All over the world, global advocacy is centered on promoting menstrual hygiene today. What does it mean for advocates like me who champion reproductive justice?

Reproductive health and reproductive justice in general are often spoken of in light of women making choices in relation with childbirth. Many a times, these discussions are focused on older women (even for those within the youth bracket). Little of the discussions center around younger women and girls.

As the world takes time to commemorate Menstrual Hygiene Day, let me take the time to point out why menstrual hygiene is a reproductive justice issue and why any country with the aim of achieving reproductive justice and human rights advancement must pay particular attention to Menstrual Hygiene and indeed have an inclusive strategy and policy to help promote menstrual hygiene nationwide.

When a girl is born, some degree of reproductive health responsibility comes with her birth. This is usually the case with those who are born with a vagina. It is as though you are expected to be birthed with the knowledge of all that having a vagina entails because no one (especially from where I come) takes their sweet time to teach you same. So yes, your reproductive health responsibilities as a woman starts the very moment you develop a vagina.

In Ghana, as I'm sure is the case in many other countries, when a girl is closer to puberty, the event of menstruation becomes an intriguing one which she cannot wait to demystify.

For some girls, they hear something about having a period from their "older" siblings or friends who have already had theirs. Others hear it from older women in the family who mention it to scare them away from having pre-marital sex.

Yes, in telling girls about period, many are told that having your period means your ability to get pregnant which then signifies your transition into womanhood. There is always some kind of celebration to signify this event.

It could be as small as giving the girl a boiled egg to as big as popping a bottle but whatever means is chosen, there is a celebration for some girls.

For others, having a period is their worst nightmare. This is usually the case where treatment given to those who have gone ahead of them in this journey was not pleasant.

These girls tend to dread the day their first period arrives. From that day they are treated differently. They can no longer play with their friends who are boys. They are no longer welcome in certain meetings especially because they are now "women". Whichever side you find yourself on this coin, your life has some change to it the day you see your first period. One thing is for sure; YOU ARE NOW A WOMAN. Or so you are told.

Our curriculum in schools in Ghana, especially junior and senior high schools have a lesson or two on the reproductive system. Somewhere in this curriculum is where you are taught about menstruation. I had this lesson myself and speaking for myself and I am sure many like me, it was quite an inadequate lesson. It basically tells you when you are expected to have your first period as a girl and why there is bleeding. It does nothing to prepare you to even recognise such bleeding when the day comes. I know this because I certainly was not prepared and many of my friends who have all had this lesson share my sentiments.

It does not give you lessons on what your sanitary options are. It does not provide you with lessons on complications that may or may not arise and how to deal with them. It does not provide any education on how to deal with cramping or period pimples or aching labias or painful palms and feet associated with having your period. I could go on and on but you understand. The point is, our academic curriculum provides inadequate information and education on menstruation and for many of us, school is where we get to hear of it for the first time, perhaps the only actual education we are provided is what we get from school. Is this an actual education or lack thereof?

Let me share a couple experiences of my friends and I when we had our first period. Perhaps it will bring some perspective to readers who cannot relate.

I was about 12/13 years. I was getting ready to start Junior High School so it was during the vacation. One morning while taking my bath, I had a very uncomfortable pain in my stomach (something I later came to learn was called cramps). So as the pain came, I bent down for it to subside. It lasted a few seconds and passed. I went on to have my bath as usual. Shortly after resuming my bath, I noticed a huge clot of something that looked like blood on the bathroom floor. It was about the size of the 1 cedi coin.

It was dark and scary. I thought to myself: "I hope this did not come out from me ooo". It haunted me the whole day. Later in the day, I went to my grandma who I lived with at the time and told her about what had happened. All she said was for me to go put on a sanitary pad I was given by an organisation that came to my school to do advocacy on menstrual health. I didn't understand why she was asking me to go put on a pad. I thought to myself "those things are used for periods and surely I haven't had my period yet". I however went to do as she said. That was when I noticed very dark stains on my underwear. Long story short, I had those black clots and stains almost every day for the entire month. I thought that was the normal period for everyone. I didn't know any different.

How could I have known? Who would tell me? My period was not discussed. It was even spoken of in secret. My younger sister was even kept out of the loop. She had no idea about it even though as nature would have it, she was to join me in about a month or so after. Poor her. Yes, I was also given an egg to signify my transition into womanhood. My aunt in telling my dad about it said "efut)m p3" meaning "her vagina burst".

I was so embarrassed. He said nothing to me. No one actually gave me any education on this whatsoever. The month after my period came (which lasted a whole month), I had no period at all. Now for someone who had never had sex, I was scared about the no period month as I feared I was pregnant because I had been told by my "reproductive health education " that one of the signs of pregnancy is no period. So yes I was scared. It took a lot of google at the time to learn that it was normal for first timers to have this pattern.

