Worth bleeding for: Part 1

Following from my previous post on the DWSS master-plan project in Cameroon to drastically improve rural access to safe water, another parallel major aim was targeted towards sanitation. The project seeks to increase sanitation access rates from 15% to 60%, with plans to service almost 750,000 rural inhabitants. However, whilst DWSS is focused on rural communities, urban sanitation in Cameroon still stands at 17%. This ultimately sheds light on the large development gap in sanitation despite greater infrastructural progress in Cameroon. In fact, access to sanitation regressed from 1990 through to 2008 and thus not meeting the sanitation Millennium Development Goal. This may be explained as Cameroon's infrastructure, like in many African urban areas face the challenges of meeting vastly expanding populations (Davis, 2006). Hence, due to ill-equipped water infrastructure of maintenance and rehabilitation, sewage systems remain blocked, leading to the reliance on traditional slab/pit latrines.  

Poor sanitation can often result in widespread cases of severe diarrhoea, where according to the WHO, 88% of the cases align with poor environmental conditions and a lack of excreta management. In addition to the well known physical health impacts, immense economic impacts of poor sanitation form major losses for nations such as Ghana. From a study by the Water and Sanitation Program, Ghana suffers an overall loss of GHC420 million (equivalent to almost $71.2 million) annually. A segment of the cost analysis break-down is shown below:

        Source: WSP, 2012

This analysis break-down highlights the essential element of time poverty that accompanies poor sanitation. As 4.8 million people in Ghana have no latrines to access at all and defecate in the open, time is heavily spent on finding locations to safeguard privacy and dignity, as well as to avoid considerable social implications of physical attack and sexual abuse. Notably, this disproportionately affects women and young girls, who are additionally under various other time constraints for childcare, household duties, and collecting water. So not only do they walk long distances for water sources as described in my previous posts, but also face the burden of travelling an average of 52 metres to either shared facilities or safe open spaces to defecate. Furthermore, studies have shown that women experience greater health vulnerabilities as opposed to men. Strunz et al., 2014 have analysed that women exposed to inadequate sanitation are more susceptible to hookworm infections from contaminated soil that infect their intestines, eventually resulting in severe iron deficiencies and causing maternal anemia. Another effect, mainly to pregnant women and girls in their reproductive ages, is the interaction of both diarrhoea from sanitation and malnutrition, which induces a vicious intergenerational cycle, deteriorating the health of both women and infants. Grouping these impactful health concerns with the intensified time poverty ultimately contributes to the breakdown of Ghana's economic analysis we started with above. Majority of the loss, US$215 million, stems from premature deaths and infant mortality. 

However, whilst the report tackles economic losses from productivity in the yellow bar, this only refers to losses due to school absences and care time for sicknesses. A shortened attention here therefore falls under the loss of productivity and school attendance among young girls mainly as a consequence of difficulties around menstruation and period poverty. In this case, it is the essence of the unavailability of menstrual hygiene products such as sanitary pads and washing facilities that adversely affect girls' ability to attend school as they not only feel highly conscious of how they may carry themselves comfortably when menstruating in public, but also due to the lack of gender-sensitive toilets and adequate facilities in schools themselves. The video below is an account of young school girls facing the adverse impacts of period poverty at Loloto Presby School in Kpandai, northern Ghana:  

From this video alone, a clear insight into the rather social and cultural implications of menstruation on girls' education is given. Factors of discomfort, fear, shame, bullying and teasing from the opposite gender played higher roles in determining girls' attendance and forcing them to stay home for their entire cycle period. Arguably, it has gone to the extent to which studies have found strong links between school drop-outs in higher primary and secondary education and puberty among girls, where temporary absences turn permanent. What strikes most is the use of rags and sometimes leaves, newspapers or animal feathers during menstruation as many girls remain unable to afford appropriate products. Certain practices such as these may create pathways to further health complications for women such as greater risks of bacterial infections (WSSCC, 2013). 

               Health risks associated with menstrual hygiene management practices | Source: Kaiser, 2019 

Thirteen year-old Agnes Bui in the video describes her need to fetch firewood to sell when not in school in order to buy sanitary pads. But the harsh reality for many other girls to afford pads goes beyond firewood. Recent stories have emerged, stating the act of sex work or abuse in exchange for sanitary pads or money to then be used to buy pads. To me, as a women myself, I found this truly shocking to my core. In one woman's account in the article, she discloses how she even faced a pregnancy as a result of forced intercourse for pads, describing this event as a trap just for menstrual products. What further exacerbates the likelihood of these transactions to continue is the deeply entrenched taboo that surrounds menstruation, both among men and women, and society as a whole in many villages and towns. 

Here, I showcased the disproportionate effects on women, stemming from poor sanitation, a lack of sanitary products for menstrual hygiene management and considerable societal factors involved for which calls towards an urgency for solutions of sanitation targeted towards women's health and menstrual needs. In doing so, a call for overcoming the ingrained taboo around menstruation and its sheltered nature is required to enable important conversations and promote open education to both females and males. In my next post, I will be exploring further the deepened societal perceptions and stigmas of menstruation that perpetuate the ongoing struggles of adolescent girls and discuss potential sustainable solutions to safeguard their health, justice and dignity. 

Till next time!