A Bloody Serious Matter in Uganda SUMMARY
In Uganda menstruation is limiting the potential of girls to reach their full potential. They don’t receive proper information how to manage their menstruation, don’t have access to menstrual products and safe and clean latrines. Taboos and myths surrounding menstruation also limit what they are allowed to do when menstruating. Many girls drop out of school to prevent embarrassing leaks at school. Same parents also believe that when girls start to menstruate it’s time for them to get married.
 “A Bloody Serious Matter” Project started in 2013 and aims to (1)  improve knowledge and break menstruation taboos among 150.000 girls, boys, women and men, (2) increase access to affordable and hygienic sanitary pads, (3) and increase access to girl friendly toilets and water at schools. Plan International works together with AFRIpads a manufacturer of reusable menstrual hygiene pads. The project is  implemented in, Tororo, Lira and Kamuli district. MHM requires an holistic integrated approach to improve knowledge attitude and practice (KAP). It is not about pads, but the KAP comes first among all stakeholders to change the status quo. These stakeholders include boys and men. They need to be brought on board for understanding and appreciation of what happens to boys and girls in order to the break the culture and take menstruation as normal.
The reusable pads promoted by AFRIpads are a durable product. Once purchased by one consumer it takes another year for that consumer to get another set. This has created tension between the social enterprise which requires profits and returns within a short period and Plan whose target is not only on access but the social outcome from its activities. Four media campaigns in newspapers and on TV about Menstrual Hygiene Management are run to create awareness among the Ugandan population and government. 
32 Radio talk shows and 1,440 radio commercials are broadcasted.
Three national campaigns are executed to gain more national (and government) attention for MHM.
Three well known good will ambassadors supported the project, and two of them travelled to Uganda to raise publicity. Specially designed Bag to School clutches were marketed. The project featured in 77 articles, three radio interviews and three TV shows. It generated a lot of attention on social media.  The NPL uses part of its income from customers buying lots to support so called “Good causes”. This project is one of the projects supported by the NPL. Menstruation is the most normal thing in the world. It is a universal biological process that every healthy girl will have to deal with sooner or later. On average a healthy woman will have around 400 periods in her lifetime and menstruation lasts between four days and a week. In a woman's lifetime that means on average 1,600 days of inconvenience: blood loss, abdominal pain, backache, headache and raging hormones that can turn the sunniest nature crabby and moody. Luckily, the shelves of every chemist and supermarket are bulging with painkillers and sanitary products that keep the discomfort and inconvenience of menstruation to a minimum. Unfortunately, in Uganda good sanitary protection isn't available to buy in their area or they can't afford it. And they don't have the luxury of a toilet round every corner, where they can freshen up. If they are having a period, they have to make do with banana leaves, cloths, newspapers or even earth. Month after month. And as if that weren't unpleasant enough, normally menstruation is seldom if ever talked about. The menstrual cycle is surrounded by a web of fables and cultural and religious taboos. For example, in Uganda girls and women are not allowed to walk in the vegetable garden if they are having a period, because it would cause all the plants to wither. The consequences: for girls and women in Uganda having a period is a monthly dose of shame and humiliation and the lack of hygiene soon leads to health problems. Schoolgirls stay at home when they're having a period. Better to miss school than suffer the embarrassment of leaking in front of your classmates, or the discomfort of a newspaper chafing between your thighs. This means they miss four or five days of school every month, a backlog that many girls hardly ever catch up: they can no longer keep up at school, drop out early. Because without schooling their subsequent opportunities for work and income are limited forever. In order for adolescent girls and young women to manage their menstruation effectively and hygienically, Plan, AFRIpads and the local government have their roles to play.  

Plan will train the (local) government on raising hygiene awareness, so that they in turn can train the schools and local communities. Plan will also attract attention to MHM on a grand scale through lobbying and various awareness-raising campaigns. AFRIpads is responsible for training the members of the savings and loan groups that promote the sale of the sanitary pads. AFRIpads takes care of the distribution of the sanitary pads and the coordination and management of the AFRIpads sellers. The local authorities in Lira and Kamuli take care of structural improvement of awareness regarding menstrual hygiene in schools and among the Village Health Teams in the communities involved.

