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Moving the needle forward for menstrual health requires multi-sectoral partnerships

South Africa has made some strides in its commitments to end period poverty and fully realise menstrual justice, said the Women, Youth and Persons with Disabilities Minister, Maite Nkoana-Mashabane, in the Moving the Needle Forward on Menstrual Health and Hygiene in South Africa webinar hosted by the United Nations Population Fund (UNFPA) in partnership with the South Africa Coalition on Menstrual Health Management (SACMHM), which is led by the department.

“Sanitary dignity in South Africa means that every girl child and woman in the country can manage their menstruation in a dignified manner. This means that all girls and women, irrespective of socioeconomic status, will have the menstrual information and knowledge; menstrual products; safe, hygiene and private spaces to carry out their menstrual health practices and will be able to walk away from these activities feeling clean and hygienic,” the minister said.

The South African government has made numerous financial commitments towards the sanitary dignity programme, including an investment of more than R210-million to roll out sanitary pads to learners in all nine provinces. During the 2020/21 financial year, about 2.3-million learners in no fee-paying, farm and special schools also received consignments of sanitary pads.

The deliberate and intentional co-ordination of menstrual health management remains paramount in the menstrual health landscape and over the past year, it has been further compounded by the multiple challenges exacerbated by the Covid-19 pandemic. Learners bore the brunt of the pandemic when it came to accessing menstrual products as many could not get their regular supply of sanitary pads. This was because some schools were inaccessible as a result of the lockdown restrictions, Nkoana-Mashabane explained. 

But, through collaboration with UNFPA and other donor agencies, the department was able to reach communities through innovations implemented during the height of the pandemic, which has also strengthened and expanded these partnerships so that there will be consistent mitigation strategies when such crises recur. The department has also worked closely with education authorities in order to address issues of water supply, sanitation and hygiene, especially in rural schools.  

Together with UNFPA the department is conducting acceptability studies for alternative menstrual products and research is being conducted with regards to the efficacy of reusable and washable sanitary towels to ensure product safety. 

“In collaboration with the Department of Basic Education and Water and Sanitation, we are addressing water supply, sanitation and hygiene (WASH) issues in schools, in particular in rural environments, because this has implications for menstrual health and the dignity of the girl,” Nkoana-Mashabane said. “I’m pleased that WaterAid, as a partner in the coalition, is running a project to mitigate Wash issues in Vhembe district schools, in Limpopo Province. They are upgrading toilets and ensuring improved sanitation, safety, privacy and hygiene so that girls do not become vulnerable. Such positive work by our partners deserves to be commended and we are thankful to WaterAid for that effort.”

Elijah Adera, regional programme manager for sanitation and hygiene at WaterAid, made it clear that menstrual health management cannot be achieved by individuals, but will require collaboration and joint efforts from all stakeholders, including funding from the private sector.

“One of the key things that we have to do as partners in this coalition is to engage and unlock private sector financing. If we are able to engage the private sector such as Kimberly-Clark, Procter & Gamble and Unilever, we might be able to not only look at the financial aspect of the resources, but also we could also use their expertise and skills in the production of some of these menstrual health products that support women and girls during their menstrual cycle.”

Beatrice Mutali, UNFPA’s representative for South Africa and Country Director for Botswana and Eswatini, said significant progress had been made in achieving menstrual health globally, but there are gaps that need to be filled and it is the responsibilities of governments across the globe to come up with commitments for their own countries. In this respect,  the South Africa government has become a key player and is committed to the provision of sanitary towels for girls and women across the board. 

“UNFPA has worked with the coalition platform to advocate for safe and quality products by supporting the e-training of 40 women-owned women manufacturing and social enterprises on reusable sanitary towels,” she explained. “We have also engaged in advocacy platforms to develop materials for the poor. Our commitments in moving the needle forward have included  supporting sexual reproductive health training to ensure that there is a module that integrates menstrual health management, such that menstrual health management becomes part of the sexual and reproductive health training.”

