Using the PDIA Approach for Menstrual Hygiene in Nigeria

Guest blog by Uchechi Okonmah

There have been a lot problems and misconceptions surrounding Menstruation in developing countries particularly in Nigeria. Menstrual Hygiene management amongst women and adolescent girls has become a matter of concern in recent age especially in rural areas where accesses to modern facilities are hindered by a number of factors and myths surrounding this subject.

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This era as described by the PHAAE Organization as an “era of new puberty” by a recent study where increasing number of girls starts to develop their sexuality at an early age of 7 or 8. In sharp contrast to the 1960s, where only 1% of girls would enter puberty before their 9th birthday.

In tackling this issue, PHAAE adopted the Problem Driven Iterative Adaptation (PDIA) in order not to be mired by the “big stuck” or “capability trap” where developing countries and organizations thereof are stuck doing the same thing year after year that doesn’t improve or help the situation or produce results. Even when everyone can agree in broad terms that Menstrual hygiene management amongst adolescent girls and women in marginalized areas is very poor as a result of lack of modern facilities, an inability to actually implement a strategy that addresses this means there is little or nothing to show for this realization despite the time, money and efforts (if any).

This explains how low capability exists around this subject on menstrual hygiene management. The first thing we did was to adopt a strategy that constructs and deconstructs the problem using the Ishikawa diagram also known as the Fish bone diagram: in this we noted the cause and effect of this situation by defining the problem statement and then considering the health and environmental implication of this, and bearing in mind the social norms, processes and policies that exist or have been implemented (if any); this also includes laws and solutions that have been adopted again and again, hoping for a different outcome but never producing one.  Our major aim was to get “unstuck” from the root, the lack of basic sanitation facilities and hygiene behavior for menstruating females in marginalized areas. First we launched a hygiene promotion program amongst the school girls in a bid to be inclusive and produce sustainable results: this we did in partnership with medical personnel who were on ground to educate the girls on the medical implications of poor hygiene behavior during menstruation.

With the help of the Ishikawa diagram, we were able to construct the problem and aim our interventions at making impact and producing solutions and not a case of Isomorphic Mimicry – where it looks good but will not be the solution. The comprehensive hygiene education had girls and boys in participation where we aimed at dealing with the perception by most people in Nigeria, that menstruation was unclean, dirty, shameful and based on this menstrual hygiene management be treated with secrecy and as an embarrassment. These perceptions are confirmed as a result of social norms and behaviors around period management.

Our primary authorizer for this intervention was our team, comprising of all the partners from Women Environmental Programme, Medical Professionals, volunteers etc. The value of a strong Team showed in this intervention and the reason why we succeeded at this is that the Communication channel amongst the team was alive. Together we evaluated the stakeholders and authorities and who is the key group we needed for this intervention: We settled for the local authorities, the teachers, parents, physicians, youth leaders, school prefects, etc in fighting this pervasive taboo and lifting this veil.

Team of Advocacy workers from Public Health Aid Awareness & Education Organization in collaboration with Women Environmental Programme, WSSCC visited Junior Secondary School GwaGwad, situated at the outskirts in one of the marginalized communities in Abuja, Nigeria: there we thoroughly educated over 2000 students, girls between the ages of 8-15 and boys between the ages of 9-16. There were about 1500-1700 girls in number while the boys were between 700-1000 in number; To a very interactive and educative session on menstrual hygiene management.

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It is important to note that the grave lack of sanitation facilities and sanitary products has pushed menstruating girls out of school temporarily and even permanently. In lieu of this PHAAE proposed and advocated to National Authorities, ie the government, federal ministry of health, national human rights commission, Law makers to initiate policies that ensures that girls and women have separate and private toilet facilities with running water in their schools and even at workplaces. And in addition, access to essential sanitary products such as sanitary pads should come as normal school supplies by the government, through the Federal Ministry of Education. Most importantly, national, community and religious leaders must speak out to change attitudes, traditions and customs that restrain the menstruating woman or girl from coming to places of worship during their period.

PHAAE adapted the PDIA approach of identifying the major problem in this context and also identifying the key players who have the authority to positively deviate from what has not worked in the past to try something new and also reinforce that which have worked. In the end, inequality gaps surrounding access to resources and facilities will be closed for good.

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