Data were collected in six localities and included 6 focus group discussions with young girls, 9 interviews with teachers and 6 observation tools from each locality that contained information on menstrual supplies in the community. Results from this study have been arranged into three broad categories: personal feelings toward menstrual management, environmental factors that affect menstrual management and behaviours undertaken to address menstrual management. During focus group discussions, students echoed one another, expounded on opinions of their peers and, in one case, began an impromptu demonstration on how to sew a homemade pad. A mention of sex and/or sexuality arose in nearly all discussions. Despite the sensitive nature of this topic, there was no apparent or expressed tension or mistrust of the moderator or note taker. Following each focus group discussion, at least one student approached the female moderator or note taker to ask specific questions about menstruation and pregnancy. Many girls remarked that this was their first opportunity to discuss menstruation without embarrassment or guilt.
While at times girls expressed neutrality about their periods, saying it is normal or "something that all women have", the topic is often associated with negative feelings such as shame, fear, distraction, confusion and powerlessness. Two notable exceptions include one instance in which a Standard 7 girl said, "When I have my period I am happy because I know I have no pregnancy" and another instance in which a Standard 8 student described menstruation as "part of God's plan for all females to pass through a stage together".
The most commonly described feeling toward menstruation is shame. Girls had difficulty articulating the source of their shame, but often mentioned unwanted attention from classmates and a general feeling that the secrecy surrounding the topic of menstruation is intertwined with a collective understanding that menstruation is somehow bad.
"The girl with her period is the one to hang her head." (Standard 7)
"Why would she hang her head?" (moderator)
"Children and boys will make fun of her." (Standard 7)
"The children have never seen this and they will start saying that she is dirty and people will start talking about her." (Standard 8)
Along with teasing from male students and younger students, which was discussed and confirmed across data collection activities - and directly observed in one school - several girls noted a societal expectation to maintain secrecy about menstruation. When probed on why periods should not be discussed, girls would often say, "Because that's the way it is" or "That's how it has always been." At other times girls were more forthcoming:
"Why can't you know that your friend is carrying Always™?" (moderator)
"It is normally kept secret, you would not allow the other people to know this." (Standard 8)
"Why do you keep it like that?" (moderator)
"You don't want other people to see this." (Standard 7)
"Others should not know this." (Standard 7)
"Why is this? Is it bad when somebody sees you with Always™?" (moderator)
"It is only that it brings you shame." (Standard 8)
"Why does it bring you shame?" (moderator)
"There are some people when they realize that you are in the periods, they take the story around even with children and you know this is shameful." (Standard 7)
"Others should not know about this." (Standard 8)
Shame overlapped with feelings of fear and distraction. Girls fear getting their periods while at school or in public. They fear having blood stains on their uniforms and being looked at "differently" or being stigmatized by peers.
If a period comes while a girl is in class, "she will be scared. Her whole mind will be centred there." (Standard 7)
"You will not be free even when you are in class, you will be thinking about your period and not pay attention to the teacher." (Standard 8)
Girls often said that they feel - or they believe others feel - incapable of managing an unexpected onset of their period:
"Sometimes a girl might not know that she is in her period until someone tells her that she is dirty on her hind and she will be frightened because... maybe it's her first time or maybe she doesn't know what to do about the blood." (Standard 8)
"When it comes, I don't feel good because sometimes it comes when I don't have pads and there is nothing I can do." (Standard 8)
In one school, girls reported that male teachers began looking at them "differently" when they started menstruating and would tease them upon returning to school after a 2 or 3-day absence in which they attended to their periods.
Teachers Perspectives on Girls' Personal Feelings
Teachers' insights served as a rich source to triangulate data reported by students. Teachers reported that they did not tease their students. They did confirm teasing particularly from small children and boys toward girls. Teachers added that many girls engage in teasing among one another and will sometimes join with boys to taunt a girl and "get back" at her. Common teases include "go make a home", "go get married", "you have visitors" or calling the menstruating girl an "upmooner," a derogatory term that indicates that a girl is menstruating (moon or "dwe" is the word for period in Dholuo). One teacher emphasized that shame expressed by girls and teasing observed in her peers is linked to the "sexual dimension" of menstruation, which underpins the topic's forbidden nature.
"When she starts to menstruate, there is a perception in our culture that she has left childhood and now she may get jumpy jumpy," (Teacher, referring to girls generally)
"Please tell me what you mean by jumpy jumpy." (Interviewer)
"I mean in our culture, when a girl begins attending (menstruating) others may view her with new eyes, as she may view others with new eyes."
"Which others?" (Interviewer)
"The men. And then the family may then worry that 'This girl may need to be dehorned. She may become horny'." (Teacher)
In general, teachers were less focused on teasing and emotions such as fear and shame, and emphasized the more pragmatic concern of menstruating girls being distracted or unfocused while in class.
