challenge of inaccessible water, sanitation and hygiene facilities in communities as well as schools, health-care facilities and public places, which prevents girls and women with disabilities from participating fully in social and economic life," adds Dr Nabukenya. 

Way forward

● It is important that those with intellectual and developmental impairments have accessible and easy-to-read materials tailored towards supporting them to communicate their needs and learn about menstrual health and hygiene.

● Education of parents, relatives and caretakers of girls with disability is needed to dispel menstruation and disability myths.  

● Girls and women with disabilities should be included in monitoring and feedback processes designed to suit their varied communication needs and sanitary supplies. 

● Sanitary materials and supplies such soap and water should be placed at heights reached by little persons and those in wheelchairs. 

● According to Bob Mayonza, the country director for Pilgrim Centre for Reconciliation, involving boys is one of the most important ways to fight stigma that comes with menstruation. 

“Let all boys and men get involved in the menstruation process by providing sanitary supplies and support to all women with or without disability in order to counter stereotypes associated with menstruation,” he says.