UNFPA has also partnered with UNICEF and donated R3-million to support collaboration with the Department of Women, Youth and Persons with Disabilities. This was done through a joint programme called “Empowering women and girls to realise their sexual and reproductive health rights in South Africa” which was implemented in KwaZulu-Natal and the Eastern Cape. Activities have included procurement of menstrual products, designing of IEC material, disbursements of products and implementation of a monitoring and evaluation framework that will also be critical to the menstrual health management programme.

“We’re also working on documenting stories and the lessons learned, which will help enhance our programming. As we move forward in terms of increasing access to mental health management products,” said Mutali.

All panellists committed to continually moving menstrual health forward and emphasised how this cannot be done alone but must be done together with civil society, UN agencies as well as the private and public sectors. 

Nkoane-Mashabane announced that from the 2019/20 financial year, the government of South Africa has unconditionally committed finances towards menstrual health — and it is one of the only countries that have a specific policy and monetary focus on menstrual health management. 

Thobile Mthiyane, Deputy Director at the Department of Water and Sanitation, said that there there is a clear demonstration of how the coalition operates in terms of each individual institution and how they are contributing their time and  personnel resources to ensure that the work that needs to be done fulfills this sanitary dignity framework. 

“The coalition also recognises the strategic advantage of this collaborative work. We are trying to break down the silo mentality [because] when we operate in parallel, and are not in competition with one another, this eventually improves the impact on the ground.”

How to realise menstrual justice in South Africa

Menstrual Hygiene Day is commemorated across the world on 28 May. This is a global day of action and advocacy that brings together non-profit organisations, the public and private sectors and individuals to promote good menstrual health that breaks the silence, raises awareness and changes negative social norms around menstruation. This year, the Mail & Guardian sat down with Maite Nkoane-Mashabane, the Minister of the Department of Women, Youth and People Living with Disabilities, which is at the forefront of the South Africa Coalition on Menstrual Health Management. 

Minister Maite Nkoane-Mashabane (MP), Department of Women, Youth and Persons with Disabilities

1. How is South Africa planning to move the needle forward in terms of menstrual health and access to safe products for all people who menstruate? 

In collaboration with the South African Bureau of Standards (SABS) and the Department of Trade, Industry and Competition, supported by UNFPA, the department is ensuring that all manufacturers and distributors of menstrual products in South Africa trade in products that are SABS certified, especially those that are keen to partner with the department, which represents the government’s policy position as espoused by the Sanitary Dignity Implementation Framework. SABS is conducting an audit of all local and multinational manufacturers for compliance in terms of SABS and the International Organisation of Standards because the South African government believes in product safety.  Another important development to access was the proclamation made by the Minister of Finance [Tito Mboweni] that value-added tax was removed from sanitary pads as of April 2019. 

2. What has the minister or the department learned since the first Menstrual Health Symposium in partnership with UNFPA? 

Firstly, collaboration is the key because the government does not have infinite resources to address the challenge. In fact, right now the government has resources for the first phase of implementation, which is for Quintiles one to three schools, farm and special schools. 

3. What have been the challenges in providing menstrual health products in South Africa? 

Before April 2019, there was no financial mandate until an equitable financial share allocation for all provinces was provided for by the government, but as I have said, we are embarking on an incremental approach.  At the moment, we are happy to state that indigent learners in the identified quintiles in all provinces are benefiting from the programme. 

4. What has the South African Coalition on Menstrual Health Management (SACMHM) achieved so far and what are its goals?

The goals of the SACMHM are to ensure a collaborative and integrated interface between government, private sector (manufacturers), civil society, the UN and other agencies so that South Africans can have a common understanding and approach on menstrual health matters and cross-pollinate that knowledge with the African coalitions and global coalition. 

Despite the challenges brought on by the pandemic, the coalition was able to convene a two-day workshop in October to introduce the SABS standard to 40 local women, youth and disabled manufacturers of reusable and washable sanitary towels, in order to assist them with certification and compliance. We were also able to engage with manufacturers of menstrual cups in order to encourage them to obtain a SABS standard. Additionally, we hosted two webinars that discussed a South African study that directly links school absenteeism with a lack of access to menstrual products. 