"It's like you can see that she is thinking something, that she has something urgent to share, but she will say nothing." (Teacher)
"Do you ask her what she is thinking? Do you ask why she's distracted?" (Interviewer)
"I know why she is distracted. This is something (teachers) know... when the session ends, she will not leave the room (until she is the last to leave) and then when she leaves, she will wrap sweaters around her middle and she will say, 'Teacher I am so sick' and then she will go from school and not come back all day or many days." (Teacher)
When this teacher was probed, he outlined a recurring pattern observed among many of his Standard 6 students. At first, girls will try to cope with menstruation while in school. Later, they will miss school routinely - being absent for three to five days each month "in anticipation of menstruation". While the teacher's enrolment ledger showed regular absences for several female students, it was not possible to know if the absences were attributed to menstruation or another cause. Across all schools, teachers confirmed this pattern sometimes stating that instead of being absent for several days, girls will come to school but refuse to wear a uniform. Students reported varying levels of understanding on behalf of teachers accommodating the needs of a menstruating girl. While some teachers were described as supportive, others reportedly punish girls who wish to leave school early. In the latter case, girls reported leaving school "in secret".
"A girl will be among the most lively in class, she will participate and make good marks. Then she turns a corner and she will not partake and she is gone." (Teacher)
Environmental factors, here, include both the physical environment and the social environment, but it also speaks to a broader reality for girls in this setting: poverty.
Poverty prevents girls from effectively managing their periods. For example, while girls often state that commercially-available pads are their preferred method for managing their periods, a lack of money inhibits them from purchasing pads and, in two instances, inhibited shopkeepers' or kiosk owners' ability to stock pads.
"The Always™ costs money, but with cloths you just find an old piece of cloth and tear." (Standard 8)
"I choose rags because sometimes there is no money to buy pads so these help." (Standard 8)
Girls also stated that families with many orphans especially struggle to afford sanitary napkins.
Physical Environment and Sanitary Facilities
Girls reported that it is difficult to manage their periods in school due to a lack of water and an inability to bathe, which is a preferred practice if a girl is menstruating while at home. Girls reported that bathing is difficult or impossible because school washrooms are not private, lack water, or have cold water.
"It is different at school because at times you are late to school so you can't get time to warm your bathing water as required. During lunch break, also there is often no time for that so you must bathe using cold water." (Standard 7)
This student later said she typically goes home at lunch to bathe and does not return to school. Bathing at school, which is rare in Kenya though available at a few SWASH+ intervention schools, also involves the risk of being seen by others, which can lead to shame.
"May be when you go bathing there, all of the other people will know that you are in your menstrual period." (Standard 7)
Others said bathing in school is also difficult as there is no dry place to lay a sanitary napkin or cloth, and there is no basin or soap.
At one primary school, bathing is practiced in school washrooms because soap is provided by the school and water can be discretely accessed. Girls bathe immediately before going home at the end of the day. Embarrassment was not a concern as many girls engage in the behaviour regardless of menstrual status.
Social environment here refers to the household and community context in which girls live and the network of individuals surrounding a girl. In past generations, teachers said, when a Luo girl began menstruating she was not permitted to lay or sit on her mothers' bed nor could she sleep in her parent's house; instead she was sent to live with her grandmother. If the girl's father had died (implying that the mother was no longer sexually active) a girl could continue to live in her parental home. When a girl is menstruating, she is barred from engaging in a variety of household chores, such as washing the family water pot, and she may not cross the threshold into her parents sleeping quarters. These rules were described by teachers as mechanisms to maintain "respect for mothers and cleanliness in the home". Also in the past, grandmothers - or other non-sexual female elders - played an instrumental role in explaining menstruation and discussing menstrual management and reproductive health with young girls. Today, teachers stated that, due to the AIDS epidemic and its dramatic impact on the lives and livelihoods of individuals, families and communities, grandmothers are often unavailable to girls.
"In the past, she could talk to her granny about this. The grandmother would take the girl into her place and explain the way it works. Now grannies are so young - they are like age-mates with you - or they are raising so many orphans or maybe they are even now dead... Now there is no time. And nobody else is having this conversation with the girls." (Teacher)
Teachers mentioned that mothers and teachers also feel discomfort while discussing menstruation. According to one teacher, the topic of menstruation is firmly linked with the topic of sex, which is only discussed behind closed doors and among adults.
"If the parents or neighbours heard me explaining, really explaining, how to manage the issues with attending (one's menstruation) they may either become angry or they may think, 'That man is crazy.'" (Teacher)
Teachers most often said it is not their role - and it is perhaps beyond their professional authorisation- to explain menstruation to students. Several teachers added that they never received instruction on menstruation in school as young students or as teachers-in-training in Teacher College, and they therefore felt ill equipped to teach the topic.
