Teaching girls (and boys) about menstruation takes moxie

“I wasn’t shy from the first time,” says Genet Birhanu of her job as a menstrual educator in Ethiopia.

“I understand menstruation cycle is an old taboo,” she says, but “I’m not afraid” to talk about it.

And she was fearlessly teaching the topic to both girls and boys, starting with fourth graders.

Only 39% of schools around the world offer this kind of education on menstruation, according to a UNICEF report released on May 28 – designated as “World Menstrual Hygiene Day” by the United Nations.

What it takes to be a menstrual educator

To say there are many challenges for a menstrual educator is a colossal understatement.

Sometimes, girls don’t have support for the most basic aspects of hygiene at school. In sub-Saharan Africa, for instance, only 1 in 10 schools have waste bins in the bathroom to dispose of sanitary pads, the UNICEF report says. One in three Ethiopian girls wait until they go home after school to change their pads.

Then there’s the stigma. Teasing from boys is a major reason why girls in Ethiopia skip school during their periods, second only to pain from cramps, says Kalkidan Gugsa, social and behavior change specialist at UNICEF in Ethiopia.

And there is a need for education. In Ethiopia, half of girls surveyed they had no source of information on menstrual health, and one-third said the information came from teachers, the UNICEF report says. And only 39% of the girls knew what periods were before theirs arrived, the report says.

Teachers in Ethiopia have added menstruation to biology lessons, beginning in fourth grade, Gugsa says. And students who are curious about menstrual health and hygiene can take additional lessons on menstruation through a program supported by UNICEF that first launched in 2012. Schools and teachers decide when, where, and how long the sessions will be.

Some schools have created “safe rooms” and gender clubs, Gugsa says. The safe rooms usually have a bed, a wash station, and sanitary pads and painkillers for menstruating students so they don’t have to return home to rest due to pain and fatigue or to wash their clothes.

During morning announcements, for instance, schools may tell students about extracurricular classes held by the gender club to learn more about menstruation. Menstrual educators may also sit in the safe rooms and chat with girls as they use the space or hold sessions there for girls on menstrual health and hygiene.

Girls, boys and then girls and boys

Birhanu quickly learned that to make students comfortable, she needed to divide and conquer.

First, she speaks with just the girls — talking about the practical aspects of taking care of themselves during their periods. Before, “the teachers helped students by buying them sanitary pads,” Birhanu says. But now, they can hand out menstrual pads that were made locally and paid for by UNICEF.

Then she speaks to the boys, answering their many questions, including “wait, does my mom deal with this?” and “can I get sick from being near the blood?” She pays special attention to bullying. She tells the boys they shouldn’t tease girls if they see blood on their clothes or sanitary napkins in their bookbags.

After those separate sessions, she brings the boys and girls together to talk about why menstruation isn't shameful — and why it's important to make sure girls can continue participating at school during their period.

Students who step up

Students who attend these voluntary lessons may become peer mentors, trained by the menstrual educators to answer questions or encourage their friends and siblings to attend future sessions.

Asdenaki Dereje, 16, a peer mentor in her school’s gender club, talks to her friends about attendance.

“I know some students who leave class at the menstruation cycle time. But I tell them, don't leave and miss the class.”

Sometimes they stay home on the day of a menstrual education class, she says. As a peer mentor, she will give them the lowdown when they return.

“Now the attitudes are changing,” Dereje says. It’s been a huge help to learn about menstruation at school and have access to sanitary supplies and places to rest, she says. More of her friends are able to continue learning during their periods — a development that makes her “too happy,” she says.

Getting students on board is key to success, Gugsa says — and that means both girls and boys. Under the teacher’s guidance, boys are encouraged to “champion” girls’ school attendance. The hope is that they'll be more understanding about menstrual issues in school and, looking ahead, as they start their own families.

At first, “I was shy,” says Abinet Abebe, 15. “But I got involved in the gender club, and now I know more about the menstruation cycle.” He has three sisters, and he talks to them about the importance of staying in school and taking care of themselves at their time of the month.

Why it's a universal issue

“It's important that boys and men know about menstruation, and its role in reproduction and the lives of anyone who menstruates,” says Marni Sommer, a professor of sociomedical sciences at Columbia University’s Mailman School of Public Health. She has written books about menstruation and puberty that are used in schools in Ethiopia and other countries.

“Ideally, you would want fellow male students or teachers to be supportive and to encourage them to rest or get pain medication or do whatever they need to do,” Sommer says, “just as you want girls and female teachers to be understanding when a boy's voice squeaks or he has something that may feel embarrassing about puberty.”

Simply having access to clean, functioning toilets and appropriate waste disposal, like trash cans or incinerators, can also help support girls and women in schools. “There's only so much you can do to change behavior if there's not a safe, clean, accessible toilet for students and female teachers to use when they're at school,” she added.

In fact, functioning toilets can help all students, menstruating or not, to stay in school, Sommer says. “Would you go to school if there was no toilet?”

Stigma is everywhere

Secrecy and silence around menstruation can make it seem shameful, embarrassing, and scary, Sommer says. “Menstrual stigma is alive and well everywhere, including in U.S. schools.”

That’s something that Birhanu, the teacher, knows from her own experience. When she first got her period as a girl, she was terrified and she missed an important test at school – yet she was too ashamed to tell her teacher or her family why.

That’s why she’s a vocal advocate now for teaching students — and their families and wider communities — about how to care for themselves and each other during this time.

“All students and other community members – males and females – need to understand about the menstruation issues. So, I tell them, Do not be afraid to talk about the menstruation cycle.”

Melody Schreiber is a journalist and the editor of What We Didn't Expect: Personal Stories About Premature Birth.