Keeping Girls in School
Family Planning, Sex Education, and RUMPS (Re-Usable Menstrual Pads)
by Jessica Dubow (Lode Jimata, Oromia, 2015-2017)
Ethiopia is ranked 126 of 127 countries on the UNESCO Education for All Development Index. For every 100 boys enrolled in secondary school, there are only 77 girls enrolled. In addition to low enrollment the number of female dropouts is high in Ethiopia, especially in the transition from primary to secondary education. Eighty percent of Ethiopian girls are enrolled in primary school, but only 30% of girls are enrolled in secondary education.
Educating girls has a positive impact on those girls, their families, and their communities. Girls who complete primary and secondary education are likely to earn higher incomes, have fewer unwanted pregnancies, and break the cycle of poverty. Educated girls marry later than girls who do not attend school.
In Ethiopia if the wife marries before age 15, the average age difference between spouses is 10.1 years compared to a difference of 8.6 years if the wife marries after age 20. When girls are married at a young age, the power in the relationship usually belongs to their older husbands, and girls do not take part in making family decisions like when and how many children to have. Married girls are significantly more likely than their unmarried peers to be sexually active (73% versus 0.3%) and because of tremendous social pressure for them to prove their fertility, these young brides become young mothers. Sixty-eight percent of married girls in Ethiopia have unprotected sex compared to only 1% of unmarried sexually active girls. For this reason, young married girls are at high risk for HIV infection and for pregnancy.
Pregnancy is dangerous for adolescent girls. Risk of pregnancy-related death is twice as high for girls aged 15-19 and five times as high for girls aged 10-14 compared to women in their 20s. It is estimated that if all these high-risk pregnancies were avoided through the use of family planning, one quarter to one third of maternal deaths could be prevented. The World Health Organization has found that “Family planning saves lives of women and children and improves the quality of life for all. It is one of the best investments that can be made to help ensure the health and well-being of women, children, and communities.” A girl’s educational status is a significant predictor for her use of family planning because education affects the distribution of power in a household. Educated girls are more aware of their family planning options, and they are more likely to feel empowered to demand that their partner use a condom or to discuss family planning with their partner. In turn, girls who use family planning are more likely to stay in school longer, even if they get married early.
When educated girls eventually do have children, they provide better health care and education to their children who then grow up to be healthier and to earn higher incomes, eventually breaking the cycle of poverty. A single year of primary school has been shown to increase a woman’s wages later in life by 10%–20%, while each year of secondary school increases a woman’s wages later in life by 15%–25%. On average, girls reinvest 90% of their income in their families (on average, men reinvest 30%-40% into their families) which means their children are more likely to go to school and subsequently be immunized. If every Ethiopian girl finished school it would add almost $4 billion to the economy.
Introducing sex education to girls at my secondary school
Given the overwhelming evidence that education and family planning can have a positive impact for economic development, public health, and gender equality on individual, family, and even national levels, I wanted to have a frank conversation with girls at my local secondary school about puberty, menstruation, pregnancy, and family planning. Because there are many cultural taboos that make it uncomfortable for Ethiopians — especially young women — to talk and ask questions about sexual and reproductive health, I decided to plan a girls-only workshop to reduce their embarrassment.
I spent many tea breaks talking to teachers in the staff lounge, and they identified menstruation, early marriage, and teenage pregnancy as barriers to girls’ education in my community. Without hesitation these fantastic teachers volunteered their time to co-teach two 2.5 hour workshops for 9th and 10th grade girls — one in the morning for students who are in class during the afternoon shift, and one in the afternoon for students who are in class during the morning shift. By the afternoon workshop, my counterparts were teaching with little support necessary from me; I am confident they will continue to be mentors and trusted adults the girls can consult on these topics. Between the two workshops, 124 girls were in attendance.
We started with a low-risk discussion of the many physical, emotional, and social changes that girls experience during puberty. In their brainstorm, the girls identified menstruation as one of these changes, which provided a transition to identifying internal and external female reproductive anatomy that I had drawn on posters.
The girls were visibly embarrassed when I called them forward to label sexual organs, but I wanted to engage them before speaking on each organ’s purpose. They blushed and giggled through the lecture, but my counterparts handled everything with incredible class and without any sign of awkwardness. Using the posters as aids, I demonstrated the cycle of an egg as it moves from the ovaries through the fallopian tubes where it can either be fertilized by sperm and result in pregnancy or it can be expelled through the vagina along with the lining of the uterus as menstruation. I gave the girls as many facts as I could, especially those facts that corrected their misconceptions. I showed them how the urethra and the vagina are separate for a girl, so urinating after intercourse cannot wash out sperm and cannot prevent pregnancy. I showed them how incredibly small the cervix is and explained that only sperm can pass through it into the uterus — if a condom comes off during intercourse it cannot go anywhere but into the relatively shallow vagina — important because many students fear that a condom can get lost deep inside a woman’s body, discouraging condom use. I explained what a hymen is and that it can be stretched or broken through physical exercise long before a girl’s sexual initiation, so not bleeding on her wedding night is not necessarily a sign that she is not a virgin.
I don’t think anyone has ever given these girls such comprehensive information, information that can affect their behavior and help them make better, educated decisions.