"It is very very difficult to discuss menstruation with girls because then you must also discuss sex. And how should we then discuss sex? We are not grannies." (Teacher)
In one school, which is an exception in that it is dominated by female teachers, an older female teacher mentioned that she has begun individually counselling young girls on menstruation and menstrual management. She does this informally on an as-needed basis, such as when a girl has a stained dress or begins complaining of stomach aches and asks to go home. Using personal funds, this teacher also procures commercial supplies and makes them available to students when necessary. The teacher also loans kanga (cloth) or sweaters to girls if they have a stained uniform. Without prompting, students confirmed this teacher's statements.
Girls described various behaviours for managing their periods. Girls discussed several different material resources that they use (to varying success) to manage the flow of their period. The most frequently cited material used to absorb menstrual blood is cloth, including cloth from shirts or dresses, or scraps of old towels or blankets. Cloths were frequently mentioned as ineffective because blood leaks through the cloth, a bloodied cloth can slip out of panties and fall on the ground, and bloodied cloth smells "like bad eggs" or feels wet or heavy. Mattress cuttings were also mentioned as a material for absorbing blood although sometimes, if a mattress cutting gets too saturated, it can stain a girl's uniform when she sits. Commercially-available sanitary towels are used primarily among girls who have financial means (the minority). In the absence of napkins or cloth, bunches of dry, soft grass are placed in the panties or sat upon at home or girls "go for a walk."
"When you are at home you can't tie a sweater because you have to work and walk, you know, and when you sit down it can come out to the clothes. But if you go walking, it can't stain the clothes." (Standard 7)
Many girls discussed coping mechanisms in the absence of material resources, namely sanitary pads, which often are referred to as 'towels' and occasionally as 'a loaf of bread' or a 'mud guard'. These mechanisms include wearing many layers (including several panties, biker (spandex) shorts, a skirt, and a sweater wrapped around one's waist). Girls also report wearing dark clothes or wearing civilian clothes (to avoid ruining one's only school uniform). Girls reported that they sometimes try to avoid sitting and instead prefer to "loiter", or stand and wait idly in the back of the class to avoid sitting. Others reported that they try to avoid standing, which is problematic as many students must stand when participating in class (in order to answer a teacher's question). Girls added that they often try to be the last person to leave a classroom in case there is a stain on their clothing.
"The cloth may at times smell bad, or it may also fall down so some people put on many panties or many bikers. But blood can pass through the pants because they are very light. At times when blood passes through your outer clothes, you have to wait until everybody has left the class and that is when you leave." (Standard 8)
Sometimes a girl will ask a trusted friend to walk very closely behind her so that nobody will see a stain on her clothing. When asked for the most effective mechanism for coping with menstruation while in school, many girls said simply "go home."
"It's not good to go home during the morning, but sometimes one must do this." (Standard 8)
Beyond behaviours as they relate to coping mechanisms and menstrual management, girls also discussed their behaviours in terms of seeking guidance from others on menstrual management. In this sense, girls' behaviours were largely linked to social pressure to refrain from asking questions about menstrual management from family or friends. When one moderator mentioned to the girls that they seemed at ease discussing the issue in the focus group, girls explained that it was "okay" to discuss periods in this setting because the moderator was not from their community and the topic was broached by the moderator rather than the girls making it "safe" for discussion. In contrast, girls in all focus groups said they rarely or never discussed menstruation with parents, teachers or casual friends. Concerning their mothers, statements by girls included:
"You can't know what your mother does. Her period is her secret... like you want your period to be yours alone." (Standard 8)
"(A period) is normal but if your mum is a cruel person she will not understand you. She will always tell you to use cloths... She will say she did not have Always™ so why should you. " (Standard 8)
Periods are not typically discussed with teachers or the headmaster:
"Madams will just talk about you when you walk by." (Standard 8)
"Teachers can sometimes be harsh with you. She may have nothing to help you... we are not given pads at school." (Standard 8)
Teachers said that on rare occasions they had discussed menstruation with girls, typically in a one-on-one setting and only when the topic is teacher-initiated if, for instance, a girl has a stain on her uniform.
Students said if they must ask questions about menstrual management, the best person to approach is an older sister. In the absence of a sister, the next best option is to speak with a sister-in-law or a "friend in heart" (best friend). These women are most likely to explain how to use sanitary napkins and/or give money to purchase sanitary napkins or absorbent materials.
Periods are not typically discussed with friends because friends may gossip about your period, or they may interpret your confession as a veiled request for money to buy supplies.
Another behavioural factor, mentioned by a minority of girls, was a feeling that with menstruation came new responsibilities. Menstruation meant a distinct moment in the transition from childhood and child-like behaviours toward adulthood and its accompanying responsibilities. Girls mentioned that menstruation meant their bodies were "coming alive" and they were "like an adult" in the sense that they could now "mako ich" a Dholuo term that literally translates as catching a stomach, but here refers to getting pregnant.