This will result in improved knowledge and practices around personal hygiene and health of girls and young women; removed barriers to education, so that girls can stay in school longer; and improved income of (young women) through the sales of reusable and affordable sanitary pads and which will result in increased investments in the family lives, because for every dollar a woman earns, she invests 80 cents in her family. This project builds on a pilot project that Plan is carrying out in Tororo, Uganda. It extends on previous work of a School WASH project implemented in Lira and Kamuli from 2010-2012.  Reviews of the School WASH project noted limited knowledge around MHM, and consistent with global studies, that girls were dropping out of school due to an inability to manage their period effectively.  Plan decided to develop a pilot where MHM was the sole focus. A project that could support girls and women to manage their menstruation hygienically, that went beyond giving out free pads in schools.  The initial results of the pilot were really successful and the enthusiastic input from the girls, women and other villagers showed that Plan, with its combined approach of advice and education, the provision of sanitary protection and the creation of income-generating activities, is indeed having a positive influence on the daily lives of girls and young women, even during the uncomfortable days of the month. The end beneficiaries of this MHM project are 150,000 adolescent girls and young women in the rural communities of Lira and Kamuli, Uganda. These girls and women attend school (around 40,000 girls) and live in the communities (almost 110,000 girls and women). 

Boys and men will also be targeted as Involving boys and men can reduce teasing of girls by boys and help fathers to be more supportive of their daughters and wives by acknowledging the issues, exposing myths and stigma and providing a platform for discussion. O:\IP\4 Programma's\Projecten\UGA100278 MHM\Key Documents\Project proposals The most important aim of the project is to give girls and young women in Uganda the opportunity to take full part in education and work, without menstruation being a limiting factor, by making AFRIpads Menstrual Kits available. This will make lasting improvements to the health, freedom of movement and future chances of girls and women. With this relatively simple solution the project will enable girls to finish their schooling, thus increasing the likelihood that they will go on to earn more, marry later, have healthier children and supervise the education of their sons and daughters. Various studies have revealed that educated girls are the key to breaking the poverty spiral.

Financial:
The project focuses on the generation of extra income for members of the savings and loan groups. Women receive business training and can therefore become ales representative of AFRIpads. Apart from this Plan does not believe in hand-outs and people will have to pay for the menstrual pads themselves. Because of rising sales (by increasing the distribution market for AFRIpads) - and therefore production volume - the purchase price can remain low. This that the affordability of the menstrual pads is guaranteed.

Institutional:
The local authorities are very interested in working together with Plan and AFRIpads on better hygiene and sanitation, raising awareness in schools, improving health, improving family income and stimulating the local economy. The Ministry of Education is open to dialogue on MHM. At district and community level the local authorities are in a position to promote awareness, together with Plan, in relation to hygiene and sanitation. Plan will train the local government staff on menstrual hygiene, so that they themselves can take care of the structural improvement of awareness regarding menstrual hygiene in schools and among the Village Health Teams in the communities involved.

Ecological:
The reusability of the sanitary pads ensures ecological sustainability, certainly compared to (commercially-available) sanitary protection.

Technical:
The reusable sanitary pads of AFRIpads re made by local women and packaged in the AFRIpads Menstrual Kits. A kit like this, which can last for more than a year, consists of a set of:
-	Five washable sanitary pads (three for heavy days and two for light days)
-	Two holders (you clip these to your knickers and insert the pads)
-	Watertight bag (in which you can keep your sanitary pads if they can't be washed immediately).

Social:
It is also important to note that the project contributes towards the improvement of personal hygiene during menstruation, brings about a permanent change in behaviour and increases the knowledge about the menstrual cycle as a completely natural process, among all those directly and indirectly involved.