My friend ASA says she went to bath as well when she noticed she was bleeding. She was so scared she went to tell her grandma who laughed at her and told her she was having her period. Her mum also gave her an egg. She was scared because she did not know what was happening to her at the time and she was also grateful to know she was not going to die.

My friend WAEC shared a similar story to that of ASA. She said " I was scared because the more I washed, the more the blood was oozing. I did not know if I had cut myself in my sleep. My younger sister even laughed at me when I was being taught how to wear a pad because she thought I was wearing diapers".

There was the excitement among my classmates as many of us had our first period during that vacation and were now "grown women" LMHO!!! We taught each other how to wear a pad and mimicked the ALWAYS ULTRA advert by pouring coloured liquid on a pad and cutting it.

I had no idea what that was even about. Even with all our "sisterhood" demonstrations, we couldn't talk about it. There was this unspoken message of shyness or taboo associated with speaking about it. Eventually we stopped. Whatever other information we needed, we had to read online or get it from the media. rather unfortunately.

The above stories are from girls in the cities. That is not to say that this is the reality of all girls in the cities but it makes you wonder what the story of the girl in the village (or less privileged communities) might be. The story of the girl who cannot afford a sanitary pad and must use a rag. The story of the girl who had no formal education. The story of the girl who has been raised to believe that having a period is an abomination. The story of the girl who has been made to believe that period makes a girl filthy. As part of my work in advocating for girl child education and reproductive justice, I have had the privilege of engaging girls in such communities.

I was surprised when I heard for the first time that a girl exists who has never heard of anything called sanitary pad. She has never seen one and would probably never do. She uses a rag which she has to wash every time. Some also shared their stories of not being able to go to school during the period of their menstruation. They miss lessons. Some are not even allowed to go to school at all as they are deemed filthy and are not allowed to associate with others during this period. Indeed, older women in these communities are not exempted from this treatment. Some are not even allowed to cook for their husbands. The list goes on and on.

No matter which part of the social fabric you find yourself as a girl/woman, there are challenges which come with having your period. Many of these challenges are shared by every girl/woman. Let's talk about the "shame" of soiling yourself. I have always had a heavy period. Unfortunately for me, this comes with a lot of challenges. The fear of staining my clothes. The fear of not being able to wear a white outfit and NO! Those adverts in the media about a particular product preventing stains are not accurate. I can never be too careful. Granted that a bad sanitary product can cause leaks but when you are like me, you can never be too secure.

So yes, I have had challenges with staining myself in public. One time in Junior High School, I had a "dot" on my skirt and was called to work out a problem on the board. I heard giggles as my back was faced to the class. Little did I know that it was because of the dot I had on my checkered skirt. I was so surprised that the "dot" which was no bigger than the purple square on my skirt fabric had caused such dismay. I was not embarrassed but I cannot say the same for many women and girls who have to go through this every month. Sometimes your pad gets soaked in less than an hour and starts to overflow. The blood starts to trickle down your thighs.

Imagine if this happened to you (and yes it happened to me) in public transport where you were standing throughout your one-hour journey (I boarded Aayalolo bus from Adenta to Ridge). For me, every period is a whole sport. On days when I can afford to stay at home, I just do that. Because spending time in a public bathroom just to minimize pad use is to fun and really not the most hygienic thing you can do on your period and this is the reality of many girls like me.

Let's talk about sanitary challenges. First of all, who gives us any information on what options are available? No one! Unfortunately, our health authorities have done little about this. For me, pads were my first knowledge of sanitary products. I was given ALWAYS ULTRA when I was in class 6 by an organisation doing advocacy in my school. After using ALWAYS for some time, I realised I started having swollen and painful skin in my inner thighs where the pads touched or rubbed when I walked. It could get so bad that I would not be able to walk well. I felt sore. I was in pain.

Imagine going through this for all the 5 days of my period. I did not know of options at the time and I felt I had no choice. This went on until I got to Senior High when I confided in the school nurse who spoke to me about getting tampons. It was a relief to know there were options. Tampons at the time were said to be bad for girls because "It would break your virginity". The myths were really bad! I had to do my own research to demystify it and guess what? Tampons were my saviour during that period. Many women and girls have no idea what their options are when it comes to sanitary products. Even when they do, there are so many myths around them and little education to debunk them.