5. Does the minister believe there has been a shift in the political will within government leaders regarding the importance of Menstrual Health Management? 

The South African government had political will right from the beginning, because the integrated and urgent need to address menstrual health management and sexual reproductive health rights issues of women was announced by the president at the state of the nation address as far back as 2011.  The challenge is for some and society, in general, to unlearn certain prejudices and stereotypes about menses, from a cultural and religious point of view.  

6. If the minister had a chance to speak to young people who cannot afford menstrual products, what would she say to them?

If they are learners, I would find out which province, district and school they come from because quintiles one to three, farm and special schools are automatic recipients.  If they are post-education and training institution students [tertiary], l would indicate that for NSFAS [National Student Financial Aid Scheme] beneficiaries, there is a stipend of R290 per student per month earmarked for menstrual products, among other things. 

For other categories outside of the above, I would link up with the Department of Social Development, because they have what is referred to as the Social Relief of Distress (SRD) Programme ,which caters for indigents in communities, and includes those who cannot access menstrual products.

More action & investments needed for holistic menstrual health

In many countries menstrual health is now widely integrated into cross-sectoral coordination mechanisms and national education & health systems, in humanitarian responses and in ongoing research on product acceptability and impact, learning, monitoring and evaluation. In addition, many countries are introducing a wider range of menstrual health products, including locally manufactured reusable and disposable pads & menstrual cups, and new distribution channels have been established. South Africa has taken great strides to create an enabling environment to address Menstrual Health holistically. This includes, but not limited, to the development of the Sanitary Dignity Implementation Framework (SDIF), sanitary dignity programme (SDP) national rollout and the removal of value added taxes on sanitary towels.

Beatrice Mutali ,UNFPA Representative for South Africa and Country Director for Botswana and Eswatini

However, in spite of this progress, most of these efforts remain undocumented, limited in geographical coverage and lacking a strong evidence-base. More needs to be done to strengthen high-level commitment, coordination, and knowledge sharing; develop effective and innovative approaches to supply management and distribution; and ensure financial resources to sustain efforts and bring programmes to scale.

In order to coordinate country efforts on Menstrual Health, the United Nations Population Fund (UNFPA) supported the launch of the South African Coalition on Menstrual Health and Hygiene Management (SACMHM) in March 2020. It is an alliance for collective action to ensure the success of the Sanitary Dignity Implementation Framework (SDIF) in South Africa, by coordinating responsive menstrual health solutions. Since its inception, it has forged successful collaborations with partners such as the Department of Women, Youth and Persons with Disabilities (DWYPD), Department of Social Development (DSD), UNFPA, WaterAid, Days for Girls (DFG), Langalethu Youth Foundation and Footprints Foundation to respond to Covid-19 by recognising that periods do not stop during pandemics. These multi-sectoral partnerships and mainstreaming menstrual health within existing structures are some of the emerging trends we learned can support coordination efforts and leverage the lean resources available.

Since its formation, the SACMHM platform has advocated for safe and quality products by supporting e- training of women-owned manufacturing social enterprises on the SANS 1812:2020 reusable sanitary towels, which was published by the South African Bureau of standards in May 2020. The coalition has strengthened coordination among key stakeholders working on menstrual health in South Africa and being led by the Department of Women, Youth and Persons with Disabilities, its success and sustainability is ensured. Taken together these efforts contribute significantly to the menstrual health landscape and by pooling our resources together; we will make an impact on the ground.

The potential impact of investing in menstrual health can positively benefit several areas across women and girls’ lives, such as economic benefits, participation in education, empowerment, health and mental health; and thus menstrual health is central to advancing gender equality as a whole. The commitment to moving the needle forward on menstrual health continues, we as the partners strive to support the government of South Africa to raise and tackle critical issues towards the normalisation of menstruation and to promote dignity and self-esteem among the menstruating population.

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