SEPTEMBER 2021 - Most girls in Ethiopia are unaware of basic information on menstruation before they experience it for the first time. A 2017 KAP survey indicated that myths relating to menstruation are widespread in Ethiopia, the most pervasive of which being that menstruation is an indicator of sexual activity. Girls experience harassment and teasing from their classmates, particularly schoolboys, leading to absenteeism from school. Negative social norms around menstruation management create several barriers for girls. UNICEF is implementing comprehensive C4D interventions targeting girls, boys and communities in Amhara, Oromia, SNNP, Benishangul, Afar and Gambella to address some of these barriers.

Linking with multisectoral interventions such as increasing access to Menstrual Hygiene Health (MHH)-friendly WASH facilities, the establishment of safe spaces and the provision of MHH supplies, the C4D interventions focus on empowering both adolescent girls and boys in schools with information to break down social taboos surrounding menstruation. In coordination with the relevant Government entities, Social and Behaviour Change Communication (SBCC) interventions were developed based on the barriers and drivers highlighted in the baseline survey undertaken in 2017.

Face to face platforms in schools and communities were leveraged extensively to disseminate information, including through the engagement of health extension workers (HEWs), religious leaders, the Parent Teacher Student Association (PTSA), student journalist-led broadcasts on megaphones in schools, flag ceremonies, drama productions, song groups and others. UNICEF has also been partnering with Girl Effect (see a full story on the partnership here), to produce an influential girl’s empowerment TV series called ‘’Yegna”, which has produced series of story lines around menstruation (a video of the characters Fiker and Saba chatting about menstrual hygiene and creating sanitary pads aired over 400 times on TV and radio).

Advocacy has also been a key pillar of the approach, resulting in the thematic promotion of MHH on Global MHH Day, the development of national MHH sanitary pad standards for both disposable and reusable pads, the revision of institutional WASH manuals to be inclusive of MHH, and the inclusion of MHH into the health sector transformational plan.

Perhaps the most important result on an advocacy level has been growing attention on the need to address the MHH needs of girls and women, which has led to the establishment of a taskforce headed by the President’s office. The task force primarily focuses on resource mobilization, awareness raising and expansion of access on MHM items in the country.

A June 2021 end line KAP survey indicated a substantial positive impact of the overall MHH interventions. Among the changes are:

• Knowledge of girls about the importance of changing menstrual materials three to four times a day over 24 hours has increased by 39 per cent from 24 at baseline (24 per cent, 2016 national WASH KAP survey; 63 per cent end line).

• There was a significant increase (58 per cent) in the percentage of girls who said they discuss menstruation with other people from 36 per cent in the 2016 WASH KAP survey to 94 per cent at end line.

• Access to information on MHH has significantly increased by 50 per cent (45 per cent in 2017 baseline; 95 per cent end line)

• School became one of the key areas to get the information about MHH followed by TV, at 72 per cent and 36.6 per cent respectively.

• The percentage of girls who reported that they discuss menstruation with other people showed a significant increase by 58 per cent (36 per cent, 2016 national WASH KAP survey; 94 per cent at end line).

Beyond the significant achievements, two major lessons were learnt thanks to this initiative.

Lesson #1: Awareness creation through SBCC activities about menstruation among schoolboys are vital. Findings from the end line KAP survey revealed that changes in attitudes among boys towards menstruation prevent teasing of menstruating girls and girl’s school absenteeism due to fear of teasing. Moreover, the attitude change empowers schoolboys to be supportive instead of enforcing a norm of bullying and mockery. Boys who participated in focus group discussions (FGDs) said they are willing to help a girl who missed a school class during menstruation by copying notes and giving their clothes if they saw menstrual blood stained a girl’s cloth to cover the stain.

Lesson #2: Open discussion about menstruation is becoming a norm, and teachers are actively engaging in menstrual health management activities. Yet, more efforts need to be done in future programs to enhance male teachers' participation as some study participants said that some male teachers could be uncomfortable discussing or teaching about menstruation. Hence the boys/men involvement should also target the male teachers.

The MHH interventions are expected to be expanded beyond the targeted geographic focuses to reach wider and hard to reach communities in rural and emergency settings using an approach which is Government-led, evidence-based, inclusive, collaborative and at-scale. This includes reinforcing equality between girls and boys, reaching and co-designing solutions with young people, and ensuring that MHH research, programmes and results are built into planning across programmes (WASH, Education, Health, Nutrition, Child Protection, and cross-cutting areas of Gender, Adolescent Development, and Disability).