Then there’s the problem of taboos and superstition. Just like I mentioned earlier, menstruation comes with a lot of taboos and superstitious challenges. Many are deemed filthy and not allowed to socialize during this period. For others, they cannot even provide their duties with family because of this. Some have shared their realities where they aren’t allowed to cross certain water bodies in their villages when on their period thereby depriving them of their education and trade.

There’s also the challenge of irregular periods. This is also the reality of many women and girls. No one seems to address this in the already deficient education we get. As my friend DEZA puts it, “I’m a fee-paying student”. That is how she refers to herself for not having a regular menstrual cycle. To the best of my knowledge, she has done nothing about it till now. This was also the reality of ROSALIND. She on the other hand, went to see a specialist who put her on some contraception that corrected her cycle and now has a regular monthly cycle. She got sick from taking those pills but this is also something no one prepares you for.

Since today is the day earmarked to celebrate menstrual health, I believe it is important to also speak about the reality of women and girls who DO NOT HAVE ANY PERIOD. Yes, they exist. Some women and girls are born without the ability to have a period (for want of a better sentence). Using a particular case in point, let’s call her MISS X. MISS X was born a girl with a vagina just like many others. When she turned 18, it was evident she was not going to have her period as it hadn’t happened yet. She goes to see the doctor where it is found that instead of a womb/ ovaries, MISS X was born with internal testes.

This is not who you would call a hermaphrodite, no. On the outside, she has no features of a man. In fact, her body is what you would typically describe as an “African woman’s body”. However, this is also her reality as she may share with many others. No one talks about this. No one prepares women and girls for these realities. What does it mean for women and girls like MISS X? As we talk about periods and menstrual hygiene today, let us talk about women and girls like MISS X who have no menstruation which is also no fault of theirs and perhaps get specialists to educate us on what their options are and the many situations that may lead to a women or girl having no period.

So, why is this a human rights problem? Or what has this got to do with reproductive justice? Well, if you haven’t figured it out yet, the current menstrual health situation in Ghana undermines women’s rights. Let me take the time to outline some of them for you.

1. The Right To Education. The education we receive (both men and women) on menstrual health is deficient. As explained above, it does little to give accurate information on the reality of menstrual health. The said education included in our school curriculum does not even teach students how to properly use pads, tampons or menstrual cups and effectively dispose off same. Said education does not prepare the young girl to take care of herself as she has her period; be it hygiene, nutrition etc. A lot of this education is left to CSOs and other individuals to provide education or access to same. There is a limit to what these bodies can do. This usually leaves our girls and women to the mercy of social and mainstream media and the internet. There is also the problem of the educational system not providing alternatives for girls who have to miss school (for one reason or another) to enable them catch up with their studies. Girls should not be denied their right to education because of a natural phenomenon they have no control over. All practices and beliefs which deny girls access and their right to education should also be discontinued and banned.

2. Right To Health: The right to health and access of same is paramount in every nation. It is a basic human right. However, in Ghana, even though we have a National Health Insurance Policy and Scheme, access to menstrual health is greatly limited on the NHIS. The NHIS does not give us access to sanitary products. The NHIS does not give women and girls access to the said medications that are used to correct irregular menstrual cycles. The NHIS does not give us access to surgical procedure that may be required to correct any complication or matter affecting your menstrual health. Sanitary products are expensive and not affordable. We even have taxes imposed on sanitary pads in Ghana which is ridiculous. I do not know of any facility where a girl can walk in and receive a free sanitary pad for an emergency situation. It is disheartening and an infringement on our right to access to affordable healthcare.

3. Right To Associate: Every Ghanaian has the freedom of association. However, many women and girls are prevented from enjoying this right when they are on their periods. This is not only an infringement on this right but also discriminatory as well. Preventing girls from playing with their friends who are boys or women from sitting among men when on their period is a huge infringement on their rights and discrimination against them for being girls and women.

4. Economic Abuse: Let me just say abuse in general. But many women suffer economic abuse when their culture, community and beliefs prevent them from exercising their trade and earning income on the days when they have their periods. Just like the education issue, anything that denies a woman finance or access to her income based on her being on her period is discriminatory and illegal.

For reproductive justice advocates like me, these are some of the discussions we want to engage in and listen to when the world commemorated MENSTRUAL HYGIENE DAY. Let’s talk about the hard realities. Let’s talk about the issues no one wants to talk about or what they are pretending doesn’t exist. Let’s sensitise the public and create awareness on the realities of menstrual health. Let’s push the government and authorities in charge to recognize that women’s rights are human rights and menstrual health is inclusive. Let’s educate our boys and men so they know as much as we expect women and girls to do; this is the only way they can recognize our health problems and do their bit to help. This is the surest way to end certain practices and secure a better and healthy future for generations to come.