To check the girls’ comprehension, I asked them to use their bodies to form the shape of internal reproductive anatomy. One girl represented an egg and she had to travel from the ovary (several girls standing in a circle holding hands) through the fallopian tube (two girls with their arms stretched out) towards the uterus. Another girl represented sperm and in one scenario she traveled up through the vagina, cervix, and uterus to hug the “egg.” In another scenario the “sperm” did not enter the “vagina” and so the “egg” traveled out of the body. The girls directed each other through the process.
I brought examples of each method of family planning available at my local health center for show-and-tell and passed them around. Through health posts and a Health Extension Worker program, Ethiopia has improved access to family planning services in even the most rural parts of the country. All family planning is free of charge, but there are many cultural barriers to utilization. Even though the condoms were wrapped, the girls tossed them to each other like hot potatoes, they were so embarrassed to touch them. It made me realize this should be the first of many family planning workshops; if a girl won’t touch a wrapped condom, it seems unlikely she’ll push her partner to use an unwrapped one. The girls were more comfortable with the birth control pill and injection, but looked at me with shock and horror when I explained implants and IUDs.
After explaining the effectiveness, risks, and correct use of each method of family planning, I wanted to use the remaining time to answer questions. I offered to continue the workshop for any interested girls two days later. It was three days before Easter, a major holiday, so I was pleased that between the morning and afternoon shifts 54 girls returned for Part II of the “Women’s Health Workshop.” We began with an interactive review in which one side of the room represented “True” and one side of the room represented “False.” My counterpart read a statement and the girls had to stand relative to their beliefs and then use prior knowledge to explain their position. I was impressed with how much they remembered, and the game allowed me to informally make clarifications or answer their questions.
Making re-usable menstrual pads
Many rural girls miss school during their menstruation because they cannot afford to buy store-bought pads on a regular basis. Instead they use unhygienic alternatives (like dirty rags) that result in embarrassing leaks on their school uniforms. When girls miss school for up to a week every month, they fall behind in classes, underperform on tests, and are more likely to drop out.
Re-Usable Menstrual Pads (RUMPs) are a popular solution among Peace Corps Volunteers in Ethiopia. RUMPs reduce waste because they are re-usable, can be made from materials at home, will last for a year or more, and allow girls to feel safe going to school. I made a sample RUMP and demonstrated how to use it, how to take care of it, and how to maintain proper menstrual hygiene. I brought sewing needles, thread, stencils, scissors, buttons, and cloth for the girls to make their own RUMPs.
RUMPs can be made from any scraps of cloth at home, but for the demonstration my counterparts helped me find materials around town. This included a hilarious exchange at the tailor where my counterparts asked the tailor which cloth would absorb the most blood and he replied, “I’m not sure, I’ve never tried that before!”
For the rest of the session, we played music and walked around giving the girls feedback and answering questions while they sewed. An unexpected highlight was how many girls copied the stencils into their notebooks to take home and make future RUMPs.
Giving girls the knowledge and the tools to make healthy decisions regarding their bodies is just a start. For long-term behavior change and utilization, girls have to become comfortable with these topics and these tools. Cultural changes need to happen that allow girls to ask questions and access resources without fear or embarrassment. And boys need to be involved in future discussions because family planning is the responsibility of both partners. But, I’m pleased with this
initial workshop. The teachers and the students increased their capacity and will hopefully pass on their sexual health knowledge in my community. After all, to educate a girl is to educate a generation.
How to Make a Reusable Menstrual Pad:
Step 1: Trace the pattern onto your fabric. Your fabric or material should be 100% cotton. You can use old t-shirts, school uniforms, baby blankets, etc. The material to make “shitties,” or pajamas, works well.
Cut out your pattern pieces, two of each. Cut one of the cloth pad wings in half.
Step 2: Prepare the bottom piece of the pad. Take the two halves (these form the bottom piece) and fold the opening edge over ¼ inch, press then fold over again, press and sew in place.
Step 3: Prepare the bottom of the pad. Pin the pieces together and sew around the edge. Do not sew the center line (that’ll be where you insert the liner).
Step 4: Sew the top to the bottom. Press the cut out piece of fabric from Step 1 to the bottom you have been sewing. Top stitch around the edge and sew down each side to form the wings. Add buttons to the wings.
Step 5: Make the insert for the pad. You can use the template cloth pad liner or you can simply use a square piece of fabric folded in quarters. Layering 3–4 pieces of cloth is recommended; you can add more layers if you have a heavier flow. Thick cloth, like an old rag or washcloth, is recommended for the pad insert. If you have a sewing machine, you can randomly quilt the pad center to keep it in shape.
Step 6: Place the insert inside the pad
Care Instructions: When you have your period, you will need a day pad and a night pad. You need to make at least two outer parts and at least two pad inserts because while you are wearing one pad, the other will need to be washed and dry. Make sure to consistently change your pad and wash your dirty one during the course of your cycle. To wash the insert and the pad, place both separate pieces in cold water with soap and let them soak for a few minutes. Then scrub the inside and outside of both pieces. Once you have scrubbed everything, hang them in the sun to dry. The sun will kill any bacteria on the pad. The pad and insert will have stains on them, but this doesn’t mean they are dirty — blood is hard to remove from cloth.